Characterizing the transformation near indents and cracks in clinically used dental yttria-stabilized zirconium oxide constructs.

OBJECTIVES: Tetragonal zirconia polycrystal (TZP) materials are widely used for full ceramic partial dentures, even though their mechanical properties might change during service. A key property for the durability of the constructs is thought to be an inhibition of crack propagation by phase transformation toughening. Because dental prosthesis are ground and polished for adjustment purposes, it is important to understand the effects of mechanical surface treatments, on localized transformation and around the propagating cracks. METHODS: Sintered samples of commercially available 3 mol-% Yittria-doped TZP were ground and polished and the surface structure and phase composition were compared with those of re-transformed annealed samples. Microindentation was used to induce cracks and nanoindentation was performed to determine the local variety of hardness and indentation modulus, coupled with XRD and SEM investigations. RESULTS: Y-TZP polished surfaces exhibited 9% monoclinic phase content and have reduced hardness and indentation modulus amounting 16.3 GPa and 210.6 GPa, respectively. Y-TZP re-transformed annealed sample revealed 19.4 GPa and 242.3 GPa, respectively. A localized reduction of the stiffness around the crack tips on the annealed surface reveals an irregular arrangement of t-m-transformed grains. Electron micrographs show more damage on the transformed surface following microindentation than on indented annealed surfaces. SIGNIFICANCE: Y-TZP prostheses are adapted and roughened by clinicians prior to bonding to teeth. Annealing recovers properties and microstructure that is changed by the adaptation of the outer layer. This might be important to ensure long-term toughening functionality of the dentures and optimal comfort for the patients.

Influence of preparation form, luting space setting and cement type on the marginal and internal fit of CAD/CAM crown copings.

PURPOSE: To evaluate the influence of two different tooth preparation forms, two luting space settings and two cement types on the marginal and internal adaptation of all-ceramic crown copings produced using Cerec3 CAD/CAM system. MATERIALS AND METHODS: Forty working stone dies were made from two metal master casts (1. Tooth 36: with anatomic occlusal reduction, 2. Tooth 36: with flat occlusal reduction). Forty crown copings were milled using Vita In-Ceram 2000 YZ: 20 with an luting space settings of 0 = 100 microm and 20 with -50 = 50 microm. Copings were cemented using two cements (zinc phosphate cement, P21: Panavia21), then embedded and sectioned bucco-lingually and mesio-distally. Widths of marginal and internal gaps were measured using a light microscope at magnification of 40X. Data were submitted to one-way ANOVA, and statistical significance was set at p < 0.05. RESULTS: Copings with flat occlusal reduction and luting space settings of 100 pm had a better internal and marginal fit compared with copings with anatomic occlusal reduction and luting space settings of 50 microm, regardless of the cement used. P21 showed a significantly better fit compared with zinc phosphate cement. CONCLUSION: The presented Cerec3 CAD/CAM system can provide a marginal and internal adaptation which is comparable to that of conventional cast and conventional all-ceramic crowns.

Monoclinic phase transformations of zirconia-based dental prostheses, induced by clinically practised surface manipulations.

Full-ceramic zirconia crowns and bridges have become very popular with dentists and patients because of their excellent esthetics and mechanical properties. We studied phase transformations within the outermost surface layer of 3 mol.% yttria-stabilized zirconia (Y-TZP) samples of small, clinically relevant thicknesses, manipulated by polishing, grinding and fracture as might be encountered in everyday clinical practice. Stress-induced transformations of the tetragonal phase were studied in three dimensions in order to better understand the organization and extent of the monoclinically transformed phase. By means of laboratory- and synchrotron-based X-ray diffraction measurements, coupled with electron microscopy and multimodal tomography, it was possible for the first time to visualize and quantify the phase distributions non-destructively and in three dimensions. Highly variable degrees of local transformation result in ragged transformed zones of very inhomogeneous thickness. The overall thickness of the transformation layers strongly depends on the severity and rate of loading. Gentle diamond cutting resulted in surprisingly low transformation ratios of less than 0.1%. When Y-TZP constructions are manipulated before bonding, toughness of the outer layers is reduced and they may become brittle with important implications for the stability of the bond: dental practitioners thus need to be cautious when altering the surfaces of these materials after sintering.

Preterm twin gestation and cystic periventricular leucomalacia.

OBJECTIVE: To identify risk factors for the development of cystic periventricular leucomalacia (PVL) in twin gestation. DESIGN: Retrospective case-control study. SETTING: Tertiary care university hospital, Department of Paediatrics, Division of Neonatology, Graz, Austria. PATIENTS: Preterm twin gestations with one sibling having developed cystic PVL, diagnosed by ultrasound scans, compared with their co-twins without PVL, in hospital between 1988 and 2000. MAIN OUTCOME MEASURES: Perinatal and postnatal risk factors for the development of PVL. RESULTS: Eighteen preterm twin gestations were included. Monochorionicity was evident in 47% of the pregnancies, and twin to twin transfusion syndrome occurred in two cases (11%). Fetal distress correlated inversely with PVL (15% v 53%, p = 0.019, relative risk (RR) = 2.057, 95% confidence interval (CI) = 1.067 to 3.968). Hypocarbia with Pco(2) levels below 30 mm Hg (4 kPa) was diagnosed in 29% of the cases compared with 6% of the controls (p = 0.038, RR = 1.944, 95% CI = 1.113 to 3.396). There were no significant differences between groups with regard to premature rupture of the membranes, early onset infection, respiratory distress syndrome, mechanical ventilation, arterial hypotension, persistent ductus arteriosus, and hyperbilirubinaemia. Asphyxia was only evident in three controls. Three infants died and another three were lost to follow up. None of the cases compared with 62% of the controls were diagnosed as having developed normally (p < 0.001), and 14 cases (82%) compared with two controls (15%) developed cerebral palsy (p < 0.001). CONCLUSION: Hypocarbia was the only risk factor strongly associated with cystic PVL. The general outcome of the infants was poor.