Load-bearing capacity under fatigue of bonded-yttria tetragonal zirconia polycrystals and -yttria-stabilized zirconia: Effects of the viscosity of a dual-cured resin cement.

This study aimed to evaluate the effect of low and high viscosities of dual-cured resin cement on the mechanical fatigue behavior of yttria tetragonal zirconia polycrystals (3Y-TZP) and yttria-stabilized zirconia (4YSZ) adhesively luted to a dentin analogue (glass fiber-reinforced epoxy resin). Ceramic discs were randomly divided into four groups (n = 20) based on the following study factors: dual-cured resin cement viscosities (low and high) and zirconia microstructure (3Y-TZP and 4YSZ). The discs were treated by air abrasion with aluminum oxide particles (50 µm), followed by the application of primer, and then luted with high or low viscosity resin cement to the dentin analogue. Subsequently, the luted sets underwent a step-stress fatigue test, which involved an initial load of 200 N, step increments of 100 N, 10,000 cycles per step, and a frequency of 20 Hz. Data on fatigue failure load (FFL) and the number of cycles for failure (CFF) were collected and analyzed using survival tests, including Kaplan-Meier and Mantel-Cox analyses, as well as Weibull analysis. Additionally, topography analysis, fractographic features, bonding interface analysis, and Raman spectroscopy were performed. The results revealed that 3Y-TZP exhibited superior fatigue behavior compared to 4YSZ, regardless of the viscosity of the resin cement used for luting. Among all groups, 3Y-Low exhibited the best fatigue performance, while 4YSZ luted with low or high viscosity resin cements yielded the lowest fatigue behavior (FFL). There were no significant differences in Weibull modulus among the groups. After air abrasion, both ceramics showed similar topography. Raman analysis indicated that the surface of 3Y-TZP ceramics prior to sintering had a monoclinic phase, which transitioned predominantly to tetragonal phase peaks after sintering. A similar transition was observed in 4YSZ ceramics. In summary, 3Y-TZP exhibited superior mechanical fatigue behavior compared to 4YSZ. The influence of resin cement viscosity on fatigue behavior was more pronounced in 3Y-TZP, with low-viscosity resin cement enhancing its performance. However, the mechanical fatigue behavior of 4YSZ was less affected by the viscosity of the dual-cured resin cement, showing similar results with both low and high viscosities. In conclusion, 3Y-TZP demonstrated superior mechanical fatigue behavior compared to 4YSZ. The impact of resin cement viscosity on fatigue behavior was more pronounced in 3Y-TZP, with low-viscosity resin cement enhancing its performance. Conversely, the mechanical fatigue behavior of 4YSZ was less sensitive to the viscosity of the dual-cured resin cement, resulting in similar outcomes with both low and high viscosities.

Does Adhesive Luting Reinforce the Mechanical Properties of Dental Ceramics Used as Restorative Materials? A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review aims to explore and compile the effect of adhesive luting on the mechanical properties of dental ceramics used as restorative materials. MATERIALS AND METHODS: The PubMed/MEDLINE, Web of Science and Scopus databases were searched on January 31st, 2021 to select laboratory studies written in English, without publishing-date restrictions, which compared the mechanical properties of commercially available dental ceramics as restorative materials luted using adhesive vs non-adhesive strategies. A total of 20 (out of 2039) studies were eligible and included in the analysis. Two authors independently selected the studies, extracted the data and assessed the risk of bias. Mean differences (RevMan5.1, random effects model, α = 0.05) were obtained by comparing resistance values of adhesive and non-adhesive conditions (global analysis). Subgroup analyses were performed considering ceramic composition and aging. RESULTS: In the global analysis, adhesive luting induced higher mechanical resistance values compared to non-adhesive luting (p ≤ 0.01). The same effect was observed for glass and alumina ceramics (p ≤ 0.01), but not for zirconia polycrystals (p = 0.83). Adhesive luting was favorable in both the aged and non-aged subgroup analysis (p ≤ 0.01). High heterogeneity was found in all meta-analyses. All analyzed studies in the systematic review scored negatively for risk of bias in most of the factors considered. CONCLUSIONS: Adhesive luting reinforces the mechanical properties of dental ceramics used as restorative materials, with the exception of zirconia polycrystals.

In-lab simulation of CAD/CAM milling of lithium disilicate glass-ceramic specimens: Effect on the fatigue behavior of the bonded ceramic.

The aim of this study was to evaluate the effect of in-lab simulation procedures performed on a lithium disilicate ceramic luted to a dentin-analogue material regarding the fatigue performance and topographic changes. Lithium disilicate ceramic (IPS e.max CAD) discs (Ø = 13.5 mm and 1.5 mm of thickness) were produced in different ways: milled in a CAD/CAM system (CAD/CAM - control group); mirror-polished (POL group); produced in-lab and ground with #60 silicon carbide paper (SiC group); with #60 wood sandpaper (WS group); with a fine diamond bur (DB group); or with a CAD/CAM bur adapted in a handpiece with a custom mandrel (MANDREL group). The ceramic discs were adhesively luted (Multilink N) onto dentin analogue discs (Ø = 12 mm and 2 mm of thickness) and fatigue testing (n = 19 discs) was performed by step-stress methodology (initial load of 200 N; step-size of 50 N; 10,000 cycles per step; 20 Hz). Surface roughness and contact angle analysis were also performed. According to Kaplan-Meier and post-hoc Mantel-Cox (log-rank), distinct fabrication methods affected the fatigue performance of bonded glass-ceramic discs (p< 0.001). The CAD/CAM group presented the lowest fatigue failure loads (1250 N) and number of cycles for failure (185,000), while the POL groups obtained the highest results (1752 N; 284,444 cycles). The in-lab groups had intermediate values (1355 - 1526 N; 206,052 - 238,684 cycles). Polished specimens presented the lowest roughness values (Ra = 0.041 µm), while the SiC (1.604 µm), WS (1.701 µm), and MANDREL (1.867 µm) groups showed statistically similar roughness values to the CAD/CAM group (1.738 µm). Despite differences before etching, the contact angle was similar among the milled and simulated groups after etching, except for the polished group. Even with some topographic similarities, the tested in-lab simulation methods were not able to mimic the milled specimens in terms of fatigue findings, leading to distinct magnitude of overestimations of the results.