Improved Ceramics through New Measurements, Processing, and Standards

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These novel zirconia-reinforced lithium silicate glass-ceramics have good mechanical properties associated with an excellent esthetic quality, thus being a valid alterative to lithium disilicate materials for prosthetic rehabilitations with high aesthetic demand. The main advantage of these materials is their timesaving ability for the production of dental restorations, since they are faster to be milled in CAD-CAM machines than lithium disilicate glass-ceramics 53 and are already offered in their fully crystallized state CELTRA Duo, Dentisply-Sirona, Bensheim, Germany no furnace need or need a very short crystallization cycle Suprinity, Bad Sachingen, Germany.

A particular advantage of the lithium silicate ceramic over the lithium disilicate version is the superior polishability due to the smaller crystal sizes in the microstructure. In the last decades, the use of CAD-CAM systems in dentistry has increased exponentially, especially because of the general trends towards high productivity and aesthetics. However, problems commonly related to resin composite systems still need to be overcome, such as the reduced mechanical properties and poor wear resistance.

A recent publication 62 reported that Enamic showed elastic modulus values similar to that reported by the manufacturer around 30 GPa , however, the fracture toughness values measured in this investigation 0. The fracture toughness value obtained for PICN was similar to that of the feldspathic ceramic evaluated.

Therefore, the authors rejected the hypothesis that the presence of a polymer network would create toughening mechanisms in the microstructure of the material. This raised the question if the polymer is susceptible to water permeation and degradation. PICNs have positive properties related to both the ceramic and composites, with an interesting balance between elasticity and strength, being indicated for single crowns, inlays, onlays and veneers. As expected for a composite material, the properties are intermediate between those of ceramics and particle-filled resins.

The elastic modulus of these materials is in the range of 30 GPa, which is half of that reported for conventional veneering ceramics but closer to what is usually reported for dentin 15—20 GPa. The Vickers hardness of human enamel 3. With respect to optical properties, the shrinkage of the curing resin results in interfacial stresses occurring between the ceramic framework and the polymer resulting in debonding and leading to a higher opacity because of the gaps developed at the interface.

The selection of resin, the application of high pressure during the curing phase, and the silanization process enhanced bonding and helped overcoming the aesthetic problems by increasing the translucency of the material. Clinical simulations show promising lifetime results for PICN.

A chewing simulation of five years demonstrated that none of the Enamic crowns failed, while six IPS e. Due to the inferior optical properties, PICNs are more suitable in the molar than in the anterior region. CAD-CAM refers to a computer system that is used to both design and manufacture a dental restoration. CAD technology uses a software to define the shape and dimensions of the restoration, while CAM technology takes the designed model to a computer numeric control CNC machine to manufacture the restoration, usually from a block made of a dental material subtractive manufacturing.

Currently, the production of metal-free restorations using polycrystalline ceramic infrastructures e. CAD-CAM systems have been used in Dentistry for almost 30 years, 79 and during this period different machines have been launched, as these systems are constantly evolving and producing restorations with much better adaptation. The first one is the machining of the prosthetic restoration from a block of the sintered material, while the second consists of machining a block in a partially sintered state with subsequent final sintering in a specific furnace.

Both techniques are used in dentistry and each of them have their advantages and disadvantages. Machining a block of sintered material provides the restoration with a greater precision of its contours and shape in addition to saving clinical time, since the restoration does not require an additional heat treatment. However, when machining a material with high strength like polycrystalline ceramics, both the wear of the machining unit tools and the machining time are very high.

Also, machining brittle materials such as dental ceramics can lead to the formation of microcracks and surface defects. Although the CAD-CAM systems described above are already well established in the dental market, they present a major drawback related to the great waste of material upon machining. Therefore, new technologies have been developed to overcome this problem. Some of them produce the restoration by means of adding layers instead of grinding pre-fabricated blocks additive manufacturing. In this technique, the laser beam sinters thin layers of a ceramic from a container filled with powder to create a single coping or framework, in which each layer represents a cross section of the CAD model.

Stereolithography is frequently used nowadays, and has already evolved enough to allow production of more complex ceramic pieces, whereas the previously mentioned techniques are in the early development stage for dental applications. Stereolithography is similar to 3D printing, however it makes use of a suspension containing ceramic particles mixed with a resin components acrylates or epoxy monomers. The great advantage associated with all additive techniques is that they provide minimal or no material waste. One still existing disadvantage of all additive methods to date is the rough surface quality and the poor fit or marginal precision.

Considering the mentioned additive methods, Direct 3D Printing is the technique that stands out, as the equipment is relatively more accessible and allows for the production of a dense green body ready for sintering. In , 91 using a modified inkjet printer, a zirconia crown was manufactured with sufficient mechanical properties to be used in the oral cavity. Robocasting uses extruded filaments instead of ejected droplets to produce the object.

Also, a trend towards the use of monolithic restorations has changed the way clinicians produce all-ceramic dental prostheses, since the more aesthetic multilayered restorations unfortunately are more prone to chipping or delamination. Complete and partial contour zirconia designs for crowns and fixed dental prostheses: a clinical report. J Prosthet Dent. Eur J Oral Sci. Effect of alumina dopant on transparency of tetragonal zirconia. J Nanomater. Zhang Y. Making yttria-stabilized tetragonal zirconia translucent. Dent Mater. Microwave sintering of transparent alumina.

Ceramics International

Mater Lett. J Am Ceram Soc. Optical properties of pre-colored dental monolithic zirconia ceramics. J Dent. Influence of coloring procedure on flexural resistance of zirconia blocks.

Ceramics International

Effect of the number of coloring liquid applications on the optical properties of monolithic zirconia. Rinke S, Fischer C.

Range of indications for translucent zirconia modifications: clinical and technical aspects. Quintessence Int. Effect of the amount of thickness reduction on color and translucency of dental monolithic zirconia ceramics. J Adv Prosthodont. Contrast ratio of veneering and core ceramics as a function of thickness. Int J Prosthodont. Comparison of four monolithic zirconia materials with conventional ones: contrast ratio, grain size, four-point flexural strength and two-body wear. J Mech Behav Biomed Mater. Wear of enamel opposing zirconia and lithium disilicate after adjustment, polishing and glazing.

A study on the in-vitro wear of the natural tooth structure by opposing zirconia or dental porcelain. Lohbauer U, Reich S.

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Antagonist wear of monolithic zirconia crowns after 2 years. Clin Oral Investig.

In vitro evaluation of marginal discrepancy of monolithic zirconia restorations fabricated with different CAD-CAM systems. Influence of aging on flexural strength of translucent zirconia for monolithic restorations. Mechanical behavior of a Y-TZP ceramic for monolithic restorations: effect of grinding and low-temperature aging. Mater Sci Eng C. J Esthet Restor Dent. Fracture rate of monolithic zirconia restorations up to 5 years: a dental laboratory survey. Prosthet Dent.

All-ceramic or metal-ceramic tooth-supported fixed dental prostheses FDPs? A systematic review of the survival and complication rates. Partm: multiple-unit FDPs. Biodegradation of restorative metallic systems.

Ceramics for Dental Applications: A Review

Adv Dent Res. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Five-year clinical results of zirconia frameworks for posterior fixed partial dentures.

Measuring the Real Fracture Toughness of Ceramics: ASTM C | SpringerLink

Effect of core design and veneering technique on damage and reliability of Y-TZP-supported crowns. Flexural strength of a layered zirconia and porcelain dental all-ceramic system. Influence of veneering porcelain thickness and cooling rate on residual stresses in zirconia molar crowns. Load-bearing capacity and failure types of anterior zirconia crowns veneered with overpressing and layering techniques.

Effect on in vitro fracture resistance of the technique used to attach lithium disilicate ceramic veneer to zirconia frameworks.

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  4. In vitro evaluation of fracture strength of zirconia restoration veneered with various ceramic materials. Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramic-based dental prostheses?