Effect of ZrO2 paste, surface treatments, and storage on Weibull characteristics and resin bond strength to zirconia.

The objective is to evaluate the effect of different surface treatments and storage on the shear strength of ultratranslucent zirconia. 36 blocks of ultra-translucent zirconia were fabricated (7x7x2mm) and sintered. Then, divided into 12 groups according to the "surface treatment" (C -Primer; Al -Sandblasting with Al2O3 + Primer; Si -Silicate + Primer; Gl -Glaze + HF + Primer; Z -Zirlink; Zp -Zirlink + Primer) and "storage" factors (ST-with 150 days/37º and without). After surface treatment, five cylinders (Ø=2mm; h=2.0mm) of resin cement (n=15) were constructed in each ceramic block; at the end, the shear strength test was performed (1mm/min, 50Kgf), and analysis of surface failures. 60 additional samples (2x2x2mm) were made for extras analysis (surface roughness, MEV, and EDS). Bond strength and surface roughness data were statistically evaluated by ANOVA (2 factors/1 factor), Tukey test (5%), and Weibull analysis, respectively. ANOVA (2-way) revealed that all factors were statistically significant for bond strength. The silicatization groups (SiST: 30.47AMPa; Si: 29.21AMPa) showed the highest bond strength values, regardless of storage (Tukey's test). While the groups treated with Zirlink (ZST: 2.76FMPa; Z: 5.27EFMPa) showed the lowest values, just similar to the GlST group (5.14EFMPa). The Weibull modulus (m) showed a statistical difference between groups (p=0.000). ANOVA (1 factor) revealed that the "surface treatment" factor (p=0.0000) was statistically significant for surface roughness. Therefore, the application of Zirlink and Glaze on pre-sintered zirconia did not promote efficient adhesion of the ultratranslucent zirconia to the resin cement, even when associated with a primer containing MDP.

Effect of ZrO2 paste, surface treatments, and storage on Weibull characteristics and resin bond strength to zirconia

Abstract The objective is to evaluate the effect of different surface treatments and storage on the shear strength of ultratranslucent zirconia. 36 blocks of ultra-translucent zirconia were fabricated (7x7x2mm) and sintered. Then, divided into 12 groups according to the "surface treatment" (C -Primer; Al -Sandblasting with Al2O3 + Primer; Si -Silicate + Primer; Gl -Glaze + HF + Primer; Z -Zirlink; Zp -Zirlink + Primer) and "storage" factors (ST-with 150 days/37º and without). After surface treatment, five cylinders (Ø=2mm; h=2.0mm) of resin cement (n=15) were constructed in each ceramic block; at the end, the shear strength test was performed (1mm/min, 50Kgf), and analysis of surface failures. 60 additional samples (2x2x2mm) were made for extras analysis (surface roughness, MEV, and EDS). Bond strength and surface roughness data were statistically evaluated by ANOVA (2 factors/1 factor), Tukey test (5%), and Weibull analysis, respectively. ANOVA (2-way) revealed that all factors were statistically significant for bond strength. The silicatization groups (SiST: 30.47AMPa; Si: 29.21AMPa) showed the highest bond strength values, regardless of storage (Tukey's test). While the groups treated with Zirlink (ZST: 2.76FMPa; Z: 5.27EFMPa) showed the lowest values, just similar to the GlST group (5.14EFMPa). The Weibull modulus (m) showed a statistical difference between groups (p=0.000). ANOVA (1 factor) revealed that the "surface treatment" factor (p=0.0000) was statistically significant for surface roughness. Therefore, the application of Zirlink and Glaze on pre-sintered zirconia did not promote efficient adhesion of the ultratranslucent zirconia to the resin cement, even when associated with a primer containing MDP.

Resumo O objetivo é avaliar o efeito de diferentes tratamentos superficiais e do envelhecimento na resistência ao cisalhamento da zircônia ultratranslúcida. Foram confeccionados 36 blocos de zircônia ultratranslúcida (7x7x2mm) e sinterizados. Em seguida, divididos em 12 grupos de acordo com o "tratamento de superfície" (C-Primer; Al-Jateamento com Al2O3+Primer; Si-Silicato+Primer; Gl -Glaze+HF+Primer; Z-Zirlink; Zp-Zirlink+Primer) e fatores de "armazenamento" (ST-com, 150 dias/37º e sem). Após o tratamento superficial, foram construídos cinco cilindros (Ø=2mm; h=2,0mm) de cimento resinoso (n=15) em cada bloco cerâmico; ao final foi realizado o ensaio de resistência ao cisalhamento (1mm/min, 50Kgf) e análise de falhas superficiais. Foram confeccionadas 60 amostras adicionais (2x2x2mm) para análises extras (rugosidade superficial, MEV e EDS). Os dados de resistência de união e rugosidade superficial foram avaliados estatisticamente por ANOVA (2 fatores/1fator), teste de Tukey (5%) e análise de Weibull, respectivamente. ANOVA (2 fatores) revelou que todos os fatores foram estatisticamente significativos para a resistência de união. Os grupos de silicatização (SiST: 30,47AMPa; Si: 29,21AMPa) apresentaram os maiores valores de resistência de união, independente do armazenamento (Tukey). Enquanto os grupos tratados com Zirlink (ZST: 2,76FMPa; Z: 5,27EFMPa) apresentaram os valores mais baixos, apenas semelhantes ao grupo GlST (5,14EFMPa). O módulo de Weibull (m) apresentou diferença estatística entre os grupos (p=0,000). A ANOVA (1 fator) revelou que o fator "tratamento superficial" (p=0,0000) foi estatisticamente significativo para rugosidade superficial. Portanto, a aplicação de Zirlink e do Glaze na zircônia pré-sinterizada não promoveu adesão eficiente da zircônia ultratranslúcida ao cimento resinoso, mesmo quando associada a primer contendo MDP.

Tooth discoloration induced by endodontic sealers and cervical limit: 1-year in vitro evaluation.

This laboratory study aimed to evaluate the influence of endodontic sealer and cervical limit of root filling on the discoloration of root canal treated teeth. Bovine incisors were randomly distributed into six experimental groups and control (n=21/group), according to the endodontic sealer used [AH Plus (AP); MTA Fillapex (MF) and Sealer Plus BC (SPB)] and the cervical limit of root filling [dental cervix (DC) or 2 mm in apical direction (2mm-AD)]. Tooth discoloration (ΔE) was evaluated by a digital spectrophotometer using the CIED2000 method. Color assessments were performed immediately before (baseline), 1 week, 1, 3, 6 months, and 1 year after obturation. Data were analyzed by ANOVA and Tukey's post-hoc tests (α=5%). Teeth filled with the three sealers showed perceptible tooth discoloration (ΔE≥2.7) in 1 week, maintaining similar values over time. There was a significant difference between MF and SPB sealers in the 2mm-AD groups. In addition, 2mm-AD groups promoted significantly lower discoloration than DC groups for AH (3 months) and SPB (1 and 3 months) sealer,s. Teeth filled with AP, MF, and SPB sealers displayed discoloration from 1 week to one year, with differences between MF and SPB sealers. A cervical limit of filling material at 2 mm from the dental cervix seems more advisable, promoting lower crown discoloration.

Resin cement coating reverts the machining damage on the flexural fatigue strength of lithium disilicate glass-ceramic.

This study evaluated the effect of resin cement coating with high and low viscosities on the flexural fatigue strength of machined lithium disilicate glass-ceramic. Discs (IPS e.max CAD; Ivoclar Vivadent) were prepared and divided according to the surface condition (machining [M]-CEREC inLab; and polishing [P]-laboratory procedures), resin cement coating (with or without), and cement viscosity (high [H] and low [L]). The ceramic bonding surface was etched/primed by a one-step primer application followed by resin cement application (Variolink N base + high or low viscosity catalyst; Ivoclar Vivadent). Biaxial flexural fatigue strength was evaluated on a piston-on-three-ball set by the step-test method (n = 15) (initial stress: 60 MPa; incremental steps: 20 MPa; 10,000 cycles/step, at 20 Hz). Weibull statistics were used for fatigue data. Contact angle, topographic, and fractographic analysis were also performed. Machining produced statistically lower contact angle than polishing and a significant detrimental effect on the fatigue behavior (σ0 M = 247.2 [246.9-268.3]; σ0 P = 337.4 [297.8-382.4]). Machined groups followed by resin cement coating (σ0 MH = 297.9 [276.0-321.5]; σ0 Ml = 301.2 [277.1-327.4]) behaved similarly to the polished and coated groups (σ0 PH = 342.0 [308.9-378.5]; σ0 PL = 357.3 [324.7-393.1]), irrespective of the cement viscosity. Therefore, cement coating has able to revert the detrimental effects of the machining on the fatigue strength of lithium disilicate glass-ceramic. High and low viscosity cements behaved similarly in the improvement of CAD-CAM lithium disilicate fatigue strength.

Tooth discoloration induced by endodontic sealers and cervical limit: 1-year in vitro evaluation

Abstract This laboratory study aimed to evaluate the influence of endodontic sealer and cervical limit of root filling on the discoloration of root canal treated teeth. Bovine incisors were randomly distributed into six experimental groups and control (n=21/group), according to the endodontic sealer used [AH Plus (AP); MTA Fillapex (MF) and Sealer Plus BC (SPB)] and the cervical limit of root filling [dental cervix (DC) or 2 mm in apical direction (2mm-AD)]. Tooth discoloration (ΔE) was evaluated by a digital spectrophotometer using the CIED2000 method. Color assessments were performed immediately before (baseline), 1 week, 1, 3, 6 months, and 1 year after obturation. Data were analyzed by ANOVA and Tukey's post-hoc tests (α=5%). Teeth filled with the three sealers showed perceptible tooth discoloration (ΔE≥2.7) in 1 week, maintaining similar values over time. There was a significant difference between MF and SPB sealers in the 2mm-AD groups. In addition, 2mm-AD groups promoted significantly lower discoloration than DC groups for AH (3 months) and SPB (1 and 3 months) sealer,s. Teeth filled with AP, MF, and SPB sealers displayed discoloration from 1 week to one year, with differences between MF and SPB sealers. A cervical limit of filling material at 2 mm from the dental cervix seems more advisable, promoting lower crown discoloration.

Resumo O presente estudo laboratorial teve como objetivo avaliar a influência do cimento endodôntico e do limite cervical da obturação radicular na alteração de cor de dentes tratados endodonticamente. Incisivos bovinos foram distribuídos aleatoriamente em seis grupos experimentais e um controle (n=21/grupo), de acordo com o cimento endodôntico utilizado [AH Plus (AP); MTA Fillapex (MF) e Sealer Plus BC (SPB)] e o limite cervical da obturação [Colo dentário (CD) ou 2mm na direção apical (2mm-DA)]. A alteração de cor (ΔE) foi avaliada por um espectofotômetro digital usando o método CIED2000. As avaliações de cor foram realizadas imediatamente antes (baseline), 1 semana, 1, 3, 6 meses e 1 ano após a obturação. Os dados foram analisados pelos testes ANOVA e post-hoc de Tuckey (α=5%). Dentes obturados com os três cimentos apresentaram alteração de cor perceptível (ΔE≥2.7) em 1 semana, mantendo valores semelhantes ao longo do tempo. Houve uma diferença significativa entre os cimentos MF e SPB nos grupos 2mm-DA. Além disso, os grupos 2mm-DA promoveram uma alteração de cor significativamente menor do que o grupos CD para os cimentos AH (3 meses) e SPB (1 e 3 meses). Os dentes obturados com os cimentos AH, MF e SPB apresentaram alteração de cor entre 1 semana a um ano, com diferenças entre os cimentos MF e SPB. O limite cervical do material obturador a 2mm do colo dentário parece mais aconselhável, promovendo menor alteração de cor da coroa dentária.

Translucency and masking ability of a translucent zirconia with different thicknesses over dark backgrounds / Translucidez e capacidade de mascaramento de uma zircônia translúcida com diferentes espessuras sobre substratos escuros

ABSTRACT Objectives: To evaluate the translucency, contrast ratio and masking ability of a translucent zirconia with different thicknesses. Methods: Disc shaped specimens (n= 3) with 10 mm (Ø) x 1.5 mm, 1 mm and 0.7 mm (thickness) were manufactured simulating all-ceramic simplified restorations. Substrate discs (n= 2; Ø: 10 mm; thickness: 2 mm) were simulated with composite resin shades: A2 (positive control) and C4; and metal alloys: silver (Ni-Cr) and golden (Cu-Al). Optical properties of the 9 translucent zirconia specimens placed on the 3 different substrates were analyzed by a spectrophotometer. The color variation (ΔE00) between each ceramic structure over the positive control substrate (A2) and over the dark backgrounds (C4, silvery, golden) were obtained as to their ceramic masking ability and subjected to non-parametric Kruskal Wallis test (5%). The translucency parameter (TP00) and contrast ratio (CR) of the different thicknesses of the ceramic discs were also collected and analyzed by one-way ANOVA and the Tukey test (5%). Results: The translucent zirconia showed greater opacity in the thickness of 1.5 mm, although it was not statistically different between 0.7 and 1.0 mm. All dark backgrounds significantly affected the final color of the simplified restoration in all evaluated thicknesses. However, the increase in ceramic thickness showed a decrease in ΔE00 values for all substrates. Conclusion: The translucent zirconia was not able to mask the dark substrates, independent of the evaluated thickness.

RESUMO Objetivos: Avaliar a translucidez, razão de contraste e capacidade de mascaramento de uma zircônia translúcida com diferentes espessuras. Métodos: Espécimes em forma de disco (n= 3) com 10 mm (Ø) x 1,5 mm, 1 mm e 0,7 mm (espessura) foram confeccionados simulando restaurações simplificadas em cerâmica pura. Discos de substrato (n= 2; Ø: 10 mm; espessura: 2 mm) foram simulados com as cores de resina composta: A2 (controle positivo) e C4; e ligas metálicas: prata (Ni-Cr) e ouro (Cu-Al). As propriedades ópticas dos 9 espécimes de zircônia translúcida posicionados nos 3 substratos diferentes foram analisadas por um espectrofotômetro. A variação de cor (ΔE00) entre cada espécime cerâmico sobre o substrato controle positivo (A2) e sobre os fundos escuros (C4, prateado, dourado) foi calculada quanto à capacidade de mascaramento da cerâmica e submetida ao teste não paramétrico de Kruskal Wallis (5%). O parâmetro de translucidez (TP00) e a razão de contraste (CR) das diferentes espessuras dos discos cerâmicos também foram coletados e analisados por ANOVA de uma via e teste de Tukey (5%). Resultados: A zircônia translúcida apresentou maior opacidade na espessura de 1,5 mm, embora não tenha sido estatisticamente diferente entre 0,7 e 1,0 mm. Todos os fundos escuros afetaram significativamente a cor final da restauração simplificada em todas as espessuras avaliadas. No entanto, o aumento da espessura da cerâmica mostrou uma diminuição nos valores de ΔE00 para todos os substratos. Conclusão: A zircônia translúcida não foi capaz de mascarar os substratos escuros, independente da espessura avaliada.

Color and translucency stability of CAD/CAM restorative materials

Aim: This study assessed the color and translucency stability of a polymer infiltrated ceramic network (PICN) and compared it with a resin composite (RC) and a feldspathic ceramic (FEL). Methods: Disc-shaped samples of a PICN (Vita Enamic), a feldspathic ceramic (Vitablocks Mark II), and a resin composite (Brava block) were prepared from CAD/CAM blocks. PICN and RC surfaces were finished with a sequence of polishing discs and diamond paste. FEL samples received a glaze layer. The samples were subjected to 30-min immersions in red wine twice a day for 30 days. CIEL*a*b* coordinates were assessed with a spectrophotometer at baseline and after 15 and 30 days of immersion. Color alteration (ΔE00) and translucency parameter (TP00) were calculated with CIEDE2000. Average roughness was measured before the staining procedures. Color difference and translucency data were analyzed with repeated-measures ANOVA and Tukey's tests. Roughness was analyzed with the Kruskal-Wallis test. Results: Roughness was similar among the experimental groups. All materials had their color alteration significantly increased from 15 to 30 days of staining. PICN reached an intermediate ΔE00 between FEL and RC at 15 days. PICN revealed a color alteration as high as the composite after 30 days. No statistical difference was observed regarding translucency. Conclusion: PICN was not as color stable as the feldspathic ceramic at the end of the study. Its color alteration was comparable to the resin composite when exposed to red wine. However, the translucency of the tested materials was stable throughout the 30-day staining

Biaxial flexure strength and physicochemical characterization of a CAD/CAM lithium disilicate ceramic: effect of etching time, silane, and adhesive applications.

OBJECTIVE: To evaluate the effect of different acid etching time and bonding agent (silane and/or adhesive system) on biaxial flexural strength and physico-chemical properties of a lithium disilicate ceramic. MATERIAL AND METHODS: One hundred twenty ceramic discs were made and divided into 8 groups (n = 15) according to factors "etching time" (20 and 120 s) with hydrofluoric acid (HF) and "bonding agent" (C, no bonding agent; S, silane, A, adhesive; and SA, silane + adhesive). After surface treatment, a resin cement layer was applied to the surface and all specimens were subjected to biaxial flexural strength (BFS) test with treated surfaces loaded in tension (1 mm/min). The Weibull analyses and complementary analyses were also performed. Statistical analysis was done with 2-way ANOVA and the Tukey test (α = 0.05). RESULTS: ANOVA revealed that the factors "etching time" (p = 0.0003) and "bonding agent" (p = 0.007) were statistically significant. In the overall analysis, the HF120S group (272.02 ± 35.30A MPa) presented significantly higher BFS than that of HF120C (218.45 ± 17.15CD MPa) and HF20S (228.40 ± 37.83BCDMPa). On the other hand, the HF20A group (208.92 ± 31.16D MPa) had significantly lower BFS than HF120S (272.02 ± 35.30A), HF120A (254.42 ± 26.87ABC) and HF120SA (259.30 ± 36.55AB) groups (Tukey). The Weibull modulus (m) of all groups was significantly different from each other (p = 0.000). CONCLUSIONS: Regardless of etching time, the application of silane alone is sufficient to increase the flexural strength of glass ceramic, eliminating the need for the application of adhesive systems. Moreover, if only silane or adhesive is applied, 120-s HF application should increase the flexural resistance of the lithium disilicate ceramic. CLINICAL SIGNIFICANCE: Applications of adhesive systems after silanization can be suppressed from the surface treatment protocol of glass ceramics, since it does not improve their mechanical strength.

Effect of milling, fitting adjustments, and hydrofluoric acid etching on the strength and roughness of CAD-CAM glass-ceramics: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Whether procedures performed before the cementation of computer-aided design and computer-aided manufacturing (CAD-CAM) glass-ceramic restorations, including milling, fitting adjustment, and hydrofluoric acid etching introduce defects on the ceramic surface that affect the mechanical and surface properties is unclear. PURPOSE: A systematic review and meta-analysis were conducted to assess the effect of milling, fitting adjustments, and hydrofluoric acid etching (HF) on the flexural strength and roughness (Ra) of CAD-CAM glass-ceramics. MATERIAL AND METHODS: Literature searches were performed up to June 2020 in the PubMed/MEDLINE, Web of Science, and Scopus databases, with no publication year or language limits. The focused question was "Do milling, fitting adjustments, and hydrofluoric acid etching affect the flexural strength and roughness of CAD-CAM glass-ceramics?" For the meta-analysis, flexural strength and Ra data on milling, fitting adjustment, and HF etching versus control (polishing) were analyzed globally. A subgroup analysis assessed the effect of etching parameters (HF concentration and time) on the flexural strength and roughness of CAD-CAM glass-ceramics with different microstructures. Comparisons were performed with random-effect models at 5% significance. RESULTS: Fourteen studies from 2764 potentially relevant records were included in the qualitative syntheses, and 12 in the meta-analysis. Milling and fitting adjustments increased roughness and reduced the flexural strength of CAD-CAM glass-ceramics. The effect of HF etching was dependent on the glass-ceramic microstructure, HF concentration, and etching time. For feldspathic- and leucite-reinforced ceramics, HF 5% applied for between 30 and 120 seconds increased roughness without affecting flexural strength. For lithium disilicate glass-ceramics, HF concentrations greater than 4.9% used for 20 seconds or more reduced the strength without affecting the surface roughness. CONCLUSIONS: The flexural strength of CAD-CAM glass-ceramic is reduced by grinding procedures such as milling and fitting adjustment. Ceramic microstructure, HF concentration, and etching time determined the effect of hydrofluoric acid etching on the flexural strength and surface roughness of glass-ceramic materials.

Surface treatment and adhesion approaches on polymer-infiltrated ceramic network: influence on the bond strength to resin cement

Aim: To evaluate the effect of different surface treatments and adhesive approaches on the microshear bond strength of resin cement to a polymer-infiltrated ceramic network (PICN). Methods: PICN blocks were randomly assigned into 9 groups (n=10): CTRL: no treatment; HF: 5% hydrofluoric acid etching; HF-S: HF + silane; HF-S-A: HF-S + adhesive (Adper Single Bond 2); HF-UA: HF + universal adhesive (Single Bond Universal); SB: sandblasting with 50 µm Al2O3 particles; SB-S: SB + silane; SB-S-A: SB-S + adhesive; SB-UA: SB + universal adhesive. Resin cement microcylinders (Ø = 0.96 mm; height = 1 mm) (RelyX Ultimate) were built upon the PICN surface after roughness and contact angle measurements. Next, microshear bonding tests (µSBS) were performed (0.5 mm/min) after water storage (37ºC, 90 days) and thermocycling (12,000 cycles; 5ºC-55ºC). Failure modes were observed under stereomicroscope. Bond strength data were analyzed by two-way ANOVA/Tukey's test and t-tests. Kruskal-Wallis/Dunn's tests were conducted for roughness and contact angle data (α = 0.05). Results: A rougher surface and lower contact angles were observed for Sandblasting. HF-S (18.54 ± 2.03 MPa), SB-S (19.00 ± 1.66 MPa) and SB-UA (18.07 ± 2.36 MPa) provided the highest bond strength values, followed by the other treated groups. The CTRL group resulted in lower bond strength (7.18 ± 2.34 MPa). Conclusion: Hydrofluoric acid etching followed by silane application and sandblasting followed by silane or universal adhesive are useful clinical steps to enhance bonding to PICN. Adhesive applications after HF etching have no advantages in bonding to PICN

Influence of testing environment on static fatigue behavior of a glass and a polycrystalline ceramic.

It aims on evaluate the effect of the test environment on static fatigue behavior of lithium disilicate-based (LD), and yttrium oxide-stabilized zirconia (YSZ) ceramics. Specimens of LD (IPS e.max CAD, Ivoclar Vivadent) and YSZ (IPS e.max ZirCAD MO, 3 mol% Y2O3, Ivoclar Vivadent) were randomly allocated into three groups: tested in air, inert (paraffin oil, Sigma Aldrich) or distilled water. The static fatigue test (n=15) was performed using a piston-on-three ball assembly, adapted from ISO 6872, as follows: starting load 100 N for LD and 300 N for YSZ; loading application time set to 1 hour for each loading step; step size of 50 N for LD and 100 N for YSZ, applied successively until fracture. Data from static fatigue strength (MPa) and time to fracture (hours) were recorded. Fractographic analysis was executed. Survival analysis corroborates absence of influence of environment on static fatigue outcomes (fatigue strength, time to fracture and survival rates) for YSZ. For LD, specimens tested in air presented statistically superior survival rate and static fatigue strength (p= 0.025). In regards of time to fracture, LD tested in air were superior than when tested in distilled water (p=0.019) or inert (p=0.017) environments. No statistical differences for Weibull modulus were observed. Failures started on the tensile stress surface. Thus, the test environment did not affect slow crack growth (SCG) mechanisms during static fatigue test of YSZ ceramics, but it plays a significant role for the static fatigue behavior of lithium disilicate-based glass ceramics, indicating a high susceptibility to SCG.

Residual stresses explaining clinical fractures of bilayer zirconia and lithium disilicate crowns: A VFEM study.

OBJECTIVE: To understand the stress development in porcelain-veneered zirconia (PVZ) and porcelain-veneered lithium disilicate (PVLD) crowns with different veneer/core thickness ratios and cooling rates. To provide design guidelines for better performing bilayer restorations with the aid of Viscoelastic Finite Element Method (VFEM). METHODS: The VFEM was validated by comparing the predicted residual stresses with experimental measurements. Then, the model was used to predict transient and residual stresses in the two bilayer systems. Models with two different veneer/core thickness ratios were prepared (2:1 and 1:1) and two cooling protocols were simulated (Fast: ∼300 °C/min, Slow: ∼30 °C/min) using the heat transfer module, followed by stress analysis in ABAQUS. The physical properties of zirconia, lithium disilicate, and the porcelains used for the simulations were determined as a function of temperature. RESULTS: PVLD showed lower residual stresses than PVZ. The maximum tensile stresses in PVZ were observed in the cusp area, whereas those in PVLD were located in the central fossa. The 1:1 thickness ratio decreased stresses in both layers of PVZ. Slow cooling slightly decreased residual stresses in both systems. However, the cooling rate effect was more evident in transient stresses. SIGNIFICANCE: Slow cooling is preferable for both systems. A thinner porcelain layer over zirconia lowers stresses throughout the restoration. The different stress distributions between PVZ and PVLD may affect their failure modes. Smaller mismatches in modulus, CTE, and specific heat between the constituents, and the use of low Tg porcelains can effectively reduce the deleterious transient and residual tensile stresses in bilayer restorations.

Dentists' Attitudes towards the Dental Ceramic Choice for Metal-Free Restorations: a Questionnaire Survey / Atitudes de Dentistas Frente à Escolha de Cerâmicas Dentárias para Restaurações Livres de Metal: uma Pesquisa de Questionário

A wide variety of dental ceramics is launched every year. Therefore, clinicians should constantly study and update themselves to correctly indicate these materials. This cross-sectional study aimed to assess the association of dentists' academic aspects with their knowledge and the indication of dental ceramics for metal free restorations. All the dentists from private clinics who affirmed to perform prosthetic treatments on their patients in a Southern Brazilian city were personally invited to this research to avoid dropouts. Participants answered questions related to their knowledge of different dental materials, their information sources and usage frequency of ceramic materials, and related to their academic training/education. Chi-square tests were performed to evaluate the association among the outcomes (knowledge of different materials, information sources considered for material selection and their frequencies of use) and exposure variables (time since graduation and post-graduation degree). Significant associations were also submitted to Chi-square residual analysis. A response rate of 73.3% was reached. The most known and used materials were Y-TZP and porcelain veneered zirconia, respectively, whereas the least known was leucite-based ceramic. The majority of the professionals with at least 25 years since graduation claimed not to know lithium disilicate or leucite-based ceramics, and a significant number of these professionals allow the laboratory prostheses technician to choose the restorative material. In addition, most of dentists with no post-graduation said they did not have knowledge about leucite and lithium disilicate. It was evidenced that continuing education plays an important role in the dentists' attitudes regarding ceramic materials. (AU)

Uma grande variedade de cerâmicas é lançada no mercado a cada ano. Portanto, os clínicos devem se manter em constante estudo e atualização para indicar corretamente o uso desses materiais. Assim, este estudo transversal teve por objetivo avaliar a associação entre aspectos acadêmicos de dentistas com seus conhecimentos e as indicações de cerâmicas dentárias para uso em restaurações livres de metal. Para isso, todos os dentistas de clínicas privadas que afirmaram realizar tratamentos protéticos em seus pacientes em uma cidade do sul do Brasil foram pessoalmente convidados a participar desta pesquisa para evitar desistências. Os participantes responderam a questões relacionadas ao seu conhecimento sobre diferentes materiais dentários, suas fontes de informação, a frequência de uso de materiais cerâmicos, e, também, sobre sua formação acadêmica. Testes qui-quadrado foram realizados para avaliar a associação entre os desfechos (conhecimento de diferentes materiais, fontes de informação consideradas para a seleção do material e sua frequência de uso) e as variáveis de exposição (tempo desde a graduação e grau de pós-graduação). As associações significativas foram submetidas à análise de resíduos do qui-quadrado. A taxa de resposta obtida foi de 73,3%. O material mais conhecido e usado foi a Y-TZP e zircônia recoberta por porcelana, respectivamente, enquanto que o material menos conhecido foi a cerâmica a base de leucita. A maioria dos profissionais com pelo menos 25 desde a graduação afirmaram não conhecer as cerâmicas a base de dissilicato de lítio ou leucita, e um significativo número desses profissionais permitem que o técnico em prótese dentária escolha o material restaurador. Ainda, a maioria dos dentistas sem pós-graduação disseram não conhecer as cerâmicas a base de dissilicato de lítio ou leucita. Concluiu-se que a educação continuada é um fator determinante nas atitudes de dentistas em relação aos materiais cerâmicos. (AU)

Influence of testing environment on static fatigue behavior of a glass and a polycrystalline ceramic

Abstract It aims on evaluate the effect of the test environment on static fatigue behavior of lithium disilicate-based (LD), and yttrium oxide-stabilized zirconia (YSZ) ceramics. Specimens of LD (IPS e.max CAD, Ivoclar Vivadent) and YSZ (IPS e.max ZirCAD MO, 3 mol% Y2O3, Ivoclar Vivadent) were randomly allocated into three groups: tested in air, inert (paraffin oil, Sigma Aldrich) or distilled water. The static fatigue test (n=15) was performed using a piston-on-three ball assembly, adapted from ISO 6872, as follows: starting load 100 N for LD and 300 N for YSZ; loading application time set to 1 hour for each loading step; step size of 50 N for LD and 100 N for YSZ, applied successively until fracture. Data from static fatigue strength (MPa) and time to fracture (hours) were recorded. Fractographic analysis was executed. Survival analysis corroborates absence of influence of environment on static fatigue outcomes (fatigue strength, time to fracture and survival rates) for YSZ. For LD, specimens tested in air presented statistically superior survival rate and static fatigue strength (p= 0.025). In regards of time to fracture, LD tested in air were superior than when tested in distilled water (p=0.019) or inert (p=0.017) environments. No statistical differences for Weibull modulus were observed. Failures started on the tensile stress surface. Thus, the test environment did not affect slow crack growth (SCG) mechanisms during static fatigue test of YSZ ceramics, but it plays a significant role for the static fatigue behavior of lithium disilicate-based glass ceramics, indicating a high susceptibility to SCG.

Resumo O presente estudo objetivou investigar a influência do ambiente de teste no comportamento a fadiga estática (resistência à fratura e tempo para falha) de cerâmicas à base de dissilicato de lítio (LD) e zircônia estabilizada com ítria (YSZ). Espécimes de LD (IPS e.max CAD, Ivoclar Vivadent) e YSZ (IPS e.max ZirCAD MO, 3mol% Y2O3, Ivoclar Vivadent) foram obtidos e alocados aleatoriamente em três grupos: testado em ar, em líquido inerte (óleo de parafina) ou em água destilada. O teste de fadiga estática (n= 15) foi realizado usando o teste pistão sobre três esferas, ISO 6872, da seguinte forma: carga inicial 100 N para LD e 300 N para YSZ; tempo de aplicação de carregamento definido para 1 hora para cada etapa de carregamento; tamanho do passo de 50 N para LD e 100 N para YSZ, aplicados sucessivamente até a fratura. Dados de resistência à fadiga estática (MPa) e tempo até a fratura (horas) foram registrados. A análise fractográfica foi executada. A análise de sobrevivência corrobora a ausência de influência do ambiente de teste nos resultados de fadiga estática (resistência à fadiga, tempo de fratura e taxas de sobrevivência) para a YSZ. Para LD, os corpos de prova testados em ar apresentaram taxa de sobrevivência e resistência à fadiga estática estatisticamente superiores (p= 0,025). Em relação ao tempo de fratura, os espécimes LD testados em ar foram superiores aos testados em água destilada (p= 0,019) ou em ambiente inerte (p= 0,017). Não foram observadas diferenças estatísticas para o módulo de Weibull. Todas as falhas começaram no lado onde se concentra a tensão de tração (lado de baixo) durante o teste. Com base nisso, observa-se que o ambiente de teste não afetou os mecanismos de crescimento lento de trinca durante o teste de fadiga estática da cerâmica YSZ, mas desempenha um papel significativo na resistência à fadiga estática da cerâmica de vidro à base de dissilicato de lítio, indicando alta susceptibilidade ao crescimento lento e subcrítico de trincas.

Extended glaze firings for porcelain-veneered zirconia: Effects on the mechanical and optical behavior.

OBJECTIVE: This study evaluated the effect of dwell time (conventional or extended) and cooling protocol (fast or slow) of self-glaze firings on the mechanical (flexural strength and crack propagation) and optical (color and translucency) properties of a porcelain-veneered zirconia system. METHODS: Bilayer disc-shaped samples were prepared (Vita VM9 + In-Ceram YZ) and divided according to the final thermal treatment: glaze firing followed by slow cooling (furnace opening at 200 °C) (G-S) or fast cooling (furnace opening at 600 °C) (G-F, manufacturer-recommended protocol), extended glaze firing (15 min of dwell time) followed by slow cooling (EG-S) or fast cooling (EG-F), or no thermal treatment (CTRL). Porcelain roughness (Ra and Rz) was measured before and after glaze firings. Color (ΔE00) and translucency (TP00) alteration were also evaluated. Flexural strength was measured with the piston-on-three-ball test and crack propagation analysis was performed after Vickers indentations. Complementary analyzes of crystalline phase and scanning electron microscopy were carried out. RESULTS: Significant effect of dwell time was observed, with extended glaze leading to higher flexural strength and shorter crack lengths. Cracks of EG groups were observed to end in clusters of crystals. Color and translucency changed below perceptibility thresholds. All treatments led to a smoother surface and EG groups reached the lowest Rz values. An extra SiO2 peak was revealed in control and EG groups. No effect of cooling protocol was found. SIGNIFICANCE: Extended glaze firing was able to improve the resistance to crack initiation and propagation of porcelain-veneered zirconia without clinically perceptible changes in optical properties.

Do thermal treatments affect the mechanical behavior of porcelain-veneered zirconia? A systematic review and meta-analysis.

OBJECTIVES: A systematic review of in vitro studies was conducted to assess the effect of thermal treatments on flexural strength or critical load to failure of porcelain-veneered zirconia (PVZ). SOURCES: Literature searches were performed up to June 2018 in PubMed/MEDLINE, Scopus and Web of Science databases, with no publication year or language limits. DATA: From 393 relevant studies, 21 were selected for full-text analysis, from which 7 failed to meet the inclusion criteria. The 14 remaining papers were included in the systematic review: 8 for meta-analysis and 6 restricted to descriptive analyses. Hand searching of reference lists resulted in no additional papers. STUDY SELECTION: In vitro studies using PVZ specimens testing the influence of thermal treatments on the fracture resistance to monotonic or cyclic loading. Papers evaluating cooling rate were divided into those applying fast cooling from above the porcelain glass transition temperature (Tg), or from below it. Meta-analyses were performed separately for flexural strength and critical load to failure, using random effects at a 5% significance level. CONCLUSIONS: Delaying furnace opening at a temperature below the porcelain Tg is advised for PVZ restorations, in order to improve their fracture resistance. Additional information is required to confirm the apparent beneficial effect of self-glaze and repeated veneer firings on the mechanical properties of these restorations. Finally, in order to obtain conclusive and relevant evidence regarding thermal treatments and the fracture resistance of PVZs, future studies should concentrate on anatomically-correct crown specimens.

Y-TZP surface treatments and their effects on the bond strength to resin cement

Aim: This study evaluated the effect of surface treatments of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramics on their bond strength to a resin cement. Methods: Seventy zirconia blocks (6 × 6 × 2 mm3, IPS e.max ZirCAD) were assigned into 7 groups (n=10) ­ as-sintered (AS), no treatment; tribochemical silica coating + silanization (TBS; Cojet-sand; ProSil); airabrasion with 45 µm alumina particles + universal primer (AAP; Monobond®Plus); fusion sputtering (FS); SiO2 nanofilm + silanization (SN; ProSil); FS+SN+ silanization (FSSN; ProSil); FS+SN+Universal Primer (FSSNP; Monobond®Plus). Afterwards, a resin cement (RelyX™ ARC) was applied inside cylinders (Ø = 0.96 mm × 1 mm height) placed on the zirconia surfaces. Microshear bond strength tests (µSBS) were carried out (1 mm/min). Failure and phase transformation analysis were performed. Bond strength data (MPa) were subjected to Kruskal-Wallis/Mann Whitney tests. Results: TBS (27 ± 1.2) and AAP (24.7 ± 0.8) showed higher bond strengths than the other groups, followed by FSSNP (15.5 ± 4.2) and FSSN (13.3 ± 3.6). FS (3.4 ± 0.44) and SN (9.5 ± 2.7) showed the lowest values (p < 0.001). Most of the specimens exhibited an adhesive failure. Conclusion: Air-abrasion by silica-coated alumina particles followed by silanization or by alumina particles followed by universal primer resulted in the highest resin bond strength to zirconia. Fusion sputtering and silica nanofilm deposition induced low strengths. However, when these methods are applied in combination and with a primer (FSSN and FSSNP), higher bond strengths may be achieved. Low bond strengths are obtained when no zirconia treatment is performed

Internal adjustments decrease the fatigue failure load of bonded simplified lithium disilicate restorations.

OBJECTIVE: To investigate the effect of intaglio surface adjustment of simplified lithium disilicate ceramic restorations adhesively cemented to a dentin-like material on its fatigue behavior. METHODS: Ceramic discs (IPS e.max CAD) were prepared and an in-Lab simulation of machining roughness was performed by grinding with SiC paper (#60). Ceramic discs were divided into 4 groups according to the internal adjustment of the cementation surface: no adjustments (CTRL); adjustment with a medium (M), fine (F), or extra fine (FF) diamond bur. Dentin-like material discs were also produced. Ceramic disc intaglio surfaces were etched (5% hydrofluoric acid; 20s) and received a silane coating. Dentin-like material discs were etched (10% hydrofluoric acid; 1min) and received a primer coating. Pairs of ceramic/dentin-like material were adhesively cemented (Multilink Automix), and fatigue failure load tests were performed using the Staircase approach (250,000 cycles; 20Hz). Roughness, topographic and fractographic analyses were performed. Statistical analyses were carried out through ANOVA tests. RESULTS: All ground groups (M=521.3 N; F=536.9 N; FF=676.2 N) presented lower fatigue failure load values than the control (1241.6 N). M diamond bur created a rougher surface than F (Ra and Rz parameters). However, FF was similar to F and M for Ra, and similar to F for Rz. SIGNIFICANCE: Bur adjustments on the intaglio surface of simplified lithium disilicate ceramic restorations greatly decreased the fatigue failure load even using an extra-fine diamond bur. Care should be taken when internal adjustments are needed.

Surface change assessment of Co-Cr alloy subjected to immersion in denture cleansers

Choosing the right chemical cleanser for removable partial dentures is a challenge, because they present an acrylic and a metallic portion, which should be cleaned and not damaged. Aim: The aim of this study was to assess surface changes of cobalt chromium alloys immersed in diferente cleaners solutions: 0.05% sodium hypochlorite, 4.2% acetic acid, 0.05% sodium salicylate, sodium perborate (Corega Tabs®) and 0.2% peracetic acid. Material and Methods: One hundred and twenty circular specimens (10 mm in diameter) of two commercial available Co-Cr alloys were tested: GM 800 ® (Dentaurum) and Co-Cr® (DeguDent). The samples were randomly divided into tem experimental groups (n=10), according to the trend mark of alloy and cleaners solutions in which they were immersed, and two control groups, in which the samples of the two alloys were immersed in distilled water. Evaluations were performed through roughness measurement (rugosimeter Surftest 211, Mitutoyo), visual evaluation with stereomicroscope (Stereo Discovery 20, Carl Zeiss) and scanning electron microscope surface (JSM, 6360 SEM, JEOL), at experimental times T0 ­ before immersions, T1 - after one immersion, and T2 - after 90 immersions. Intergroup comparison for the effect of immersion in the different cleanser agents was evaluated through ANOVA/Tukey tests (p≤0.05). The effect of the time in the immersion of each alloy was evaluated by t-pared test (p≤0.05). The two alloys were compared using the t-Student test. Results: The analysis of roughness and microscopy showed that surface changes were significantly greater in groups submitted to 0.05% sodium hypochlorite after 90 immersions (T2). When comparing the two alloys, a similar behavior of roughness was observed for the cleaning agents. However, alloy GM 800® showed significant statistical difference for roughness variations in experimental times (Δ1 and Δ2), when immersed in sodium 0.05% hypochlorite. The number of exposures of the alloys to the cleaning agents showed a negative influence when using sodium hypochlorite solution. Conclusions: It is possible to conclude that 0.05% sodium hypochlorite has caused the greatest apparent damage to alloy surface. (AU)

Cuspal deflection of directly or indirectly restored teeth / Deflexão cuspídea de dentes restaurados direta ou indiretamente

Objective: The aim of this study was to evaluate the cuspal deflection of teeth restored directly and indirectly. Material and Methods: Forty sound maxillary premolar teeth were restored with composite and different base materials. Wide mesial-occlusal-distal cavity preparations were performed, with isthmus width of one third of the distance between the cuspal tips, 3 mm occlusal and a 5 mm interproximal preparation height. The teeth were divided into 4 groups (n = 10), according to the restoration type: G1) GIC-DCR (1 mm glass ionomer cement base and direct restoration using nanoparticulate composite); G2) FL-DCR (1 mm base of flowable composite resin and direct restoration using nanoparticulate composite); G3) GIC-ICR (1 mm glass ionomer cement base and indirect restoration using nanoparticulate composite GIC base); G4) FL-ICR (1 mm base of flowable composite resin and indirect restoration using nanoparticulate composite). The specimens were submitted to compressive load of 50 N on the buccal and lingual cusps, in a universal testing machine. The lingual cusp microstrain (με) measurements were executed by strain gauges. Results: The Kruskal-Wallis (5%) test was used and showed there were no significant differences among the microstrain values for the four study groups (G1 = 1250; G2 = 1075; G3 = 1279; G4 = 937). Conclusion: It could be concluded that the restorative techniques and the bases employed did not show any influences in cuspal deflection

Objetivo: O objetivo deste trabalho foi avaliar, por meio de medidores de tensão, a deflexão cuspídea sofrida por dentes restaurados, direta e indiretamente, com resinas compostas e diferentes materiais de base. Material e Métodos: Para o preparo dos corpos-de-prova (CP) foram utilizados 28 dentes pré-molares humanos íntegros, extraídos por razões ortodônticas que tiveram suas raízes embutidas em poliuretano de densidade semelhante a do osso e suas raízes recobertas por um espaçador visando simular o espaço referente ao ligamento periodontal. Na etapa seguinte os dentes receberam preparos cavitários do tipo mésio-ocluso-distais amplos e então restaurados direta e indiretamente com resina composta e dois diferentes materiais de base/forramento, resina flow e cimento de ionômero de vidro. Para a realização das medidas de deflexão das cúspides foram utilizados extensômetros lineares elétricos colados à face lingual de cada dente e submetidos a uma carga de 50 N aplicada por uma ponta romba de diâmetro de 3,0 mm, que promoveu compressão simultânea nas vertentes triturantes das cúspides vestibular e lingual, numa máquina universal de ensaios. Resultados: Foi realizado o teste de Kruskall-Wallis (5%) de significância e não foram encontradas diferenças estatísticamente significantes entre os grupos (G1 – 1250; G2 = 1075; G3 = 1279; G4 = 937). Conclusão: Pode-se concluir que o tipo de restauração bem como o tipo de base empregados nesse estudo não alteram a deflexão cuspídea dos dentes com restaurações amplas.