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This article reports a case of maxillary rehabilitation with implant-supported fixed dental prostheses on six zirconia implants. A woman with impacted maxillary canines attended our dental clinic seeking a metal-free maxillary restoration. After the extraction of both impacted maxillary canines and the placement of autogenous bone graft, six two-piece zirconia implants with straight abutments were placed in the anterior maxilla. Two zirconia fixed dental prostheses with porcelain veneering, separated at the midline, were placed on these zirconia implants. The 10-year follow-up monitored the adequate evolution of both implants and restorations with no signs of peri-implant disease. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the study were to evaluate the clinical performance and the complications of combined tooth-/implant-supported three-unit fixed partial dentures (FPDs) in the posterior mandible. Materials and Methods: A total of 78 partially edentulous patients in the posterior mandible were recruited for the study (n = 26/group). Group 1 served as the control group and received two dental implants to support a three-unit FPD. Groups 2 and 3 were the experimental groups in which one implant was placed in conjunction with support from an adjacent tooth to support a three-unit FPD. Standard implants (= 8 mm) were included in Group 2, while short implants (< 8 mm) were included in Group 3. Periapical radiographs were taken for evaluation of crestal bone loss (CBL). Modified plaque index (MPI), bleeding index (BI), and sulcus depth values of the abutment teeth were recorded at the time of FPD delivery, 6 months after FPD delivery, and annually thereafter. Recorded complications included abutment tooth intrusions, cementation failures of the restorations, porcelain chipping/delamination, framework fracture, abutment screw loosening, abutment and abutment screw fracture, and implant fracture. Results: Statistically significant differences were observed between Group 1 (0.06 ± 0.17) and Group 2 (0.18 ± 0.32) and between Group 1 and Group 3 (0.17 ± 0.30) in terms of MPI (P = .05). No difference was observed between Group 2 (0.11 ± 0.34) and Group 3 (0.14 ± 0.36) or between Group 1 (0.04 ± 0.22) and Group 2 in terms of BI. There were statistically significant differences in terms of CBL between Group 1 (0.259 ± 0.05 mm) and Group 3 (0.11 ± 0.03 mm) and between Group 2 (0.03 ± 0.03 mm) and Group 3 (P = .05). The mean abutment tooth sulcus depth was 1.11 ± 0.31 mm for Group 2 and 1.20 ± 0.46 mm for Group 3. Conclusions: Within the limitations of the current study, it was concluded that combined tooth/implant-supported prostheses (CTISPs) are a predictable treatment choice in the posterior mandible. When a CTISP is planned, it is more predictable to use a short implant than a standard-length implant. [ABSTRACT FROM AUTHOR]

Background: Partial coverage concepts have met the main goal of conservative dentistry. Vonlays, which combine features of veneers and onlays, are a recent alternative to full coverage designs and overlay partial coverage restorations. This in vitro study was conducted to compare the fracture resistance of the newly introduced pressable zirconia-reinforced lithium silicate with pressable lithium disilicate ceramic and to determine the optimal preparation design for partial coverage on upper premolars. Methods: Fifty-two duplicated epoxy resin dies were prepared following vonlay and overlay preparation guidelines. For each preparation (n = 26), the specimens were divided into two subgroups to be restored with lithium disilicate (IPS e.max Press) or zirconia-reinforced lithium silicate (Vita Ambria) (n = 13 each). Ceramic vonlays and overlays were bonded using dual cure resin cement, subjected to thermomechanical fatigue, and the load to fracture was tested by using a universal testing machine. The specimens were fractographically analyzed via scanning electron microscopy (SEM). The normality of the fracture resistance data was checked using the Shapiro‒Wilk test and Q‒Q plots, and two-way ANOVA was used to assess the effect of the type of preparation and ceramic material on the fracture resistance. Results: The group of overlays restored with zirconia-reinforced lithium silicate showed the highest mean fracture load (1218.69 N), while the group of vonlays restored with lithium disilicate had the lowest mean fracture resistance (967.15 N). The effect of preparation design and material type on fracture resistance was significant for both factors, p = 0.003 and p < 0.0001, respectively. Different features of the fracture surfaces, such as arrest lines, hackles, and directions of crack propagation, were observed. Conclusions: Zirconia-reinforced lithium silicate exhibited greater resistance to fracture compared to lithium disilicate, making it a potential substitute for partial coverage restorations. Additionally, the overlay showed superior fracture resistance when compared to the vonlay preparation design. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant‐supported single crowns with external connections under mechanical cycling. Materials and Methods: Fifty specimens were divided into groups: (1) metal–ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. Results: The failure‐related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all‐ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). Conclusions: Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. Clinical Significance: The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer‐aided design and computer‐aided manufacturing monolithic zirconia. [ABSTRACT FROM AUTHOR]

This study aimed to determine the crystalline phase composition of 3–6 mol% yttria-stabilized zirconia (3–6YSZ), specifically investigating the presence of tetragonal (t), cubic (c), and/or additional yttria-rich tetragonal (t') phase. Laboratory-fabricated specimens comprising 3–5YSZ, resembling translucent dental zirconia ceramics (TZ specimens), and a blend of 3YSZ and 8YSZ, representing a c -phase reference, were prepared. Additionally, 25 dental zirconia products stabilized with 3–6 mol% yttria were analyzed. Whole X-ray diffraction (XRD) patterns were obtained for Rietveld analysis, complemented by fine scanning in the 2θ region from 72º to 76º for qualitative phase analysis. Moreover, yttria concentrations in each specimen were determined using X-ray fluorescence (XRF) spectroscopy. In the 2θ region from 72º to 76º, TZ and dental zirconia product specimens displayed four peaks attributed to t - and t' -phases, but the c -phase peak was absent. Rietveld analysis of the whole XRD patterns, utilizing a t - t' model, demonstrated the t -phase fraction ranging from 86 mass% in 3YSZ to 11 mass% in 6YSZ. Rietveld analysis appeared reliable, as the yttria contents calculated based on lattice parameters aligned well with those measured by XRF. This study established that dental 3–6YSZ consisted of yttria-lean t - and yttria-rich t' -phases. The present study enhances understanding of the crystalline structure of dental zirconia ceramics. Future crystallographic analyses of these ceramics should consider the presence of t - and t' -phases. • Examined crystalline phases of 3-6 mol% yttria-stabilized zirconia. • Applied XRD and XRF for phase and chemical composition analyses. • Identified dominant yttria-lean and yttria-rich tetragonal phases. • Demonstrated the absence of cubic phase. • Improved understanding of dental zirconia's crystalline structure. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Immediate dentin sealing (IDS) was introduced to overcome the disadvantages of delayed dentin sealing like pollution of dentin tubules, microleakage, and bond strength destruction over time. The effect of IDS on the bond strength of indirect restorations is still debatable. Purpose: This study was conducted to determine the effect of IDS on the bond strength of ceramic restorations to dentin. Materials and Method: In this systematic review and meta-analysis, the study protocol was registered on the PROSPERO database under the registration number CRD420202014 27. MEDLINE (PubMed), Web of Science, Scopus, and ProQuest databases were searched until January 2021 and updated in January 2022. Worldcat.org and Opengrey.eu, ProQuest dissertation and thesis, and Google Scholar were searched to explore the grey literature. The in vitro studies evaluating the bond strength of ceramic restoration to dentin with and without IDS were included. Seven criteria were assessed to evaluate the risk of bias in the study. Statistical analyses were conducted using RevMan 5.3. The inverse variance method was used to determine the mean difference of micro-tensile bond strength (µTBS) and shear bond strength (SBS). Results: A total of 10 studies (20 datasets) were included in the meta-analysis. Regarding the µTBS analysis, IDS had a significantly higher bond strength than Delayed Dentin Sealing (DDS) (MD:1.16, 95%CI:0.28_2.03, I² =0%). However, no significant difference was found between them in the SBS analysis (MD:0.25, 95%CI: -0.56-1.06, I² =96%). All studies were categorized to have a moderate or high risk of bias. Conclusion: Most in vitro evidence showed favorable results for the effect of IDS on the bond strength and durability of indirect restorations. The adhesive system and the type of ceramic and its treatment before cementation are determining factors. Due to the heterogeneity of the outcomes and studies with a moderate/high risk of bias, the quality of the evidence was low. [ABSTRACT FROM AUTHOR]

Featured Application: This study highlights the potential application of ultra-short femtosecond lasers for modifying the surface of ceramic dental materials with high precision in a controlled manner. This study investigated the dose-dependent changes in the chemical composition of three dental ceramic materials—zirconia, lithium disilicate (LD), and VITA ENAMIC® hybrid composite (VITA En)—following irradiation with an ultra-short femtosecond (fs) laser (800 nm, 30 fs, 1 kHz) in an ambient air environment using average laser power (76 mW) and scanning speeds (50, 100, and 200 mm/s), simulating dental treatment processes. The chemical composition of the ablated regions was analyzed using energy dispersive spectroscopy. All irradiated samples showed increased carbon content (by up to 42%) and reduced oxygen (by up to 33%). The observed increase in C content is likely attributed to a combination of surface reactions, adsorption of carbon from the ambient environment, and carbon deposition from the laser-induced plasma, all facilitated by the high-energy conditions created by fs-laser pulses. Scanning electron microscopy revealed ablation with progressive controlled melting and recrystallization, with an absence of pile-up features typically associated with significant thermal damage. These findings demonstrate that ultra-short fs-laser irradiation induces highly controlled, dose-dependent changes in the chemical composition and surface morphology of dental ceramic materials. [ABSTRACT FROM AUTHOR]

Objective Clinical Considerations Conclusions Clinical Significance This article aims to describe a systematic method for tooth color reproduction with ceramics restorations employing artificial intelligence (AI) software named Matisse. It provides a comprehensive analysis of the entire process, beginning with shade‐taking and extending to ceramic application in a complex clinical case in the anterior region—specifically, a single central restoration supported by an implant.The clinical case presented highlights the potential of Matisse software for generating ceramic (inSync‐Jensen Dental, USA) and staining (Miyo‐Jensen Dental, USA) recipes over a zirconia abutment (Katana‐Noritake Dental, Japan). This approach achieves an optimal single central restoration utilizing CAD‐CAM and layering techniques.The systematic method employing the Matisse software achieved accurate color reproduction for a single central restoration supported by an implant. This result was achieved by the dental ceramist within the first attempt and without seeing the patient in the entire process.The Matisse AI‐assisted protocol offers a systematic and scientifically grounded method for color reproduction in dentistry for indirect restorations. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the feasibility of monolithic zirconia laminate veneers (MZLV) compared to lithium disilicate laminate veneers (LDLV). Materials and methods: Sixty resin replicas, each prepared with depths of 0.5 mm, 0.7 mm, and 1 mm, were produced using a 3D printer from acrylic teeth. Laminate veneers of these thicknesses were milled from pre-sintered monolithic zirconia (3rd generation) and lithium disilicate blocks. The intaglio surface of MZLV was treated with air abrasion using 110 μm diameter silica-modified aluminium oxide particles and ceramic primer, while LDLV was etched with etchant gel and treated with the ceramic primer before cementation with resin cement. Vertical marginal discrepancy (VMD) was assessed using a stereomicroscope, and a load-to-failure test was conducted using a universal testing machine. Failure modes were evaluated macroscopically on fractured surfaces. Data were analysed statistically using Two-way ANOVA and Bonferroni correction (α = 0.05). Results: LDLV samples exhibited significantly larger VMD compared to MZLV samples across all thicknesses, especially in cervical, palatal, and mean data. Within the LDLV group, load-to-fracture values for 0.7 mm and 1.0 mm thicknesses were similar, whereas for 0.5 mm thickness, it was significantly lower. In the MZLV group, load-to-fracture values were lower for 0.7 mm and 1.0 mm thicknesses compared to LDLV, but higher for 0.5 mm thickness. Conclusions: Material choice and restoration thickness significantly influence laminate veneer restorations' success. MZLV generally exhibits superior vertical marginal fit compared to LDLV, with varying load-to-failure values across different thicknesses. Clinical management of debonding in MZLV is simpler compared to restoration fracture in LDLV. Clinical relevance: Considering clinical factors, MZLV may be a preferable option to LDLV for this restoration with the thickness of 0.5 mm. [ABSTRACT FROM AUTHOR]

To evaluate the hygroscopic expansion characterization of resin composite dies during thermal cycling, and their influence on the fracture resistance of dental ceramic materials as well as the effect of pre-immersion on these measurements. Disc-shaped specimens (φ = 15.0 mm, h = 1.2 mm) and anatomical crown dies of four resin composites (epoxy, Z350, P60, G10) were fabricated. Disc-shaped samples were continuously soaked in distilled water and the volume expansion was measured at different time point by Archimedes method. Disc-shaped samples were pre-immersed for 0, 7, or 30 days, elastic modulus and hardness were measured using Nanoindentation test; thermal cycling (TC) test was performed (5 °C-55 °C, 104 cycles), and volume expansion during TC was measured. Four kinds of resin die with pre-immersion for 0, 7, or 30 days were cemented to 5Y-Z crown, or epoxy dies without pre-immersion were cemented to 5Y-Z, 3Y-Z and lithium disilicate glass (LDG) crowns, and load-to-failure testing was performed before and after TC. Finite element analysis (FEA) and fractography analysis were also conducted. The hygroscopic expansion was in the order: epoxy > Z350 > P60 > G10. Except for G10, the other three resin composites exhibited different degrees of hygroscopic expansion during TC. Only the elastic modulus and hardness of epoxy decreased after water storage. However, only the fracture loads of 5Y-Z and LDG crowns supported by epoxy dies were significantly decreased after TC. FEA showed a stress concentration at the cervical region of the crown after volume expansion of the die, leading to the increase of the peak stress at the crown during loading. Significance : Only the hygroscopic expansion of epoxy dies caused by TC led to the decrease in the fracture resistance of the 5Y-Z and LDG crown, which may be related to the decrease in the elastic modulus of the epoxy die and the tensile stress caused by it. • The hygroscopic expansion of resin dies during thermal cycling decreases the fracture load of their supported ceramic crowns. • The susceptibility of hygroscopic expansion is related to the elastic modulus and the filler/matrix ratio of the resin die. • Pre-immersion of the resin dies could reverse their hygroscopic expansion effect on the supported crown. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of different veneering ceramics and veneering techniques on the bond strength to zirconia. Materials and Methods: 3Y‐TZP zirconia blocks were sliced into 60 slabs, polished, and sintered. Each slab received one ceramic cylinder (Ø = 3.4 mm, 5 mm‐high), according to the veneering ceramic type (feldspathic—FEL or lithium disilicate‐based—LD) and the veneering technique (file‐splitting with resin‐based luting agent—RC, file‐splitting with fusion ceramic—FC, or heat‐pressing—HT), which resulted in six groups: FEL‐RC, FEL‐FC, FEL‐HT, LD‐RC, LD‐FC, LD‐HT. After preparation, the samples were immersed in distilled water for 24 h before the shear bond strength (SBS) test. The failure modes were classified as adhesive, predominantly adhesive, or cohesive. Representative failure mode images were taken in a Scanning Electron Microscope. The SBS data were analyzed by two‐way ANOVA and Tukey's test. Results: Both type of veneering ceramic and technique affected the bond strength. FC led to the highest SBS values. RC and HP provided similar results when compared within each veneering ceramic. Lithium disilicate achieved lower bond strength than feldspathic ceramic when the heat‐pressing technique was applied. The most frequent failure modes were predominantly adhesive and adhesive for FEL and LD, respectively. Conclusion: File‐splitting with fusion ceramic provided the highest adhesion to zirconia when feldspathic or lithium disilicate‐based ceramics were used. The heat‐pressing technique for veneering with lithium disilicate significantly decreased the bond strength when compared to the feldspathic ceramic. [ABSTRACT FROM AUTHOR]

This study compares the clinical performances of two lithium disilicate (Initial LiSi press vs. Initial LiSi Block, GC Corp.) and a 3D printed resin (Temp Print, GC Corp.) partial crown using modified United States Public Health Service (USPHS) evaluation criteria and survival rates after one year of clinical service. Eighty-nine partial adhesive restorations on posterior teeth were realized using different materials: Group 1 used Initial LiSi press, Group 2 used Initial LiSi Block, and Group 3 used Temp Print. An analog workflow was used to realize the restoration of Group 1, while a fully digital workflow was used for Groups 2 and 3. The modified USPHS parameters, together with periodontal parameters, were collected at baseline and at the one-year recall. Contingency tables to assess for significant differences of success over time in each group were used. All modified USPHS parameters showed Alpha or Bravo; no Charlie was recorded. No statistically significant difference emerged between the three groups in any of the assessed variables (p > 0.05). All modified USPHS scores were compatible with the outcome of clinical success, no restoration was replaced or repaired, and the survival rate was 100% at the one-year recall. No difference was found between the traditional and digital workflows used to fabricate the restorations. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the effects of 15% and 20% carbamide peroxide (CP) on color, surface roughness, and hardness of computer‐aided design/computer‐aided manufacturing (CAD/CAM) dental ceramics. Materials and Methods: This in vitro study was conducted on 120 Vita Mark II, Celtra Duo, and Suprinity CAD/CAM ceramic specimens. The ceramic specimens in each group (n = 40) were randomly assigned to two subgroups (n = 20) for polishing and glazing, and their baseline color, surface roughness (Ra), and hardness were assessed. In each subgroup, half of the specimens were exposed to 15% CP, while the other half were exposed to 20% CP. Their color change (ΔE), surface roughness, and hardness were then measured again. Surface roughness, hardness, and color were analyzed sequentially by profilometer, Vickers hardness tester, and spectrophotometer, respectively. Data were analyzed by repeated measures ANOVA, one‐way ANOVA, and post hoc Bonferroni test (α = 0.05). Results: The surface roughness of all groups significantly increased after bleaching treatment (p < 0.05). Surface hardness of all groups decreased after bleaching treatment, but this reduction was only significant in Vita Mark II subgroups (glazed, polished, 15%, and 20% CP). The ΔE was not clinically and visually perceivable in any group. Conclusion: The present results revealed that concentration of CP and type of surface treatment affected the surface properties of CAD/CAM ceramics. Type of surface treatment only affected the surface hardness of Vita Mark II ceramics (p < 0.05). Concentration of CP had a significant effect only on polished Vita Mark II. [ABSTRACT FROM AUTHOR]

Background: Osseointegration is fundamental to achieving successful implant therapy in dentistry. However, the heat generated during implant placement emerges as a critical factor predisposing to implant failure. Objective: This study aimed to analyze the different factors related to heat generation during implant placement, offering insights to clinicians in their daily clinical practice. Methods: Utilizing the PubMed, Web of Science, and Embase databases, we conducted an electronic search for articles published between January 2013 and December 2023. The analysis focused on several factors including bone type, drill shape, drill speed, drill material, drilling force, osteotomy depth, drill load, drilling technique (intermittent or continuous), presence of a surgical guide, irrigation methods, drill wear, and preparation tools available. Results: Initially, 2525 records were identified. After applying the inclusion and exclusion criteria and full-text assessment, 93 articles were included in this scoping review. Additionally, some articles published before 2013 were incorporated in the bibliography to ensure completeness of the review. Conclusions: Heat generation during implant placement arises from a complex interplay of multiple factors. While irrigation and bone hardness appear to be crucial determinants of heat generation during the osteotomy phase, the involvement of other factors remains less clear. Further studies are needed to better understand the precise contribution of these factors towards increasing temperature at the implant site. [ABSTRACT FROM AUTHOR]

Background: The fit of a metal-ceramic restoration is essential to its long-term durability. Regarding marginal and internal fit, there is not enough information about the technologies used in the production of metal-ceramic restorations. The aim of this in vitro study is to compare, both before and after porcelain firing, the marginal, axial, axio-occlusal, and occlusal fit of metal-ceramic restorations manufactured using casting, additive or subtractive computer-aided design, and computer-aided manufacturing techniques (CAD/CAM). Methods: CAD/CAM were used to create 50 prepared maxillary first molar-shaped Co-Cr die models, which were randomly divided into 5 groups (n = 10). Cobalt-chrome copings were produced by casting (C), hard metal milling (HM), soft metal milling (SM), selective laser melting (SLM), and selective laser sintering (SLS) techniques. Before and after porcelain firing, discrepancies of the copings were measured using the silicone replica technique. The data obtained by measurements with a stereomicroscope at x80 magnification were analyzed statistically in the SPSS program. The ROBUST three-way analysis of variance (ANOVA) method was used to compare the discrepancy values. Results: There were statistically significant differences among fabrication methods (P <.001). The HM method showed the highest discrepancy (90.1 μm), and the C (63 μm) method showed the lowest discrepancy in terms of the die model- crown fit. The C, SLS, and SM methods (63 μm; 61.6 μm; 67.7 μm) were statistically similar (P >.001). The highest discrepancy was observed on the occlusal area (87.1 μm), and the lowest discrepancy was observed on the axial area (47.7 μm) of the coping. Porcelain firing had a decrease in the discrepancy values (P =.001). Conclusion: All CAD/CAM techniques are appropriate for clinical use; selective laser sintering and soft milling can be the more recommended methods for the compatibility of metal-porcelain restorations, as they have lower discrepancy values than the SLM and HM methods. [ABSTRACT FROM AUTHOR]

Computer-aided design (CAD)/computer-aided manufacturing (CAM) milling and handpiece grinding are critical procedures in the fabrication and adjustment of ceramic dental restorations. However, due to the formation of microfractures, these procedures are detrimental to the strength of ceramics. This study analyzes the damage associated with current brittle-regime grinding and presents a potential remedy in the application of a safer yet still efficient grinding regime known as "ductile-regime grinding." Disc-shaped specimens of a lithium disilicate glass-ceramic material (IPS e.max CAD) were obtained by cutting and crystallizing the lithium metasilicate CAD/CAM blanks (the so-called blue blocks) following the manufacturer's instructions. The discs were then polished to a 1 µm diamond suspension finish. Single-particle micro-scratch tests (n = 10) with a conical diamond indenter were conducted to reproduce basic modes of deformation and fracture. Key parameters such as coefficient of friction and penetration depth were recorded as a function of scratch load. Further, biaxial flexure strength tests (n = 6) were performed after applying various scratch loads to analyze their effects on ceramic strength. Scanning electron microscopy (SEM) and focused ion beam (FIB) were used to characterize surface and subsurface damage. Statistical analysis was performed using one-way analysis of variance and Tukey tests. While the SEM surface analysis of scratch tracks revealed the occurrence of both ductile and brittle removal modes, it failed to accurately determine the threshold load for the brittle–ductile transition. The threshold load for brittle–ductile transition was determined to be 70 mN based on FIB subsurface damage analyses in conjunction with strength degradation studies. Below 70 mN, the specimens exhibited neither strength degradation nor the formation of subsurface cracks. Determination of the brittle–ductile thresholds is significant because it sets a foundation for future research on the feasibility of implementing ductile-regime milling/grinding protocols for fabricating damage-free ceramic dental restorations. [ABSTRACT FROM AUTHOR]

There has been enormous research on diagnostic and therapeutic dental methods due to the growing recognition of oral wellness. Numerous studies in this area have resulted in dental biomaterials, including polymers, metals, and acrylic resins, essential to restore teeth affected by illnesses or accidents. Compared to other biomaterials, such as metals or polymers, ceramics offer distinct features. Materials like zirconia and alumina demonstrate their high intrinsic strength, making them appropriate for biomedical applications like dental implants or artificial joints. Additionally, they have outstanding biocompatibility, which lowers the possibility of adverse effects or inflammation. Some ceramics, like hydroxyapatite (HA) and bioactive glasses, even encourage tissue integration and regeneration. Moreover, because of their adaptability, they can be precisely shaped and composed to emphasize specific characteristics. Yttria‐stabilized tetragonal zirconia offers outstanding mechanical properties and biocompatibility but faces concerns over long‐term durability due to low‐temperature degradation. To address this, researchers have developed non‐oxidic ceramics like silicon nitride and advanced oxide‐based materials like alumina‐zirconia composites, aiming to enhance the durability and reliability of biomedical applications. In this review, we highlighted the recent advancements in ceramic dental implants; examples and applications of different ceramics‐based materials, including zirconia, alumina, HA, and beta calcium phosphate, are provided in detail. [ABSTRACT FROM AUTHOR]

Zirconia dental ceramics incorporated with inert dental glass (IDG) were fabricated by digital light processing (DLP). The effects of the amount of added IDG on the physical properties and microstructure of sintered samples were investigated. Highly dense zirconia dental ceramic samples with a relative density of 98.9% were obtained by adding different amounts of IDG sintered at 1500°C. With the addition of 1 wt% IDG, the Vickers hardness, fracture toughness, and wear resistance increased to 13.03 GPa, 6.33 MPa m1/2, and 0.03 mg/(mm2 min), respectively. However, with the incremental addition of IDG at 3 and 5 wt%, a slight reduction in Vickers hardness, fracture toughness, and wear resistance was observed. The values recorded were 12.68 GPa, 5.90 MPa m1/2, and 0.05 mg/(mm2 min) for the former, and 11.86 GPa, 5.48 MPa m1/2, and 0.06 mg/(mm2 min) for the latter. Scanning electron microscopy observation suggested that 1 wt% IDG incorporated into zirconia dental ceramic samples resulted in an optimal microstructure, with IDG existing at triple junctions of zirconia grains to form a discrete secondary phase. The broken surface revealed transgranular fracture features. This investigation indicates that adding a proper amount of IDG is an effective method to enhance the properties of DLP‐fabricated zirconia dental ceramics. [ABSTRACT FROM AUTHOR]

Development of restorative materials capable of mimicking optical and mechanical performance of natural teeth is a quest in aesthetic density. Yttria-Stabilized Zirconia (YSZ) ceramics represent one of the most popular choices for dental restorations, owing to their biocompatibility, white colour, and the possibility to use CAD-CAM technologies. In particular, YSZ doped with 3 mol. % yttria (3YSZ) is popular because it presents high strength. Nonetheless, the limited light transmission of commercially available high strength 3YSZ does not meet the requirements of highly aesthetic cases. On the other side, YSZ presenting a larger portion of yttria are more translucent but exhibit modest strength. Here, we report on fabrication of dense zirconia nanostructures in bulk form via conventional pressure-less sintering at temperatures down to 1100–1200 °C, achieving highly translucent and strong 3YSZ with significant opalescent behaviour. Both Hall−Petch and inverse Hall-Petch relationship were observed in 3YSZ samples with average grain size in the range of 250 nm and 55 nm, demonstrating the importance of grain size control to enhance both optical and mechanical properties of zirconia ceramics, simultaneously. Maximum biaxial strength of 1980 ± 260 MPa, in-line light transmission of 38% in the visible spectrum and opalescence approaching that of enamel were obtained at optimum grain size of 80 ± 5 nm. The notable optical properties are linked to the miniaturization of the residual pores and refinement of grain size towards the nanoscale while the superior mechanical strength is justified by the activation of different energy dissipation processes at nano and macroscale. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to identify and quantify artifacts produced by commonly used dental restorative materials in both standard and high-resolution cone beam computed tomographic imaging. In this in vitro study, 25 different dental materials were placed in holes (3 mm in diameter x 2 mm thick) prepared in the center of 10 x 10-mm polymethyl methacrylate plates. The specimens, along with a control plate prepared with an unfilled hole, were scanned at standard and high resolutions. The gray values (GVs) of the specimens were measured at 1-, 2-, 4-, and 8-mm distances from the material surfaces, and in 8 different directions, resulting in 32 measurements per specimen. The absolute value of the difference (AGV) between the GV of each measurement point on the specimen disc and the GV of the corresponding point on the control disc was considered to be the number of artifacts at that point. The median AGV of each material was calculated, and the materials were then ranked in terms of artifact formation using the Kruskal-Wallis test. At standard resolution, the greatest numbers of artifacts were caused by AH 26 root canal sealer and Heraenium S nickel-chromium alloy, and the fewest were caused by Whitepost DC #3 glass fiber post and ChemFil Superior glass ionomer cement. At high resolution, the greatest numbers of artifacts were found in amalgam (admix; SDI) and Heraenium S, and the fewest in Whitepost DC and GC Initial enamel porcelain. The median AGV values at standard and high resolutions were 46.0 and 57.0, respectively. High and standard resolutions were significantly different in terms of artifact formation (P = 0.001; Wilcoxon test). AH 26 sealer was the only material that demonstrated a statistically significant reduction in artifact formation at high resolution compared with standard resolution (P = 0.05; Wilcoxon test). The number of artifacts produced by dental materials at both resolutions decreased with an increasing distance from the surface of the material. [ABSTRACT FROM AUTHOR]

• Lithium disilicate and advanced lithium disilicate CAD/CAM ceramics displayed the highest translucency and color stability. • Thickness significantly affected color stability, with 0.5 mm thickness showing the least color change unlike 1.5 mm thickness. • The duration of exposure to staining solutions also impacted color changes, with 30 days causing the most significant shift. • Coffee and tea induced more pronounced reductions in translucency and color stability among all tested CAD/CAM ceramics. • Novel advanced lithium disilicate CAD/CAM ceramics show that it can be used to fabricate esthetic restorations as dental veneers, all ceramic restorations, and endocrown of optimum shade matching and color stability. Translucency and optical characteristics significantly affect the aesthetics of ceramic restorations. The introduction of new virgilite crystals to novel ceramic advanced lithium disilicate through a matrix firing process enhances the material's strength and aesthetic quality according to the manufacturer. Four types of CAD/CAM ceramics; lithium disilicate (LD), leucite reinforced (LR), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS) exposed to different staining solutions (tea, cola, coffee, and distilled water). Each ceramic type had 120 specimens, divided into subgroups based on thickness (0.5 mm, 1 mm, and 1.5 mm). Color changes (ΔE00) and translucency parameters (TP00) were measured after thermocycling, and spectrophotometry was employed to evaluate ΔE00 and TP00 after 1, 7, and 30 days of exposure to the staining solutions. ZLS exhibited the lowest color stability, while lithium LD and ALD displayed the highest. Thickness significantly affected color stability, with 0.5 mm thickness showing the least change. The duration of exposure also impacted color changes, with 30 days causing the most significant shift. LD demonstrated the highest translucency. Coffee and tea induced more pronounced reductions in translucency and color stability compared to the control group. Material structure, thickness, staining solution, and exposure duration significantly influenced the color stability and translucency of CAD/CAM ceramics, with LD and ALD demonstrating superior color stability and LD exhibiting the highest translucency. [ABSTRACT FROM AUTHOR]

Aim: The aim of this umbrella review was to systematically review the systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Settings and Design: This was an umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Materials and Methods: An electronic search of PubMed, Cochrane Central, EBSCOhost, and Google Scholar search engines for articles published from January 1, 2013, to January 1, 2023, was conducted using keywords "enamel wear," "zirconia," "feldspathic," "dental ceramics," and "Y-TZP" to identify systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Statistical Analysis Used: Qualitative analysis. Results: A total of 86 articles were obtained through electronic search, of which four articles were selected after abstract screening that met the inclusion criteria for evaluating antagonist enamel wear. As compared to feldspathic groups, zirconia had substantially less antagonist wear, while surface polishing exhibited less enamel wear than glazing. Because of the heterogeneity in study design, measurement methods, and outcome variables, a meta-analysis was not possible. Conclusions: Over time, the opposing enamel wear caused by polished monolithic zirconia will be either equal to or less than that of natural enamel wear. Polished monolithic zirconia also maintains lower values of enamel wear compared to metal ceramics, feldspathic porcelains, and lithium disilicate. [ABSTRACT FROM AUTHOR]

Porcelain laminate veneers (PLV) offer a conservative aesthetic solution for interdental space closure. However, space is typically not distributed symmetrically, and the mesiodistal width of the restored teeth may increase unless multiple teeth are prepared for conventional PLV to maintain appropriate individual tooth proportion. Ceramic fragments can be suggested to close the space without modifying tooth size and dental proportion. This article presents two cases where interdental gaps were closed using lingually placed porcelain laminate (LPPL). All stages of the restorative procedures, including treatment planning, temporization, tooth preparation, and cementation of these delicate restorations, are detailed. Based on the results of these clinical reports, we regard the use of LPPL as a successful treatment option in selected cases, as evidenced by 2- and 6-year follow-ups. The Modified United State Public Health Criteria is reported. [ABSTRACT FROM AUTHOR]

In addition to many materials, silver vanadate (AgVO3) has gained interest due to its antimicrobial properties, which opens up the potential for use as an antibacterial agent for biomedical applications. This work aimed to study the effect of AgVO3 addition on the structural and morphological properties of a developed dental porcelain (DP) prepared from natural raw materials. AgVO3 nanowires, prepared by the coprecipitation method, were added in different amounts (1, 3, and 5 wt.%) to a DP mass with the initial composition of 80 wt.% feldspar, 15 wt.% quartz, and 5 wt.% kaolin, obtained by sintering the mixture at 1300 °C. The structural and morphological properties of AgVO3 and DP were investigated by X-ray powder diffraction (XRPD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS), and transmission electron microscopy (TEM). The results showed the formation of α-AgVO3 nanowires coated with semispherical metallic silver nanoparticles. Moreover, α-AgVO3 additions do not influence the structural and morphological properties of DP, with the presence of Ag and V clearly identified in the DP with the α-AgVO3 addition. Our findings highlight the potential of this novel material for use in various dental applications. Future studies need to establish the antibacterial properties of the prepared dental material. [ABSTRACT FROM AUTHOR]

As a subserie of the dental ceramic material family, glass–ceramics are favored for their excellent aesthetic properties. The feasibility of current commercially available dental glass–ceramics applications has been proven, while the assurance and development of more functional properties for them are still being explored. Effective utilization of various modification mechanisms by adjusting the chemical composition and microstructure is essential to improve the mechanical properties, aesthetic properties, and other properties such as biocompatibility of dental restorative materials. Among them, the mechanical properties of restorations should take into account the mechanical properties of glass ceramics and the final restoration (restoration and tooth set) in the mechanical behavior. This paper provides an overview of the chemical composition design, classification of microstructure, property requirements, and strengthening methods applied to dental glass–ceramics, including ion exchange, chain effects, heat treatment modulation, and strengthening mechanisms. In addition, research on traditional hot pressing, subtractive manufacturing, and newly developed additive manufacturing in glass–ceramics are systematically presented. Finally, the tendency of dental glass–ceramics was forecasted by analyzing the relationship between glass–ceramic composition, process, and mechanical properties. [ABSTRACT FROM AUTHOR]

Aim: The aim of this umbrella review was to systematically review the systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Settings and Design: This was an umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Materials and Methods: An electronic search of PubMed, Cochrane Central, EBSCOhost, and Google Scholar search engines for articles published from January 1, 2013, to January 1, 2023, was conducted using keywords “enamel wear,” “zirconia,” “feldspathic,” “dental ceramics,” and “Y-TZP” to identify systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Statistical Analysis Used: Qualitative analysis. Results: A total of 86 articles were obtained through electronic search, of which four articles were selected after abstract screening that met the inclusion criteria for evaluating antagonist enamel wear. As compared to feldspathic groups, zirconia had substantially less antagonist wear, while surface polishing exhibited less enamel wear than glazing. Because of the heterogeneity in study design, measurement methods, and outcome variables, a meta-analysis was not possible. Conclusions: Over time, the opposing enamel wear caused by polished monolithic zirconia will be either equal to or less than that of natural enamel wear. Polished monolithic zirconia also maintains lower values of enamel wear compared to metal ceramics, feldspathic porcelains, and lithium disilicate.

Dental multilayer zirconia ceramics are attractive materials for restorative dentistry because they offer significant esthetic advantages over monolithic, white, or monocolored zirconia. They enable anatomical adjustments in dental prostheses, making them more similar to natural teeth. New categories of dental ceramics have been developed using varying translucency and color within the same piece to meet esthetic requirements. This technique employs zirconia with different yttria (Y2O3) contents to achieve varying levels of translucency. This study investigated two types of dental ceramics based on multilayer zirconia, correlating their mechanical properties, translucency, and color variations concerning their application in dental prostheses. Two types of multilayer zirconia pre-sintered blocks with different Y2O3 content were examined: 1) blocks with a Y2O3 gradient chemical composition between 3 mol.% and 4 mol.%, named M3-4YSZ; 2) blocks with a Y2O3 gradient chemical composition between 4 mol.% and 5 mol.%, named as M4-5YSZ. Samples were cut in cross-section to separate the layers based on Y2O3 content and color and were then sintered at 1530 °C for 2 h. The sintered samples were characterized by relative density, crystalline phases, microstructure, Vickers hardness, fracture toughness (KIC), and optical properties (color and contrast ratio). Fully dense ceramics were obtained after sintering. Layers containing a greater amount of Y2O3 in the zirconia matrix have a higher content of the ZrO2 cubic phase, while layers with a lower content of Y2O3 in the matrix are predominantly tetragonal ZrO2. No statistical variation in hardness was observed depending on the layers of the material. However, fracture toughness values showed significant statistical variations, with an increase in the tetragonal phase content responsible for the increase in fracture toughness. KIC in M3-4YSZ samples varied between 3.63 and 7.73 MPa.m1/2, while M4-5YSZ samples ranged from 2.70 to 5.65 MPa.m1/2. The smooth and gradual variations in color and translucency observed between the layers of the two groups of dental ceramics studied indicate stability and homogeneity between the layers, contributing significantly to esthetic effects in dental applications.

Background: Translucency and optical characteristics significantly affect the aesthetics of ceramic restorations. The introduction of new virgilite crystals to novel ceramic advanced lithium disilicate through a matrix firing process enhances the material’s strength and aesthetic quality according to the manufacturer. Materials and Methods: Four types of CAD/CAM ceramics; lithium disilicate (LD), leucite reinforced (LR), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS) exposed to different staining solutions (tea, cola, coffee, and distilled water). Each ceramic type had 120 specimens, divided into subgroups based on thickness (0.5 mm, 1 mm, and 1.5 mm). Color changes (ΔE00) and translucency parameters (TP00) were measured after thermocycling, and spectrophotometry was employed to evaluate ΔE00 and TP00 after 1, 7, and 30 days of exposure to the staining solutions. Results: ZLS exhibited the lowest color stability, while lithium LD and ALD displayed the highest. Thickness significantly affected color stability, with 0.5 mm thickness showing the least change. The duration of exposure also impacted color changes, with 30 days causing the most significant shift. LD demonstrated the highest translucency. Coffee and tea induced more pronounced reductions in translucency and color stability compared to the control group. Conclusions: Material structure, thickness, staining solution, and exposure duration significantly influenced the color stability and translucency of CAD/CAM ceramics, with LD and ALD demonstrating superior color stability and LD exhibiting the highest translucency.

Objective: This in vitro study evaluated the color differences when discolored tooth substrates were restored with CAD/CAM monolithic ceramics depending on ceramic type and thickness, and the try-in paste shade. Method and materials: Six ceramic types were tested: high-translucent lithium disilicate (LD-HT); medium-translucent lithium disilicate (LD-MT); low-translucent lithium disilicate (LD-LT); low-translucent leucite (LC-LT); feldspathic ceramic (FC); and BL1 low-translucent lithium disilicate, stained to A1 shade (LD-BL1-LT). The ceramics were tested in disk-shaped specimens with 0.5-, 1.0-, and 1.5-mm thickness (n = 10; N = 180; shade A1). The try-in pastes were tested to simulate luting materials and corresponded to colors A1 and Opaque White. Six substrates were used: A1 (reference), B2, B3, A3, C2, and C3. Color differences (ΔE00) and translucency parameter (TP00) were assessed with the CIEDE2000 formula. The results were compared with acceptability (1.77) and perceptibility (0.81) thresholds. Results: Ceramic type, thickness, and the try-in paste shade influenced the color differences. LD-LT and LC-LT ceramics and Opaque White try-in paste provided, in general, lower ΔE00 values. The most adequate ceramic thickness varied according to the substrate discoloration. With 1.0 mm of ceramic thickness, it was possible to obtain ΔE00 lower than the perceptibility threshold for substrates C2 and A3, and ΔE00 lower than the acceptability threshold for C3 and B3. ΔE00 lower than the acceptability threshold were obtained with 0.5 mm of ceramic thickness for B2, A3, and C2. Conclusion: The use of low-translucent glass-ceramics and Opaque White try-in paste are useful to reduce color differences. The most adequate ceramic thickness depends on the substrate discoloration. [ABSTRACT FROM AUTHOR]

Porous zirconia scaffolds manufactured using polymer-infiltrated ceramic network (PICN) and additive manufacturing technologies are emerging as promising alternatives to traditional ceramic materials in dental restorations. However, incomplete osseointegration and bacterial infections still represent challenges for the long-term performance of this new composite material. To address this, the present study aims to investigate the effect of peptide biofunctionalization on the biological performance of infiltrated zirconia scaffold surfaces. The samples used in the work consisted of a 3D-printed zirconia scaffold infiltrated with a dimethacrylate copolymer. Surface biofunctionalization was achieved using a synthetic platform containing the cell-adhesive sequence RGD and the antibacteria LF1-11 peptide (RGD-LF). The attachment of the molecule was characterized through fluorescence confocal laser scanning microscopy and X-ray photoelectron spectroscopy. The biological performance of the samples was evaluated in terms of human mesenchymal stem cell adhesion and early attachment of S. aureus. The physicochemical characterization verified the successful anchoring of the biomolecule to the surface, leading to a peptide density of 288 pmol/cm2. The biological assays confirmed the potential of RGD-LF to improve cell adhesion and spreading. In this sense, the average cell area increased fourfold in the biofunctionalized surface. Regarding bacterial adhesion, it was demonstrated that RGD-LF significantly inhibited it, reducing early adhesion by half compared to the untreated surface. Overall, this study provides valuable insights into the biofunctionalization of polymer-infiltrated 3D scaffolds for the development of cell-instructive and antibacterial surfaces tailored for dental applications. [ABSTRACT FROM AUTHOR]

The clinical failure mode of dental crown ceramics involves radial cracking at the interface, driven by the surface tension generated from the flexure of the ceramic layer on the subsurface. This results in a reduced lifespan for most all-ceramic dental crowns. Therefore, investigating optimal material combinations to reduce stress concentration in dental crown materials has become crucial for future successful clinical applications. The anisotropic complex structures of natural materials, such as nacre, could potentially create suitable strong and damage-resistant materials. Their imitation of natural structural optimisation and mechanical functionality at both the macro- and micro-levels minimises weaknesses in dental crowns. This research aims to optimise cost-effective, freeze-casted bioinspired composites for the manufacture of novel, strong, and tough ceramic-based dental crowns. To this end, multilayer alumina (Al 2 O 3) composites with four different polymer phases were tested to evaluate their bending behaviour and determine their flexural strength. A computational model was developed and validated against the experimental results. This model includes Al 2 O 3 layers that undergo gentle compression and distribute stress, while the polymer layers act as stress relievers, undergoing plastic deformation to reduce stress concentration. Based on the experimental data and numerical modelling, it was concluded that these composites exhibit variability in mechanical properties, primarily due to differences in microstructures and their flexural strength. Furthermore, the findings suggest that bioinspired Al 2 O 3 -based composites demonstrate promising deformation and strengthening behaviour, indicating potential for application in the dental field. [Display omitted] [ABSTRACT FROM AUTHOR]

The primary aim of this in vitro study was to compare the load-bearing capacity of lithium disilicate occlusal veneers, fabricated via different manufacturing processes. Secondary objectives included assessing internal accuracy and production time-efficiency. Four fabrication methods for ultra-thin lithium disilicate occlusal veneers on extracted human molars with simulated erosive defects were compared (n = 20/group): CAM: milled lithium disilicate (IPS e.max CAD); HPR: heat-pressed lithium disilicate (IPS e.max Press) out of a milled PMMA template (Ddpmma CAST); 3DP: 3D-printed lithium disilicate (experimental lithium disilicate); PTE: heat-pressed lithium disilicate (IPS e.max Press) out of a 3D-printed template (SilaPrint cast). Internal accuracy was measured prior to thermo-mechanical aging, followed by static loading to measure the load-bearing capacity (F max). Fabrication time (time-efficiency) was also recorded. Statistical analysis was performed using the Kruskal-Wallis (KW) test. No statistically significant differences were found in median load-bearing capacities (F max) between the groups (KW p = 0.5902): CAM 1821 N, HPR 1896 N, 3DP 2003 N, PTE 1687 N. Significant differences were found in internal accuracy between the groups that employed printing processes (3DP, PTE) and all other groups in margins (p < 0.001), cusps (p < 0.0018), and fossae (p < 0.0346). The time-efficiency measurements indicated an increase in fabrication time, starting from CAM 67.2 ± 5.8 min, followed by HPR 200.8 ± 33.0 min, PTE 289.2 ± 38.7 min, and peaking with the highest duration observed for 3DP 701.6 ± 8.1 min. The fabrication method of ultra-thin lithium disilicate occlusal veneers does not significantly impact their load-bearing capacity, but affects the clinical fit and adaptation of the veneers. • All fabrication methods exhibited high load-bearing capacities, with no significant differences between the groups. • Milled or heat-pressed restorations demonstrated minimal marginal discrepancies and high internal accuracy. • 3D-printed restorations showed larger marginal gaps but superior internal accuracy in the cusp and fossa regions. • Direct milling was the most time-efficient; 3D-printing the most time-consuming, and procedures involving methacrylate-based templates were intermediate. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 15-year survival rate of zirconia (Y-TZP) implants with a roughened acid-etched surface in a retrospective post-market clinical follow-up (PMCF) study. Materials and Methods: One-piece ceramic implants (CeraRoot) with a roughened acid-etched surface (ICE) were used. Six different implant shapes/sizes were used in this study. Either a standard or flapless surgical approach was used for implant placement. Simultaneous bone augmentation or sinus elevation was performed when bone height or width was deficient. Definitive zirconia restorations were placed after 2 months or later if the Periotest value was > -3. The implants were followed up for up to 15 years. Results: A total of 1,828 implants were placed in 771 patients with a mean age of 51.18 years. The overall implant survival rate after 15 years of follow-up was 98.69%. Conclusion: From this long-term investigation, it can be concluded that CeraRoot ceramic implants showed a 15-year long-term clinical performance with a survival rate of 98.69% under the described protocol, without significant differences between the six implant shapes/sizes. [ABSTRACT FROM AUTHOR]

Purpose: To compare the load-to-failure values of different ceramic CAD/CAM implant crown materials with drilled screw-access holes with and without cyclic loading applied. Materials and Methods: Forty zirconia abutments with a titanium base were pre-loaded onto implants to support maxillary right first premolar crowns milled from four different CAD/CAM ceramic materials (zirconia-reinforced lithium silicate, hybrid ceramic, lithium disilicate, and zirconia; n = 10 each). After cementing the crowns, the screw-access channels were prepared by drilling through the occlusal surfaces. Half of the specimens were subjected to cyclic loading for 5 million cycles at 2 Hz (n = 5/material). After cyclic loading, vertical loads were applied until failure. The load-to-failure values of all crowns were recorded and statistically analyzed. Two-way ANOVA was used with restricted maximum likelihood estimation and Tukey-Kramer adjustments (α = .05). Results: During cyclic loading, the zirconia abutment under one lithium disilicate specimen cracked at 2 million cycles, and a zirconia-reinforced lithium silicate crown also fractured. Results for the load-to-failure test series showed statistical differences between the materials. Zirconia resulted in significantly higher failure loads when compared to the other materials (P < .001). Cyclic loading did not significantly affect the load-to-failure values. Conclusion: Cyclic loading did not significantly influence the load to failure of any of the materials tested. Zirconia crowns with drilled screw access channels cemented on zirconia abutments with a titanium base had higher load-to-failure values compared to the other ceramic crown materials. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the minimum ceramic thickness needed to increase the lightness by one value by means of glass-ceramic restorations, as perceived by dental technicians, dentists, and laypersons. Materials and Methods: A total of 15 assessment pairs (= reference and test sample) were formed using glass-ceramic blocks in four different colors. Each assessment pair was comprised of two underground blocks differing by one value of lightness. On top of the underground blocks, glass-ceramic platelets were cemented in 5 different thicknesses (0.1 to 0.5 mm) in the same color as the reference. Dental technicians, dentists, and laypersons (n = 41/group) were asked to determine the presence of a color difference between the two samples under standardized light conditions. The threshold ceramic thickness was defined as the thickness at which = 50% of the evaluators were not able to perceive a difference within an assessment pair. The thresholds were analyzed, and groups were compared by applying chi-square test (P < .05). Results: The majority of dentists and dental technicians (> 50%) detected a lightness difference between test and reference samples up to a ceramic thickness of 0.5 mm. The majority of laypersons (= 50%) did not perceive lightness differences with ceramic thicknesses of 0.5 mm. If separated by the different color changes, the threshold ceramic thickness started at 0.4 mm and varied within the groups of evaluators and the lightness of the assessed color. Conclusions: A considerable number of evaluators perceived a lightness difference when minimally invasive ceramic restorations of 0.5-mm thickness were applied. The threshold ceramic thickness, however, was reduced when the lightness of the substrate was lower. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate hard and soft tissue response and mechanical integrity for screw-retained layered zirconia crowns bonded to titanium nitride-coated titanium (TiN) CAD/CAM abutments supported by implants at 1- and 2-year followups. Materials and Methods: A total of 46 patients were restored with a total of 102 free-standing implant-supported layered zirconia crowns, which were bonded to their respective abutments in the dental laboratory and delivered as a one-piece screw-retained crown. Baseline, 1-year, and 2-year data were collated on pocket probing depth, bleeding on probing, marginal bone levels, and mechanical complications. Results: Of the 46 patients, 4 patients with one implant each were not followed-up. These patients were not included in the analysis. Of the remaining 98 implants, due to failed appointments during the global pandemic, soft tissue measurements were recorded for 94 implants at year 1 and 86 implants at year 2, with a mean buccal/lingual pocket probing depth of 1.80/1.95 mm and 2.09/2.17 mm, respectively. Mean bleeding on probing was 0.50 and 0.53 at 1 and 2 years, which represents somewhere between no bleeding and a spot bleed according to the study protocol. Radiographic data were available for 74 implants at year 1 and 86 implants at year 2. The mean marginal bone change from baseline was +0.11 mm mesially and +0.19 mm distally at 1 year and +0.24 mm mesially and +0.16 mm distally at 2 years. The final bone level with respect to the reference point was +0.49 mm mesially and +0.19 mm distally at the end of the study period. Mechanical complications involving a slight misfit of the crown margin were recorded for one unit (1%), porcelain fracture for 16 units (16%), and a loss of preload for 12 units (12%) of < 5 Ncm (< 20% of initial preload). Conclusion: The biologic and mechanical stability of ceramic crowns bonded to CAD/CAM screw-retained abutments using angulated screw access was considered to be high, with overall bone gain, excellent soft tissue health, and only limited mechanical complications related to generally small fractures of the porcelain and a clinically insignificant loss of preload. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of plasma-enhanced chemical vapor deposition (PECVD) with silicon hydride (SiH4) at different times on HT-zirconia surface characteristics and bonding of composite cement before and after thermocycling. Materials and Methods: Blocks of HT zirconia were obtained, polished, sintered and divided into five groups, according to PECVD time (n = 31): Zr-30 (30 s), Zr-60 (60 s), Zr-120 (120 s) and Zr-300 (300 s). The control group (Zr-0) did not receive PECVD. X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), energy dispersive spectroscopy (EDS) in conjunction with field-emission scanning electron microscopy (FE-SEM), x-ray photoelectron spectroscopy (XPS), goniometry, and profilometry tests were used for chemical and topographic characterization. Monobond N silane (Ivoclar Vivadent) was applied to the surface, and a cylinder of composite cement (Variolink N) was made (3 x 3 mm). Half of the specimens of each group were stored for 24 h or subjected to thermocycling (6 x 10³ cycles). A shear bond strength (SBS) test was performed. Results were subjected to one-way ANOVA and Tukey’s tests (α = 0.05). Results: For experimental groups, XPS showed that formation of Si-O bonds contributed to increased surface free energy (SFE). FE-SEM and EDS showed that the longer the deposition time, the greater the amount of silicon on the surface. Zr-60 and Zr-300 presented higher and lower surface roughnesses, respectively. The silicon penetrated the microstructure, causing higher stress concentrations. The bond strength to composite cement was improved after all PECVD deposition times. Conclusion: The PECVD technique with SiH4, associated with chemical treatment with primer based on silane methacrylate, is a solely chemical surface treatment capable of maintaining bonding between composite cement and HT zirconia. [ABSTRACT FROM AUTHOR]

Abstract Background The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics. Methods Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro–Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05). Results Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P

Background: Effects of ceramic translucency, layer thickness, and substrate colour on the shade of lithium disilicate glass-ceramic restorations proved to be significant in several studies, however, quantitative, numerical results on the relationship between the colour difference and these parameters are still lacking. The purpose of this in vitro study was to quantitatively determine how the colour reproduction ability of a lithium disilicate glass-ceramic is affected by its translucency, layer thickness, and substrate colour. Methods: Ceramic samples were prepared from A2 shade IPS e.max CAD blocks with high and low translucencies (HT and LT) in a thickness range of 0.5–2.5 mm (+/- 0.05 mm). Layered samples were acquired utilizing composite substrates in 9 shades; transparent try-in paste was used. The spectral reflectance of the specimens was assessed under D65 standard illumination with a Konica Minolta CM-3720d spectrophotometer. The CIEDE2000 colour difference (ΔE00) between two samples was analysed using perceptibility and acceptability thresholds set at 50:50%. Statistical analysis involved linear regression analysis and the Kruskal–Wallis test. Results: An increase in the thickness of 0.5 mm reduced the ΔE00 of the HT samples to 72.8%, and that of the T samples to 71.1% (p < 0.0001). 7 substrates with HT and LT specimens had significantly different results from the mean (p < 0.05). A thickness of 0.5 mm is not sufficient to achieve an acceptable result at any level of translucency, while the low translucency ceramic at a thickness of 1.5 mm gave acceptable results, except for severely discoloured substrates (ND8 and ND9). Conclusions: The colour reproduction ability of lithium disilicate glass-ceramics is significantly affected by their translucency, layer thickness, and 7 substrates out of 9 substrates examined. [ABSTRACT FROM AUTHOR]

This study aimed at examining the bond strength between zirconia and ceramic veneer, following the ISO 9693 guidelines. A total of fifty specimens of zirconia/ceramic‐veneer system were produced using two commercial zirconias (VITA YZ‐HTWhite and Zolid HT+ White, referred to as Group A and Group B, respectively) and a ceramic‐veneering material (Zirkonia 750). The microstructure (via x‐ray diffraction analysis, XRD and Secondary Electron mode, SEM) and the mechanical properties (via 3‐point bending tests) of the two groups were assessed. Then, experiments were conducted according to the ISO 9693 and conventional protocols applied for producing zirconia/ceramic‐veneer restorations. Bond strength values, measured by 3‐point bending tests, were 34.42 ± 7.60 MPa for Group A and 31.92 ± 6.95 MPa for Group B. SEM observations of the cohesively fractured surfaces (on the porcelain side) and the examination for normality using the Shapiro–Wilk test suggested the use of Weibull statistical analysis. Median strength (σ50%) for Group A and Group B was 34.76 and 32.22 MPa, while the characteristic strength (σ63.2%) was 35.78 and 33.14 MPa, respectively. The Weibull modulus disparity between groups (12.69 and 13.07) was not significant. Bond strength exceeded the ISO 9693 minimum of 20 MPa, suggesting satisfactory strength for clinical use. [ABSTRACT FROM AUTHOR]

Considering the rapid evolution of lithium silicate-based glass ceramics (LSCs) in dentistry, this review paper aims to present an updated overview of the recently introduced commercial novel LSCs. The clinical and in vitro English-language literature relating to the microstructure, manufacturing, strengthening, properties, surface treatments and clinical performance of LSC materials was obtained through an electronic search. Findings from relevant articles were extracted and summarised for this manuscript. There is considerable evidence supporting the mechanical and aesthetic competency of LSC variants, namely zirconia-reinforced lithium silicates and lithium–aluminium disilicates. Nonetheless, the literature assessing the biocompatibility and cytotoxicity of novel LSCs is scarce. An exploration of the chemical, mechanical and chemo-mechanical intaglio surface treatments—alternative to hydrofluoric acid etching—revealed promising adhesion performance for acid neutralisation and plasma treatment. The subtractive manufacturing methods of partially crystallised and fully crystallised LSC blocks and the additive manufacturing modalities pertaining to the fabrication of LSC dental restorations are addressed, wherein that challenges that could be encountered upon implementing novel additive manufacturing approaches using LSC print materials are highlighted. Furthermore, the short-term clinical performance of zirconia-reinforced lithium silicates and lithium–aluminium disilicates is demonstrated to be comparable to that of lithium disilicate ceramics and reveals promising potential for their long-term clinical performance. [ABSTRACT FROM AUTHOR]

(1) Background: The presence of various dental ceramic materials with different chemical compositions complicates clinicians' decision making, especially in cases with a highly acidic environment appearing in patients suffering from gastroesophageal reflux disease or other eating disorders. Thermal alterations in the oral cavity can also affect surface structure and roughness, resulting in variations in both degradation mechanisms and/or bacteria adhesion. The aim of the present in vitro study was to evaluate the effect of thermal cycling and exposure to simulated gastric acid on the surface roughness of different ceramics; (2) Methods: Five groups of different ceramics were utilized, and twenty specimens were fabricated for each group. Specimens were either thermocycled for 10,000 cycles in distilled water or immersed in simulated gastric acid for 91 h. The evaluation of surface roughness was performed with optical profilometry, while scanning electron microscopy, X-ray diffraction analysis and inductively coupled plasma atomic emission spectroscopy were also performed; (4) Conclusions: Based on the combination of the surface roughness profile and structural integrity, zirconia specimens presented the smallest changes after immersion in simulated gastric acid followed by lithium disilicate materials. Zirconia-reinforced lithium silicate ceramic presented the most notable changes in microstructure and roughness after both treatments. [ABSTRACT FROM AUTHOR]

Background: New lithia-based glass–ceramics, including Advanced Lithium Disilicate (ALD), have become popular in dentistry. However, it is unclear if glazing protocols for ALD might compromise its surface or optical properties. Thus, evaluating color and translucency changes in ALD and traditional lithium disilicate (LD) is crucial. Methods: This study aimed to assess how different firing protocols affect the surface and optical properties of LD and ALD. Sixty disc-shaped specimens were prepared, divided into three subgroups based on firing protocols, and subjected to surface roughness analysis. Specimens were immersed in coffee, wine, and water for 7 days, and then brushed. Color and translucency were measured. Results: Firing protocols significantly influenced surface roughness in LD (0.09–1.39 µm) and ALD (0.05–0.88 µm). Color differences were observed in both LD and ALD after 7 days, with visible changes within clinically acceptable thresholds. Translucency remained stable across firing protocols and staining liquids. Conclusions: Varying firing protocols impact surface roughness and color stability in LD and ALD. Despite differences, color and translucency changes remained within acceptable clinical thresholds, suggesting both materials are suitable for dental applications. Therefore, this study reinforces the reliability and versatility of these materials in restorative dentistry. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cerium (Ce) is the most abundant element among lanthanides, which is mostly in the form of ceria. The reversible transformation between Ce3+ and Ce4+ ions contributes to the high redox activity of cerium. Because of its antibacterial, anti-inflammatory, osteogenic, angiogenic and anti-tumor properties, cerium has been widely used in stomatology. OBJECTIVE: To summarize the antibacterial, anti-inflammatory, osteogenic, angiogenic and anti-tumor mechanism of cerium, and to review the research status and application prospects of cerium and cerium-based materials in the modification of oral materials and the diagnosis and treatment of oral diseases in recent years. METHODS: The articles published from database inception to 2023 were retrieved from Web of Science, PubMed, CNKI and WanFang databases with the search terms “cerium, ceria, prosthodontics, prosthesis, restorative dentistry, denture, dental implant, caries, endodontics, pulpitis, periodontitis, periodontal diseases, oral cancer” in English and “cerium, ceria, prosthodontics, implant, dental caries, dental pulp, periodontitis, periodontal disease, oral cancer” in Chinese. By analyzing and reading literature for screening, according to the inclusion and exclusion criteria, 73 articles were finally included in this review. RESULTS AND CONCLUSION: (1) Cerium exerts an antibacterial effect through direct contact with bacteria, oxidative stress and destroying bacterial biofilm, and exerts an anti-inflammatory function based on mimetic enzyme activity. The osteogenic and angiogenic activities of cerium involve a series of signaling pathways including ERK and Wnt signaling pathways. (2) Antibacterial, anti-inflammatory, osteogenic, and angiogenic activities allow cerium significant potential in the treatment of oral infectious diseases and regeneration of oral soft and hard tissues. However, there is still a certain gap in the application of cerium’s anti-tumor properties in the oral field. (3) Due to excellent mechanical properties and a low light-transmitting property, ceria-stabilized zirconia as a dental ceramic material can be used for core ceramics, the frameworks of dental prostheses and dental implants. (4) Benefited from its biological properties, cerium-based materials have the ability to promote osseointegration and soft tissue integration, inhibit demineralization and cariogenic bacteria, facilitate regeneration of the dentin-pulp complex, lessen inflammatory response and enhance periodontal tissue regeneration. There are wide applications of cerium in surface modifications of implants and treatments of caries, pulpitis, periodontitis and oral cancers. (5) Cerium shows certain toxicity under conditions of high concentration and long-term administration. To further expand clinical applications of cerium in dentistry, biosafety and optimization of cerium-based materials need to be further explored in the future. [ABSTRACT FROM AUTHOR]

Background: The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics. Methods: Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro–Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05). Results: Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P < 0.001). Thermocycling had no significant impact on the fracture toughness of either the glazed or unglazed specimens. Furthermore, statistical analysis revealed no significant effects on hardness with thermocycling in either group, and glazing alone did not substantially affect hardness. Conclusions: The impact of glazing on the fracture toughness of LiSiCAD restorations is noteworthy, but it has no significant influence on their hardness. Furthermore, within the parameters of this study, thermocycling was found to exert negligible effects on both fracture toughness and hardness. [ABSTRACT FROM AUTHOR]

Objective: Demonstrate the ability of 0.5 mm thickness lithium disilicate laminates associated with resin cement to mask different substrate saturations. Methods: 60 specimens (n = 5) were prepared with CAD/CAM lithium disilicate glass–ceramic IPS e.max CAD, 0.5 mm thick, in three degrees of translucency (HT, MT and LT); cemented by Variolink Esthetic LC Light+ (L) and Neutral (N) on composite resin substrates A1 and A4 shades. Color measurements were performed by a spectrophotometer (CM‐3700d ‐Konica Minolta). The L*, a*, b* parameters of the tri‐layer structure (laminate/ resin cement/ substrate) were used to calculate color difference (∆E00) by CIEDE2000 formula and Translucency Parameter (TP00). This study adopted ∆E00 = 0.8, as perceptibility threshold (PT), and ∆E00 = 1.8, as acceptability threshold (AT). Statistical analyses were performed by one‐way ANOVA and Tukey tests (a = 0.05). Results: Color difference between resin cement shades showed statistical differences (p < 0.0001) and ∆E00 > 1.8 for all groups. Color difference between substrates saturations showed a significant statistical difference (p < 0.0001) and ∆E00 values above AT for all groups. The TP00 demonstrated significant statistical differences (p < 0.0001). The LTL combination, the opaquest set, showed the smallest ∆E00 values between substrate shades differences, however, above AT. Conclusion: The translucency of the lithium disilicate, the substrate saturation and the resin cement opacity influenced final color of restoration. The ceramic translucency impact on final color was reduced by opaque resin cement. Furthermore, the LT lithium disilicate and the Light+ resin cement reduced the translucency of the restoration, contributing to mask saturated substrate. Clinical Relevance: This study shows the influence of conservative lithium disilicate laminates with different degrees of translucency associated with resin cement on final color of saturated substrate restorations. A minimally invasive esthetic protocol for masking substrates is demonstrated by associating low translucency ceramic laminates and opaque resin cement. [ABSTRACT FROM AUTHOR]

Functionally graded materials (FGM) with indistinct boundaries potentially eliminate the damaging stresses occurring at the interfaces. FGM applications in dental ceramics have enhanced their fatigue resistance and interfacial toughness. This scoping review aims to map graded designs in dental ceramics, distinguish their methodological approaches with their material characteristics and properties, and understand the factors affecting the outcomes of each of the graded approaches. A systematic electronic search was performed with the databases MEDLINE (PubMed), Scopus, Cochrane Library, EBSCO, and Google Scholar along with a manual search. About 2675 articles were initially found from all the searches with no date restriction till July 2023. After rejecting duplicates and based on exclusion criteria, about 52 articles were included. Methodological approaches in grading such as glass-infiltration and silica-infiltration have been investigated on pre-sintered zirconia. The type of infiltration and the method of infiltrate application significantly influenced the phase transformation of zirconia, its microstructure, surface hardness, fracture toughness, flexural strength, wear, and fatigue strength of graded dental zirconia. Interlayers were accommodated between metal-ceramic and veneer-core all-ceramic layers. Fractions of zirconia-porcelain and alumina-porcelain showed high bending strength and better stress distribution. The results of finite element analysis studies predicted that using 10-layered graded layers reduced the stresses at the crown-cement-dentin interface. [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: To evaluate the 3‐ to 8‐year outcomes of dental implants placed with lateral sinus floor augmentation (LSFA) and to identify factors affecting implant survival. Materials and Methods: This retrospective study was performed by screening all implants placed with LSFA procedures, which were conducted between January 2012 and December 2016. Subantral bone gain (SABG) and apical bone height (ABH) were assessed using panoramic radiographs. The cumulative survival rate of implants was analysed using life‐table analysis and Kaplan–Meier survival curves. The influential risk factors affecting survival were assessed using univariate log‐rank tests and multivariable mixture cure rate model. Implant complications were recorded. Results: Based on the established criteria, a total of 449 patients (760 implants) were included in this study. In the 3‐ to 8‐year follow‐up (mean ± SD, 5.81 ± 1.33 years), 15 implants in 14 patients failed, with a CRS of 96.81% on an implant basis and 95.07% on a patient basis. A history of periodontitis and poor compliance with supportive periodontal treatment was associated with a significantly higher risk of implant failure at both implant and patient levels. Significant decreases in ABH occurred during each yearly interval except for 3 years. A similar trend has been observed for SABG at 1, 2, 6 and 8 years. The total complication rate was 31.84% on implant basis, with peri‐implant mucositis (21.58%) being the most frequent biologic complication and porcelain cracking (5.00%) being the most common technical complication. Conclusions: Implant with LSFA is a reliable treatment option in atrophic maxilla. A history of periodontitis without regular supportive periodontal treatment was identified as a predictor for implant failure. Slight but significant shrinkage of vertically augmented bone can be observed after implant placement. [ABSTRACT FROM AUTHOR]

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It would be very beneficial to have a method for joining of ceramics to titanium reliably. Although several techniques have been developed and tested to prevent extensive interfacial chemical reactions in titanium‐ceramic systems, the main problem of the inherent brittleness of interfaces was still unsolved. To overcome this problem also in dental applications, we decided to make use of an interlayer material that needs to meet the following requirements: First, it has to be biocompatible, second, it should not melt below the bonding temperatures, and third, it should not react too strongly with titanium, so that its plasticity will be maintained. Considering possible material options only the metals: gold, platinum, palladium, and silver, fulfill the first and second requirements. To find out—without an extensive experimental testing program—which of the four metals fulfills the third requirement best, the combined thermodynamic and reaction kinetic modeling was employed to evaluate how many and how thick reaction layers are formed between the interlayer metals and titanium. With the help of theoretical modeling, it was shown that silver fulfills the last requirement best. However, before starting to test experimentally the effect of the silver layer on the mechanical integrity of dental ceramic/Ag/Ti joints it was decided to make use of mechanical analysis of the three‐point bending test, the result of which indicated that the silver layer increases significantly the bond strength of the joints. This result encouraged us to develop a new technique for plating silver on titanium. Subsequently, we executed numerous three‐point bending tests, which demonstrated that silver‐plated titanium‐ceramic joints are much stronger than conventional titanium‐ceramic joints. Hence, it can be concluded that the combined thermodynamic, reaction kinetic, and mechanical modeling method can also be a very valuable tool in medical research and development work. [ABSTRACT FROM AUTHOR]