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Statement of problem Current computer-aided design and computer-aided manufacturing (CAD-CAM) technology has digitalized some traditional prosthodontic processes, but manual interventions are still needed for both clinical and dental laboratory procedures, and improved digital workflows are required. Purpose The purpose of this retrospective clinical study was to develop a straightforward completely digital workflow to fabricate monolithic zirconia crowns and evaluate clinical efficiency and prosthetic outcomes. Material and methods Self-glazed zirconia crowns (N=229) were placed in 177 participants between 2016 and 2019 with a completely digital workflow. The extent of clinical adjustment needed for each crown was recorded and then divided into 3 categories: zero adjustment, minimal adjustment, and unacceptable. Color match and marginal adaption were evaluated according to the modified US Public Health Service (USPHS) criteria. Results A total of 213 (93.0%) crowns required zero adjustment during clinical evaluation, 11 (4.8%) needed minimal adjustment, and 5 (2.2%) were deemed unacceptable since they could not meet the clinical requirements through adjustment. Except for the unacceptable crowns, the marginal adaption of the remaining 224 crowns was rated as Alfa and the color match as Alfa (91.5%), Bravo (6.3%), and Charlie (2.2%). Conclusions The self-glazed monolithic zirconia crowns fabricated with the completely digital workflow provided efficient and satisfactory clinical performance.

Statement of problem The accuracy of impressions for implant-supported prostheses is essential to ensure a passive fit of the definitive prosthesis. Intraoral scanners (IOSs) have been developed as an alternative to complete-arch implant-supported restorations; however, whether they are sufficiently accurate when more than 3 nonaligned implants are involved is unclear. Purpose The purpose of this pilot clinical study was to determine whether the fit of complete-arch zirconia implant-supported frameworks processed on a cast obtained with an IOS and adjusted with an auxiliary device is equivalent to a prosthesis obtained from an elastomeric impression. Material and methods Twelve consecutive participants who were ready for complete-arch restorations on already osseointegrated implants were enrolled. Two records were made, one open-tray with polyether and splinted impression copings and the second with an IOS. A verification gypsum device was used for the elastomeric impression, and a prefabricated auxiliary device was used to adjust the intraoral scans. Two zirconia frameworks with the same design were processed and evaluated intraorally by 2 independent calibrated observers. Results In 11 of the 12 participants, the digitally processed prosthesis was preferred over the conventionally processed prosthesis. The clinical fit of the prostheses obtained with the completely digital workflow was better than that of those obtained with the conventional workflow. Conclusions The use of a prefabricated auxiliary device after intraoral scanning allowed delivery of complete-arch implant-supported monolithic zirconia prostheses with a fit better than those fabricated from conventional impressions.

An orthodontic magnetic extrusion technique is described for the management of an extensively damaged maxillary premolar. A cylindrical neodymium-iron-boron (Nd2Fe14B) magnet was attached to the remaining tooth structure, and a second magnet was placed on a resin-bonded partial denture. A 4.5-mm extrusion was obtained after 3 adjustments, and the tooth was prepared with a 3-mm buccal and 2-mm lingual ferrule by following a biologically oriented preparation technique and restored with a monolithic zirconia crown. Eighteen months after completing the treatment, no evidence of soft tissue dehiscence, abnormal tooth mobility, endodontic failure, or root resorption was found.

Background/purpose Advancements in digital dentistry and the development of intraoral scanners (IOS) have provided clinicians with an accurate and efficient alternative to analog impressions. The aim of this study was to assess the accuracy of the marginal and internal fit of 5-unit monolithic zirconia fixed dental prostheses (FDPs) fabricated with CAD/CAM technology using direct and indirect digitalization methods. Material and methods Three teeth in a maxillary typodont model were prepared to receive a 5-unit zirconia FDP. Six different groups were created according to the type of scanner (intraoral and extraoral) and the type of workflow. For direct workflow, the typodont was scanned with two different IOS (3Shape Trios 3 [3S-IOS] and Cerec Omnicam [C-IOS]). For indirect workflow, after conventional impressions were obtained, the impressions (IMP) were scanned with two different laboratory scanners (3S-IMP and C-IMP). After the impressions were poured, the stone (STN) casts were scanned with the same laboratory scanners (3S-STN and C-STN). Sixty 5-unit monolithic zirconia FDPs (10 in each group) were designed and milled. The marginal and internal fit was assessed. Results The mean marginal gap values were 78.2±9 μm in the IOS group, 82.6± 9 μm in the IMP group, and 82.6±9 μm in the STN group, indicating no statistically significant differences among groups (p > 0.05). The mean axial gap values were 77.7 ± 10 μm in IOS group, 83.61 ± 15 μm in the IMP group, and 84.5±9 μm in the STN group, indicating no statistically significant differences among groups (p > 0.05). Conclusion The marginal and internal fit of 5-unit monolithic zirconia FDPs fabricated with direct and indirect digital scans were similar. The smallest gap values were observed at the marginal region while the greatest gap values were detected at the occlusal region.

Adult patients with bilateral cleft lip and palate present unique challenges for prosthodontic treatment because of mobility of the premaxillary segment, oral-nasal communication, multiple missing and malpositioned anterior teeth, unfavorable soft tissues, and scar tissue underneath the maxillary lip. This clinical report describes the prosthodontic treatment of an adult patient with a terminal maxillary dentition and bilateral cleft palate, by using 5 dental implants and a 1-piece complete-arch fixed implant-supported prosthesis made of monolithic zirconia. The zirconia prosthesis aided in rigidly splinting not only the implants but also in orthopedically splinting the mobile premaxillary segment to the maxilla. Additional surgical and prosthodontic considerations in splinting the mobile premaxilla as well as biomechanical principles involved in management of such patients are also presented in this article.

Objective To investigate the intraoral development and kinetics of low-temperature degradation (LTD) in second-generation 3 mol.% yttria-doped tetragonal zirconia polycrystal (3Y-TZP) monolithic prostheses, as well as the influence of masticatory mechanical stress and glaze layer on it. Methods A total of 101 posterior tooth elements were included in a prospective clinical study, which included ex vivo LTD monitoring (at baseline, 6 months, 1 year, and 2 years) using Raman spectroscopy (n = 2640 monoclinic phase measurement points per evaluation time) and SEM. Four types of areas (1–2 mm2 surface, 6 on molars, and 4 on premolars) were analyzed on each element surface: occlusal, axial, glazed, or unglazed. Raman depth mapping and high-resolution SEM were performed on the selected samples. Results LTD developed in 3Y-TZP monolithic restorations 6 months after intraoral placement and progressed with time. After two years, the tetragonal-to-monoclinic transformation was non-uniform, with the presence of localized clusters of transformed grains. In axial areas, the grain aspect was typical of the classical nucleation-growth process reported for LTD, which progresses from the surface to a depth of several tens of microns. However, in occlusal areas, tribological stress generated surface crushing and grain pull-out from the clusters, which induced an underestimation of the aging process when the evaluation was limited to monoclinic phase quantification. Glazing cannot be considered a protection against LTD. Significance If LTD occurs in dental prostheses in the same way as in orthopedic prostheses, its clinical impact is unknown and needs to be further studied.

The mechanical behavior of ceramic endocrowns is unclear.The purpose of this in vitro and 3-dimensional finite element analysis (3D-FEA) study was to evaluate the mechanical behavior of endodontically treated teeth restored with ceramic endocrowns made by using different computer-aided design and computer-aided manufacturing (CAD-CAM) systems.Sixty mandibular human molars were endodontically treated, prepared for endocrowns, and divided into 4 groups (n=15) according to the following various ceramic systems: leucite-based glass-ceramic (LC group), lithium disilicate-based glass-ceramic (LD group), glass-ceramic based on zirconia-reinforced lithium silicate (LSZ group), and monolithic zirconia (ZR group). After adhesive bonding, the specimens were subjected to thermomechanical loading and then to fracture resistance testing in a universal testing machine. The failure mode of the specimens was qualitatively evaluated. Three-dimensional FEA was performed to evaluate the stress distribution in each group. Data were analyzed by using a 1-way ANOVA and the Tukey HSD test (α=.05).Statistically significant differences among the groups were observed (P.05). The outcomes of the LC, LD, and LSZ groups were similar (1178 N, 1935 N, and 1859 N) but different from those of the ZR group (6333 N). The LC and LD groups had a higher ratio of restorable failures, while LSZ and ZR had more nonrestorable failures. Fractographic analysis indicated a regular failure pattern in the ZR group and irregular failure patterns in the other groups. Three-dimensional FEA revealed similar values and stress pattern distributions among the groups.The mechanical performance of monolithic zirconia was better than that of the other ceramic endocrowns considered in this research; however, monolithic zirconia presented a higher rate of catastrophic tooth structure failure.

New zirconia compositions with optimized esthetic properties have emerged due to the fast-growing technology in zirconia manufacturing. However, the large variety of commercial products and synthesis routes, make impossible to include all of them under the general term of “monolithic zirconia ceramics”. Ultra- or high translucent monolithic formulations contain 3–8 mol% yttria, which results in materials with completely different structure, optical and mechanical properties. The purpose of this study was to provide an update to the current knowledge concerning monolithic zirconia and to review factors related to strength and aging resistance. Factors such as composition, coloring procedures, sintering method and temperature, may affect both strength and aging resistance to a more or less extend. A significant reduction of mechanical properties has been correlated to high translucent zirconia formualtions while regarding aging resistance, the findings are contradictory, necessitating more and thorough investigation. Despite the obvious advantages of contemporary monolithic zirconia ceramics, further scientific evidence is required that will eventually lead to the appropriate laboratory and clinical guidelines for their use. Until then, a safe suggestion should be to utilize high-strength partially-stabilized zirconia for posterior or long span restorations and fully-stabilized ultra-translucent zirconia for anterior single crowns and short span fixed partial dentures.

Statement of problem Information regarding the precision of monolithic zirconia crowns fabricated by using a standard computer-aided design and computer-aided manufacturing (CAD-CAM) workflow is available. However, information on the effect of a modified workflow using 3D laboratory scanning and/or cone beam computed tomography (CBCT) for monolithic zirconia crown fabrication is lacking. Purpose The purpose of this in vitro study was to evaluate the effect of different scans on the marginal fit of CAD-CAM monolithic zirconia crowns fabricated by 3D laboratory scanning and CBCT. Material and methods An extracted maxillary left first molar was prepared and digitized by using a 3D laboratory scanner (D900; 3Shape A/S) (control group). The tooth was also scanned by CBCT (i-CAT; Imaging Sciences) to generate a second virtual 3D model (CBCTscan group). A tooth cast out of polyurethane (PU) (Zenotec Model; Wieland) was reproduced from the CBCT data by using a CAD software program (Dental System 2.6; 3Shape A/S) and milling machine (CORiTEC 550i; imes-icore) and further scanned by using the 3D laboratory scanner to generate a third virtual 3D model to represent a clinical scenario where a patient's cast is needed (PU3DLab group). A monolithic zirconia crown design (cement space: margin 40 μm, 1 mm above 70 μm) was used on the virtual models, and crowns were fabricated out of presintered zirconia blocks (ZenostarT4; Wieland) by using a 5-axis milling machine (CORiTEC 550i; imes-icore). The crowns were sintered (Sinterofen HT-S Speed; Mihm-Vogt), and the vertical marginal discrepancy (VMD) was measured by ×100-magnification microscopy. Measurements were made at 384 points in 3 groups of 16 specimens. The measurements for each specimen were averaged, and VMD mean values were calculated. The Kruskal-Wallis test was used for the statistical analysis (α=.05). The Mann-Whitney U test and Bonferroni adjustment were further used to compare the pairs (α=.017). Results The mean VMD value was 41 μm (median: 38 μm) for the control group, 44 μm (median: 42 μm) for the CBCTscan, and 60 μm (median: 58 μm) for the PU3DLab. No significant difference was found between control and CBCTscan groups (P=.274). However, there was a significant difference between control and PU3DLab and CBCTscan and PU3DLab groups (P Conclusions Marginal fit of the crowns fabricated by using the 3D laboratory scanner and through the direct use of CBCT was better than that of the crowns fabricated by using the workflow that combined the use of CBCT, PU cast, and 3D laboratory scanner. All tested protocols enabled the fabrication of monolithic zirconia crowns with a marginal discrepancy smaller than 120 μm.

Objective Significant technological advances are occurring in the dental industry that are complementary to the introduction of monolithic restorative materials. Glidewell Laboratories has been at the forefront of innovation of these developments and these internal developments may be instructive of future trends in dentistry. Methods This paper examines internal Glidewell data from 2010 to 2019 about zirconia-related technology and provides context for some technological advancements at Glidewell Laboratories. Results The trend towards increased use of monolithic zirconia in both, posterior and anterior regions continues to grow. With the advent of intraoral scanners and chairside CAD/CAM technologies, more and more dentists are able to provide same day dentistry. Despite the many clinicians that have made the leap to digital dentistry the low rate of growth in ownership and utilization means PVS impression will be common place long into the future. Glidewell Laboratories has an advanced, automated impression scanning, AI crown design, automated milling and glazing system extending the advantages of digital dentistry to all dentists and pushing the bounds of the technology further. Significance This paper describes the first use of AI GAN to design dental crowns and also shows the strong path monolithic zirconia restorations are paving into the future. Supporting technologies will continue to evolve around zirconia and this paper provides a snapshot of those that exist and a few that are in development.

Application of monolithic zirconia crowns (MZCs) with reduced thickness to the molar region has been proposed, but potential complications have yet to be fully evaluated in laboratory tests. The present study aimed to develop a clinically relevant load-to-failure test in combination with fatigue treatments involving thermal and mechanical cycling (TC and MC) to evaluate the fracture resistance of molar MZCs. MZCs with a minimal thickness of 0.5 mm were bonded to dies made of resin-based composite (RBC), epoxy resin (EP), or polyoxymethylene-copolymer (POM-C). The samples were either untreated (UT) or subjected to TC (5–55 °C for 1 × 105 cycles) and MC (300 N for 2.4 × 106 cycles). The stress generated by TC and MC was simulated by finite element modeling. The load-to-failure test was performed using an inverse V-shaped two-plane indenter and was followed by fractographic analysis. The median values of fracture load for MZC/RBC and MZC/EP in the TC group were significantly lower than those in the UT group. MC also decreased the median value of fracture load for MZC/RBC significantly, but not that for MZC/EP and MZC/POM-C. Fractography revealed that the fracture started in the cervical area in all groups, which is similar to clinically failed crowns. The simulation confirmed stress concentration at the cervical area in both TC and MC groups. The present study suggests that the load-to-failure test using a two-plane indenter could induce clinically relevant fracture of MZCs, the vulnerability of the MZCs depends largely on the die material employed, and MZCs are more likely to be damaged by thermal fatigue than mechanical fatigue.

Sjögren syndrome is a chronic autoimmune disorder with xerostomia, increased tooth wear, high rates of caries, and repeated failure of dental restorations as the main oral symptoms. These render the prosthetic treatment challenging. This clinical report describes a contemporary approach to the treatment of a patient with Sjögren syndrome using translucent multilayered monolithic zirconia restorations and focuses on the treatment protocols before, during, and after the prosthetic treatment.

The clinical applications of high-translucency monolithic zirconia restorations have increased. Chairside and laboratory adjustments of these restorations are inevitable, which may lead to increased roughness and reduced strength. The influence of grinding and polishing on high-translucency zirconia has not been investigated.The purpose of this in vitro study was to compare the roughness averages (Ra) of ground and polished zirconia and investigate whether roughness influenced strength after aging.High-translucency zirconia disks were milled, sintered, and glazed according to the manufacturer's recommendations. Specimens were randomized to 4 equal groups. Group G received only grinding; groups GPB and GPK received grinding and polishing with different polishing systems; and group C was the (unground) control group. All specimens were subjected to hydrothermal aging in an autoclave at 134°C at 200 kPa for 3 hours. Roughness average was measured using a 3-dimensional (3D) optical interferometer at baseline (Ra1), after grinding and polishing (Ra2), and after aging (Ra3). A biaxial flexural strength test was performed at a rate of 0.5 mm/min. Statistical analyses were performed using commercial software (α=.05).Group G showed a significantly higher mean value of Ra3 (1.96 ±0.32 μm) than polished and glazed groups (P.001), which showed no statistically significant difference among them (GPB, 1.12 ±0.31 µm; GPK, 0.88 ±0.31 µm; C: 0.87 ±0.25 μm) (P.05). Compared with baseline, the roughness of groups G and GPB increased significantly after surface treatments and after aging, whereas aging did not significantly influence the roughness of groups GPK or C. Group G showed the lowest mean value of biaxial flexural strength (879.01 ±157.99 MPa), and the highest value was achieved by group C (962.40 ±113.84 MPa); no statistically significant differences were found among groups (P.05). Additionally, no significant correlation was detected between the Ra and flexural strength of zirconia.Grinding increased the roughness of zirconia restorations, whereas proper polishing resulted in smoothness comparable with glazed surfaces. The results provide no evidence that grinding and polishing affect the flexural strength of zirconia after aging.

In a patient with edentulism, distally tilted implants with a novel sloped implant platform were used to minimize the discrepancy between the implant platform and alveolar bone crest and to restore complete-arch monolithic zirconia implant-supported fixed prostheses.

Statement of problem The effect of thermal aging on the color stability of monolithic zirconia has not been thoroughly investigated. Purpose The purpose of this in vitro study was to evaluate the color stability before and after thermocycling of monolithic zirconia specimens, which were either preshaded or characterized in the laboratory through the assessment of color parameters L*, a*, and b*. Material and methods A total of 80 specimens (10×10×15 mm) were prepared from zirconia disks (BruxZir) and divided into 2 groups. The first group consisted of preshaded specimens from disks 100, 200, 300, and 400, and the second group consisted of white specimens characterized before the sintering stage with coloring liquids in shades A2, B2, C2, and D2. Ten specimens of each shade were used. A double-beam ultraviolet-visible light recording spectrophotometer was used to assess the color parameters L*, a*, and b* before and after thermocycling. The color difference ΔE was calculated based on ΔE=[(ΔL*) 2 +(Δa*) 2 +(Δb*) 2 ] ½ . The reliability of the examiner was investigated by MedCalc v12.5 software, and the tests of normality, homogeneity of variances, and 1-way ANOVA statistical analysis of variance were performed by IBM Statistics SPSS v20.0 software (α=.05). Results No statistically significant ΔE ( P >.05) was observed among the different groups after thermocycling. All ΔE values were below the limit of the 3.7 that an untrained observer can perceive. Only for the specimens in shades 200 and 400 was ΔE above 1, revealing a visible color difference, which, however, was still clinically acceptable. The L*, a*, and b* values for both liquid-shaded and preshaded zirconia specimens were not significantly affected by thermocycling. A higher color stability for laboratory-characterized compared with preshaded monolithic zirconia was observed irrespective of the color shade. Conclusions Within the limitations of this in vitro study, monolithic zirconia specimens of any shade, either preshaded or characterized in the laboratory, can be considered as color-stable materials after thermocycling.

The effect of the number of external staining applications on the color, translucency, and surface roughness of monolithic zirconia is not known.The purpose of this in vitro study was to investigate the effect of glazing and repeated external staining on the color, translucency, and surface roughness of 2 types of monolithic zirconia with 2 different thicknesses.Thirty-two 10×10-mm monolithic zirconia blocks, of which 16 were super high translucent and 16 were high translucent, were milled. The thickness of half the blocks was 0.7 mm, and the others were 1.2-mm thick. Four specimens in each subgroup were colored with value stain, and the other half with yellow stain. Staining was repeated twice for each specimen. The color and translucency of each specimen were measured before overglazing as the baseline, after overglazing, and after each staining process by using a spectrophotometer. The surface roughness (Ra) was measured after overglazing, the first staining, and the second staining. Data were analyzed by using repeated measures ANOVA and the independent t test (α=.05).The number of coloring, type of coloring, and thickness changed the optical properties of monolithic zirconia. a∗, b∗, L∗ Value and ΔE were affected by the stage of firing (glazing, first staining, and second staining) (P.001). ΔE Increased after the first and second staining in each type and thickness of monolithic zirconia and each type of stain. The amount of ΔE change was more for the first staining stage. The color difference (ΔE) after overglazing ranged from 3.08 to 3.75. The highest changes in color were related to the first staining with yellow colorant of super-high-translucent monolithic zirconia (cubeX²) with 0.7-mm thickness (ΔE=17.62). The surface roughness of the specimens was affected by the number of colorings (P.001). In all groups, the first staining increased the surface roughness, and the second staining decreased the surface roughness. The type of monolithic zirconia (P=.756), thickness (P=.735), and type of stain (P=.239) had no significant effect on the surface roughness.The first stage of staining with both stains caused more color change in all types and thicknesses of monolithic zirconia. Translucency increased after glazing and decreased after the first and second staining. The first staining increased the surface roughness, and the second decreased the surface roughness.

The aim of this study was to evaluate the effect of different preparation and framework designs on the retention of posterior resin bonded fixed dental prostheses (RBFDPs) made from monolithic zirconia ceramic. Forty-eight caries-free upper premolars and forty-eight upper third molars were used in this study. The teeth were randomly divided into six main groups (n = 8 each) according to the preparation design of two-retainer RBFDPs: narrow or wide rest, combined with 0, 1 or 2 retainer wings. All RBFDPs were milled from monolithic zirconia (KATANA Zirconia ML). They were bonded using Panavia V5 with its corresponding primer, and underwent thermodynamic loading (98 N, 1,200,000 cycles). Retention was evaluated for the surviving RBFDPs in a universal testing machine by means of a debonding test. Failure modes were evaluated using a light microscope. Data was statistically analyzed by Kruskal-Shapiro-Wilk followed by Mann-Whitney with Bonferroni correction for multiple testing. The survival rates after the chewing simulation were 75% (group narrow rest/no retainer wing), 62.5% (group wide rest/no retainer wing) and 100% (the other groups). The mean retention ranged from 31 N to 766 N. Designs with two retainer wings showed significantly higher bond strength than the other designs (p ≤ 0.05). The rest width did not show a significant effect on the retention. Posterior RBFDPs with a modified design (occlusal rest and two retainer wings) exhibited promising durability and retention. Designs with two additional retainer wings should be preferred over designs with one or no retainer wing, irrespectively of the rest width.

OBJECTIVES This double-blinded randomized controlled trial investigated economic performance indicators (EPI) in terms of time-efficiency and production costs of 3-unit monolithic zirconium-dioxide (ZrO2) implant fixed dental prostheses (iFDP) in three different workflows. METHODS Twenty patients with two Straumann Tissue-Level-Implants received three iFDPs; two were fabricated in proprietary complete digital workflows with intraoral optical scanning and model-free fabrication with company-related CAD/CAM lab-software while one iFDP was manufactured on digitized casts from conventional impressions. The sequence of impression-taking for the three workflows (TRIOS 3/3Shape [Test-1]; Virtuo Vivo/Dental Wings [Test-2]; Impregum/3M Espe [Control]) was randomly allocated. Sixty iFDPs bonded to ti-base abutments were analyzed. Clinical and technical worksteps for Test-1/Test-2/Control were recorded and evaluated for time-efficiency including cost-analysis (CHF=Swiss Francs) using ANOVA-Tests (significance level α=0.05). RESULTS Mean total work time, as the sum of clinical plus technical steps, was 97.5 min (SD±23.6) for Test-1, 193.1 min (SD±25.2) for Test-2, and 172.6 min (SD±27.4) for Control. Times were significantly different between Test-1/Test-2 (p

Objective this in vitro investigation aims to evaluate and compare optical properties of three types of esthetic CAD-CAM monolithic multi-layered zirconia materials with a control (conventional lithium disilicate, IPS e. max CAD). Methods Four monolithic CAD-CAM ceramic materials were investigated: Ceramill Zolid® FX Multilayer (ZF), IPS e. max® ZirCAD MT Multi (ZM), Katana® STML (KS) and one lithium disilicate glass-ceramics as a control (IPS e. max® CAD LT; LC). A total of 72 (15 × 15 × 1 mm) samples were CAD CAM fabricated and sintered based on sample-size power calculations, and each material comprised 18 samples. The translucency and opalescence parameters with the contrast ratio were evaluated with a dental spectrophotometer over the backgrounds of black and white. The data were analyzed by ANOVA, then Bonferroni post hoc comparison test was made between groups. The statistical significance was set at p < 0.05. Results Zirconia materials revealed lower optical properties than the lithium disilicate control LC (P < 0.05). TP values ranged from 14.174 to 20.439. No differences were detected between the zirconia products in terms of TP and CR (P = 1.000). OP values ranged from 5.068 to 10.097. The lowest OP values were found statistically significant for ZF followed by KS and ZM (P = 1.000). LC had the highest TP and OP values, as well as the lowest CR (p < 0.05). Conclusions The optical properties of monolithic zirconia systems tested here are still lower than those of lithium disilicate glass-ceramics. The only difference observed between the monolithic CAD CAM zirconia materials, was for the low opalescence parameter for the ZF. Clinical significance Multi-layered monolithic zirconia systems have better esthetics by shade layers resembling natural tooth color gradients. CAD-CAM technology allowed for in-office milling and shaping of restorations using these systems. This study reports on their optical properties affecting human vision/perception of natural tooth shade to conclude about their use in the esthetic zones., Monolithic ceramic systems, Multilayered zirconia, Lithium disilicate, Opalescence, Contrast ratio, Translucency.

Statement of problem Dental laboratories use different computer-aided design and computer-aided manufacturing (CAD-CAM) systems to fabricate fixed prostheses; however, limited evidence is available concerning which system provides the best marginal discrepancy. Purpose The purpose of this in vitro study was to evaluate the marginal fit of 5 different monolithic zirconia restorations milled with different CAD-CAM systems. Material and methods Thirty monolithic zirconia crowns were fabricated on a custom-designed stainless steel die and were divided into 5 groups according to the type of monolithic zirconia crown and the CAD-CAM system used: group TZ, milled with an MCXL milling machine; group CZ, translucent zirconia milled with a motion milling machine; group ZZ, zirconia milled with a dental milling unit; group PZ, translucent zirconia milled with a zirconia milling unit; and group BZ, solid zirconia milled using an S1 VHF milling machine. The marginal fit was measured with a binocular microscope at an original magnification of ×100. The results were tabulated and statistically analyzed with 1-way ANOVA and post hoc surface range test, and pairwise multiple comparisons were made using Bonferroni correction (α=.05). Results The type of CAD-CAM used affected the marginal fit of the monolithic restoration. The mean (±SD) highest marginal discrepancy was recorded in group TZI at 39.3 ±2.3 μm, while the least mean marginal discrepancy was recorded in group IZ (22.8 ±8.9 μm). The Bonferroni post hoc test showed that group TZI was significantly different from all other groups tested ( P Conclusions Within the limitation of this in vitro study, all tested CAD-CAM systems produced monolithic zirconia restorations with clinically acceptable marginal discrepancies; however, the CAD-CAM system with the 5-axis milling unit produced the best marginal fit.

Purpose The objective of the study was to evaluate the translucency of different thickness of a translucent zirconia before and after accelerated aging. Materials and methods Sixty slices of translucent zirconia were obtained by cutting InCoris TZI blocks into slices using Micracut precision cutting machine. The slices were divide into four groups (n = 15) according to their thickness (0.5 mm, 0.8 mm, 1 mm and 1.2 mm). CIE lab coordinates were measured for each slice against black and white backgrounds using vita easy shade and TP was calculated. All specimens were subjected to accelerated aging using autoclave (134 oC, 0.2 MPa) and TP was calculated after accelerated aging. One way analysis of variance combined with a Tukey-post hoc test was used to analyze the data obtained ( P = 0.05). Results Results of the present study showed that thickness of zirconia has determinal effect on its translucency as there was no statistically significant difference in TP between 0.5 mm and 0.8 mm thicknesses while there were statistically significant differences in TP between 0.8 mm, 1.0 mm, 1.2 mm. Effect of aging was significant on 0.5 mm thickness. Conclusion Thickness of zirconia has significant effect on translucency. Aging has significant effect on thinner sections of zirconia. More research is required on zirconia towards making the material more translucent for its potential use as esthetic monolithic restoration.

Background Recent introduction of computer-aided design/computer-aided manufacturing (CAD/CAM) monolithic zirconia dental prostheses raises the issue of material low thermal degradation (LTD), a well-known problem with zirconia hip prostheses. This phenomenon could be accentuated by masticatory mechanical stress. Until now zirconia LTD process has only been studied in vitro . This work introduces an original protocol to evaluate LTD process of monolithic zirconia prostheses in the oral environment and to study their general clinical behavior, notably in terms of wear. Methods/design 101 posterior monolithic zirconia tooth elements (molars and premolars) are included in a 5-year prospective clinical trial. On each element, several areas between 1 and 2 mm 2 (6 on molars, 4 on premolars) are determined on restoration surface: areas submitted or non-submitted to mastication mechanical stress, glazed or non-glazed. Before prosthesis placement, ex vivo analyses regarding LTD and wear are performed using Raman spectroscopy, SEM imagery and 3D laser profilometry. After placement, restorations are clinically evaluated following criteria of the World Dental Federation (FDI), complemented by the analysis of fracture clinical risk factors. Two independent examiners perform the evaluations. Clinical evaluation and ex vivo analyses are carried out after 6 months and then each year for up to 5 years. Discussion For clinicians and patients, the results of this trial will justify the use of monolithic zirconia restorations in dental practice. For researchers, the originality of a clinical study including ex vivo analyses of material aging will provide important data regarding zirconia properties. Trial registration: ClinicalTrials.gov Identifier: NCT02150226 .

Statement of problem With the development of translucent zirconia, questions regarding the influence of cements on the final color of monolithic zirconia restorations have arisen. Purpose The purpose of this in vitro study was to evaluate color changes in terms of the perceptibility and acceptability of monolithic zirconia-and-cement combinations with 2 monolithic zirconia thicknesses and 3 types of cement. The translucency parameters of these combinations were also compared. Material and methods Sixty monolithic zirconia ceramic disks were milled with 2 different thicknesses (0.6 mm and 1 mm). A conventional glass ionomer cement, a resin-modified glass ionomer cement, and a resin cement from the same manufacturer were applied to the ceramic surfaces of both thickness disks (n=10). Translucencies and color changes of the monolithic zirconia specimens after cement application were examined by using a spectrophotometer, and translucency parameters (TPs) and color changes (?Es) were calculated and statistically analyzed. Results Colors and TPs of the zirconia disks changed significantly after being cemented to 0.6- and 1-mm-thick disks (P

Subtractive manufacturing has become the dominant method in fabricating zirconia dental restorations while additive manufacturing is emerging as a potential alternative. The aim of this in vitro study was to investigate the performance of stereolithography (SLA) and milling in fabricating monolithic zirconia crowns with different finish line designs. Full-contour crowns with three finish lines (chamfer, rounded shoulder, knife-edge) were designed and fabricated by SLA and milling. Fabrication accuracy was accessed by 3D deviation analysis and margin quality was characterized under microscopes. The obtained root mean square value was significantly influenced by finish line design (P 0.05) but not by fabrication method (P＞0.05). However, the color-difference map showed crowns fabricated by SLA and milling had different error distribution in external surfaces. SLA-printed crowns exhibited margins of rounded line angle and without small flaws, although large chippings were found in knife-edged crowns. In milling group, crowns showed margins of sharp line angle and with separate chippings. More and larger margin chippings were found in knife-edged crowns by milling. The results indicate that SLA and milling can fabricate monolithic zirconia crowns of comparable accuracy and knife-edged crowns are prone to large margin chippings by either of the two manufacturing methods.

Statement of problem Chairside and laboratory adjustments of translucent monolithic zirconia restorations sintered by short cycles are inevitable. Therefore, the optical properties of these materials should be evaluated under conditions similar to those in the oral environment. Purpose The purpose of this in vitro study was to evaluate the color stability and the translucency changes of translucent monolithic zirconia after the sintering procedure, simulated clinical adjustment, and coffee thermocycling. Material and methods Eighty monolithic zirconia disks (diameter: 10 mm; thickness: 1 mm) were milled from 4 zirconia brands (Zolid FX Preshaded, Zolid FX White, DD Cubex2, and DD Bio ZX2). Two sintering procedures (standard or speed) were performed for each zirconia brand. The color coordinates and the translucency after sintering, clinical adjustment, and after 5000 cycles in a coffee solution were analyzed with a reflectance spectrophotometer, and the translucency parameters and contrast ratio were measured. The color differences and the translucency variations were calculated for each tested variable and statistically analyzed with 2-way ANOVA and pairwise comparison (α=.05). Results Both clinical adjustment procedure and coffee thermocycling had significant influence on color differences (P Conclusions The color and the translucency of the translucent zirconia can be affected by the type of the zirconia brand and the sintering protocol. Furthermore, the color and the translucency were affected by both the clinical adjustment procedure and the coffee thermocycling, but not beyond the clinically acceptable limit of the color difference. Clinical Implications

Mechanical failure of zirconia-based full-arch implant-supported fixed dental prostheses (FAFDPs) remains a critical issue in prosthetic dentistry. The option of full-arch implant treatment and the biomechanical behaviour within a sophisticated screw-retained prosthetic structure have stimulated considerable interest in fundamental and clinical research. This study aimed to analyse the biomechanical responses of zirconia-based FAFDPs with different implant configurations (numbers and distributions), thereby predicting the possible failure sites and the optimum configuration from biomechanical aspect by using finite element method (FEM). Five 3D finite element (FE) models were constructed with patient-specific heterogeneous material properties of mandibular bone. The results were reported using volume-averaged von-Mises stresses (σVMVA) to eliminate numerical singularities. It was found that wider placement of multi-unit copings was preferred as it reduces the cantilever effect on denture. Within the limited areas of implant insertion, the adoption of angled multi-unit abutments allowed the insertion of oblique implants in the bone and wider distribution of the multi-unit copings in the prosthesis, leading to lower stress concentration on both mandibular bone and prosthetic components. Increasing the number of supporting implants in a FAFDPs reduced loading on each implant, although it may not necessarily reduce the stress concentration in the most posterior locations significantly. Overall, the 6-implant configuration was a preferable configuration as it provided the most balanced mechanical performance in this patient-specific case.

Monolithic zirconia restorations are increasingly common. Dual-polymerizing cements have been advocated for cementation. The opacious nature of zirconia restoration can attenuate light, compromising optimal resin polymerization and eventually restoration debonding.The purpose of this in vitro study was to evaluate the influence of material thickness on light irradiance, radiant exposure, and the degree of monomer conversion (DC) of 2 dual-polymerizing resin cements light-polymerized through different brands of monolithic zirconia.Dual-polymerizing resin cements (RelyX Ultimate; 3M-ESPE, and Variolink II; Ivoclar, Vivadent) were mixed according to the manufacturers' instructions with a film thickness of 40 μm, placed under a 10 × 10 mm specimen of monolithic zirconia (Prettau Anterior by Zirkonzahn, Katana by Noritake, BruxZir by Glidewell, and Zenostar by Wieland) and a zirconia core control (ICE zirkon by Zirkonzahn) at various thicknesses (0.50, 1.00, 1.50, and 2.00 mm, n = 5 of each thickness). Each specimen was irradiated for 20 seconds (RelyX Ultimate) and 40 seconds (Variolink II) with Elipar S10 (3M-ESPE, 1200 mW/cm(2)). The amount of irradiance and radiant exposure was quantified for each specimen. Fourier transform infrared spectroscopy was used to measure the DC from the bottom surface of the resin. Statistical analysis was performed with 2-way ANOVA and post hoc Tukey honest significant difference (HSD) tests (α = .05).Light irradiance and radiant exposure decreased as the thickness of the specimen increased (P.05) regardless of the brand. The ranking from least to highest was BruxZirICE zircon = WielandKatana = Prettau Anterior. The zirconia brand, thickness, and cement type had a significant effect on the DC (P.001). The DC decreased significantly as the thickness of the zirconia increased (P.001). Katana and Prettau Anterior showed the highest DC and BruxZir showed the lowest.The thickness of zirconia affects the DC of resin-based cements. The DC of the resin cements differed significantly between cements and among zirconia brands. More polymerizing time may be needed to deliver sufficient energy through some brands of zirconia.

To examine the effects of glass infiltration (GI) and alumina coating (AC) on the indentation flexural load and four-point bending strength of monolithic zirconia.Plate-shaped (12 mm × 12 mm × 1.0 mm or 1.5 or 2.0 mm) and bar-shaped (4 mm × 3 mm × 25 mm) monolithic zirconia specimens were fabricated. In addition to monolithic zirconia (group Z), zirconia monoliths were glass-infiltrated or alumina-coated on their tensile surfaces to form groups ZGI and ZAC, respectively. They were also glass-infiltrated on their upper surfaces, and glass-infiltrated or alumina-coated on their lower (tensile) surfaces to make groups ZGI2 and ZAC2, respectively. For comparison, porcelain-veneered zirconia (group PVZ) and monolithic lithium disilicate glass-ceramic (group LiDi) specimens were also fabricated. The plate-shaped specimens were cemented onto a restorative composite base for Hertzian indentation using a tungsten carbide spherical indenter with a radius of 3.2mm. Critical loads for indentation flexural fracture at the zirconia cementation surface were measured. Strengths of bar-shaped specimens were evaluated in four-point bending.Glass infiltration on zirconia tensile surfaces increased indentation flexural loads by 32% in Hertzian contact and flexural strength by 24% in four-point bending. Alumina coating showed no significant effect on resistance to flexural damage of zirconia. Monolithic zirconia outperformed porcelain-veneered zirconia and monolithic lithium disilicate glass-ceramics in terms of both indentation flexural load and flexural strength.While both alumina coating and glass infiltration can be used to effectively modify the cementation surface of zirconia, glass infiltration can further increase the flexural fracture resistance of zirconia.

Objective The purpose of this study was to investigate and analyze the indentation size effect (ISE) in Vickers hardness of monolithic yttria partially stabilized zirconia (Y-TZP) dental ceramics without and with the addition of dental dye A3. The ISE is analyzed using the Mayer law, a proportional specimen resistance (PSR) model and a modified proportional specimen resistance (MPSR) model. Methods Two samples of Y-TZP dental ceramics, trade names BruxZir (provided by Glidewell Laboratories, CA, USA), were investigated. The first sample was polished Y-TZP and the second sample was polished Y-TZP with the addition of dental dye A3, by VITA Classical Shade Guide. The Vickers hardness was measured under the following loads: 0.49 N, 0.98 N, 1.96 N, 4.90, 9.81 N and 29.42 N. Thirty indentations were made on each sample, under each load. Relationships between the applied load, F, and the resulting indentation size, d, have been analyzed by the Mayer law, the PSR model and the MPSR model. Results The Meyer index (n) for both Y-TZP dental ceramics is less than 2, which indicates that hardness is dependent on test loads. The PSR model and the MPSR model were used to calculate “true” Vickers hardness or load-independent hardness. Significance All applied mathematical models are suitable for the data analysis, which is confirmed with high correlation coefficients, but the best correlation between measured values and mathematical models was achieved with the MPSR model with a correlation coefficient of 0.9999.

A digital smile design was used to create an average smile and to develop a removable interim restoration for an edentulous patient with a high smile line and different bone levels in the maxilla. The interim restoration was used as a guide to perform bone sculpturing to create space for the biological width and to restore a monolithic zirconia implant-supported fixed restoration.

Objective This study was aimed to investigate the effect of the number of coloring liquid applications on the optical properties of monolithic zirconia. Methods Eighteen monolithic zirconia specimens (27.6 mm × 27.6 mm × 2.0 mm) were fabricated and divided into 6 groups ( n = 3). Each group was designated by the number of A2-coloring liquid applications (Group I to Group V) and Group O as a control. Color and spectral distribution of the specimens were measured with a double-beam spectrophotometer. CIE L *, a * and b * relative to the standard illuminants D65 were measured in reflectance and transmittance modes. Color difference ( Δ E a b * ) , translucency parameter (TP) and opalescence parameter (OP) were calculated. All measurements were performed on five different areas of each specimen. All data were analyzed by ANOVA and multiple comparison Scheffe test, Pearson correlations and linear regression analysis ( α = 0.05). Results With the increase of the number of coloring liquid applications, CIE L * ( R 2 = 0.878) and OP values ( R 2 = 0.701) were decreased, but CIE b * ( R 2 = 0.938) was increased. However, TP values were not significantly changed. The color differences among groups ranged from 1.3 to 15.7 Δ E a b * units. Strong correlation was found between OP and Δ b * ( R 2 = 0.982, P Significance Within the limitations of this study, it can be concluded that the number of coloring liquid applications with a single shade affects the lightness, yellow chromaticity and opalescence of monolithic zirconia, although its translucency cannot be controlled by the coloring procedure.

Statement of problem Although newly developed photoinitiators can make up for the limitations of camphorquinone, their absorption spectra are different. However, little attention has been paid to the compatibility of available wavelength spectra of light-polymerization units (LPUs) and photoinitiators within resin cements. Purpose The purpose of this in vitro study was to evaluate the effect of monowave and polywave light-emitting diode (LED) units on the adhesion of dual-polymerizing self-adhesive resin cements to monolithic zirconia. Material and methods Monowave LPUs and polywave LPUs were chosen to polymerize 2 dual-polymerizing self-adhesive resin cements. Ninety-six zirconia disks were randomly divided into 4 groups as different combinations of LPUs and resin cements, namely ES-U200, BS-U200, ES-SC, and BS-SC. Resin cements were adhered to zirconia disks, and the microshear bond strength (μSBS) test was conducted after 24 hours of H2O storage (24 h) and 10 000 thermocycles (10k/TC). Failure modes were examined by stereomicroscopy and scanning electron microscopy (SEM). The degree of conversion (DC) was tested both immediately and 24 hours later. In statistical analyses, 2-way ANOVA and the Tukey honestly significant difference post hoc test were performed for μSBS and DC results, and chi-square test was performed for failure mode analysis (α=.05 for all tests). Results The 2-way ANOVA demonstrated that different combinations of LPUs and resin cements, as well as different artificial aging levels, significantly influenced microshear bond strength values (P Conclusions Within the limitation of this in vitro study, the emission spectra of LED units significantly influenced the bond strengths, DC, and failure mode of dual-polymerizing self-adhesive resin cements to zirconia at both immediate and artificial aging levels. The LPU should provide light energy to match the absorption wavelengths of photoinitiators in the resin cements.

Statement of problem To preserve the mechanical property of color-treated zirconia for optimal restoration longevity, aqueous colorants have been developed as an alternative to acid-based coloring agents. However, little is known regarding the effects of aqueous colorants on the color of zirconia. Purpose The purpose of this in vitro study was to compare the effect of aqueous coloring liquids with acid-based coloring liquids on the color of zirconia. Material and methods Eighty monolithic zirconia specimens (10×10×2 mm) were fabricated and divided into 4 groups according to their color treatment: unshaded zirconia (control), precolored zirconia, aqueous coloring liquid on zirconia, and acid-based coloring liquid on zirconia. The shaded zirconia specimens were further divided into 3 subgroups based on the number of coloring applications used (1, 3, or 6). The International Commission on Illumination (CIELab) color coordinates were measured by spectrophotometry. Results Significant differences in the CIE a∗ and b∗ values were observed between the specimen groups treated with the aqueous coloring liquid and the acid-based coloring liquid (P Conclusions Treatment with aqueous coloring liquid on zirconia produced a greater redness or yellowness compared with treatment with acid-based coloring liquid. The coloring of zirconia lowered its brightness and imparted a red/yellow hue.

The friction and wear behavior of ZrO2 + 1.07 wt.% carbon nanofiber composite and monolithic ZrO2 has been investigated using the ball-on-disk technique with alumina balls as friction partners in an unlubricated condition at room temperature. The coefficient of friction for the composite was found to be significantly lower compared to that for monolithic zirconia with relatively low wear rates for both materials. The main wear mechanism in the nanocomposite was abrasion accompanied with a pull-out of the carbon nanofibers which act in the interface as a sort of lubricating media.

Because of their relatively small scanning area, intraoral scanners may result in less accurate fixed dental prostheses (FDPs) than do laboratory scanners.The purpose of this in vitro study was to evaluate the accuracy of monolithic zirconia FDPs with different numbers of pontics fabricated with different impression techniques.The mandibular right premolars and molars of an acrylic resin model were prepared to receive 4-unit FDPs. Three master models were fabricated with epoxy resin: model NP, no pontic; model 1P, 1 pontic; and model 2P, 2 pontics. Each master model was scanned by using direct (DD) and indirect digitalization (ID). Four-unit monolithic zirconia FDPs were fabricated and divided into 3 groups (groups NP, 1P, and 2P) and then subdivided according to the digitalization technique (group DD and ID; n=10). The FDPs were also evaluated based on the presence (Po) or absence (NPo) of an adjacent pontic. The marginal, axial, and occlusal gap widths of each FDP were measured, and statistical analyses were performed to evaluate and compare the amount of gap present (α=.05).For direct digitalization, group 2P had significantly greater marginal (69.4 μm versus 60.9 μm or 62.3 μm; P.001) and axial gap widths (127.1 μm versus 108.9 μm or 110.4 μm; P.001) than group NP or 1P. Group DD resulted in significantly smaller gaps compared with group ID at marginal (64.8 μm versus 73.6 μm), axial (114.8 μm versus 124.3 μm), and occlusal (172.6 μm versus 184.1 μm) measurement locations (P.001). Greater marginal and axial gaps were noted in group Po than NPo (P.001).The length of the edentulous area significantly influenced the extent of the marginal and internal gap with the use of direct digitalization. Direct digitalization resulted in significantly smaller gap widths in all measurement areas than indirect digitalization; however, the mean differences were less than 12 μm, which is considered clinically insignificant. The presence of an adjacent pontic had a significant effect on the adjacent marginal and axial gap widths.

Statement of problem The influences of coloring and sintering procedures on the optical and mechanical properties of monolithic zirconia have not been thoroughly investigated. Purpose The purpose of this in vitro study was to investigate the effects of the coloring procedure and of varying final sintering temperatures on the translucency parameter (TP) and biaxial flexural strength (BFS) of monolithic zirconia. Material and methods Disk-shaped specimens (N=210) of 2 different monolithic zirconia brands (Vita YZ HT White [VYZa]; Vita YZ HT Color A2 [VYZb]; Prettau Zirkonzahn [PZ]; Prettau Anterior Zirkonzahn [PZA]) with a diameter of 15 mm and a thickness of 1.0 ±0.05 mm were prepared. Half of the specimens prepared from noncolored blocks (VYZa, PZ, and PZA) received coloring liquid application. Then, the specimens were divided into 3 subgroups (n=10) according to the final sintering temperatures (1350°C, 1450°C, and 1600°C). The TP was determined by using a reflection spectrophotometer, and the BFS was tested with the piston-on-3-ball method in a universal testing machine. Data were statistically analyzed by multivariate multiple regression and Bonferroni tests (α=.05). Results Significant differences were obtained among the groups based on the results of the TP and BFS ( P P P >.05). Conclusions Increased sintering temperature leads to increased translucency with minimal impact on the BFS. The coloring procedure should be considered at the time of material selection to avoid possible reduction in translucency.

Zirconia has been recently introduced in prosthetic dentistry for the fabrication of crowns and fixed partial dentures, in combination with CAD/CAM techniques. This review encompasses the specific types of zirconia available in dentistry, together with their properties. The two main processing techniques, soft and hard machining, are assessed in the light of their possible clinical implications and consequences on the long-term performance of zirconia. An update on the status of clinical trials occurring worldwide is provided.