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.

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.

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.