Zirconia dental implants; the relationship between design and clinical outcome: A systematic review.

OBJECTIVE: To evaluate the clinical outcome of different designs of zirconia dental implants. DATA: This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228). SOURCES: The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level. STUDY SELECTION: Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described. RESULT: The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs. CONCLUSION: Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed. CLINICAL SIGNIFICANCE: Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable.

Implantoplasty and the risk of fracture of narrow implants with advanced bone loss: A laboratory study.

OBJECTIVES: To assess the impact of implantoplasty (IP) on maximum implant failure strength of narrow diameter implants of different type/design and material, with simulated advanced bone loss. MATERIALS AND METHODS: Narrow, parallel-walled implants (3.3 mm in diameter × 10 mm long) with an internal connection of different type/design [bone level (BL), tissue level (TL)] and material [Titanium grade IV (Ti), Titanium-Zirconium alloy (TiZr)] from one specific manufacturer were used. Half of the implants were subjected to IP in their coronal 5 mm; the remaining were used as controls (seven implants per group). Dynamic loading prior to maximum load strength testing was included. RESULTS: During dynamic loading, the fracture rate of BL implants was low and independent of IP, while that of TL implants increased significantly with IP compared with controls (p = .001). Maximum implant failure strength reduction (in %) due to IP, was 1.3%-25.4%; TiZr BL implants were least affected. Implants subjected to IP compared to those without IP as well as TL implants compared to BL implants showed a significantly lower maximum implant failure strength (p < .002); implant material was not significant (p = .845). CONCLUSIONS: Based on data from implants of one specific manufacturer, IP has a significant negative impact on the fracture strength of narrow implants suffering from advanced peri-implantitis. TL implants have been more severely affected compared to BL implants and presented an increased risk for failure during normal chewing forces. In addition, this negative impact of IP on TL implants was independent of the implant material (i.e., Ti or TiZr). CLINICAL RELEVANCE: Narrow single TL implants with advanced horizontal bone loss (e.g., 5 mm), when subjected to IP, appear to have an increased fracture risk during normal function.

Fracture Resistance and Fracture Behaviour of Monolithic Multi-Layered Translucent Zirconia Fixed Dental Prostheses with Different Placing Strategies of Connector: An in vitro Study.

Purpose: To evaluate the effect of different placing strategies performed in the connector area on fracture resistance and fracture behaviour of monolithic multi-layered translucent zirconia fixed dental prostheses (FDPs). Materials and Methods: Thirty 3-unit monolithic FDPs were produced and divided into three groups (n = 10) based on the different strategies for placing the connector area of FDPs in multi-layered zirconia blank with varying contents of yttria ranging from 4 to 5 mol%. The groups were as follows: FDPs with connectors placed in dentin layer with 4 mol% yttria content, FDPs with connectors placed in gradient layer, and FDPs with connectors placed in translucent layer with 5 mol% yttria content. A final group (n = 10) of conventional monolithic zirconia with a monolayer of yttria content (4 mol%) has been used as a control group. The specimens were artificially aged using thermocycling and pre-loading procedures and subsequently loaded to fracture using a universal testing machine. Fracture loads and fracture behaviour were analyzed using one-way ANOVA and Fisher's exact tests and statistically evaluated (p ≤ 0.05). Results: There were no significant differences in fracture loads among the groups based on the placing strategies of the connector area of the FDPs in the multi-layered translucent zirconia blank (p > 0.05). There was no significant difference in fracture loads between monolithic multi-layered translucent zirconia and conventional monolithic translucent zirconia materials (p > 0.05). Fracture behaviour of FDPs with connector area placed in translucent layer differed significantly compared to FDPs with connector area placed in dentin layer and FDPs in control group (p = 0.004). Conclusion: The placing strategies of the connector used in the computer aided design and manufacturing procedures do not considerably affect fracture resistance of monolithic FDPs made of multi-layered translucent zirconia. Monolithic FDPs made of multi-layered translucent zirconia show comparable strength to FDPs made of conventional translucent zirconia, but with different fracture behaviour.

Clinical and laboratory passive fit assessment of implant-supported zirconia restorations fabricated using conventional and digital workflow.

BACKGROUND: Long-term success of implant-supported restorations can be affected by the accuracy of the prosthodontic workflow which may differ between conventional and digital techniques. PURPOSE: The purpose was to compare the fit of two-implant-supported restorations, fabricated using conventional and digital workflows and to assess the influence of distance and angulation between the implants on the passive fit of the prosthesis. The SR test was selected to evaluate the fit of two-implant-supported zirconia restorations. MATERIALS AND METHODS: Forty-eight zirconia two-implant-supported restorations were fabricated according to conventional (group C, n = 24) and digital (group D, n = 24) workflows. The SR parameter was calculated as a difference of rotation angles of each screw in passive and nonpassive situations. SR values between groups C and D were compared by performing measurements intraorally, on master and control casts. RESULTS: SR intraorally in group C (16.25 ± 15.52°) was higher than it was in group D (13.85 ± 10.78°), but the difference was not statistically significant (P = .557). While measuring SR on the master cast, group C SR (6.04 ± 7.43°) had lower values than group D (13.12 ± 13.86°) (P = .0039). No statistically significant correlations were found between SR measurements and inter-implant distance or angulation. Restorations with inter-implant angle higher than 10° differed significantly from those with less than 10° angulation. CONCLUSIONS: Digital restorations had a better fit on the control cast, which was used as a reference in this study. Angulation of more than 10° between the implants could negatively affect the passive fit of the digitally fabricated restorations intraorally.

Evaluation of Stress Distribution in Tooth-Supported Fixed Dental Prostheses Made of Translucent Zirconia with Variations in Framework Designs: A Three-Dimensional Finite Element Analysis.

PURPOSE: To evaluate the influence of the framework designs on the stress distribution within tooth-supported partially veneered fixed dental prostheses (FDPs) made of translucent zirconia under simulated loads using a three-dimensional finite element analysis (3D-FEA). MATERIAL AND METHODS: For a linear 3D-FEA, simplified 3D solid models of prepared abutment teeth (first premolar and first molar) with different 3-unit FDPs were created. The models with different FDP designs-monolithic zirconia (control); semi-monolithic zirconia with 0.3 mm veneer thickness (SM0.3); semi-monolithic zirconia with 0.5 mm veneer thickness (SM0.5); semi-monolithic zirconia with 0.5 mm veneer thickness supported with cap design (SMC), and semi-monolithic zirconia with 0.5 mm veneer thickness supported with wave design (SMW)-were analyzed using 3D-FEA. The elastic properties of the components (bone, dentine, cement, translucent zirconia, and veneering porcelain) were obtained from the published data for FEA. Simulated static loading forces (300 N) were applied at 10° oblique direction over six points in the occlusal surfaces of the FDPs. Maximum principal stress, shear stress, and safety factor were calculated and analyzed among the different models. RESULTS: Semi-monolithic with cap design showed the smallest maximum principal stress levels in the veneering porcelain compared to all other models (SM0.3, SM0.5, SMW). The SM0.3 had lower maximum principal stress levels in the veneering porcelain compared to SM0.5. Regarding stresses in the zirconia framework, all models had comparable results in maximum principal tensile stresses, except SMW had a lower value. Maximum principal stress levels were located in the veneer component of SM0.3, SM0.5, and SMW, whereas, such levels were observed in the cervical areas of the zirconia frameworks of SMC and control. The SM0.3 had the highest maximum shear stress levels at the zirconia-veneer interface, while SMW had the lowest shear values. The 3D-FEA models with different FDP designs showed different minimum safety factor levels. CONCLUSIONS: Framework and veneer designs play a significant role in the stress distribution of the partially veneered zirconia FDPs under loading. The FDPs with zirconia frameworks with cap design minimize the maximum principal tensile stress in the veneering porcelain. The FDPs with 0.3-mm-veneering porcelain show low maximum principal tensile stress in the veneering porcelain, but highest maximum shear stress at the zirconia-veneer interface. The FDPs with wave design of zirconia frameworks minimize the maximum shear stress considerably.

Volumetric measurement of dentoalveolar defects by means of intraoral 3D scanner and gravimetric model.

The aim of this study was to evaluate the accuracy in volumetric measurements obtained on an experimental model using an intraoral scanner and a gravimetric method. Three identical partial dentate maxillary acrylic models with three fabricated alveolar defects, in anterior and posterior regions, were scanned using an intraoral scanner (20 scans/defects). The defects differed in terms of size and distance of neighbouring teeth. As references, replicas of each defect were created using a dimensional stable silicone impression material. After measuring the mass of each replica, the volume was calculated by dividing the mass of each replica by the density of the impression material. The defects had a volume, according to the gravimetric method, ranging from 40.5 to 143.7 mm3. The scans were imported to metrology software for analyses. Accuracy was determined in terms of trueness and precision. The mean trueness for all defect types was 0.168 mm3 (SD 0.691, range 2.82). There was no statistical significant difference between the mean trueness for all defects measured (p = 0.910). The mean precision for all defect types was 0.147 mm3 (SD 0.524, range 2.86). There were no statistical significant differences between the dental models in regard to mean precision (p = 0.401), however, there were statistical significant differences between defects in position 1 and 2 (p = 0.002) and 1 and 3 (p = 0.001). Based on the findings of this study, the intraoral scanner utilized in the current study presented an acceptable level of accuracy when measuring volume of defects.

Load-Bearing Capacity of Monolithic Zirconia Fixed Dental Prostheses Fabricated with Different Connector Designs and Embrasure Shaping Methods.

PURPOSE: To investigate the load-bearing capacity and failure mode of monolithic zirconia fixed dental prostheses (FDPs) fabricated with different connector designs and embrasure shaping methods. MATERIALS AND METHODS: Seventy four-unit zirconia FDPs (with two premolar pontics) were fabricated and divided into seven groups (n = 10) according to the different connector designs gained by using different embrasure shaping methods. The groups were as follows: monolithic FDPs fabricated with sharp embrasures, monolithic FDPs fabricated with blunt embrasures, monolithic FDPs fabricated with blunt embrasures and no occlusal embrasures, two groups of monolithic FDPs fabricated with blunt embrasures and interproximal separations made with diamond discs at the soft stage and at the fully sintered stage, and monolithic FDPs fabricated with blunt embrasures and interproximal separation accentuated by localized porcelain build-up. A final group was used as a control group, where fully veneered traditional zirconia FDPs were fabricated with default milling settings. The FDPs were artificially aged and loaded to fracture. Load to fracture and failure modes were analyzed by one-way ANOVA, Tukey's post hoc test, and Fisher exact test (α = 0.05). RESULTS: The FDPs fabricated with interproximal porcelain separation showed significantly the highest load to fracture (1038 N ± 82) of all groups (p < 0.001), with no significant difference compared to the FDPs with no occlusal embrasures (934 N ± 175; p ˃ 0.29). The FDPs fabricated with blunt embrasures showed significantly higher load to fracture (873 N ± 115) compared to the FDPs in the control group (689 N ± 75) and the FDPs with sharp embrasures (417 N ± 87; p < 0.001). There were no significant differences between the FDPs with sharp embrasures (417 N ± 87) and the FDPs with interproximal disc separations (467 N ± 94; p ˃ 0.23). Failure mode of the FDPs fabricated with sharp embrasures and interproximal disc separations differed significantly compared to the FDPs in the other groups (p < 0.001). CONCLUSIONS: Sharp embrasures and interproximal separations made with diamond discs significantly decrease the load-bearing capacity of monolithic zirconia FDPs compared to FDPs made with blunt embrasures. Blunt embrasures in combination with localized porcelain build-up produce FDPs with high load-bearing capacity in relation to loads that might be expected under clinical use.

Critical considerations on load-to-failure test for monolithic zirconia molar crowns.

Application of monolithic zirconia crowns (MZCs) with reduced thickness to the molar region has been proposed, but potential complications have yet to be fully evaluated in laboratory tests. The present study aimed to develop a clinically relevant load-to-failure test in combination with fatigue treatments involving thermal and mechanical cycling (TC and MC) to evaluate the fracture resistance of molar MZCs. MZCs with a minimal thickness of 0.5 mm were bonded to dies made of resin-based composite (RBC), epoxy resin (EP), or polyoxymethylene-copolymer (POM-C). The samples were either untreated (UT) or subjected to TC (5-55 °C for 1â€¯× 105 cycles) and MC (300 N for 2.4â€¯× 106 cycles). The stress generated by TC and MC was simulated by finite element modeling. The load-to-failure test was performed using an inverse V-shaped two-plane indenter and was followed by fractographic analysis. The median values of fracture load for MZC/RBC and MZC/EP in the TC group were significantly lower than those in the UT group. MC also decreased the median value of fracture load for MZC/RBC significantly, but not that for MZC/EP and MZC/POM-C. Fractography revealed that the fracture started in the cervical area in all groups, which is similar to clinically failed crowns. The simulation confirmed stress concentration at the cervical area in both TC and MC groups. The present study suggests that the load-to-failure test using a two-plane indenter could induce clinically relevant fracture of MZCs, the vulnerability of the MZCs depends largely on the die material employed, and MZCs are more likely to be damaged by thermal fatigue than mechanical fatigue.

Effect of different semimonolithic designs on fracture resistance and fracture mode of translucent and high-translucent zirconia crowns.

PURPOSE: The aim of this study was to describe different designs of semimonolithic crowns made of translucent and high-translucent zirconia materials and to evaluate the effect on fracture resistance and fracture mode. METHODS: One hundred crowns with different designs were produced and divided into five groups (n=20): monolithic (M), partially veneered monolithic (semimonolithic) with 0.3 mm buccal veneer (SM0.3), semimonolithic with 0.5 mm buccal veneer (SM0.5), semimonolithic with 0.5 mm buccal veneer supported by wave design (SMW), and semimonolithic with 0.5 mm buccal veneer supported by occlusal cap design (SMC). Each group was divided into two subgroups (n=10) according to the materials used, translucent and high-translucent zirconia. All crowns underwent artificial aging before loading until fracture. Fracture mode analysis was performed. Fracture loads and fracture modes were analyzed using two-way ANOVA and Fisher's exact probability tests (P≤0.05). RESULTS: SM0.3 design showed highest fracture loads with no significant difference compared to M and SMW designs (P>0.05). SM0.5 design showed lower fracture loads compared to SMW and SWC designs. Crowns made of translucent zirconia showed higher fracture loads compared to those made of high-translucent zirconia. M, SM0.3, and all but one of the SMC crowns showed complete fractures with significant differences in fracture mode compared to SMW and SM0.5 crowns with cohesive veneer fractures (P≤0.05). CONCLUSION: Translucent and high-translucent zirconia crowns might be used in combination with 0.3 mm microcoating porcelain layer with semimonolithic design to enhance the esthetic properties of restorations without significantly decreasing fracture resistance of the crowns. If 0.5 mm porcelain layer is needed for a semimonolithic crown, wave design or cap design might be used to increase fracture resistance. In both cases, fracture resistance gained is likely to be clinically sufficient as the registered fracture loads were high in relation to expected loads under clinical use.

Cast, milled and EBM-manufactured titanium, differences in porcelain shear bond strength.

The objectives were to analyze the oxide layer generated between titanium and porcelain during firing and compare it in different manufacturing techniques: cast, milled and EBM-technique. Seventy two specimens were manufactured, subdivided according to surface treatment: time of passivation (P) and no time of passivation (NP) before porcelain firing. Specimens from each group were analyzed with scanning electron microscopy: one only fired once, and one subjected to six firings. Remaining specimens were subjected to shear bond strength test. The EBM-produced NP-group had highest mean value (25.0 MPa) and the milled P-group showed lowest mean value (18.5 MPa) when all factors were compared. No significant difference was detected according to time of passivation. SEM showed consistent and well-defined boundary between the different layers. Time of passivation and impact on oxide growth was not detected. The bond strength of porcelain to milled titanium is lower when compared to cast titanium and EBM-produced titanium.

Fracture strength of veneered translucent zirconium dioxide crowns with different porcelain thicknesses.

Objective: To evaluate fracture strength of veneered translucent zirconium dioxide crowns designed with different porcelain layer thicknesses. Materials and Methods: Sixty crowns, divided into six groups of 10, were used in this study. Groups were divided according to different thicknesses of porcelain veneer on translucent zirconium dioxide cores of equal thickness (0.5 mm). Porcelain thicknesses were 2.5, 2.0, 1.0, 0.8, 0.5 and 0.3 mm. Crowns were artificially aged before loaded to fracture. Determination of fracture mode was performed using light microscope. Results: Group 1.0 mm showed significantly (p ≤ .05) highest fracture loads (mean 1540 N) in comparison with groups 2.5, 2.0 and 0.3 mm (mean 851, 910 and 1202 N). There was no significant difference (p>.05) in fracture loads among groups 1.0, 0.8 and 0.5 mm (mean 1540, 1313 and 1286 N). There were significantly (p ≤ .05) more complete fractures in group 0.3 mm compared to all other groups which presented mainly cohesive fractures. Conclusions: Translucent zirconium dioxide crowns can be veneered with minimal thickness layer of 0.5 mm porcelain without showing significantly reduced fracture strength compared to traditionally veneered (1.0-2.0 mm) crowns. Fracture strength of micro-veneered crowns with a layer of porcelain (0.3 mm) is lower than that of traditionally veneered crowns but still within range of what may be considered clinically sufficient. Porcelain layers of 2.0 mm or thicker should be used where expected loads are low only.

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.

Ten-Year Follow-Up of Implant-Supported All-Ceramic Fixed Dental Prostheses: A Randomized, Prospective Clinical Trial.

PURPOSE: The aim of this study was to evaluate the long-term clinical performance of and patient satisfaction with implant-supported all-ceramic fixed dental prostheses (FDPs) and to compare two different all-ceramic systems, Denzir (DZ) and In-Ceram Zirconia (InZ). MATERIALS AND METHODS: A total of 18 patients received 25 partial FDPs; 13 DZ, and 12 InZ. RESULTS: Of these patients, 17 attended the 10-year follow-up. None of the restorations had fractured. Fractures of the veneering porcelain were observed in nine patients; two from the InZ group and seven from the DZ group. All FDPs were in use, and all patients were fully satisfied with the treatment. CONCLUSION: Results from this long-term follow-up suggest that implant-supported all-ceramic FDPs are an acceptable treatment alternative.

Fracture strength of ceramic monolithic crown systems of different thickness.

The objective of this study was to evaluate fracture strength of high-translucent (HTZ) and low-translucent (LTZ) zirconia and glass-ceramic (LDS) crowns. HTZ and LTZ crowns were made with thicknesses of; 0.3 mm, 0.5 mm, 0.7 mm, 1.0 mm, and 1.5 mm; and LDS crowns of 1.0 mm and 1.5 mm thicknesses. Each group consisted of 10 crowns. All crowns underwent artificial aging before loading until fracture. Mean fracture strengths varied from 450 N to 3,248 N in the LTZ group, 438 N to 3,487 N in the HTZ group, and 1,030 N to 1,431 N in the LDS group. The load at fracture of HTZ and LTZ crowns was equal. The load at fracture of yttria-stabilized tetragonal zirconia polycrystals crowns was significantly greater than LDS crowns (P = 0.000). Two types of fractures were recorded; complete and partial crack-like fracture. The crack type fracture occurred most frequently in all groups except in the thicker LTZ groups (1.0 mm and 1.5 mm). According to this study, there is no difference in strength between crowns made of high-translucent or low-translucent zirconia. At equal thickness, the strength of zirconia crowns was significantly greater than that of lithium-disilicate glass-ceramic.

Reliability of the impression replica technique.

The aim of this study was to evaluate the reliability of the impression replica technique with a four-unit zirconia fixed dental prosthesis (FDP). Marginal and internal fit were measured by repeatedly placing the FDP on an epoxy cast using light-body silicone material corresponding to cement. All measured marginal and internal fit points showed varying values. The greatest variations were seen at the most distal margin (33 µm) and at the distal abutment of the FDP (77 µm). The results showed that the technique gives moderate variations and is a useful method to evaluate marginal and internal fit.

Fracture of porcelain-veneered gold-alloy and zirconia molar crowns using a modified test set-up.

Objective: The main aim of this study was to compare fracture load and fracture mode of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and metal-ceramic (MC) molar crowns using a modified test set-up to produce fractures similar to those seen in vivo, i.e. fractures of the veneering material rather than complete fractures. Materials and methods: 13 high-noble-alloy MC and 13 Y-TZP molar crowns veneered with porcelain were manufactured. The crowns were artificially aged before final load to fracture. Load was applied using a 7 mm diameter steel ball exerting force on the cusps with stresses directed toward the core-veneer interface. Fracture surface analysis was performed using light- and scanning electron microscopy. Results: The test design produced fractures of the veneering material rather than complete fractures. MC crowns withstood significantly (p > 0.001) higher loads (mean 2155 N) than Y-TZP (mean 1505 N) crowns, yet both endure loads sufficient for predictable clinical use. Fracture mode differed between MC and Y-TZP. MC crowns exhibited fractures involving the core-veneer interface but without core exposure. One Y-TZP crown suffered a complete fracture, all others except one displayed fractures of the veneering material involving the core-veneer interface with core exposure. Conclusions: The test set-up produces fractures similar to those found in vivo and may be useful to evaluate the core-veneer interface of different material systems, both metals and ceramics. The study confirms suggestions from previous studies of a weaker core-veneer bond for Y-TZP compared to MC crowns.

Surface structure and mechanical properties of impaction-modified Y-TZP.

OBJECTIVES: The objectives of the study were to describe the surface structure and the chemical surface composition of Y-TZP ceramics produced by using the modified additive technique and to evaluate the flexural strength of Y-TZP with or without surface modification and with different pretreatments: etching before or after sintering combined with or without an adhesive cement system. METHODS: Y-TZP discs were used for surface analysis (n=48) and for biaxial flexural strength testing (n=200). The specimens were divided into groups depending on the cementation surface of Y-TZP: unmodified, sandblasted or glass-modified Y-TZP surfaces, and according to the production process: etching before or after sintering. RESULTS: The surface structure and the chemical composition of glass-modified Y-TZP differ; a rougher surface and phase transformation was identified compared to unmodified Y-TZP. The unmodified Y-TZP groups showed significantly higher flexural strength compared to the glass-modified groups (p<0.001) and showed increased flexural strength after sandblasting (p<0.001). Furthermore, by adding cement to the surface, the value increased even further in comparison with the sandblasted non-cemented specimens (p<0.01). After thermocycling, however, the cement layer on the unmodified and the sandblasted surfaces had air pockets and regions with loose cement. SIGNIFICANCE: A rougher surface structure, superficial glass remnants and a higher content of m-phase was present in the cementation surface of glass-modified Y-TZP. The glass modification creates a bondable cementation surface that is durable. By etching the glass-modified Y-TZP before sintering, a more homogenous surface is created compared to one that is etched after sintering.

Titanium- and zirconia-based implant-supported fixed dental prostheses. A randomized, prospective clinical pilot study.

The aim of this study was to compare porcelain-veneered implant-supported FDPs based on zirconium dioxide and titanium respectively. Sixteen patients received 18 implant-supported partial fixed dental prostheses (FDPs); 8 titanium-based and 10 zirconia-based. The FDPs were randomized between the two material groups. Follow-up of the patients was performed at 3 months and thereafter once a year. An assessment protocol based on the California Dental Association (CDA) quality assessment system was used. Results: All patients were seen at follow-up. The mean time of clinical service at follow-up was 15,2 months (range 12-24 months). All restorations were in place and all patients were satisfied with the treatment. No technical complications were noted in either group. Minor biological complications, in the form of plaque and/or mucositis, not affecting the survival of the restorations were noted for six of the titanium-based restorations and two of the zirconia-based restorations. The difference between the two material groups was not statistically significant. The outcomes of both materials were comparable. Short term data from this study suggests that porcelain-veneered implant-supported partial FDPs based on zirconia and titanium are satisfactory and equal treatment options. This conclusion is however preliminary as it is based on a small number of patients and short-term follow-up. Long-term follow-up of larger groups of patients is needed before more definite conclusions can be made.

Fracture strength of monolithic all-ceramic crowns made of high translucent yttrium oxide-stabilized zirconium dioxide compared to porcelain-veneered crowns and lithium disilicate crowns.

OBJECTIVE: The aim of the study was to provide data on the fracture strength of monolithic high translucent Y-TZP crowns and porcelain-veneered high translucent Y-TZP crown cores and to compare that data with the fracture strength of porcelain-veneered Y-TZP crown cores and monolithic lithium disilicate glass-ceramic crowns. MATERIALS AND METHODS: Sixty standardized crowns divided into six groups (n = 10) were fabricated: monolithic high translucent Y-TZP crowns, brand A, monolithic high translucent Y-TZP crowns, brand B, veneered high translucent Y-TZP crown cores, brand A, veneered high translucent Y-TZP crown cores, brand B, heat-pressed monolithic lithium disilicate crowns and veneered Y-TZP crown cores. All crowns were thermocycled, cemented onto dies, cyclically pre-loaded and finally loaded to fracture. RESULTS: The monolithic Y-TZP groups showed significantly higher fracture strength (2795 N and 3038 N) compared to all other groups. The fracture strength in the veneered Y-TZP group (2229 N) was significantly higher than the monolithic lithium disilicate group (1856 N) and the veneered high translucent Y-TZP groups (1480 N and 1808 N). CONCLUSIONS: The fracture strength of monolithic high translucent Y-TZP crowns is considerably higher than that of porcelain-veneered Y-TZP crown cores, porcelain-veneered high translucent Y-TZP crown cores and monolithic lithium disilicate crowns. The fracture strength of a crown made of monolithic high translucent Y-TZP is, with a large safety margin, sufficient for clinical use for the majority of patients. Porcelain-veneered Y-TZP crown cores show higher fracture resistance than monolithic lithium disilicate crowns.

Bonding between oxide ceramics and adhesive cement systems: a systematic review.

The following aims were set for this systematic literature review: (a) to make an inventory of existing methods to achieve bondable surfaces on oxide ceramics and (b) to evaluate which methods might provide sufficient bond strength. Current literature of in vitro studies regarding bond strength achieved using different surface treatments on oxide ceramics in combination with adhesive cement systems was selected from PubMed and systematically analyzed and completed with reference tracking. The total number of publications included for aim a was 127 studies, 23 of which were used for aim b. The surface treatments are divided into seven main groups: as-produced, grinding/polishing, airborne particle abrasion, surface coating, laser treatment, acid treatment, and primer treatment. There are large variations, making comparison of the studies difficult. An as-produced surface of oxide ceramic needs to be surface treated to achieve durable bond strength. Abrasive surface treatment and/or silica-coating treatment with the use of primer treatment can provide sufficient bond strength for bonding oxide ceramics. This conclusion, however, needs to be confirmed by clinical studies. There is no universal surface treatment. Consideration should be given to the specific materials to be cemented and to the adhesive cement system to be used.