Sintering temperature accuracy and its effect on translucent yttria-stabilized zirconia: Flexural strength, crystal structure, tetragonality and light transmission.

OBJECTIVES: A crucial step in the preparation of yttria-stabilized zirconia materials (YSZ) is the final sintering step. Sintering parameters affect phase composition, grain growth and porosity of the material which, in turn, influence both mechanical and optical properties. Discrepancies of + /- 5% are common between actual and displayed firing temperatures depending on sintering furnace brand and condition. The aim of this study was therefore to investigate how such sintering temperature deviations in dental furnaces compared to the recommended firing protocols affected certain material properties of different yttria-stabilized zirconia materials. METHODS: Disc-shaped specimens were made from four different translucent and high translucent YSZ-powders and analysed regarding crystal structure; unit cell volume for the c, t, and t' -phases along with the tetragonality for the t and t' phases. Biaxial flexure strength and the spectral transmittance through the ceramic specimens were also measured. RESULTS: Deviations of 5% from the sintering temperature recommended for YSZ materials with different yttria content influenced material properties such as light transmittance, flexural strength, crystal phase fractions, tetragonality, and grain growth. Too low temperature resulted in decreased strength for some of the translucent zirconia materials, while others where less affected. Light transmittance varied depending on several factors such as grain size, crystal phase fractions and binder content in the start material prior to pre-sintering. SIGNIFICANCE: The use of high quality, wellcalibrated furnaces is crucial when sintering YSZ materials to avoid unwanted material changes. CONCLUSIONS: Deviations of 5% from the sintering temperature recommended for YSZ materials with different yttria content influence material properties such as light transmittance, flexural strength, crystal phase fractions, tetragonality, and grain growth. Too low temperature results in decreased strength for some translucent zirconia materials, while others are less affected. Light transmittance varies depending on several factors such as grain size, crystal phase fractions and binder content in the start material prior to pre-sintering. Consequently, the use of high quality, well-calibrated furnaces is crucial when sintering YSZ materials to avoid unwanted material changes.

Bisphenol A in dental materials - existence, leakage and biological effects.

OBJECTIVE: Recently, questions have been raised concerning the potential endocrine disrupting effects of bisphenol A (BPA). This substance is a constituent in many different products which we frequently come into contact with, such as food containers and receipts. Resin-based dental filling materials are another source of exposure, although according to previous studies the amount and potential risks are not clear. Thus, the aims of the present study were (1) to identify if direct dental filling materials are liable to leak BPA and (2) to investigate if this leakage could lead to any adverse effects on health. MATERIALS AND METHODS: A literature search was made with PubMed as the primary source, subsequently complemented with reference tracking. RESULTS: A total of 26 articles were included, 24 of which were used for the first aim (leakage) and 2 for the second aim (health risks). The majority of studies, including all in vivo studies, showed leakage of BPA from dental materials in various amounts and during different time intervals. The findings showed a contradiction in results regarding the connection between dental materials and adverse health effects. CONCLUSIONS: There is leakage of BPA from some dental materials, but critical levels are not evident. Bis-DMA contents might convert to BPA in the oral cavity. There is a contradiction between in vitro and in vivo studies concerning BPA leakage and finally, there is a lack of studies investigating the association between BPA exposure and its adverse effects on human health.

Prosthodontic decision-making relating to dentitions with compromised molars: the perspective of Swedish General Dental Practitioners.

The aim of this investigation was to study the clinical prosthodontic decision-making process relating to dentitions with compromised molars among Swedish general dental practitioners (GDPs). Eleven Swedish GDPs were purposively selected, and all agreed to participate. Then, in-depth, semi-structured interviews were conducted and covered treatment considerations concerning two authentic patient cases, initially with complete dental arches, and later, a final treatment based on a shortened dental arch (SDA) was discussed. The cases involved patients with compromised teeth situated mainly in the molar regions. One patient suffered from extensive caries and the other from severe periodontal disease. Qualitative content analysis was used to analyse the data. In the systematic analysis, two main categories were identified: holistic and functional approach. Among the interviewed GDPs, focus was put on patients' needs, background history and motivation for treatment as well as the preservation of molar support. Within the limitations of this study, the following can be concluded: keeping a dental arch with molars seems to be important to Swedish general dental practitioners. The SDA concept does not seem to have a substantial impact on the prosthodontic decision-making relating to dentitions with compromised molars. The dentist's experiences, as well as colleagues' or consulting specialist advice together with aetiological factors and the patient's individual situation, influence the decision-making more than the SDA concept. The conflicting results in the prosthetic decision-making process concerning the relevance of age and the need for molar support need further investigation, for example based on decisions made in the dentist's own clinical practice.

Fracture strength of four-unit Y-TZP FPD cores designed with varying connector diameter. An in-vitro study.

Reported clinical success rates of all-ceramic fixed partial dentures (FPDs) made of high-strength oxide ceramics range between 82.5% and 100%. The main cause of all-ceramic FPD failure is fracture in the connector area. There is, however, no consensus on what connector dimensions are adequate. The aim of this in-vitro study was, therefore, to compare the fracture strength of four-unit Y-TZP FPD cores designed with different connector diameters. A total of 40 four-unit FPD cores supported by end abutments and having two pontics were manufactured in Procera Zirconia. Five groups of FPD cores with connector dimensions of 2.0, 2.5, 3.0, 3.5 and 4.0 mm were produced. All FPD cores underwent a firing programme according to the manufacturer's recommendations for the veneering porcelain, a cyclic preload, thermocycling and finally, load until fracture. Fracture strength was significantly higher for each increase in connector diameter except for the 2.0-mm and 2.5-mm diameters where all fractures occurred during preload. All FPD cores fractured in the connector area. Within the limitations of this in-vitro study, a minimum diameter of 4.0 mm is recommended for all-ceramic zirconia-based FPDs with long spans or replacing molars. Clinical studies are, however, needed to determine adequate connector dimensions.

The effect of core framework designs on the fracture loads of all-ceramic fixed partial dentures on posterior implants.

This study evaluated the fracture loads of three-unit all-ceramic bridges on implants; the core frameworks of the bridges were made of zirconium oxide. Three core framework designs were fabricated according to the design of the bars between the retainers: (i) straight, (ii) curved in the occlusal direction, or (iii) curved in the gingival direction. A static load was applied at the centre of the pontic, and the mean initial crack and final fracture loads were measured and compared. The core framework curved in the occlusal direction had the highest final fracture loads; there were significant differences (P < 0.05) in the mean final fracture load, whereas initial fracture load, which fractured of veneered porcelain, did not show significant differences among three designs. The all-ceramic bridges on the implants made with Procera zirconium core frameworks had high final fracture load. The core framework design that curved in the occlusal direction helped the framework withstand the occlusal load, which results in reliable prostheses, especially in the molar region.

Fracture strength of two oxide ceramic crown systems after cyclic pre-loading and thermocycling.

The aim of the present study was to investigate the fracture resistance of zirconia crowns and to compare the results with crowns made of a material with known clinical performance (alumina) in away that reflects clinical aspects. Sixty crowns were made, 30 identical crowns of alumina and 30 of zirconia. Each group of 30 was randomly divided into three groups of 10 crowns that were to undergo different treatments: (i) water storage only, (ii) pre-loading (10 000 cycles, 30-300 N, 1 Hz), (iii) thermocycling (5-55 degrees , 5000 cycles) + pre-loading (10 000 cycles, 30-300 N, 1 Hz). Subsequently, all 60 crowns were subjected to load until fracture occurred. There were two types of fracture: total fracture and partial fracture. Fracture strengths (N) were: group 1, alumina 905/zirconia 975 (P = 0.38); group 2, alumina 904/zirconia 1108 (P < 0.007) and group 3, alumina 917/zirconia 910 (P > 0.05). Total fractures were more frequent in the alumina group (P < 0.01). Within the limitations of this in vitro study, it can be concluded that there is no difference in fracture strength between crowns made with zirconia cores compared with those made of alumina if they are subjected to load without any cyclic pre-load or thermocycling. There is, however, a significant difference (P = 0.01) in the fracture mode, suggesting that the zirconia core is stronger than the alumina core. Crowns made with zirconia cores have significantly higher fracture strengths after pre-loading.

Clinical marginal and internal gaps of In-Ceram crowns fabricated using the GN-I system.

The marginal and internal gaps of ceramic crowns with alumina copings fabricated using a computer-aided design, computer-aided manufacturing system, were evaluated in vivo using silicone materials. Black and white silicone materials were used to record the marginal and internal gaps of 82 In-Ceram crowns before final cementation. The silicone materials were sectioned bucco-lingually and mesio-distally and viewed under a microscope to measure the thickness of the white silicone layer. Sixteen reference points were measured on each specimen. The mean marginal gaps were compared among the anterior, premolar and molar teeth, and the mean gaps at the reference points within the groups were compared by analysis of variance and the Dunnett T3 test. The mean marginal gap was 66.8 mum. There were no differences in marginal gaps among the three groups. In all the groups, the marginal gaps were the smallest, whereas the occlusal gaps were the largest. The mean marginal gaps of the In-Ceram crowns with the alumina copings fabricated using the GN-I system were within the range of clinically acceptable values.

Clinical marginal and internal gaps of Procera AllCeram crowns.

This study evaluated the marginal and internal gaps of Procera AllCeram crowns in vivo using silicone materials. Ninety Procera AllCeram crowns were evaluated before final cementation. White and black silicone materials were used to record the marginal and internal fit; then the crowns were sectioned bucco-lingually and mesio-distally to measure the thickness of the silicone layer using a microscope. Sixteen reference points were measured on each specimen. Mean marginal gaps among anterior, premolar and molar teeth, and mean gaps at the reference points within the groups were compared by analysis of variance and Dunnett T3 test. The mean values at the margins were the smallest in all tooth groups, whereas those at the rounded slope of the chamfer were the largest. There were significant differences (P < 0.001) in the mean gaps at the four reference points (margin, rounded slope of the chamfer, axial wall and occlusal surface) in each group, except for the molar teeth. The mean marginal gaps of the Procera AllCeram crowns were within the range of clinical acceptance.

All-ceramic fixed partial dentures designed according to the DC-Zirkon technique. A 2-year clinical study.

The aim of the study was to investigate whether the properties of a pre-sintered, hot isostatic post-compacted (HIP) ZrO2 are adequate for use in three-five-unit fixed partial dentures (FPDs) and to evaluate the clinical results. Twenty three-five-unit FPDs were fabricated for 18 patients on a total of 56 abutments. They were all made on abutments cut with a shoulder preparation and cemented with a zinc phosphate cement. They were clinically followed for 24 months. After 24 months all FPDs were still in use without any fractures or clinical wear but in three cases (15%) minor chip-of fractures were observed. Marginal integrity was rated excellent at 45 abutments and acceptable at 11. Within the limitations of this 2-year clinical follow-up study, FPDs made of pre-sintered HIP ZrO2 core material veneered with a compatible ceramic is an acceptable alternative in the fabrication of FPDs with the extensions investigated in this study. Special attention, however, must be paid to designing the core for an occlusal shape that provides sufficient support for the veneer.

Five-year evaluation of posterior all-ceramic three-unit (In-Ceram) FPDs.

PURPOSE: The purpose of this study was to investigate whether the properties of the In-Ceram material are adequate for use in posterior three-unit fixed partial dentures (FPD) and to evaluate the clinical method regarding preparation technique, design, and choice of cement. MATERIALS AND METHODS: Eighteen patients were treated with a total of 20 posterior three-unit FPDs according to the In-Ceram technique. The FPDs were constructed with bilateral support and one pontic and were all replacing one premolar or a molar (11 replacing premolars and 9 replacing molars). They were evaluated 6 months after delivery and then once yearly. RESULTS: Eighteen of the 20 FPDs (90%) showed no defects at any of the follow-up examinations and were functioning well after 5 years. No caries or signs of gingivitis or periodontitis exceeding those found in the rest of the dentition were registered. CONCLUSION: The In-Ceram technique is, in a 5-year perspective and adopted for three-unit FPDs, an acceptable treatment alternative. Further studies must, however, be performed before the material can be recommended for more extensive restorations than the FPDs included in this study.

Fracture strength of In-Ceram all-ceramic bridges in relation to cervical shape and try-in procedure. An in-vitro study.

Investigations were performed on the strength of dental porcelain depending on whether it was exposed to saliva before or after the final firing. Forty porcelain specimens were fabricated and subjected to different treatments. A three-point flexural test was performed. In a second study investigations were performed to compare how the cervical shape of the preparation influenced the fracture strength of fixed partial dentures made of glass-infiltrated aluminium oxide. It was concluded that short-term exposure to saliva could have a negative effect on the strength of porcelain and that all-ceramic bridges luted with non-adhesive luting techniques should be supported by abutments with shoulder preparations.

Removable partial denture design habits in general dental practice in Sweden.

An investigation was made concerning Swedish general dental practitioners' habits in removable partial denture design and their opinion of the undergraduate training programme in this matter. The investigation showed that many dentists failed to provide adequate prescriptions and that they relied heavily on the dental technician for partial dental design. A clear majority of the participants, educated at Umea dental school, considered the undergraduate training programme to be adequate, whilst a similar percentage educated at Gothenburg dental school was dissatisfied. The faculties in Stockholm and Malmo were placed between Umea and Gothenburg in this respect. The majority of the participants in this survey declared that the opportunity to attend small group postgraduate courses in the subject was desirable. A prerequisite for dentists to have control of the treatment they are responsible for, is that they at least have the necessary knowledge. This knowledge may have to be achieved after qualification instead of during their undergraduate training.