Clinical Performance of Minimally Invasive Monolithic Ultratranslucent Zirconia Veneers: A Case Series up to Five Years of Follow-up.

There is a lack of reports in the literature on the long-term clinical performance of ultratranslucent zirconia, especially considering its use in manufacturing monolithic veneers. The purpose of this case series is to describe the aesthetic treatment steps of three patients with minimally invasive ultratranslucent zirconia veneers and to report the clinical findings up to five years. Three patients (woman: 2, man: 1; mean age: 30 years) unsatisfied with their dental aesthetics sought dental treatment. The treatment plan involved cementing ultratranslucent zirconia veneers. Air-abrasion was performed on the internal surface of zirconia with alumina particles coated by silica (silicatization), followed by silane and adhesive applications for the adhesive cementation. All veneers were adhesively cemented to enamel with resin cement (Variolink Esthetic, Ivoclar). The patients were clinically evaluated annually considering the Ryge modified/ California Dental Association criteria. After a mean follow-up of 4.33 years (4-5 years), a survival rate of 100% was detected for the 28 minimally invasive ultratranslucent zirconia veneers cemented in the 3 patients. There were no absolute failures such as debonding, veneer fracture, or secondary caries. Superficial marginal discoloration was observed in one element (maxillary left lateral incisor) of one patient. Ultratranslucent zirconia is a viable option for manufacturing veneers due to its excellent clinical performance and longevity. However, further long-term clinical studies are essential to consolidate this material as an option for esthetic restorations.

Effect of Multiple Firings on the Microshear Bond Strength Between a Translucent Zirconia and a Resin Cement.

PURPOSE: This study investigated the microshear bond strength between a resin cement and a translucent zirconia subjected to multiple characterization firings. METHODS AND MATERIALS: 5Y-PSZ zirconia blocks (Katana UTML) were sliced, sintered (1550°C, 2 h), and randomly divided into six groups (n=10) according to the number of characterization firings (0, 1, 2, 3, 5, or 10) and aging (baseline or after thermocycling). Each characterization firing was performed at 750°C for 1 minute. The ceramic surfaces were all sandblasted with 50 µm Al2O3 and silanized. Then, cylinders of resin cement (0.96 mm diameter × 2 mm height) were bonded onto their surfaces. The baseline samples were immersed in distilled water for 24 hours before the microshear bond strength (µSBS) tests. The aged samples were tested after 5000 thermocycles in water (5°C-55°C). The failure modes were classified as adhesive, predominantly adhesive, or cohesive. Scanning electron microscope images of the failure modes and the ceramic surfaces after the firings were taken. The µSBS data were analyzed by two-way ANOVA and Tukey's test. RESULTS: The number of characterization firings and aging affected the bond strength. The highest bond strength values were observed from the 2-firing group at baseline. The µSBS results after 1, 2, or 3 characterization firings were similar at baseline and after aging. On the other hand, 0, 5, and 10 firings revealed the lowest bond strengths. The most frequent failures were adhesive and predominantly adhesive. Zirconia grains were not affected by the multiple firings. CONCLUSION: One to three characterization firings after sintering improve the bond strength of 5Y-PSZ to the resin cement when compared to none or several (five or ten) firing cycles.

Adhesion between zirconia and resin cement: A critical evaluation of testing methodologies.

This study aimed to analyze different methodologies (tensile, microtensile, shear, microshear, and interfacial toughness) for evaluation of the bond strength between zirconia (Y-TZP) and resin cement. Zirconia ceramic blocks (VITA in-Ceram® YZ, VITA Zahnfabrik, Germany) were obtained, substrate surfaces were air-abraded with aluminum oxide (50 µm) for 10 s (2 bar pressure, distance: 10 mm, angle: 90°). Then, the specimens were washed with distilled water, dried, and coated with Clearfil Ceramic Primer that was actively applied with a microbrush for 20 s. The specimens were then cemented with resin cement under a load of 750 g, followed by photo-polymerization (40 s on each surface). After cementation, the specimens were aged in thermocycling (8000 cycles, 5-55 °C, 30 s for each bath) and subjected to tensile, microtensile, shear, microshear or interfacial toughness tests. All specimens were inspected for failure modes. The microtensile test showed the highest bond value (18.29 N/mm2). The microshear tests showed the highest coefficient of variation (0.59) and highest number of pre-test failures. The interfacial energy to fracture test showed that as the shear stress increased its interaction in the adhesive interface, the coefficient of variation also increased. The bond strength of Y-TZP showed different results according to the methodology, as well as its interfacial energy to fracture varied according to the angulation/type of stress specimen was submitted. The lower the shear stress at the adhesive interface of the mixed tests (interfacial energy to fracture), the lower was the variability of the test.

Silica infiltration in partially stabilized zirconia: Effect of hydrothermal aging on mechanical properties.

It aimed to evaluate if silica infiltration might influence the hydrothermal degradation of zirconia by determining: the phases formed, hardness, microstructure, and flexural strength of a 3Y-TZP. Yttria partially stabilized zirconia discs (1.2 mm thickness x 13 mm diameter) (InCeram YZ, Vita Zanhfabrik) were produced and assigned into 6 groups, considering 2 factors: silica infiltration in 2 levels (as-sintered or infiltration) and hydrothermal aging (LTD-Low Temperature Degradation) in 3 levels (baseline, aging at 132 °C for 35 h or 140 h). All the groups were subjected to the biaxial flexural test (n = 30), and Vickers hardness (n = 42). Weibull analysis was performed to determine the Weibull moduli (m) and characteristic strenghts (σ0). The specimens were characterized by scanning electron microscopy (SEM) to evaluate microstructure and X-ray diffraction (XRD) for phases percentages determination. For as-sintered condition: there was saturation of the amount of monoclinic zirconia after 35 h of hydrothermal aging, with 66% of monoclinic zirconia formed on the surface. LTD generated a progressive reduction in hardness over time; flexural strength was increased by the 35-h treatment (baseline: 974 MPa; 35 h: 1161.5 MPa), but, the 140 °C treatment was deleterious (698.5 MPa). On the other hand, the infiltrated specimens had an increase in the amount of cubic zirconia on the surface and showed 26% (35h) and 31% (140h) of monoclinic zirconia after the hydrothermal aging ; the strength was kept unaltered after LTD-35 h (935.9 MPa) and an increase was observed after LTD-140 h (1033.6 MPa); the hardness values had no statistically significant changes during the process. Thus, one can concludes that the silica infiltration can prevent the decrease in the mechanical properties due to the LTD on partially stabilized zirconia materials.

Digital Image Correlation and Finite Element Analysis of Bone Strain Generated by Implant-Retained Cantilever Fixed Prosthesis.

PURPOSE: The present study evaluated the displacement and strain generated in an implant- supported fixed prosthesis under axial and non-axial loads using two methods. MATERIALS AND METHODS: Three implants were inserted in a resin block. The Digital Image Correlation (DIC) was used to measure displacement and strain generated on the surface of the resin blocks for the different load applications (500N, 1 image/second). A 3-dimensional model was constructed and a load of 500 N was applied at an axial point and a non-axial point through finite element analysis (FEA). RESULTS: Both methods gave similar trends for the strains, and both gave slightly higher strains with non-axial loading. FEA predicted higher strain magnitude (±11%) in comparison with DIC, but with the same mechanical behavior. According to ANOVA, the loading influenced the strain concentration. Higher strain was generated for non-axial loading around the implant nearest to the loading. CONCLUSIONS: For implant-retained cantilever fixed prosthesis, the same load applied in the lever arm induces higher strain in the cervical area of the last implant, which suggests more damaging potential than a load applied at the center of the prosthesis.

Streptococcus mutans Biofilm Formation and Cell Viability on Polymer-infiltrated Ceramic and Yttria-stabilized Polycrystalline Zirconium Dioxide Ceramic.

OBJECTIVE: The aim of this study was to investigate the biofilm formation and cell viability of a polymer-infiltrated ceramic (PIC) and an yttria-stabilized polycrystalline zirconium dioxide ceramic (Y-TZP). The null hypothesis was that there would be no difference in biofilm formation and cell viability between the materials. METHODS AND MATERIALS: Streptococcus mutans biofilm was analyzed with scanning electron microscopy (SEM), confocal laser scanning microscopy, and colony counting (colony-forming units/mL). The cell viability (fibroblasts) of both materials was measured with 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium) (MTT) test. Roughness measurements were also performed. RESULTS: The PIC displayed higher roughness but showed similar colony-forming units and biovolume values to those of Y-TZP. SEM showed a higher amount of adhered fibroblasts on the PIC surface on the first day and similar amounts on both materials after seven days. Moreover, the materials were biocompatible with human fibroblasts. CONCLUSION: PIC and Y-TZP are biocompatible and present the same characteristics for biofilm formation; therefore, they are indicated for indirect restorations and implant abutments.

Influence of Ceramic Materials on Biomechanical Behavior of Implant Supported Fixed Prosthesis with Hybrid Abutment.

PURPOSE: This study evaluated the stress distribution in different cement-retained implant-supported prostheses with a hybrid abutment. MATERIALS AND METHODS: Two factors were evaluated: restorative material for the crown and hybrid abutment - zirconia, lithium disilicate and hybrid ceramic, yielding 9 combinations. For finite element analysis, a monolithic crown cemented on a hybrid abutment was modeled and cemented on a titanium base (Ti base). An oblique load (45°, 300 N) was applied to the fossa bottom and system fixation occurred on the bone's base. RESULTS: Each structure was evaluated separately to find the possible weaknesses in geometry and failure criteria. In this context, results demonstrated a significant decrease of maximum principal and von-Mises stresses concentration when crowns with high elastic modulus are cemented onto a hybrid abutment with lower elastic modulus. CONCLUSIONS: Considering this theoretical study for a Morse taper implant, the association of a rigid crown with a more resilient hybrid abutment reduces the tensile stress concentration in the restoration cervical region.

Fatigue behavior of ultrafine tabletop ceramic restorations.

OBJECTIVE: The goal of this study was to investigate the fatigue life, failure modes, and stress distribution of partial ultrafine restorations for posterior teeth in different ceramics. METHODS: Sixty standard tabletop preparations in epoxy resin G10 received lithium-silicate-based zirconia-reinforced (ZLS) or hybrid ceramic (PIC) restorations in 0.5- or 1-mm thickness bonded with resin cement. The same cycling protocol was applied for all specimens, which consisted of 5000 cycles at 200N, followed by 450-N cycles until the specimens' fracture or the suspension of the test after 1.5×106 cycles. Axial load was carried out with a 4Hz frequency in Biocycle V2 equipment (Biopdi, São Carlos, SP), with samples immersed in water. The presence of cracks and/or fractures was checked every 2.5×105 cycles, and the survival analysis was performed with the number of cycles in which each specimen failed. All specimens were evaluated by stereomicroscopy and scanning electron microscopy (SEM). After data tabulation, Kaplan-Meier and Mantel-Cox (log-rank test) analyses were performed, followed by multiple pairwise comparison, all with a significance level of 5%, and Weibull analysis. Through three-dimensional finite element analysis, stress distribution and maximum principal stresses in the posterior occlusal veneers were evaluated by comparison of different types of substrate (G10, enamel/dentin, enamel), thicknesses, and ceramic materials. RESULTS: Zirconium-reinforced lithium silicate restorations with 0.5-mm thickness (ZLS.5) showed lower fatigue strength compared with that of 1.0-mm hybrid ceramic restorations (PIC1), and both were similar to other restorations (PIC.5 and ZLS1) (log-rank test, χ2=11.2; df=3; p=0.0107<0.05). ZLS groups presented random defects that culminated in fracture, whereas PIC groups presented defects that increased with mechanical fatigue after some cycling time. Stereomicroscope images show radial cracks due to the translucency of the material. There was no damage caused by the applicator. MPS (maximum principal stress) distributions were similar for the different substrate types, but the highest modulus of elasticity showed slightly lower stress concentration. SIGNIFICANCE: PIC is more likely to be used in thinner thickness than indicated by the manufacturer, with fatigue strength similar to that of thicker ZLS restorations.

Effects of Manufacturing and Finishing Techniques of Feldspathic Ceramics on Surface Topography, Biofilm Formation, and Cell Viability for Human Gingival Fibroblasts.

PURPOSE:: Feldspathic ceramic restorations can be obtained by different techniques (stratification or computer-aided design/computer-aided manufacturing [CAD/CAM] blocks) and finishing procedures (polishing or glaze application). This study evaluated the effects of techniques and finishing procedures on surface properties, biofilm formation, and viability of human gingival fibroblasts (FMM-1) in contact with these materials. METHODS AND MATERIALS:: Ceramic specimens were obtained through a stratification technique (Vita VM9) and from CAD/CAM blocks (Vita Blocs Mark II; both Vita Zahnfabrik) and their surfaces were finished by polishing (ceramisté diamond rubbers + polishing paste; "p" subgroups) or glaze spray application + sintering ("g" subgroups). Roughness (Ra and RSm parameters) and surface free energy (SFE) were measured. Early biofilm formation of Streptococcus mutans, Streptococcus sanguinis, and Candida albicans was evaluated by counting colony-forming units (CFU). MTT (3-[4.5-dimethyl-thiazol-2-yl-]-2.5-diphenyl tetrazolium bromide) cytotoxicity test evaluated cellular viability for the growth of FMM-1 after 24 hours and seven days of contact. Scanning electron microscopy (SEM) and three-dimensional optical profilometry were performed to qualitatively analyze the surface. Data were analyzed by analysis of variance, Tukey test, and t-test (all α=0.05). RESULTS:: Polished samples presented lower roughness (Ra, p=0.015; RSm, p=0.049) and higher SFE ( p=0.00). Streptococci had higher CFU in all groups, but the CFU of C albicans was lower for polished samples. Biofilm formation was influenced by the interaction of all factors ( p=0.018), and the materials showed no cytotoxicity to FMM-1 growth. CONCLUSIONS:: Polishing resulted in the lowest values for surface roughness and higher SFE values. Polished ceramics showed less C albicans adherence while the adherence of Streptococci was greater than C albicans in all conditions.

Monolithic Ceramics: Effect of Finishing Techniques on Surface Properties, Bacterial Adhesion and Cell Viability.

INTRODUCTION: This study evaluated the morphology, biofilm formation, and viability of human gingival fibroblasts in contact with two monolithic ceramics after two different finishing techniques: polishing or glazing. For this, 92 blocks (4.5 × 4.5 × 1.5 mm) of each ceramic were made using high translucency zirconia partially stabilized by yttrium (YZHT) and lithium silicate reinforced by zirconium (ZLS). METHODS AND MATERIALS: Blocks were sintered and then divided into glazing (g) or polishing (p) surface finish. Surface roughness (Ra and RSm) was evaluated through a contact rugosimeter and profilometry. Specimens were contaminated for heterotypic biofilm formation with Streptococcus mutans, Streptococcus sanguinis and Candida albicans for 16 hours. Biofilm was quantified by counting the colony forming units (CFU/mL) and analyzed by scanning electron microscopy (SEM). Fibroblast viability was evaluated by MTT assay. Surface free energy (SFE) was also determined. Roughness data were evaluated using nonparametric tests, while SFE, MTT and CFU results were evaluated by analysis of variance and Tukey test, and MTT data were also submitted to t-test (all, α=0.05). RESULTS: Results showed that polished samples presented a lower high profile mean ( p<0.001); however, YZHTg presented less space between defects ( p=0.0002). SFE showed that YZHT presented higher SFE than ZLS. Profilometry evidenced more homogeneity on polished surfaces. The interaction of finishing technique and microorganisms influenced the CFU ( p=0.00). MTT assay demonstrated initial severe cytotoxic behavior for polished surfaces. SEM images showed homogeneous surfaces, except for glazed YZHT. CONCLUSION: Glazed surfaces have a greater roughness and tend to accumulate more biofilm. Polished surfaces have higher SFE; however, they are temporarily cytotoxic.

Self-etching Primers vs Acid Conditioning: Impact on Bond Strength Between Ceramics and Resin Cement.

This study tested whether a self-etching surface agent and the conventional hydrofluoric acid (HF) would provide the same bonding capacity between resin cement and feldspathic (Fd) and lithium disilicate (Ld) ceramics. Ceramic blocks were cut with a low-speed diamond saw with water cooling (Isomet 1000, Buehler, Lake Bluff, IL, USA) into 20 blocks of 5 × 7 × 4 mm, which were ground flat in a polishing machine (EcoMet/AutoMet 250, Buehler) under water cooling. The blocks were randomly divided into eight groups (n=5), according to ceramic type (Ld or Fd), surface conditioning (HF + Monobond Plus or Etch and Prime), and aging by thermocycling (TC or absence-baseline). After 24 hours in 37°C distilled water, blocks were embedded into acrylic resin and 1-mm2 cross-section beams composed of ceramic/cement/composite were obtained. The microtensile test was performed in a universal testing machine (DL-1000, EMIC, São José dos Campos, Brazil; 0.5 mm.min-1, 50 kgf load cell). Bond strength (MPa) was calculated by dividing the load at failure (in N) by the bonded area (mm2). The fractured specimens were examined under stereomicroscopy, and one representative sample of each group was randomly selected before the cementation and was further used for analysis using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). The self-etching agent showed the highest bond strength for Fd (24.66±4.5) and Ld (24.73±6.9) ceramics and a decrease in surface wettability. SEM and EDS showed the presence of similar components in the tested materials with different topographies for both. Therefore, the self-etching primer was able to deliver even higher bonding than HF+silane to a resin cement.

Ultrathin Monolithic Zirconia Veneers: Reality or Future? Report of a Clinical Case and One-year Follow-up.

Yttria-stabilized polycrystalline zirconia ceramics have greatly advanced over the past few years. High-translucent zirconia is a newly introduced ceramic that affords high strength and esthetics and that has significantly increased the clinical indications of monolithic zirconia restorations. Thus, the purpose of this case report was to evaluate the performance of ultrathin monolithic zirconia veneers adhesively luted to enamel surfaces after minimally invasive preparations; in addition, we aimed at presenting a clinical protocol for zirconia surface treatment in order to promote bonding effectiveness to resin cement. This type of restoration presented very acceptable esthetic results and decreased the risk of fracturing the veneer during try-in and clinical use. The results were still satisfactory after one-year follow-up. However, randomized, prospective, controlled clinical trials are required to determine the long-term clinical durability of this treatment.

Different Methods for Inlay Production: Effect on Internal and Marginal Adaptation, Adjustment Time, and Contact Point.

The aim of this study was to evaluate the effect of different production methods of resin and ceramic inlays on marginal and internal adaptation, adjustment time, and proximal contacts. Forty premolars were selected, embedded (their roots), and prepared to receive inlays that were made as follows (n=10): LaRe-digital impression with a Lava C.O.S. scanner, followed by milling of Lava Ultimate block (composite resin) in a milling center; CeRe-digital impression with a Cerec 3D Bluecam scanner, followed by milling of Lava Ultimate block in Cerec; CeDis-digital impression with a Cerec 3D Bluecam scanner, followed by milling of IPS e.max CAD block (lithium disilicate) in Cerec; and PresDis-impression with polyvinyl siloxane, inlay made using the lost wax technique and IPS e.max Press pressed ceramic (lithium disilicate). Marginal and internal adaptations were measured using the replica technique. The inlay adjustments were performed using diamond burs in a contra-angle hand piece, and the time for adjustment was recorded using a timer, in seconds. The tightness of the proximal contact was measured using standardized metal blades. The statistical analyses for marginal fit data showed that at the cervical edge, CeDis (177.8 µm) had greater misfit than CeRe (116.7 µm), while all the groups had similar adaptation at the occlusal edge. The groups had similar internal fit at the pulpal wall, while LaRe (104.7 µm) > CeDis (66.7 µm) = CeRe (76.7 µm) at the axial wall. The groups restored with lithium disilicate ceramic took more time for adjustment when compared to the resin restorative material. The lowest proximal contact, in micrometers, was seen in the CeRe group (8.8 µm).

Adhesive Cementation Promotes Higher Fatigue Resistance to Zirconia Crowns.

OBJECTIVE: The aim of this study was to investigate the influence of the cementation strategy on the fatigue resistance of zirconia crowns. The null hypothesis was that the cementation strategy would not affect the fatigue resistance of the crowns. METHODS AND MATERIALS: Seventy-five simplified molar tooth crown preparations were machined in glass fiber-filled epoxy resin. Zirconia crowns were designed (thickness=0.7 mm), milled by computer-aided design/computer-aided manufacturing, and sintered, as recommended. Crowns were cemented onto the resin preparations using five cementation strategies (n=15): ZP, luting with zinc phosphate cement; PN, luting with Panavia F resin cement; AL, air particle abrasion with alumina particles (125 µm) as the crown inner surface pretreatment + Panavia F; CJ, tribochemical silica coating as crown inner surface pretreatment + Panavia F; and GL, application of a thin layer of porcelain glaze followed by etching with hydrofluoric acid and silanization as crown inner surface pretreatment + Panavia F. Resin cement was activated for 30 seconds for each surface. Specimens were tested until fracture in a stepwise stress fatigue test (10,000 cycles in each step, 600 to 1400 N, frequency of 1.4 Hz). The mode of failure was analyzed by stereomicroscopy and scanning electron microscopy. Data were analyzed by Kaplan-Meier and Mantel-Cox (log rank) tests and a pairwise comparison (p<0.05) and by Weibull analysis. RESULTS: The CJ group had the highest load mean value for failure (1200 N), followed by the PN (1026 N), AL (1026 N), and GL (1013 N) groups, while the ZP group had the lowest mean value (706 N). Adhesively cemented groups (CJ, AL, PN, and GL) needed a higher number of cycles for failure than the group ZP did. The groups' Weibull moduli (CJ=5.9; AL=4.4; GL=3.9; PN=3.7; ZP=2.1) were different, considering the number of cycles for failure data. The predominant mode of failure was a fracture that initiated in the cement/zirconia layer. Finite element analysis showed the different stress distribution for the two models. CONCLUSION: Adhesive cementation of zirconia crowns improves fatigue resistance.

Bacterial Colonization in the Marginal Region of Ceramic Restorations: Effects of Different Cement Removal Methods and Polishing.

This study evaluated the effects of excess cement removal techniques, with or without subsequent polishing, on biofilm formation and micromorphology in the marginal region of the tooth/restoration. From bovine teeth, 96 dentin blocks (4 × 8 × 2 mm) were produced, molded, and reproduced in type IV gypsum, on which 96 pressed ceramic blocks (Vita PM9, Vita Zahnfabrik; 4 × 8 × 2 mm) were produced via the lost wax technique. The dentin blocks and their respective ceramic blocks were cemented with a self-adhesive resin cement (RelyX U200, 3M ESPE), and cement excess was removed from the margin using four different techniques, followed or not by polishing with silicone rubber tips: MBr, removal with microbrush and photoactivation; MBr-Pol, MBr + polishing; Br, removal with brush and photoactivation; Br-Pol, Br + polishing; Photo-Expl, 5 seconds of initial photoactivation, removal with explorer, and final curing; Photo-Expl-Pol, Photo-Expl + polishing; Photo-SB, 5 seconds of initial photoactivation, removal with scalpel, and final curing; and Photo-SB-Pol, Photo-SB + polishing. After 24 hours, the roughness in the marginal region was analyzed using a profilometer (three measurements on each sample). Micromorphological analyses of the region were performed by stereomicroscope and scanning electron microscopy (SEM). Then the samples were contaminated with sucrose broth standardized suspension with Streptococcus mutans , Staphylococcus aureus , and Candida albicans and incubated for a period of 48 hours. The samples were quantitatively analyzed for bacterial adherence in the marginal region by confocal laser scanning microscopy and counting of colony-forming units (CFUs/mL) and qualitatively analyzed using SEM. Roughness data (Ra) were submitted to two-way analysis of variance, Tukey test at a confidence level of 95%, and Student t-tests. CFU, biomass, and biothickness data were analyzed by Kruskal-Wallis, Mann-Whitney, and Dunn tests. The removing technique statistically influenced Ra (MBr, p=0.0019; Br, p=0.002; Photo-Expl, p=0.0262; Photo-SB, p=0.0196) when comparing the polished and unpolished groups. The MBr and MBr-Pol technique differed significantly for CFU/mL values (p=0.010). There was no significant difference in the amounts of biomass and biothickness comparing polished and unpolished groups and when all groups were compared (p>0.05). Different morphological patterns were observed (more regular surface for polished groups). We conclude that margin polishing after cementation of feldspar/pressed ceramic restorations is decisive for achieving smoother surfaces, as the excess cement around the edges can increase the surface roughness in these areas, influencing bacterial adhesion.

Ceramic Inlays: Effect of Mechanical Cycling and Ceramic Type on Restoration-dentin Bond Strength.

This study aimed to evaluate the bond strength between dentin and five different ceramic inlays in permanent maxillary premolars, with and without mechanical cycling. One hundred permanent maxillary premolars were prepared and divided into 10 groups (n=10) according to the ceramic system (IPS e.Max Press; IPS e.Max CAD; Vita PM9; Vita Mark II; and Vita VM7) and the mechanical cycling factor (with and without [100 N, 2 Hz, 1.2×10(6) cycles]). The inlays were adhesively cemented, and all of the specimens were cut into microbars (1×1 mm, nontrimming method), which were tested under microtensile loading. The failure mode was classified and contact angle, roughness, and microtopographic analyses were performed on each ceramic surface. The mechanical cycling had a significant effect (p=0.0087) on the bond strength between dentin and IPS e.max Press. The Vita Mark II group had the highest bond strength values under both conditions, with mechanical cycling (9.7±1.8 MPa) and without (8.2±1.9 MPa), while IPS e.Max CAD had the lowest values (2.6±1.6 and 2.2±1.4, respectively). The adhesive failure mode at the ceramic/cement interface was the most frequent. Vita Mark II showed the highest value of average roughness. IPS e.max Press and Vita Mark II ceramics presented the lowest contact angles. In conclusion, the composition and manufacturing process of ceramics seem to have an influence on the ceramic surface and resin cement bond strength. Mechanical cycling did not cause significant degradation on the dentin and ceramic bond strength under the configuration used.

A new silica-infiltrated Y-TZP obtained by the sol-gel method.

OBJECTIVE: The aim of this study was to evaluate silica infiltration into dental zirconia (VITA In-Ceram 2000 YZ, Vita Zahnfabrik) and its effects on zirconia's surface characteristics, structural homogeneity and bonding to a resin cement. METHODS: Infiltration was performed by immersion of the pre-sintered zirconia specimens in silica sols for five days (ZIn). Negative (pure zirconia specimens, ZCon-) and positive controls (specimens kept in water for 5 days, ZCon+) were also performed. After sintering, the groups were evaluated by X-ray diffraction (XRD), grazing angle X-ray diffraction (DRXR), scanning electron microscopy (SEM), contact angle measurements, optical profilometry, biaxial flexural test and shear bonding test. Weibull analysis was used to determine the Weibull modulus (m) and characteristic strength (σ0) of all groups. RESULTS: There were no major changes in strength for the infiltrated group, and homogeneity (m) was also increased. A layer of ZrSiO4 was formed on the surface. The bond strength to resin cement was improved after zirconia infiltration, acid conditioning and the use of an MDP primer. CONCLUSION: The sol-gel method is an efficient and simple method to increase the homogeneity of zirconia. Infiltration also improved bonding to resin cement. CLINICAL SIGNIFICANCE: The performance of a zirconia infiltrated by silica gel improved in at least two ways: structural homogeneity and bonding to resin cement. The infiltration is simple to perform and can be easily managed in a prosthesis laboratory.

Resin Bonding to a Hybrid Ceramic: Effects of Surface Treatments and Aging.

The aim of this study was to verify the effects of different surface treatments on the microtensile bond strength between resin cement and a hybrid ceramic. Thirty-two hybrid ceramic slices (8 × 10 × 3 mm) were produced and allocated among four groups according to the surface treatment: Cont = no treatment, HA = 10% hydrofluoric acid applied for 60 seconds, PA = 37% phosphoric acid applied for 60 seconds and CJ = air abrasion with silica particle coated alumina (Cojet Sand, 3M ESPE, 30 µm/2.8 bar). As a control group, eight blocks of feldspathic ceramic (8 × 10 × 3 mm) were etched by hydrofluoric acid for 60 seconds (VMII). After the surface treatments, the ceramic slices were silanized (except the Cont group) and adhesively cemented to composite resin blocks (8 × 10 × 3 mm ) with a load of 750 g (polymerized for 40 seconds each side). The cemented blocks were cut into beams (bonded surface area of ∼1 mm(2)). Half of the beams were aged (thermocycling of 5°C-55°C/6000 cycles + water storage at 37°C/60 days), and the other half were tested immediately after being cut. Data were analyzed by Kruskal-Wallis and Dunn tests (non-aged groups) and by one-way analysis of variance and Tukey test (aged groups; α=0.05%). The mode of failure was classified by stereomicroscopy. The surface treatment significantly affected the bond strength in each set of groups: non-aged (p=0.001) and aged (p=0.001). Before being aged, samples in the CJ, HA, and PA groups achieved the highest bond strength values. However, after being aged, only those in the HA group remained with the highest bond strength values. Adhesive failure was found most often. In conclusion, hydrofluoric acid etching should be used for surface conditioning of the studied hybrid ceramic.

Fatigue Resistance of Y-TZP/Porcelain Crowns is Not Influenced by the Conditioning of the Intaglio Surface.

OBJECTIVES: The objective of this study was to investigate the effects of treatments of the intaglio surface of Y-TZP frameworks and luting agents on the fatigue resistance of all-ceramic crowns. METHODS: A research design was chosen that attempted to reduce the likelihood of Hertzian cracking and to increase the probability of fracture initiation at the intaglio surface of the framework. Ninety identical preparations were machined in a dentin-like epoxy composite. Each preparation was restored with a Y-TZP framework made by a CAD/CAM system and veneered using feldspathic ceramic. Prior to cementation the intaglio surface of the ceramic was treated using one of four treatments: 1) cleaning with isopropyl alcohol; 2) application of an overglaze; 3) sandblasting with 125 µm aluminum oxide powder; and 4) sandblasting with 30 µm silica powder (CJ). One of three luting cements were used: 1) zinc phosphate; 2) glass ionomer; and 3) adhesive resin cement (PN). All three cements were tested against frameworks that were alcohol cleaned. Only the PN cements were tested against frameworks that had been sandblasted or glazed. Altogether, six groups of 15 specimens each were tested. Fatigue resistance was evaluated using stepwise loads at 1.4 Hz until failure: 5000 cycles at maximum load of 200 N, followed by 10,000 cycles at maximum loads of 800, 1000, 1200, and 1400 N. The cement thickness and failure modes were analyzed using a stereomicroscope and scanning electron microscopy. The results were analyzed using the Kaplan-Meier and Mantel-Cox log rank tests (5%), a one-way analysis of variance, Tukey multiple comparison test, and Weibull nonparametric test. RESULTS: The predominant failure mode was chipping of the veneer. The crowns cemented with the adhesive resin cement exhibited chipping failure at higher mean loads than did crowns cemented with cements that usually do not bond strongly with dentin. When the adhesive cement was used, glazing and sandblasting intaglio framework surface treatments exhibited lower mean loads at chipping than did crowns whose intaglio surface was only cleaned with alcohol. Weibull analysis indicated that all specimens had a high ratio of late-to-early failures. CONCLUSIONS: The fatigue experiment produced a pattern of failures that is very similar to that observed in clinical trials of Y-TZP crowns that are veneered with feldspathic porcelain. Crowns cemented with an adhesive resin cement exhibited chipping at a significantly higher mean load than those cemented with luting cements that do not usually form strong bonds with dentin. When cemented with adhesive resin cement, glazing or sandblasting the intaglio surface of the framework significantly reduced the mean fatigue loads at which chipping of veneers occurred, as compared to crowns whose intaglio surface had only been cleaned with alcohol. For this cement glazing or sandblasting the intaglio surface of the crown is not recommended.

Effects of Surface Treatments on the Bond Strength Between Resin Cement and a New Zirconia-reinforced Lithium Silicate Ceramic.

This study evaluated the effects of surface treatments on the bond strength between the new zirconia-reinforced lithium silicate ceramic (ZLS) and resin cement. VITA Suprinity blocks were crystallized according to the manufacturer's instructions and randomly assigned to six groups (N=36; n=6), according to the surface treatment to be performed and aging conditions: HF20, 10% hydrofluoric acid for 20 seconds, baseline (control); HF20tc, 10% hydrofluoric acid for 20 seconds, aging; HF40, 10% hydrofluoric acid for 40 seconds, baseline; HF40tc, 10% hydrofluoric acid for 40 seconds, aging; CJ, CoJet sandblasting (25 seconds, 2.5 bar, 15-mm distance), baseline; and CJtc, CoJet sandblasting (25 seconds, 2.5 bar, 15-mm distance), aging. All specimens were silanized (Monobond S) and cemented with Panavia F to newly polymerized Z250 resin blocks. After specimens were immersed for 24 hours in distilled water at 37° C, 1-mm(2) cross-section microbars were obtained by means of a cutting machine under constant cooling. Baseline groups were immediately tested, whereas "tc" groups were used to analyze the effect of aging on bond strength (10,000 thermal cycles, 5/55°C, 30-second bath). The microtensile bond strength test was performed with a universal testing machine (0.5 mm/min), and bond strength (MPa) was calculated when the load-to-failure (N) was divided by the adhesive area (mm(2)). We also evaluated the surface roughness (Sa, average roughness; Str, texture aspect ratio; Sdr, developed interfacial area ratio) and the contact angle resulting from the treatments. Data were statistically analyzed by one- or two-way analysis of variance and Tukey's test (all α=5%). The failure mode of each specimen was evaluated by stereomicroscopy, and representative specimens were analyzed by scanning electron microscopy. The microtensile bond strength was affected by the surface conditioning (p<0.0001), storage condition (p<0.0001), and the interaction between them (p=0.0012). The adhesion for HF etching was stable, whereas for CJ, aging significantly damaged the adhesion. Most failures were predominantly adhesive between ceramic and cement (52.6%). The roughness of the treated samples was higher compared with that of polished specimens for the three evaluated parameters (Sa, Str, and Sdr; all p<0.0001). Contact angle was also influenced by treatments (p<0.0001), with the CJ group showing values similar to those of control specimens. It can be concluded that the three surface treatment techniques present favorable immediate results, but silica coating was not effective in maintaining the bond strength over the long term.