Bonding Characteristics of Silane Coupling Agent and MMA-Containing Primer to Various Composite CAD/CAM Blocks.

This study evaluated the bonding characteristics of a silane coupling agent (SCA) and a methyl methacrylate (MMA)-containing primer (MCP) for 11 types of commercial composite blocks (CBs) for sandblasted and non-sandblasted surfaces. The shear bond strength (SBS) was measured according to ISO 29022: Notched-edge shear bond strength test. The SBS results demonstrated statistically significant differences between the CBs under all identical conditions. For the non-sandblasted groups, the SBSs of MCP-treated specimens were significantly higher than those of SCA-treated specimens for all but two CBs. Comparing the two treatments in sandblasted groups, the SBS was significantly higher for seven out of 11 MCP-treated RCB specimens, in contrast with three cases for the SCA-treated group. Two-way ANOVA for SBS showed the interaction effect between sandblasting and primer type for specific CBs, indicating that the sandblasting treatment improved SBS more effectively for SCA-treated specimens. Moreover, the effect of the SCA treatment was more material-dependent compared to that of the MCP treatment, which did not achieve a strong bond in all CBs but proved more effective than the SCA treatment, especially for non-sandblasted surfaces.

Effect of crystal orientation on flexural strength of pressable lithium disilicate glass-ceramics.

This study examined the crystal orientation of four kinds of pressable lithium disilicate glass-ceramics and evaluated the effect of crystal orientation on flexural strength. Bar-shaped (24 mm in length, 1.2 mm in thickness, 4.0 mm in width), disk-shaped (12 mm in diameter, 0.5 mm in thickness), and crown-shaped (maxillary first molar) specimens were prepared according to the manufacturer's instructions. Three-point and biaxial flexural strengths were measured for bar- and disk-shaped specimens. Microstructure analysis was performed using X-ray diffractometry and scanning electron microscopy. Three-point flexural strength was improved by parallel crystal orientation along the longitudinal direction of the bar-shaped specimen. There was no relationship between two-dimensional crystal orientation and biaxial flexural strength. The results of this study assumed that biaxial flexural strength was improved by the crystal orientation in the cross-sectional direction. Pressed restorations are expected to possess higher strength than milled restorations due to their crystal orientation.

Development and characterization of ultra-high translucent zirconia using new manufacturing technology.

This review describes the development of ultra-high translucent zirconia (referred to as UHTZ) using new manufacturing technology and its characterization results. The development of UHTZ was primarily due to the adoption of two basic manufacturing technologies, "Cyclic CIP" and "Plus Y Technology". This manufacturing technology could provide stable processing characteristics, which improves chipping resistance during milling. Furthermore, the enlargement factor (processing coefficient) for UHTZ is smaller than those for conventional products. In general, the higher the light transmittance, the lower the flexural strength. Despite its extremely high translucency, the most significant feature of UTHZ is that its flexural strength is comparable to that of 5Y. Furthermore, UHTZ has higher chemical durability and uniform microstructure, which results in less wear on the opposing teeth and superior discoloration resistance. Therefore, UHTZ is a new option for inlay, onlay, and laminate veneer applications, where lithium disilicate glass ceramics has been widely used.

Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures.

Various types of zirconia are widely used for the fabrication of dental implant superstructures and fixtures. Zirconia-alumina composites, such as ATZ and NanoZR, are adequate for implant fixtures because they have excellent mechanical strength in spite of insufficient esthetic properties. On the other hand, yttria-stabilized zirconia has been used for implant superstructures because of sufficient esthetic properties. They are classified to 12 types with yttria content, monochromatic/polychromatic, uniform/hybrid composition, and monolayer/multilayer. Zirconia with a higher yttria content has higher translucency and lower mechanical strength. Fracture strength of superstructures strongly depends on the strength on the occlusal contact region. It suggests that adequate zirconia should be selected as the superstructure crown, depending on whether strength or esthetics is prioritized. Low temperature degradation of zirconia decreases with yttria content, but even 3Y zirconia has a sufficient durability in oral condition. Although zirconia is the hardest dental materials, zirconia restorative rarely subjects the antagonist teeth to occlusal wear when it is mirror polished. Furthermore, zirconia has less bacterial adhesion and better soft tissue adhesion when it is mirror polished. This indicates that zirconia has advantageous for implant superstructures. As implant fixtures, zirconia is required for surface modification to obtain osseointegration to bone. Various surface treatments, such as roughening, surface activation, and coating, has been developed and improved. It is concluded that an adequately selected zirconia is a suitable material as implant superstructures and fixtures because of mechanically, esthetically, and biologically excellent properties.

Effect of degradation of filler elements on flexural strength for dental CAD/CAM resin composite materials in water.

Purpose This study aimed to evaluate the effects of degradation on the strength of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite blocks (RCBs) by subjecting them to accelerated degradation in water and conducting biaxial flexural strength tests.Methods Six commercial RCBs were tested. The RCBs were cut into disks, after which the disks were immersed in purified water. For the aging experiment, the samples were subjected to heat treatment at 37, 60, 70, and 80 °C, in a constant temperature oven and stored statically for 30 d. After the aging experiment, the elements released from the RCB fillers were measured by inductively coupled plasma atomic emission spectroscopy. In addition, the biaxial flexural strength of the RCB fillers was measured after accelerated degradation at 70 °C.Results Si (the main component of the filler) was detected in all the RCB solutions after the aging experiment; however, the type and amount of other elements differed considerably among the RCBs. The flexural strength of some of the RCBs decreased by approximately 20-40% after the accelerated degradation. For most materials, the Weibull coefficient decreased or remained unchanged after the test, whereas it increased in some materials.Conclusions The strength of all the RCBs decreased after the accelerated degradation tests; however, this behavior differed among the materials. In addition, the release of elements from the filler of some of the materials into the water correlated with the decrease in the strength of these materials. These findings indicate that the evaluation of the degradation behavior of RCBs in water is essential for their long-term usage.

Chemical durability of high translucent dental zirconia.

This review describes low temperature degradation (LTD), discoloration, and erosion of high translucent dental zirconia and discusses its chemical durability in comparison with other CAD/CAM materials. The LTD of zirconia strongly depended on the firing temperature, yttria content, surface treatment, and heat treatment. Glass ceramics for CAD/CAM were remarkably etched in a lactic acid at 60°C, KOH solution at 60°C, and saline solution at 90°C, whereas zirconia showed no changes in these solutions. Glass ceramics and hybrid resins for CAD/CAM showed significant discoloration in a red wine and rhodamine B solution at 37°C, whereas zirconia showed no discolorations in either solution. It was concluded that high translucent dental zirconia has the highest chemical durability among dental CAD/CAM materials.

Leaching behaviors of computer-aided design/computer-aided manufacturing composite resin component elements immersed in water.

PURPOSE: Immersion tests in purified water were conducted to evaluate the leaching behaviors of filler elements contained in computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin. METHODS: Four commercial CAD/CAM resin composite blanks were tested: Shofu block HC 2 layer, Cerasmart, Katana Avencia block, and KZR-CAD HR Block 2. The specimens in the size of 10.0×12.0×2.0mm were immersed in a 50-mL conical tube containing 40mL of purified water, and then placed in a constant-temperature oven set at a temperature of 37, 60, 70, or 80°C and stored statically for 30 days. After storage, the concentrations of leached elements in the immersion solution were measured with an inductively coupled plasma atomic emission spectrometer. To characterize the surface of the specimen after the immersion test, secondary electron images were obtained. RESULTS: The immersion test resulted in the leaching of Si, the main component, from all materials tested. Some materials were found to have leached high amount of Ba or Sr in addition to Si, and remarkable surface degradation was observed. The amount of leached elements increased with increased immersion temperatures. CONCLUSIONS: Filler elements in CAD/CAM composite resins used in this study leached into purified water. The leached elements and its quantities greatly differed among materials and depend on the types of the oxides composing the filler. The amounts of leached elements varied in a temperature-dependent manner.

Fracture strength testing of crowns made of CAD/CAM composite resins.

PURPOSE: The purpose of this study was to ascertain whether computer aided design/computer aided manufacturing (CAD/CAM) composite resin crowns have sufficient strength to withstand the bite force of the molar teeth. The null hypothesis was that the fracture strength of CAD/CAM composite resin crowns is lower than the average maximum bite force of the molar tooth. METHODS: The crowns, which shape is the right maxillary first molar, were fabricated using four CAD/CAM blanks made of composite resins (Block HC: HC, KZR-CAD HR: HR, KZR-CAD HR2: HR2, Avencia Block: AVE) and one CAD/CAM blank made of lithium disilicate glass-ceramic (IPS e.max CAD: IPS), which was used as a control. Fracture strength of fabricated crowns bonded to metal abutment and biaxial flexural strength of the materials were evaluated. RESULTS: The results of fracture strength test and biaxial flexural strength test showed different tendencies. The fracture strength of CAD/CAM composite resin crowns except HC ranged from 3.3kN to 3.9kN, and was similar to that of IPS (3.3kN). In contrast, biaxial flexural strength of CAD/CAM composite resins ranged from 175MPa to 247MPa, and was significantly lower than that of IPS (360MPa). CONCLUSIONS: All CAD/CAM composite resin crowns studied presented about 3-4 times higher fracture strength than the average maximum bite force of the molar tooth (700-900N), which result leads to the conclusion that CAD/CAM composite resin crowns would have sufficient strength to withstand the bite force of the molar teeth.

Adhesion Properties of Human Oral Epithelial-Derived Cells to Zirconia.

BACKGROUND: Few studies have examined epithelial attachment to zirconia and the proliferative ability of epithelial cells on zirconia surfaces. PURPOSE: To evaluate the adhesion properties of zirconia materials for epithelial cell attachment and compare this with titanium and alumina. MATERIALS AND METHODS: Human oral epithelial cells were cultured on smooth-surfaced specimens of commercially pure titanium (cpTi), ceria-stabilized zirconia/alumina nano-composite (P-NANOZR), yttria-stabilized zirconia (Cercon), and alumina oxide (inCoris AL). The cell morphology, the cell viability and mRNA of integrin ß4 , laminin γ2 , catenin δ2 , and E-cadherin were evaluated by SEM, Cell-Counting Kit-8, and real-time PCR, respectively. RESULTS: Morphology of cells attached to specimens was similar among all groups. The viable cell numbers on Cercon and inCoris AL after 24 hours culture were significantly higher than for cpTi. Integrin ß4 , laminin γ2 , and catenin δ2 mRNA expression was not different among all groups. However, at 3 and 24 hours after incubation, E-cadherin mRNA expression in the P-NANOZR group was significantly higher than for cpTi. CONCLUSION: Zirconia may support binding of epithelial cells through hemidesmosomes comparable with titanium. Furthermore, P-NANOZR may impart resistance to exogenous stimuli through strong intercellular contacts with peri-implant mucosal cells when used as an abutment and implant superstructure.

Improving biocompatibility of zirconia surface by incorporating Ca ions.

Though zirconia has been used in dental implant fixtures, the biocompatibility of the zirconia surface is not optimal for the surrounding tissue, and many surface modifications have been attempted. We have developed a novel method for improving the biocompatibility of zirconia by incorporating Ca ions. Elemental analysis showed that calcium ions become thoroughly incorporated into the zirconia surface after firing with calcium acetate. Mechanical tests indicated that the Ca ions had little effect on the flexural strength and hardness. Moreover, incorporating Ca ions also dramatically improved the water wettability of specimens that had been soaked in a simulated body fluid. The surface of the Ca-modified zirconia demonstrated good initial cell attachment.

Reactivity of zirconia with phosphate-bonded investments for hot-pressing.

PURPOSE: The aim of the present study was to investigate the reactivity of zirconia to phosphate-bonded investment on the process of hot-pressing technique. METHODS: Disc-shaped specimens, 16 mm diameter and 0.4mm thick were prepared by cutting and grinding. These specimens were finally sintered. Half of them were sandblasted. The non-sandblasted specimens were used for controls. Both of zirconia discs with and without sandblasting were invested into the three kinds of phosphate-bonded investment. The investments were fired and broken to take out specimens. The biaxial strengths were measured in the way of the biaxial flexural tests according to ISO-6872. RESULTS: The biaxial strengths were ranged 762-1200 MPa at the average. The biaxial strengths of sandblasted zirconia discs heated with phosphate-bonded investment were decreased significantly (p < 0.01). SEM and EPMA revealed that the various compounds were observed on the sandblasted specimens. XRD revealed that surfaces of specimens heated with the phosphate-bonded investment showed the formation of phosphate compounds. CONCLUSIONS: The phosphate compounds inhibit stress-induction phase transformation of zirconia and decrease the biaxial strength.

HRTEM observation of bonding interface between Ce-TZP/Al2O3 nanocomposite and porcelain.

The surface of a ceria-stabilized tetragonal zirconia polycrystal (Ce-TZP/Al2O3) nanocomposite was sandblasted by alumina particles and veneered with feldspathic porcelain via a conventional condensation method. The part of each specimen containing the interface layer was sliced to ultrathin sections with an argon ion slicer, and these sliced sections were observed using high-resolution transmission electron microscopy (HRTEM). For both interfaces, Ce-TZP/porcelain and Al2O3/porcelain, no transition layers due to abrupt changes in atomic distributions were observed. Besides, the porcelain layers of both interfaces consisted of homogeneous amorphous phases. These results suggested that both Ce-TZP and Al2O3 could be directly bonded to porcelain by Van der Waals forces arising from the close contact between them.

Contamination of dental zirconia before final firing: effects on mechanical properties.

Plate-like specimens were prepared, using a diamond saw, from Cercon -a pre-sintered yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) block. These specimens were treated with 10 kinds of dental materials which acted as contaminants, and then sintered at 1,350°C or 1,450°C. After the final firing, specimens were subjected to a three-point flexural test and Vickers hardness test. Their surfaces were also characterized by scanning electron microscopy and X-ray diffractometry. Phosphorus-containing contaminants reduced the three-point flexural strength and hardness of final sintered zirconia due to the formation of YPO4 and phase transformation from tetragonal to monoclinic zirconia. Gypsum also reduced both mechanical properties due to the formation of CaZrO3 and phase transformation from tetragonal to cubic zirconia. Other contaminants showed no adverse effects on the mechanical properties of final sintered zirconia.

Current status of zirconia restoration.

During the past decade, zirconia-based ceramics have been successfully introduced into the clinic to fabricate fixed dental prostheses (FDPs), along with a dental computer-aided/computer-aided manufacturing (CAD/CAM) system. In this article (1) development of dental ceramics, (2) the current status of dental CAD/CAM systems, (3) CAD/CAM and zirconia restoration, (4) bond between zirconia and veneering ceramics, (5) bond of zirconia with resin-based luting agents, (6) surface finish of zirconia restoration and antagonist enamel wear, and (7) clinical evaluation of zirconia restoration are reviewed. Yttria partially stabilized tetragonal zirconia polycrystalline (Y-TZP) showed better mechanical properties and superior resistance to fracture than other conventional dental ceramics. Furthermore, ceria-stabilized tetragonal zirconia polycrystalline and alumina nanocomposites (Ce-TZP/A) had the highest fracture toughness and had resistance to low-temperature aging degradation. Both zirconia-based ceramics have been clinically available as an alternative to the metal framework for fixed dental prostheses (FDPs). Marginal adaptation of zirconia-based FDPs is acceptable for clinical application. The most frequent clinical complication with zirconia-based FDPs was chipping of the veneering porcelain that was affected by many factors. The mechanism for the bonding between zirconia and veneering ceramics remains unknown. There was no clear evidence of chemical bonding and the bond strength between zirconia and porcelain was lower than that between metal and porcelain. There were two alternatives proposed that might avoid chipping of veneering porcelains. One was hybrid-structured FDPs comprising CAD/CAM-fabricated porcelain parts adhering to a CAD/CAM fabricated zirconia framework. Another option was full-contour zirconia FDPs using high translucent zirconia. Combined application of silica coating and/or silane coupler, and 10-methacryloyloxydecyl dihydrogen phosphate is currently one of the most reliable bonding systems for zirconia. Adhesive treatments could be applied to luting the restorations and fabricating hybrid-structured FDPs. Full-contour zirconia FDPs caused concern about the wear of antagonist enamel, because the hardness of Y-TZP was over double that of porcelain. However, this review demonstrates that highly polished zirconia yielded lower antagonist wear compared with porcelains. Polishing of zirconia is possible, but glazing is not recommended for the surface finish of zirconia. Clinical data since 2010 are included in this review. The zirconia frameworks rarely got damaged in many cases and complications often occurred in the veneering ceramic materials. Further clinical studies with larger sample sizes and longer follow-up periods are required to investigate the possible influencing factors of technical failures.

Cellular compatibility of a gamma-irradiated modified siloxane-poly(lactic acid)-calcium carbonate hybrid membrane for guided bone regeneration.

A bi-layered silicon-releasable membrane consisting of a siloxane-poly(lactic acid) (PLA)-vaterite hybrid material (Si-PVH) microfiber mesh and a PLA microfiber mesh has been developed by an electrospinning method for guided bone regeneration (GBR) application. The bi-layered membrane was modified to a three-laminar structure by sandwiching an additional PLA microfiber mesh between the Si-PVH and PLA microfiber meshes (Si-PVH/PLA membrane). In this study, the influence of gamma irradiation, used for sterilization, on biological properties of the Si-PVH/PLA membrane was evaluated with osteoblasts and fibroblasts. After gamma irradiation, while the average molecular weight of the Si-PVH/PLA membrane decreased, the Si-PVH/PLA membrane promoted cell proliferation and differentiation (alkaline phosphatase activity and calcification) of osteoblasts, compared with the poly(lactide-co-glycolide) membrane. These results suggest that the gamma-irradiated Si-PVH/PLA membrane is biocompatible with both fibroblasts and osteoblasts, and may have an application for GBR.

A method for improving the light intensity distribution in dental light-curing units.

A method for improving the uniformity of the radiation light from dental light-curing units (LCUs), and the effect on the polymerization of light-activated composite resin are investigated. Quartz-tungsten halogen, plasma-arc, and light-emitting diode LCUs were used, and additional optical elements such as a mixing tube and diffusing screen were employed to reduce the inhomogeneity of the radiation light. The distribution of the light intensity from the light guide tip was measured across the guide tip, as well as the distribution of the surface hardness of the light-activated resin emitted with the LCUs. Although the additional optical elements caused 13.2-25.9% attenuation of the light intensity, the uniformity of the light intensity of the LCUs was significantly improved in the modified LCUs, and the uniformity of the surface hardness of the resin was also improved. Our results indicate that the addition of optical elements to the LCU may be a simple and effective method for reducing inhomogeneity in radiation light from the LCUs.

Effect of preparation route on the degradation behavior and ion releasability of siloxane-poly(lactic acid)-vaterite hybrid nonwoven fabrics for guided bone regeneration.

Two types of nonwoven fabric, consisting of siloxane-doped vaterite (SiV) and poly(lactic acid) (PLA), for guided bone regeneration (GBR) were prepared by an electrospinning. One of the fabrics, SiV-PLA(M), was derived from PLA mixed with the solution of SiV dispersed in chloroform. Another one, SiV-PLA(K), was derived from a composite prepared by kneading SiV and PLA while heating at 200°C. The SiV-PLA(K) fabric shows higher degradability in dilute NaOH aq. than the SiV-PLA(M) fabric. To improve the cellular compatibility of the fabric, the fibers were coated with hydroxyapatite (HA) by soaking in simulated body fluid. The HA-coated SiV-PLA(K) fabric showed the release of silicate ions; the amount was reduced by 1/5 to 1/8 compared with that of the HA-coated SiV-PLA(M) fabric, and the excessive release was controlled. The preparation route of kneading at 200°C led to formation of a fabric with degradation behavior and ion releasability effective for bone regeneration.

Surface damages of zirconia by Nd:YAG dental laser irradiation.

The purpose of this study was to characterize the surface damages of zirconia by Nd:YAG dental laser irradiation through a systematic evaluation of the associated microstructural changes. Disk specimens of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al2O3 nanocomposite) were irradiated by Nd:YAG dental laser. The specimens were characterized using scanning electron microscopy, X-ray diffractometry, and wavelength dispersive X-ray spectroscopy. Every single irradiated spot was indicated by a circular black pit surrounded by a circular raised rim with a sunken depression at the center. On surface changes, many cracks were formed inside each irradiated pit. On changes in elemental composition, the concentration of oxygen decreased while that of zirconium increased. After heating in air, the assembly of circular black pits turned white, although the depression and raised rim remained. This study showed that Nd:YAG dental laser irradiation induced cracking and reduced oxygen content on the surface of zirconia. Consequently, these phenomena reduced the mechanical strength of zirconia. Therefore, Nd:YAG dental laser welding should not be performed on tetragonal zirconia.

Flexural properties of ethyl or methyl methacrylate-UDMA blend polymers.

Light-curing polyethyl methacrylate (PEMA)-urethane dimethacrylate (UDMA) resins and polymethyl methacrylate (PMMA)-UDMA resins were prepared by two processes. For first step, PEMA or PMMA powders were fully dissolved in ethyl methacrylate (EMA) or methyl methacrylate (MMA) and then the PEMA-EMA/PMMA-MMA mixtures were mixed with UDMA. The flexural properties of cured PEMA-UDMA and PMMA-UDMA polymers were measured using two PEMA (Mw: 300,000-400,000 and 650,000-1,000,000) and three PMMA (Mw: 30,000-60,000, 350,000 and 650,000-1,000,000) powders with different molecular weight, four mixing ratios of PMMA-MMA, and three mixing ratios of PMMA-MMA mixture and UDMA oligomer. Polymers with PMMA(Mw: 350,000) MMA=25/50, and with PMMA(Mw: 350,000)-MMA/UDMA=1/2 and =1/1, showed no-fracture in a flexural test at 1 mm/min and flexural strength and flexural modulus showed no significant difference compared with those of commercially available heat- and self-curing acrylic resins (p>0.01). Within limitation of this investigation, methyl methacrylate-UDMA blend polymer of this composition is available for denture base resin.

Radio-opacity of core materials for all-ceramic restorations.

The aim of this study was to investigate and compare the radio-opacity of core materials for all-ceramic restorations, such as zirconia (NANOZR and Y-TZP) and alumina, against commercially pure titanium (cpTi) and aluminum. X-ray images were taken under general settings using an X-ray film. The X-ray film images were scanned using a digital scanner, and the darkness at the central area of each specimen image was quantitatively analyzed using an image analysis software. Amongst the materials investigated, alumina showed the most transparency against X-rays. Conversely, both types of zirconia showed the highest radio-opacity, whereby that of NANOZR was slightly lower than that of Y-TZP. This was because NANOZR contained 30 vol% of alumina and its density was also slightly lower than that of Y-TZP.