Fatigue resistance of simplified CAD-CAM restorations: Foundation material and ceramic thickness effects on the fatigue behavior of partially- and fully-stabilized zirconia.

OBJECTIVE: To evaluate the fatigue failure load, number of cycles until failure and survival probability of partially (PSZ) and fully-stabilized (FSZ) polycrystalline zirconia disc shaped specimens with different thicknesses adhesively cemented onto foundations with distinct elastic moduli. METHODS: Disc-shaped specimens (n = 15, Ø = 10 mm; thickness = 1.0 and 0.7 mm) of CAD/CAM PSZ and FSZ blocks were adhesively cemented onto discs with different foundations (Ø = 10 mm; thickness = 2.0 mm) made from epoxy resin, composite resin or Ni-Cr metallic alloy. The cemented assemblies were subjected to fatigue testing using a step-stress approach (600-2800 N; step-size of 100 N; 10,000 cycles per step; 20 Hz) and the data was submitted to specific statistical tests (α = 0.05). Fractography and finite element (FEA) analyzes were also performed. RESULTS: PSZ and FSZ presented higher fatigue failure load, number of cycles until failure and survival probabilities when cemented onto metallic alloy. All PSZ specimens survived the fatigue test when cemented onto Ni-Cr alloy (100% probability of survival at 2800 N; 230,000 cycles). Regardless of the foundation type, PSZ had better fatigue behavior than FSZ. For thickness, thinner PSZ restorations underperformed when bonded to softer foundations, while FSZ groups and groups bonded to metallic foundations had no statistical difference. SIGNIFICANCE: The foundation material strongly influences the fatigue performance of PSZ and FSZ restorations, which presented mechanical behavior improvements when bonded to a metallic foundation. PSZ restorations showed better fatigue behavior than FSZ, while the ceramic thickness only influenced PSZ restorations bonded to softer foundations.

Fatigue performance of adhesively cemented glass-, hybrid- and resin-ceramic materials for CAD/CAM monolithic restorations.

OBJECTIVE: To evaluate the fatigue failure load, number of cycles until failure, and survival probability of adhesively cemented materials with different microstructures (glass-, hybrid- and resin-ceramic) used to manufacture CAD/CAM monolithic restorations. METHODS: Disc-shaped specimens (n=15; Ø=10mm; thickness=1.0mm) were produced from CAD/CAM blocks as follows: feldspathic (FEL); leucite (LEU); lithium disilicate (LD); zirconia-reinforced lithium silicate (ZRLS); polymer-infiltrated ceramic network (PICN); and resin nanoceramic (RNC). Adhesive cementation was performed onto epoxy discs (dentin analogue- Ø=10mm; thickness=2.5mm). The cemented assemblies were subjected to fatigue testing using a step-stress approach (400N-2200N; step-size of 200N; 10,000 cycles per step; 1.4Hz). Fatigue data were analyzed using Kaplan-Meier and Mantel-Cox (log-rank) tests (p<0.05) and Weibull statistical analysis. Fractographic analysis was also performed. RESULTS: All RNC specimens survived the fatigue test (100% probability of survival at 2200N; 100,000 cycles) and presented occlusal deformation in response to loading, while all other tested materials failed in distinct loading steps with radial cracks starting from the bonding surface. LD (1146.7N; 47,333) and ZRLS (1013.3N; 40,666) materials obtained the highest fatigue failure loads and cycles until failure, meanwhile all PICN specimens failed during the first step (0% probability of survival at 400N; 10,000). FEL had similar Weibull modulus to LD and ZRLS and higher than LEU for both load and number of cycles outcomes. SIGNIFICANCE: The microstructure of adhesively cemented glass-, hybrid- and resin-ceramic CAD/CAM restorative materials influence their response during fatigue testing, which aids in suggesting the best clinical indications.

The effect of hydrofluoric acid concentration on the fatigue failure load of adhesively cemented feldspathic ceramic discs.

OBJECTIVE: This study investigated the influence of hydrofluoric acid (HF) etching at different concentrations on the fatigue failure load of adhesively cemented feldspathic ceramic discs (Vita Mark II). Besides, their effect on the micromorphology of ceramic surface was investigated. METHODS: Eighty ceramic discs (ϕ=10 mm; thickness=1.5 mm) were cemented to epoxy supporting discs (ϕ=10 mm; thickness=2.0mm) using different surface conditioning methods (n=20): nonetched control (CTRL), or etched for 60s with different HF concentrations: 1% (HF1), 5% (HF5), or 10% (HF10). All the ceramic discs received a silane application (Monobond Plus). The epoxy discs were etched with 10% HF for 60s and received a primer coating (Multilink Primer A+B). Adhesively cementation was performed (Multilink Automix), and the assemblies (ceramic discs/epoxy discs) were subjected to cyclic loads in water by a staircase approach (500,000 cycles; 20Hz; initial load=290N; step size=30N). Fatigue failure load data were analyzed using 1-way ANOVA and post-hoc Tukey's tests (α=.05). RESULTS: Mean failure load of the HF5 group (255.0±23.0N) was significantly lower; HF1 group (301.7±71.0N) presented intermediate values, and the highest values were achieved in CTRL (351.7±13.4N) and HF10 (341.7±20.6N) groups. All the failures were radial cracks starting from the bonding surface. SIGNIFICANCE: In terms of fatigue failure load, etching with 1% and 5% HF had a deleterious effect on the fatigue behavior of an adhesively cemented feldspathic ceramic, while 10% HF had no negative influence.

Fatigue failure load of feldspathic ceramic crowns after hydrofluoric acid etching at different concentrations.

STATEMENT OF PROBLEM: Hydrofluoric acid etching modifies the cementation surface of ceramic restorations, which is the same surface where failure is initiated. Information regarding the influence of hydrofluoric acid etching on the cyclic loads to failure of ceramic crowns is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the influence of different hydrofluoric acid concentrations on the fatigue failure loads of feldspathic ceramic crowns. MATERIAL AND METHODS: Eighty feldspathic ceramic crowns were cemented with resin cement to identical simplified complete crown preparations machined in a dentin-like polymer. The preparations were etched with 10% hydrofluoric acid for 60 seconds and received a primer coating. Before cementation, the intaglio of the ceramic crowns was treated with 1 of 4 surface conditionings (n=20): nonconditioned (control, CTRL), or etched for 60 seconds with different hydrofluoric acid concentrations: 1% (HF1), 5% (HF5), and 10% (HF10). A silane coupling agent was applied on this surface of all crowns, which were cemented to the preparations. Each crown was cyclically loaded in water with a G10 epoxy-glass piston positioned in the center of the occlusal surface. Fatigue failure loads of ceramic crowns were obtained by the staircase approach after 500000 cycles at 20 Hz. Mean failure loads were analyzed by 1-way ANOVA and the Tukey test (α=.05). RESULTS: Mean failure loads of groups CTRL (245.0 ±15.1 N), HF1 (242.5 ±24.7 N), and HF10 (255.7 ±53.8 N) were statistically similar (P>.05), while that of the HF5 group (216.7 ±22.5 N) was significantly lower (P<.05). CONCLUSIONS: HF5 acid had a negative effect on the fatigue loads of the tested feldspathic ceramic crowns, while HF1 and HF10 acids did not change the fatigue resistance.

The effect of internal roughness and bonding on the fracture resistance and structural reliability of lithium disilicate ceramic.

OBJECTIVE: To evaluate the effect of internal roughness and bonding on the load to failure and structural reliability (Weibull analysis) of a lithium disilicate-based glass ceramic under different testing scenarios. METHODS: IPS e.max CAD blocks (Ivoclar Vivadent AG) were shaped into cylinders (N=100), crystalized according to the manufacturer's instructions, and randomly assigned into two surface conditions: (1) polished surface (600-grit SiC polish papers), and (2) a roughened surface (air-abrasion with 50µm Al2O3). Two assemblies were investigated: a ceramic disc isolated (to isolate the effect of roughness); and a simplified tri-layer setup simulating the restoration of a posterior tooth (ceramic+cement+epoxy resin) to evaluated the influence of bonding isolated and the associated effect of both factors. Four different scenarios were tested: (1) isolated disc under static load (n=10); (2) disc bonded to an epoxy resin substrate and tested under a static load (n=10); (3) disc bonded and tested under fatigue (n=20); and (4) simulated-bonding tested statically (n=10). The data of load to failure were submitted to One-way ANOVA and Weibull analysis. RESULTS: At a non-bonded scenario (isolated disc and simulated-bonding) a polished internal surface presented a higher characteristic strength. However, when bonding was present this difference became inexistent. No difference was found in terms of structural reliability (Weibull moduli) among the groups. FEA analysis shows that with bonding the tensile stress is better distributed, while in a non-bonded scenario higher tensile stresses occur at the bonding interface. SIGNIFICANCE: A rough internal surface impacted deleteriously the mechanical properties of lithium disilicate ceramic when it was not properly bonded to the substrate. However, bonding to the substrate appeared to play a more significant role in the fracture resistance than internal roughness.

Effect of etching with distinct hydrofluoric acid concentrations on the flexural strength of a lithium disilicate-based glass ceramic.

This study examined the effects of distinct hydrofluoric acid concentrations on the mechanical behavior of a lithium disilicate-based glass ceramic. Bar-shaped specimens were produced from ceramic blocks (e.max CAD, Ivoclar Vivadent). The specimens were polished, chamfered, and sonically cleaned in distilled water. The specimens were randomly divided into five groups (n = 23). The HF1, HF3, HF5, and HF10 specimens were etched for 20 s with acid concentrations of 1%, 3%, 5%, and 10%, respectively, while the SC (control) sample was untreated. The etched surfaces were evaluated using a scanning electron microscope and an atomic force microscope. Finally, the roughness was measured, and 3-point bending flexural tests were performed. The data were analyzed using one-way analysis of variance (ANOVA) and Tukey's test (α = 0.05). The Weibull modulus and characteristic strength were also determined. No statistical difference in the roughness and flexural strength was determined among the groups. The structural reliabilities (Weilbull moduli) were similar for the tested groups; however, the characteristic strength of the HF1 specimen was greater than that of the HF10 specimen. Compared with the untreated ceramic, the surface roughness and flexural strength of the ceramic were unaffected upon etching, regardless of the acid concentration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 885-891, 2017.

Influence of hydrofluoric acid concentration on the flexural strength of a feldspathic ceramic.

This study evaluated the effects of etching with increasing hydrofluoric (HF) acid concentrations on the roughness and flexural strength of a feldspathic ceramic. One hundred and fifty ceramic specimens (14×4×1.2 mm(2)) were produced from ceramic blocks (VitaBlocks Mark II). All specimens were polished, chamfered and sonically cleaned in isopropyl alcohol. Specimens were randomly divided into 5 groups (n=30): SC (control) no ceramic surface etching; HF1, HF3, HF5 and HF10 ceramic surface etching for 60s with 1%, 3%, 5% and 10% HF acid concentrations, respectively. Profilometry was performed in all specimens to evaluate roughness prior to flexural strength testing. Data were analyzed using one-way ANOVA and Tukey׳s test (α=0.05). Weibull module (m) and characteristic stress (σc) were also determined. HF acid etching, regardless of the concentration used, led to significantly rougher surfaces than the control (p<0.05). However, the mean flexural strength values were not statistically different among the etched groups (106.47 to 102.02 MPa). Acid etching significantly reduced the mean flexural strength when compared with the control (143.3 MPa). Weibull modulus of the groups was similar, except for the HF5 group that was higher compared to HF3. Flexural strength was similarly affected by the different HF acid concentrations tested, but roughness increased higher the acid concentration. Ceramic etching led to a significant reduction in strength when compared to the untreated ceramic, regardless of its concentration.