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Objectives: To evaluate the effect of accelerated firing on 3D-printed zirconia., Methods: To check if formulae provided by ISO 6872 can be extended to thin samples, finite element analyses were carried out in advance of fabricating 3-mol% yttria-stabilized tetragonal zirconia polycrystal discs by milling and by 3D-printing. Four groups (n = 38 each) of 3D-printed specimens were produced with two nominal thicknesses (0.6 mm and 1.2 mm) and two firing strategies (long: 51 h, accelerated: 14.5 h). In the milled group (thickness 1.2 mm, n = 30), a standard firing program (9.8 h) was selected. Biaxial flexural strength tests were applied and mean strength, characteristic strength, and Weibull modulus were calculated for each group. Differences were analyzed using Welch ANOVA and Dunnett-T3 post-hoc tests., Results: Maximum tensile stresses occurring during biaxial strength testing can be calculated according to ISO 6872 for thin samples with b > 0.3 mm. Variability of measured strengths values was smaller for milled zirconia compared with 3D-printed zirconia. The 1.2-mm-thick 3D-printed samples had significantly decreased strength after accelerated firing than after long firing. However, for the 0.6-mm-thick samples, comparable mean biaxial strength values of about 1000 MPa were measured for both firing protocols., Significance: At the moment, long fabrication time for zirconia restorations is a major drawback of 3D-printing when compared with milling technology. This investigation showed that the strength of 0.6-mm-thick zirconia discs fabricated by 3D-printing was not impaired by accelerated firing. Thus, overnight firing of thin-walled 3D-printed zirconia restorations could be possible., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: To test strength and reliability of 3D printed compared to milled zirconia., Methods: Cylindrical specimens were fabricated from milled (group G1; e.max ZirCAD LT) and from 3D printed (group G2; LithaCon 3Y 230) 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP). While G1 and G2 were sintered in one step, a further series (G3) of 3D printed 3Y-TZP was sintered in two steps including intermediate color infiltration. In each group, two different conditioning strategies were applied (n ≥ 20 samples/subgroup): (1) final polishing with #1200 diamond discs according to ISO 6872, and (2) final polishing with #220 diamond discs resulting in imperfectly polished surfaces. All samples were tested to fracture with a universal testing device (cross-head speed: 1 mm/min). Characteristic strengths and Weibull moduli were calculated. Effects were analyzed by means of either ANOVA (homocedastic data) or Welch ANOVA (heterocedastic data)., Results: For samples conditioned according to ISO 6872, mean flexural strengths were 1462 ± 105 MPa (G1), 1369 ± 280 MPa (G2), and 1197 ± 317 MPa (G3). For the imperfectly polished subgroups, strength values were 1461 ± 121 MPa (G1), 1349 ± 332 MPa (G2), and 1271 ± 272 MPa (G3). Although all groups showed high mean strength values, the reliability of milled zirconia (Weibull moduli 14 < m <16) outperformed that of the 3D-printed material (3 < m <6)., Significance: Even after color infiltration in a partially sintered state, the tested 3D printed zirconia exceeded the ISO flexural strength criteria for all types of fixed ceramic restorations by far (800 MPa for class 6, ISO 6872), indicating its high potential for clinical use. Further optimization of the internal material structure after sintering might improve the reliability of 3D printed zirconia which is currently inferior to that of milled zirconia., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest, (Copyright © 2022 Elsevier Inc. All rights reserved.)

Intra-oral grinding is often required to optimize occlusion of all-ceramic restorations. The effect of burs of different grit size on the fracture resistance of veneered zirconia crowns was investigated in this study. Forty-eight standardized zirconia copings were produced. The ceramic veneer was designed with a positive ellipsoidal defect on the palatal aspect of the crowns. To simulate adjustment of dental restorations by burs, this palatal defect was removed by use of three different diamond-coated burs with grit sizes 46, 107, or 151 μm (fine, medium, or coarse, respectively). Each different grit size of bur was used to grind 16 crowns. All crowns were then polished and surface roughness was measured. Half of the specimens underwent thermomechanical aging (10,000 thermocycles between 6.5°C and 60°C) and 1.2 million cycles of chewing simulation (F = 108 N). A linear regression model was computed to test the effect of aging and grinding grit size at a level of significance of α = 0.05. Fracture loads increased with decreasing grit size. Grit size and aging had a significant effect on the fracture resistance of the crowns. Use of fine and coarse burs for intra-oral adjustments resulted in different fracture resistance of veneered zirconia crowns. Coarse burs should be avoided in the final stage of grinding before polishing., (© 2017 Eur J Oral Sci.)

Purpose: To compare the failure behaviour of zirconia-reinforced lithium silicate (Celtra Duo, DeguDent) with that of lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) and feldspar (Mark II, VITA) ceramics., Methods: Three groups of sixteen glazed maxillary incisor crowns were produced. The inner surfaces of the crowns were etched, then luted to metal dies with self-adhesive cement. Single load-to-failure tests were performed before and after thermo-mechanical ageing. To simulate clinical conditions, the specimens were thermocycled (10,000 cycles between 6.5°C and 60°C) and underwent chewing simulation (1,200,000 cycles, F max =86N). Statistical analyses were performed by use of non-parametric Kruskal-Wallis and Mann-Whitney U-tests., Results: Before ageing, all the monolithic incisor crowns fractured at test forces >285N. Mean fracture loads were highest for zirconia-reinforced lithium silicate (725N, SD 162N), slightly lower for lithium disilicate (701N, SD 276N), and lowest for feldspar (554N, SD 190N). The differences between the results were not statistically significant. After ageing, fracture resistance decreased for all materials except zirconia-reinforced lithium silicate. Mean fracture loads were highest for zirconia-reinforced lithium silicate (766N, SD 98N) and significantly lower for both lithium disilicate (485N, SD 64N) and feldspar (372N, SD 116N)., Conclusion: Monolithic restorations fabricated from zirconia-reinforced lithium silicate retain high fracture resistance after extensive thermo-mechanical ageing. This preclinical study suggests that cohesive failures of monolithic anterior crowns produced of these ceramics will not be a major problem in dental practice., (Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Objectives: Double-crown attachments, such as conical crowns (CCs), can retain removable partial prostheses. Digital manufacturing enables the use of innovative materials such as zirconia, and new workflows. The aim of this study was to investigate options for the adjustment of retention forces of all-zirconia CCs., Materials and Methods: Single zirconia primary crowns were produced with convergence angles (α) of 3 and 4 degrees, together with monolithic zirconia secondary crowns (n = 8 for α = 3 degrees; n = 8 for α = 4 degrees). Retention was measured by fitting the crowns with forces F = 12.5 to 100 N, and evaluating the magnitudes of the forces required for loosening (L). L/F ratios were recorded, and the coefficient of friction (µ0) was calculated. To limit the maximum force required for loosening, and to prevent high tensile stresses within the crowns, the width of the occlusal gap between the primary and secondary crowns was limited by the implementation of occlusal stops., Results: True convergence angles were more conical than expected, by approximately 0.3 degrees. For α = 3 degrees and α = 4 degrees, L/F ratios were 0.308 (SD 0.04) and 0.208 (SD 0.068), respectively. The overall coefficient of static friction was µ0 = 0.113. Maximum retention forces were successfully controlled; the average values were 12.1 N (SD 4.5 N) for zirconia occlusal stops, and 12.8 N (SD 3.3 N) for composite occlusal stops., Conclusion: The clinically desired L/F ratio of 1/3 was achieved by selecting 3-degree burs for fabrication of all-zirconia CCs. It is possible to limit retention, thereby reducing tensile stress in the circumferential direction in secondary crowns.

Purpose: To evaluate the strength, after artificial aging, of resin-zirconia bonds yielded by methods available in dental practice., Materials and Methods: Standardized test specimens consisting of composite resin cylinders cemented to Y-TZP disks were assigned to 24 groups (n=20 per group) on the basis of the surface conditioning of the disks and the adhesive used (cement+manufacturer-specific primer). Conditioning methods were: none (control), airborne particle abrasion (50-μm Al2O3 at 0.05, 0.10, or 0.25 MPa), or tribochemical silica coating (Rocatec or CoJet). Panavia 21+Clearfil Ceramic Primer, Multilink Automix+Monobond Plus, BiFix QM+Ceramic bond, or RelyX Ultimate+Scotchbond Universal were used for cementation. Specimens were stored in water at 37°C either for 3 days or for 150 days in conjunction with 37,500 thermocycles before being submitted to a tensile test (crosshead speed: 1 mm/min). Nonparametric ANOVA and post-hoc tests within the same model were applied to the results (α=0.05)., Results: Conditioning, cement, aging, and all their interactions significantly affected bond strength (p<0.0001). After storage in water for 3 days, bond strengths ranged between 4 and 45 MPa (values were lowest in the BiFix QM groups). After long-term aging, the best results were obtained for silica-coated (Rocatec) zirconia samples cemented with Panavia 21/Clearfil Ceramic Primer; this was the only group for which bond strengths were >10 MPa. Premature failure of the resin-ceramic bond was usually observed during long-term aging, the only exception being the non-control groups cemented with Panavia., Conclusion: Most bonding strategies failed to create bonds to zirconia with acceptable strength after long-term aging. It might therefore be unwise to rely solely on adhesion for retention of load-bearing Y-TZP restorations.

The purpose of this in vitro study was to assess the breaking load of zirconia-based crowns veneered with either CAD/CAM-produced or manually layered feldspathic ceramic. Thirty-two identical zirconia frameworks (Sirona inCoris ZI, mono L F1), 0·6 mm thick with an anatomically shaped occlusal area, were constructed (Sirona inLab 3.80). Sixteen of the crowns were then veneered by the use of CAD/CAM-fabricated feldspathic ceramic (CEREC Bloc, Sirona) and 16 by the use of hand-layered ceramic. The CAD/CAM-manufactured veneer was attached to the frameworks by the use of Panavia 2.0 (Kuraray). Half of the specimens were loaded until failure without artificial ageing; the other half of the specimens underwent thermal cycling and cyclic loading (1·2 million chewing cycles, force magnitude F(max) = 108 N) before the assessment of the ultimate load. To investigate the new technique further, finite element (FE) computations were conducted on the basis of the original geometry. Statistical assessment was made by the use of non-parametric tests. Initial breaking load was significantly higher in the hand-layered group than in the CAD/CAM group (mean: 1165·86 N versus 395·45 N). During chewing simulation, however, 87·5% (7/8) of the crowns in the hand-layered group failed, whereas no crown in the CAD/CAM group failed. The CAD/CAM-produced veneer was significantly less sensitive to ageing than the hand-layered veneer., (© 2013 John Wiley & Sons Ltd.)

To evaluate failure loads of teeth restored by use of alumina-coping, and to assess the effects of different amounts of residual tooth structure and different cements, standardized artificial alumina copings were fabricated on seventy-two molars. 24 of the copings were cemented by use of an adhesive resin cement (P-group), n=24 by use of glass-ionomer cement (K-group), and n=24 by use of a self-adhesive modified composite resin-cement (R-group). After artificial ageing (10,000 thermal-cycles between 6.5 and 60°C; 1,200,000 chewing cycles with Fmax=64 N), the specimens were loaded until failure (cross-head-speed: 0.5 mm/min). In the K-group 83% of the specimens failed during chewing simulation. Statistical analysis included chi-squared-test, unpaired-to-sample-t-test, and ANOVA. For severely damaged teeth, loads to failure in the P-group (384 N) were significantly (p=0.03) higher than in the R-group (295 N). For severely damaged teeth, use of composite resin cement resulted in higher loads to failure than use of other cements.

The objectives of this study were to measure the occlusal wear of composite resin denture teeth in patients wearing a complete denture and to evaluate factors affecting wear. Fifty participants provided with complete dentures in at least one jaw were included. Gypsum casts were made from preliminary vinyl polysiloxane impressions 4 weeks after insertion, then after 6 (t(1)), 12 (t(2)), and 24 months (t(3)). Three-hundred and three posterior denture teeth were evaluated after 24 months. Wear was measured indirectly, from the casts, by means of a three-dimensional laser scanner device. Sequential images of the occlusal surfaces were digitized and superimposed (occlusal matching). Statistical analysis was performed by the use of mixed regression models, with the patient being a random effect. Mean wear (median, interquartile range; micrometer) of the entire occlusal surface was 8 (19) at t(1), 18 (34) at t(2), and 40 (61) at t(3). Maximum vertical loss (median, interquartile range; micrometer) was 92 (112) at t(1), 146 (148) at t(2), and 226 (184) at t(3). The dental status of the opposing jaw and the nature of the opposing material significantly affected the wear of denture teeth at t (3). Gender, daily wearing time, jaw, and type of tooth had no significant effects on the extent of wear. Clinically relevant vertical loss of composite resin denture teeth occurs after 24 months. Considering the limitations of this study, wear of denture teeth was affected by dental status and opposing material. The results suggest that wear of composite resin denture teeth exceeds that of enamel.

Objectives: The aim of this in vitro study was to assess the ultimate load to failure of zirconia based crowns veneered with CAD/CAM manufactured ceramic., Methods: 32 identical, anatoform zirconia (Sirona inCoris ZI, mono L F1) frameworks (thickness 0.6mm) were constructed (Sirona inLab 3.80). Afterwards, 16 crowns were completed using a CAD/CAM manufactured lithium disilicate ceramic veneer (IPS e.max CAD, Ivoclar Vivadent). The remaining 16 frames were veneered using conventional manual layering technique. For the CAD/CAM manufactured veneers, the connection between framework and veneer was accomplished via a glass fusion ceramics. Before fracture tests, half of the specimens underwent thermocycling and chewing simulation (1.2 million chewing cycles, force magnitude F(max)=108 N). To further investigate the new technique, finite element computations were carried out on the basis of the original geometry., Results: Nearly all (87.5%) conventionally veneered crowns failed already during chewing simulation, whereas crowns with CAD/CAM manufactured veneers were non-sensitive to artificial ageing. Crowns veneered with lithium disilicate ceramic displayed ultimate loads to failure of about 1600 N., Conclusion: The CAD/CAM production of veneers for restorations with zirconia framework is a promising way to reduce failures originating from material fatigue., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: Chewing simulators are used for preclinical evaluation of newly developed dental restorative materials. To guarantee the independence of test conditions, contact forces during chewing simulation should be independent of the specimen. Because of its mode of operation, i.e., impact of an antagonist, this requirement is not met for a widely used chewing simulator (Willytec/SD Mechatronik, Feldkirchen-Westerham, Germany). This study was therefore intended to clarify the extent to which specimen stiffness affects maximum contact force at different impact velocities. Possible differences between the forces in the eight test chambers were also of interest., Methods: From each of five dental materials differing in Young's modulus, eight cylindrical disks were manufactured and embedded in specimen holders. Alumina spheres were used as antagonists. During chewing simulations with different impact velocities and dental materials, vertical acceleration was recorded and contact forces were estimated on the basis of these measurements., Results: Specimen stiffness and impact velocity had a substantial effect on maximum contact force. The force overshoot relative to the static load ranged from 4% for small specimen stiffness and low impact velocity to values greater than 200% for high specimen stiffness and high impact velocity. Large differences between the chambers were also detected., Significance: Weight-controlled chewing simulations should be performed either with a low impact velocity or with a spring-damper system (placed between mass and specimen) which efficiently reduces the effects of contact force variation. Influence of specimen stiffness on contact forces must be considered at data interpretation., (Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objective: The hypothesis of this study was that the fracture load of incisor teeth restored using short, threaded, parallel-sided posts (TMP) is, under special conditions, not inferior to that of teeth restored using long TMPs or fibre-reinforced posts (FRP)., Methodology: Seventy-two maxillary incisors and 72 mandibular incisors were collected. Sixty-four in each group were root filled; in half of these FRPs were cemented, and in the other half TMPs were used. Half of the FRPs were pretreated; the others were not pretreated. In the TMP-group, half of the teeth received a long post (10 mm), the other half a short post (3 mm). Crowns were fabricated and cemented with Ketac-cem or Panavia. Eight maxillary incisors and eight mandibular incisors with intact natural crowns were used as control groups. All specimens were loaded until fracture., Results: Fracture loads were higher for pretreated FRPs than for untreated FRPs. If the FRPs were not pretreated, fracture loads for maxillary incisors after use of short metal posts were significantly higher (248 N compared with 133 N, P = 0.027). Fracture loads for teeth restored using long TMPs were not higher than for teeth restored using short TMPs (277 N compared with 266 N). Fracture loads for mandibular incisors restored using long (10 mm) pretreated FRP were higher than for mandibular incisors restored using short (3 mm) metal posts (436 N compared with 285 N). Cementation of the crowns using an adhesive resin cement did not increase the fracture load for mandibular incisors, whereas for maxillary incisors, this cementation technique tended to increase fracture loads in teeth restored with FRP, although this increase was not significant at the P < 0.05 level (P = 0.06). In both groups, fracture loads were higher for mandibular incisors., Conclusions: Short, threaded, parallel-sided metal posts might be an alternative to fibre- reinforced posts for maxillary incisors, for teeth with short roots or when FRP cannot be pretreated.

The purpose of this in vitro study was to assess the breaking load of zirconia-based crowns veneered with either CAD/ CAM-produced or manually layered feldspathic ceramic. Thirty-two identical zirconia frameworks ( Sirona in Coris ZI, mono L F1), 0·6 mm thick with an anatomically shaped occlusal area, were constructed ( Sirona in Lab 3.80). Sixteen of the crowns were then veneered by the use of CAD/ CAM-fabricated feldspathic ceramic ( CEREC Bloc, Sirona) and 16 by the use of hand-layered ceramic. The CAD/ CAM-manufactured veneer was attached to the frameworks by the use of Panavia 2.0 ( Kuraray). Half of the specimens were loaded until failure without artificial ageing; the other half of the specimens underwent thermal cycling and cyclic loading (1·2 million chewing cycles, force magnitude Fmax = 108 N) before the assessment of the ultimate load. To investigate the new technique further, finite element ( FE) computations were conducted on the basis of the original geometry. Statistical assessment was made by the use of non-parametric tests. Initial breaking load was significantly higher in the hand-layered group than in the CAD/ CAM group (mean: 1165·86 N versus 395·45 N). During chewing simulation, however, 87·5% (7/8) of the crowns in the hand-layered group failed, whereas no crown in the CAD/ CAM group failed. The CAD/ CAM-produced veneer was significantly less sensitive to ageing than the hand-layered veneer. [ABSTRACT FROM AUTHOR]