Initial damage and failure load of zirconia-ceramic and metal-ceramic posterior cantilever fixed partial dentures.

OBJECTIVES: The aim of this study was to compare failure load and initial damage in monolithic, partially veneered, and completely veneered (translucent) zirconia cantilevered fixed partial dentures (CFPDs), as well as completely veneered metal-ceramic CFPDs under different support and loading configurations. MATERIALS AND METHODS: Eight test groups with anatomically congruent CFPDs (n = 8/group) were fabricated, differing in CFPD material/support structure/loading direction (load applied via steel ball (Ø 6 mm) 3 mm from the distal end of the pontic for axial loading with a 2-point contact on the inner cusp ridges of the buccal and oral cusps and 1.3 mm below the oral cusp tip for 30° oblique loading): (1) monolithic zirconia/CoCr abutment teeth/axial, (2) monolithic zirconia/CoCr abutment teeth/oblique, (3) partially veneered zirconia/CoCr abutment teeth/axial, (4) partially veneered zirconia/CoCr abutment teeth/oblique, (5) completely veneered zirconia/CoCr abutment teeth/axial, (6) completely veneered CoCr/CoCr abutment teeth/axial (control group), (7) partially veneered zirconia/implants/axial, and (8) partially veneered zirconia/natural teeth/axial. Restorations were artificially aged before failure testing. Statistical analysis was conducted using one-way ANOVA and Tukey post hoc tests. RESULTS: Mean failure loads ranged from 392 N (group 8) to 1181 N (group 1). Axially loaded monolithic zirconia CFPDs (group 1) and controls (group 6) showed significantly higher failure loads. Oblique loading significantly reduced failure loads for monolithic zirconia CFPDs (group 2). Initial damage was observed in all groups except monolithic zirconia groups, and fractography revealed design flaws (sharp edges at the occlusal boundary of the veneering window) in partially veneered zirconia CFPDs. CONCLUSIONS: Monolithic zirconia CFPDs might be a viable alternative to completely veneered CoCr CFPDs in terms of fracture load. However, oblique loading of monolithic zirconia CFPDs should be avoided in clinical scenarios. Design improvements are required for partially veneered zirconia CFPDs to enhance their load-bearing capacity. CLINICAL RELEVANCE: Monolithic zirconia may represent a viable all-ceramic alternative to the established metal-ceramic option for CFPD fabrication. However, in daily clinical practice, careful occlusal adjustment and regular monitoring should ensure that oblique loading of the cantilever is avoided.

Automated Crack Detection in Monolithic Zirconia Crowns Using Acoustic Emission and Deep Learning Techniques.

Monolithic zirconia (MZ) crowns are widely utilized in dental restorations, particularly for substantial tooth structure loss. Inspection, tactile, and radiographic examinations can be time-consuming and error-prone, which may delay diagnosis. Consequently, an objective, automatic, and reliable process is required for identifying dental crown defects. This study aimed to explore the potential of transforming acoustic emission (AE) signals to continuous wavelet transform (CWT), combined with Conventional Neural Network (CNN) to assist in crack detection. A new CNN image segmentation model, based on multi-class semantic segmentation using Inception-ResNet-v2, was developed. Real-time detection of AE signals under loads, which induce cracking, provided significant insights into crack formation in MZ crowns. Pencil lead breaking (PLB) was used to simulate crack propagation. The CWT and CNN models were used to automate the crack classification process. The Inception-ResNet-v2 architecture with transfer learning categorized the cracks in MZ crowns into five groups: labial, palatal, incisal, left, and right. After 2000 epochs, with a learning rate of 0.0001, the model achieved an accuracy of 99.4667%, demonstrating that deep learning significantly improved the localization of cracks in MZ crowns. This development can potentially aid dentists in clinical decision-making by facilitating the early detection and prevention of crack failures.

Finite element evaluation of dentin stress changes following different endodontic surgical approaches.

The aim was to compare the effect of different endodontic surgical treatments on the stress distributions in dentin of a simulated first mandibular molar tooth using the finite element analysis method. Three surgical endodontic procedures (apical resection, root amputation, and hemisection) were simulated in a first mandibular molar. Biodentine or mineral-trioxide-aggregate was used to repair the surgery site in apical resection and root amputation models; the remaining root canal spaces were filled with gutta-percha. Access cavities were restored using resin composite. In hemisection model, root canal was filled with gutta-percha, and coronal restoration was finished with a monolithic zirconia crown. A sound tooth model was created as a control model. An oblique force of 300 N angled at 45° to the occlusal plane was simulated. Maximum von Mises stresses were evaluated in dentin near the surgery regions and the entire tooth. Apical resection/Biodentine and apical resection/mineral-trioxide-aggregate models generated maximum von Mises stresses of 39.001 MPa and 39.106 MPa, respectively. The recorded maximum von Mises stresses in root amputation models were 66.491 MPa for root amputation/Biodentine and 73.063 MPa for root amputation/mineral-trioxide-aggregate models. The highest maximum von Mises stress value among all models was observed in the hemisection model, measuring 138.87 MPa. Hemisection induced the highest von Mises stresses in dentin, followed by root amputation and apical resection. In apical resection, Biodentine and mineral-trioxide-aggregate did not show a significant difference in stress distribution. Biodentine in root amputation may lead to lower stresses compared to mineral-trioxide-aggregate.

CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology.

OBJECTIVE: This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS: Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION: The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE: Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

The effect of aging on the translucency of contemporary zirconia generations: in-vitro study.

BACKGROUND: The translucency of different zirconia generations at each time point after thermocycling aging is still lacking. METHODS: Four zirconia materials were used with a total of 60 samples produced from monolithic third generation (5Y) 5 mol% yttria-stabilized zirconia polycrystalline ceramic and fourth generation zirconia (4Y) 4 mol% yttria-stabilized zirconia polycrystalline ceramic, represented by [group1:[CM-5Y] Ceramill Zolid fx (3rd generation zirconia) (Amann Girrbach, Koblach, Austria), group 2:[CM-4Y] Ceramill Zolid HT + (4th generation zirconia) (Amann Girrbach, Koblach, Austria), group 3:[CC-5Y] Cercon XT/ML (Dentsply Sirona, Germany) (3rd generation), and group 4:[CC-4Y] Cercon HT/ML (Dentsply Sirona, Germany) (4th generation)]. The L*a*b* figures were measured by using a spectrophotometer at baseline and after 10,000, 30,000, and 50,000 cycles of thermocycling. At each interval, the translucency of the samples was estimated by using the translucency formula CIEDE2000. The Scheffe post-hoc compared differences among each of the four materials. The Repeated measures ANOVA tested the differences between the materials at each of the different thermocycling intervals (p < .001). Data analyses were evaluated at a significance level of p < .05 (CI 95%). RESULTS: Two-way ANOVA revealed that at baseline the third and fourth generation's zirconia showed statistically significant differences in translucency (P < .001). Translucency values at baseline and after thermocycling exhibited statistically significant changes (p = .003). At each of the time interval; CM-4Y had the highest translucency values followed by CM-5Y, CC-4Y and CC-5Y had the least translucency values. CONCLUSIONS: The third and fourth generations of zirconia displayed different translucencies. Thermocycling affected the translucency of both third and fourth generations of zirconia. At each of the time intervals group 2:[CM-4Y] had the highest TP followed by group1:[CM-5Y], while, group 3:[CC-5Y] and group 4:[CC-4Y] had the least TP.

Evaluation of vertical marginal discrepancy and load-to-failure of monolithic zirconia and lithium disilicate laminate veneers manufactured in different thicknesses.

OBJECTIVES: This study aimed to evaluate the feasibility of monolithic zirconia laminate veneers (MZLV) compared to lithium disilicate laminate veneers (LDLV). MATERIALS AND METHODS: Sixty resin replicas, each prepared with depths of 0.5 mm, 0.7 mm, and 1 mm, were produced using a 3D printer from acrylic teeth. Laminate veneers of these thicknesses were milled from pre-sintered monolithic zirconia (3rd generation) and lithium disilicate blocks. The intaglio surface of MZLV was treated with air abrasion using 110 µm diameter silica-modified aluminium oxide particles and ceramic primer, while LDLV was etched with etchant gel and treated with the ceramic primer before cementation with resin cement. Vertical marginal discrepancy (VMD) was assessed using a stereomicroscope, and a load-to-failure test was conducted using a universal testing machine. Failure modes were evaluated macroscopically on fractured surfaces. Data were analysed statistically using Two-way ANOVA and Bonferroni correction (α = 0.05). RESULTS: LDLV samples exhibited significantly larger VMD compared to MZLV samples across all thicknesses, especially in cervical, palatal, and mean data. Within the LDLV group, load-to-fracture values for 0.7 mm and 1.0 mm thicknesses were similar, whereas for 0.5 mm thickness, it was significantly lower. In the MZLV group, load-to-fracture values were lower for 0.7 mm and 1.0 mm thicknesses compared to LDLV, but higher for 0.5 mm thickness. CONCLUSIONS: Material choice and restoration thickness significantly influence laminate veneer restorations' success. MZLV generally exhibits superior vertical marginal fit compared to LDLV, with varying load-to-failure values across different thicknesses. Clinical management of debonding in MZLV is simpler compared to restoration fracture in LDLV. CLINICAL RELEVANCE: Considering clinical factors, MZLV may be a preferable option to LDLV for this restoration with the thickness of 0.5 mm.

Translucency of recent zirconia materials and material-related variables affecting their translucency: a systematic review and meta-analysis.

BACKGROUND: Recent forms of translucent zirconia material have been developed, offering a wide range of options and varieties for enhancing aesthetics, making it a preferred choice in the field of prosthetic dentistry. However, there is insufficient understanding regarding the recent types of zirconia materials and their optical behavior. Understanding the variables that influence the translucency of zirconia and identifying strategies to enhance its esthetics are crucial. PURPOSE: The current systemic review highlights a comprehensive understanding of different zirconia generations in relation to their optical characteristics and evaluates material-related variables affecting their translucency. METHODS: The present review studied in-vitro studies that evaluated the optical characteristics of different yttria content of yttria stabilized materials. The topics explored were: (1) the different zirconia material generations and their optical behavior; (2) material-related factors that affect their translucency. The research was restricted to online publication in the English language from July 1, 2010, to July 31, 2023, using PubMed, Scopus, and Science Direct resources. The search key terms and their combinations were "zirconia," "translucent zirconia," "cubic zirconia," "highly translucent zirconia," "yttria partially stabilized zirconia," "monolithic zirconia," "translucency," "optical properties," and "light transmission." RESULTS: The data obtained from fifty-three studies addressed the optical characteristics of various zirconia generations. They reported that changing yttria content had a significant impact on translucency. Different kinds of zirconia ceramics of the same generation have varying translucencies. Achieving optimum aesthetics with monolithic zirconia is challenging due to factors related to material aspects such as the presence of additives, point defects, microstructure, thickness, phase distribution, and sintering conditions. CONCLUSIONS: Newly developed monolithic dental zirconia ceramics have improved aesthetics and translucency. However, additional research is necessary to evaluate their performance and long-term durability. TRIAL REGISTRATION: This systematic review was registered in PROSPERO, under number CRD42023474482.

Effect of acidic environment on color and translucency of different indirect restorative materials.

PURPOSE: The aim of the current study was to evaluate the effect of simulated gastric acid on the color and translucency of different indirect restorative materials. MATERIALS AND METHODS: A total of 36 disc-shaped samples were cut by using an isomet saw and divided into four equal groups (n = 9) according to the material type: Group Z: translucent zirconia (Ceramill® Zolid ht.+ preshade, Amann Girrbach, Koblach, Austria); Group E: lithium disilicate (IPS e.max CAD, Ivoclar Vivadent AG, Schaan, Liechtenstein); Group C: resin nanoceramic (Cerasmart, GC, Tokyo, Japan); Group P: polyether ether ketone (PEEK) (Bettin Zirconia Dentale Italy) veneered with indirect high impact polymer composite (HIPC) (breCAM HIPC, Bredent GmbH & Co. KG, Germany). The samples were immersed in simulated gastric acid (HCl, pH 1.2) for 96 hours at 37 °C in an incubator. The color change (ΔE00) and translucency (RTP00) were measured every 9.6 hours (one-year clinical simulation) of immersion in simulated gastric acid. RESULTS: For color change (∆E00) and translucency (RTP00) among the tested materials, there was a highly statistically significant difference (P < 0.001) after every year of follow-up. The color change in both Z and G groups was the lowest after 1 year of acid immersion, followed by that in group H, and the highest change in color was recorded in group P. CONCLUSION: High translucent zirconia is recommended in patients who are concerned about esthetic, especially with acidic oral environment.

Clinical performance of monolithic zirconia crowns on titanium-zirconium reduced-diameter implants in the molar area: Interim data at three years of a randomized controlled trial.

AIM: The aim of the present study was (i) to evaluate the clinical performance of reduced-diameter implants placed in the molar area and (ii) to test whether monolithic zirconia implant-supported crowns lead to similar clinical outcomes compared to porcelain-fused-to-metal crowns. MATERIALS AND METHODS: A total of 76 patients needing a single implant crown in the posterior region were recruited. All patients received a titanium-zirconium reduced-diameter implant (Straumann Roxolid, Tissue Level, Standard Plus, diameter 3.3 mm, regular neck) randomly allocated to receive either a (1) monolithic zirconia crown (test) or (2) porcelain-fused-to-metal crown (control). Implant survival, prosthetic outcomes, and patient-reported outcomes were assessed at crown delivery and after 3 years of follow-up. Marginal bone levels (MBL) as well as clinical parameters including probing depth (PD), bleeding on probing (BOP), and plaque levels (PCR) were also recorded. RESULTS: A total of 59 patients were available at the 3-year follow-up; 32 patients with a monolithic zirconia crown (TEST) and 27 patients with a porcelain-fused-to-metal crown (CONTROL). 14 implants (11 implant fractures/3 aseptic losses) were lost leading to an estimated implant survival rate of 80% ± 5.1% (95% CI 70.8%-90.8%). Prosthetic complications were limited to the control group and involved minor chippings. CONCLUSIONS: This type of reduced-diameter implant to support single implant molar crowns in the molar area cannot be recommended. Monolithic zirconia crowns appear to be a viable option in the posterior region showing similar prosthetic outcomes to porcelain-fused-to-metal crowns.

Evaluation of the effects of different composite materials and surface roughening techniques in bonding attachments of clear aligner on monolithic zirconia.

OBJECTIVE: The aim of this study is to evaluate the bond strengths of two different composite types used in the production of clear aligner attachments on monolithic zirconia with three different surface roughening processes. MATERIALS AND METHODS: Packable composite Filtek Z250 was used in one group (PC-G) and flowable composite Filtek Supreme Ultra Flowable was used in the other group (FC-G). PC-G and FC-G groups were also divided into three subgroups as diamond bur+silane (Group 1), 50 µm aluminium oxide (Al2 O3 ) sandblasting+silane (Group 2) and 110 µm Al2 O3 sandblasting+silane (Group 3). Scanning electron microscopy (SEM) analysis was performed. Clear aligner attachments were bonded to the monolithic zirconia specimens. Shear bond strength (SBS) values were measured. Statistical analysis was performed using two-way ANOVA and post-hoc Tukey's tests (P < .05). RESULTS: The highest SBS value was found in PC-G sandblasted with 110 µm Al2 O3 (P ≤ .001). The etching method with 110 µm sandblasting showed high SBS values in both composite types. The lowest SBS value gave FC-G in diamond bur roughening (P ≤ .001). CONCLUSIONS: For the bonding of clear aligner attachments on monolithic zirconia, roughening with 110 µm particle size sandblasting and the choice of packable composite could be recommended in terms of retention.

Reliability and lifetime of lithium disilicate, 3Y-TZP, and 5Y-TZP zirconia crowns with different occlusal thicknesses.

OBJECTIVES: To assess the probability of survival of crowns made with a 3Y-TZP, a 5Y-TZP, and a lithium disilicate. MATERIALS AND METHODS: CAD-CAM premolar crowns with occlusal thicknesses of 1.0 mm or 1.5 mm and cemented on a metal dye. Step-stress accelerated life testing (SSALT) was performed to access the use level probability Weibull curves and reliability were calculated for the completion of a mission of 100,000 cycles at 300 to 1200 N. RESULTS: All ceramics showed a high probability of survival (87-99%) at 300 N, irrespective of thickness. 3Y-TZP shows no significant decrease in the probability of survival up to 1200 N (83-96%). Lithium disilicate presented lower reliability than zirconia under the 600 N mission. 5Y-TZP showed lower reliability than 3Y-TZP at 1200 N. There was no significant difference in the Weibull modulus (3.23-7.12). 3Y-TZP had the highest characteristic strength (2483-2972 N), followed by 5Y-TZP (1512-1547 N) and lithium disilicate (971-1154 N). CONCLUSION: Zirconia ceramics have a high probability of survival (up to 900 N-load), while lithium disilicate survives up to 300 N load only, irrespective of the thickness (1.0 mm or 1.5 mm). CLINICAL RELEVANCE: The probability of survival of posterior crowns made with zirconia ceramics resists extreme loads while glass ceramics resist normal chewing loads. In addition, crowns with thinner occlusal face showed sufficient mechanical behavior.

Clinical outcomes of tooth-supported monolithic zirconia vs. porcelain-veneered zirconia fixed dental prosthesis, with an additional focus on the cement type: a systematic review and meta-analysis.

PURPOSE: To compare the failure rates and the prevalence of technical complications between full-coverage tooth-supported monolithic zirconia (MZ) and porcelain-veneered zirconia (PVZ) fixed dental prosthesis, based on a systematic literature review. METHODS: An electronic search was performed in three databases, supplemented by hand searching. Several statistical methods were used. RESULTS: Seventy-four publications reported 6370 restorations (4264 PVZ; 2106 MZ; 8200 abutment teeth; 3549 patients), followed up until 152 months. A total of 216 prostheses failed, and survival was statistically significant different between groups. PVZ had higher occurrence of complications than MZ; the difference was especially greater for either minor or major chipping. The difference in prevalence of either minor or major chipping was statistically significant for PVZ prostheses between cementation with glass ionomer and adhesive resin cement (higher), adhesive resin and resin-modified glass ionomer cement (RMGIC, higher), and between RMGIC (higher) and glass ionomer cement. For MZ the difference was significant only for minor chipping between RMGIC (higher) and adhesive resin cement. Abutment teeth to PVZ prostheses more often lost vitality. Decementation was not observed with RMGIC. Air abrasion did not seem to clinically decrease the decementation risk. The 5-year difference in the occurrence of minor or major chipping between MZ and PVZ prostheses was statistically significant, but nor for catastrophic fracture. CONCLUSION: Tooth-supported PVZ prostheses present higher failure and complication rates than MZ prosthesis. The difference in complications is striking when it comes to chipping. CLINICAL RELEVANCE: Awareness of the outcome differences between different types of zirconia prostheses is important for clinical practice.

Clinical evaluation of marginal fit of uncemented CAD-CAM monolithic zirconia three-unit restorations in anterior areas, using scannable and conventional polyvinyl siloxane impression materials.

BACKGROUND: The accuracy of impression techniques determines the marginal fit of fixed prostheses. Marginal accuracy plays a main role in the success and failure of treatments. This in-vivo study evaluated the marginal fit of anterior three-unit monolithic zirconia fixed partial dentures (FPDs) using conventional and scannable polyvinyl siloxane impression materials. METHODS: Ten patients were selected to replace the lateral teeth with a three-unit monolithic zirconia bridge. For each patient, in the first group, an impression was made with a two-step putty-wash technique using scannable polyvinyl siloxane material (BONASCAN; DMP, Greece). In the identical session, as the second group, an impression of conventional putty-wash polyvinyl siloxane was taken (BONASIL A+ Putty; DMP, Greece). The marginal discrepancy was measured through the replicas, which were cut perpendicularly within the buccolingual and mesiodistal directions. An Independent t-test was employed for data analyses (P < 0.05). RESULTS: The marginal discrepancy in a conventional method for central abutment in mid-buccal, mid-lingual, mid-mesial, and mid-distal was higher than in the scannable method but it was not significant (P > 0.05). Also, the marginal discrepancy for canine abutment in the conventional method was higher than in the scannable method, but it was not significant, either (P > 0.05). CONCLUSIONS: FPDs fabricated from both scannable and conventional impression materials were not superior to each other in marginal fit for both central and canine abutments by evaluation using the replica technique.

The influence of core-build up materials on biaxial flexural strength of monolithic strength-gradient zirconia; an in-vitro study.

BACKGROUND: Since their introduction, there has been limited research regarding the mechanical properties of novel strength-gradient monolithic zirconia. In addition to that, studies evaluating the effect of different core-build materials on the strength of indirect restorations are scarce. Therefore, the aim of this study was to investigate the effect of using different core build-up materials on biaxial flexural strength of a new monolithic multilayered zirconia material. METHODS: Forty zirconia discs were fabricated from IPS e.max ZirCAD Prime (Ivoclar Vivadent AG, Schaan, Liechtenstein) and divided into 2 groups (n = 20). Forty composite discs were prepared from Tetric N-Ceram (Ivoclar Vivadent AG, Schaan, Liechtenstein) and MultiCore Flow (Ivoclar Vivadent AG, Schaan, Liechtenstein). The zirconia discs were adhesively cemented to the 2 types of composite forming 2 groups (Zirconia-Tetric N-Ceram and Zirconia-MultiCore Flow). Biaxial flexural strength was determined using a piston-on-3-ball test. The data were statistically analyzed with an independent t-test for significant differences (p = 0.05). RESULTS: Tetric N-Ceram had significantly higher strength than MultiCore Flow (p < 0.001) but no statistically significant differences were found in strength values between Zirconia-Tetric N-Ceram and Zirconia-MultiCore Flow bilayered samples (p = 0.27). CONCLUSIONS: It was concluded that although the tested composite core materials significantly differ in their biaxial flexural strength values, they had no influence on the biaxial flexural strength of the overlying zirconia.

Adhesive bond strength of monolithic zirconia ceramic finished with various surface treatments.

BACKGROUND: This study aimed to investigate different surface treatments thought to increase the bond strength between zirconia ceramic and adhesive resin cement. METHODS: The samples were prepared in 15 × 10 × 2 mm dimensions by cutting off monolithic zirconia ceramic blocks (Incoris TZI; Sirona, Germany). Surface roughness measurements were made with a profilometer, the average surface roughness (Ra1) was recorded, and five different surface treatments were applied. Group 1: Control group. No surface treatment was applied. Group 2: Sandblasted with Al2O3 under pressure of 50 µm. Group 3: Sandblasted with 30 µm Al2O3 - SiOx under pressure, then tribochemical silica coating, silane bonding agent, and ceramic primer were applied. Group 4: Samples were etched in a hot acid solution containing methanol, HCl, and chloride at 100 °C. Group 5: Samples were coated in a solution containing Grade C Aluminum Nitrite at 75 °C for 15 Sects. 12,000 thermal aging was carried out to all samples. Then, samples were bonded to a composite surface (Filtek Z250) with two different types of adhesive cement (Panavia F 2.0, Rely X U200) (n = 10). A load was applied to the samples attached to the Universal Test Device for the SBS, and the SBS was recorded. The surface roughness measurements of all samples were made again, and the average surface roughness Ra2 was recorded. The data was analyzed with a two-way ANOVA test. Bonferroni correction was used for multiple comparisons of the groups. p = 0.005 was accepted as the statistically significant value. RESULTS: There was no statistically significant difference between the groups in the Ra1 measurements (p = 0.031). There was a statistically significant difference between the Ra2 values of Groups 4 and 5 and the Ra2 values of Groups 1,2 and 3 in the Ra2 measurements (p < 0.001). There was no statistically significant difference between the SBS values of the groups (p > 0.005). Also, there was no statistically significant difference in the SBS values of all groups for the two different cements tested (p > 0.005). CONCLUSIONS: None of the surface treatments applied to monolithic zirconia ceramic samples increased the SBS between ceramic and adhesive resin cement.

Zirconia restorations and the tool diameter compensation.

AIM: The aim of the present article is to describe a new method to reduce the undesirable loss of material thickness that results from overmilling due to the tool diameter compensation correction of common CAD/CAM software. MATERIALS AND METHODS: Today's CAD/CAM software (eg, 3Shape or Exocad) specifies the same tool diameter compensation for different ceramics. In the case of zirconia ceramics milled in the raw state, this leads to excessive milling of the inner surfaces of crowns, which results in unnecessarily large cementation gaps and a restoration that is thinned out from the inside. By manually reducing the preset correction in the digital design process by the volumetric sintering shrinkage factor specified by the manufacturer, excessive thinning of the zirconia can be avoided. RESULTS: The inner geometry of the restorations changes only slightly after manually reducing the preset tool diameter compensation correction. Consequently, a design of the restoration with the required minimum interocclusal thickness yet with accurate passive seating and marginal fit is possible without any further interventions. CONCLUSIONS: Understanding the specifics of the subtractive fabrication process as well as the properties of the restorative materials is a key factor in achieving optimal clinical outcomes with all-ceramic restorations fabricated with CAD/CAM technology. The use of monolithic zirconia combined with a calculated reduction in the preset tool diameter compensation correction might be beneficial in cases with thin or uneven geometry.

Clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures: A systematic review.

PURPOSE: To determine the survival rates of implant-supported monolithic zirconia crowns and fixed partial dentures (FPD). MATERIAL AND METHODS: An electronic search for articles in the English language literature published from January 1, 2001 to September 17, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying predetermined inclusion and exclusion criteria, the definitive list of selected articles was used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR). Restoration failure in this study was defined as the fracture or compromise of any part of the ceramic restoration that required the removal or remake of the implant-supported restoration. RESULTS: The electronic search resulted in 457 titles. The systematic application of inclusion and exclusion criteria resulted in 14 clinical studies that addressed the clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures. Of these, 3 were randomized controlled trials, 5 were prospective studies, and 6 were retrospective studies. Follow-up periods ranged from 1 to 5 years. Of the 644 implant-supported monolithic zirconia restorations computed in this systematic review, there was only 1 reported failure of the monolithic zirconia restorative material over a follow-up period of up to 5 years, for a cumulative survival rate of 99.84%. At the maximum follow-up interval of 5 years, the cumulative survival rate for monolithic zirconia single crowns was 100% and the cumulative survival rate for monolithic zirconia fixed partial dentures was 99.60%. CONCLUSIONS: Implant-supported monolithic zirconia single crowns and fixed partial dentures have excellent short-term (<5 years) survival rates but the evidence for medium-term survival (>5 years) and beyond is lacking.

A micro-computed tomography analysis of internal and marginal fits of fixed partial dentures: Effect of preparation finish line designs on monolithic zirconia and heat-pressed zirconia-reinforced lithium disilicate.

PURPOSE: To evaluate the effect of finish line design (chamfer and feather-edge) and ceramic type on the internal and marginal fits of fixed partial dentures on abutment teeth. MATERIALS AND METHODS: Two typodont mandibular casts, missing right first premolar tooth, received tooth preparation on canine and second premolar abutments (one cast with chamfer finish line and the other cast with feather-edge finish line). The preparation segment of each typodont model was scanned, 3D printed in resin, and then invested and casted in metal to obtain two metal models. Polyvinyl siloxane impressions were made for the metal models and poured in type IV stone. The stone models (n = 40) were randomly assigned into four groups (n = 10): chamfer finish line with heat-pressed zirconia reinforced lithium disilicate fixed partial denture (CL), chamfer finish line with monolithic zirconia fixed partial denture (CZ), feather-edge finish line with heat-pressed zirconia-reinforced lithium disilicate fixed partial denture (FL), and feather-edge finish line with monolithic zirconia fixed partial denture (FZ). After the fabrication of ceramic restoration, micro-computed tomography was used to evaluate the internal and marginal fits of each fixed partial denture. Data were statistically analyzed with three-way ANOVA (α = 0.05). RESULTS: There were no significant interactions between preparation type, material type, and tooth type at any of the areas assessed. There was significant difference (p = 0.01) between CZ (59.15 ± 4.6 µm) and FZ (73.6 ± 17.1 µm) groups at the finish line area. Regarding the horizontal marginal discrepancy area, there were significant differences between CZ (62.65 ± 10.5 µm) and FZ (90.05 ± 5.6 µm) groups (p < 0.001), CL (77.45 ± 8.1 µm) and CZ (62.65 ± 10.5 µm) groups (p < 0.001), and FZ (90.05 ± 5.6 µm) and CL (77.45 ± 8.1 µm) groups (p < 0.001). At finish line area, there was a significant difference (p = 0.018) between feather-edge with canine (72.75 ± 13.3 µm) and chamfer with canine (59.05 ± 5.8 µm); however, there was no significant difference (p = 0.774) between feather-edge with premolar (69.45 ± 12 µm) and chamfer with premolar (65.1 ± 7.4 µm). Moreover, there was no significant difference (p = 0.886) between feather-edge with canine and feather-edge with premolar. CONCLUSIONS: The internal and marginal fits of the ceramic fixed partial dentures can be affected by the finish line design and ceramic type. The feather-edge finish line had a negative impact on the marginal and internal fits of ceramic fixed partial dentures at certain measurement points. Regarding the effect of finish line design on abutment teeth, the difference in fit was only detected at the finish line area of the anterior abutment (canine) with the feather-edge finish line.

Evaluation of Er,Cr:YSGG laser irradiation for debonding of zirconia hybrid abutment crowns from titanium bases.

To evaluate the efficacy of Er,Cr:YSGG laser irradiation on the removal of zirconia hybrid abutment crowns (HAC) from ti-bases and investigate the effects of laser output power and zirconia generation on debonding time and fracture resistance of crowns. A hundred monolithic zirconia HACs were fabricated by using 4Y-TZP and 5Y-TZP materials and subsequently cemented onto the ti-bases with a resin luting agent. Each zirconia group was further divided into 5 subgroups according to the debonding procedure as control (no debonding), 4.5 W-, 5 W-, and 6 W-laser irradiation, heat processed (n = 10). Er,Cr:YSGG laser (Waterlase MD; Biolase Technology Inc., Irvine, CA) was used on a noncontact hard tissue mode at a 20-Hz repetition rate and 140-µs pulse duration with 50% water and 50% air. Debonding durations were recorded for each specimen, and modes of failure were investigated. Crowns were re-cemented on their corresponding ti-bases, and HACs were subjected to fracture strength test. Debonding duration and fracture strength data were statistically analyzed. Fractured zirconia crown surfaces of ti-bases were examined under the scanning electron microscope. 5Y-TZP crowns were debonded from ti-bases in significantly lower durations in comparison with 4Y-TZP crowns for all output powers [4.5 W (P = 0.001), 5 W (P = 0.002), and 6 W (P = 0.0014)]. For both 4Y-TZP and 5Y-TZP materials, debonding duration was significantly decreased with the increase in laser output power (P ≤ 0.001 for 4Y- and 5Y-TZP). In comparison with 4Y-TZP heat-processed group to the 4Y-TZP laser-irradiated groups, no significant differences were detected in terms of fracture strength (P > 0.05), while heat-processed crowns exhibited significantly lower fracture strength values than those of control group (P = 0.006). All debonding procedures significantly reduced fracture strength values of 5Y-TZP crowns in comparison with the control group (P ≤ 0.001). The common failure type was the adhesive failure between the zirconia crown and resin cement for all groups. SEM evaluation showed no visible damage caused by laser irradiation or heat application. The use of Er,Cr:YSGG laser irradiation is an efficient way to retrieve zirconia crowns from ti-bases. The higher the output power of the laser, the shorter the bonding procedure. The debonding duration and fracture strength of the crown were affected by the zirconia generation. Debonded 5Y-TZP zirconia crowns should not be reused due to the decrease in mechanical strength values.

The effect of adjustment and finishing procedure on roughness, strength, and phase transformation of monolithic zirconia.

OBJECTIVE: To evaluate the effect of adjustment and finishing procedures and thermal aging of monolithic zirconia on the surface roughness, phase transformation, and flexural strength. MATERIAL AND METHODS: One hundred disk-shaped monolithic zirconia specimens were randomly divided into 5 groups: control, received only glazing; group Gr, was grinded; group GrP, was grinded and polished; group GrG, was grinded and re-glazed; group GrPG, was re-glazed after grinding and polishing. Half of the each group were stored in distilled water for 24 h and the remaining were thermocycled for 5000 cycles. Topographic evaluations were done with profilometer and scanning electron microscope. Phase changes were assessed through X-ray diffractometer. The biaxial flexural strength test was calculated by universal test machine. Statistical analysis was performed by using two-way ANOVA and Tukey multiple comparison test (p < 0.05). RESULTS: Group Gr showed statistically higher surface roughness and flexural strength values than the other groups (p < 0.001). However, no significant differences were observed between finishing groups (p >0.05). Phase transformation was occurred in all groups but the differences were not statically significant (p >0.05). Artificial aging had no effect on surface roughness, flexural strength, and phase transformation (p >0.05). CONCLUSION: Surface roughness significantly increased after grinding, but finishing procedure approximated it to the control group. Glazing after grinding decreased the flexural strength, but polishing did not. Zirconia polishing system may be an alternative to re-glazing for monolithic zirconia. CLINICAL RELEVANCE: Polishing is one of the most effective finishing procedures that can improve the physical properties of the material without damaging its mechanical properties.