A practice‐based clinical evaluation of the survival and success of metal‐ceramic and zirconia molar crowns: 5‐year results

This practice‐based study evaluates the survival and success of conventionally luted metal‐ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty‐three patients were treated from 07/2008 to 07/2009 with either metal‐ceramic crowns (MCC) or zirconia crowns (ZC). Forty‐five patients (26 female) with 91 restorations (obser‐vational period: 64·0 ± 4·8 months) participated in a clinical follow‐up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan–Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0·05). Five complete failures (MCC: 2, ZC: 3) were recorded (5‐year ECSv: MCC: 97·6%, (95% confidence interval (95%‐CI): [93%; 100%]/ZC: 94·0%, (95%‐CI): [87%; 100%]). Of the MCCs (n = 41), 85·0%, [95%‐CI: (77%; 96%)] remained event‐free, whereas the ECSc for the ZCs (n = 50) was 74·3% (95%‐CI): [61%; 87%]. No significant differences in ECSv (P = 0·51), ECSc (P = 0·43) and ECVCSc (P = 0·36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0·035), (5‐year VCF‐rate: 14·8%) than crowns placed on tooth‐neighboured abutments (n = 47), (5‐year VCF‐rate: 4·3%). In the present study, zirconia molar crowns demonstrated a 5‐year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.     

Complication rate of molar crowns: a practice-based clinical evaluation

This practice-based study evaluates the initial clinical performance of conventionally luted metal-ceramic and zirconia molar crowns fabricated with a prolonged cooling period of the veneering porcelain. Forty-nine patients were treated (group A: high precious alloy + low fusing porcelain; group B: zirconia crowns). All zirconia crowns were veneered with a modified porcelain firing cycle including a 6-minute cooling period. Ninety-two restorations (74 vital abutments/18 nonvital abutments) were evaluated after a mean observation period of 18.2 +/- 4.6 months. No complete failures or loss of vitality were recorded in either group. Two events were recorded in group A (1 loss of retention/1 minor ceramic chipping < 2 mm2). The third event occurred in group B (minor ceramic chipping <2 mm2). All ceramic defects could be polished intraorally. Statistical analysis revealed non-significant differences in success rates (p = 0.91) of metal-ceramic and zirconia crowns fabricated with a modified porcelain firing. The modified firing of the zirconia porcelain seems to decrease the risk for early ceramic chipping in the molar area, leading to a technical complication rate comparable to that of metal-ceramic crowns.     

Five‐year results of a prospective randomised controlled clinical trial of posterior computer‐aided design–computer‐aided manufacturing ZrSiO4‐ceramic crowns

The aim of this prospective randomised controlled clinical trial was to evaluate the clinical outcome of shrinkage‐free ZrSiO₄‐ceramic full‐coverage crowns on premolars and molars in comparison with conventional gold crowns over a 5‐year period. Two hundred and twenty‐three patients were included and randomly divided into two treatment groups. One hundred and twenty‐three patients were restored with 123 ZrSiO₄‐ceramic crowns, and 100 patients received 100 gold crowns, which served as the control. All crowns were conventionally cemented with glass–ionomer cement. After an observation period of 6, 12, 24, 36, 48 and 60 months, the survival probability (Kaplan–Meier) for the shrinkage‐free ZrSiO₄‐ceramic crowns was 98·3%, 92·0%, 84·7%, 79% and 73·2% and for the gold crowns, 99%, 97·9%, 95·7%, 94·6% and 92·3%, respectively. The difference between the test and control group was statistically significant (P = 0·0027). The gold crowns showed a better marginal integrity with less marginal discoloration than the ceramic crowns. The most common failure in the ceramic crown group was fracture of the crown. The 60‐month results of this prospective randomised controlled clinical trial suggest that the use of these shrinkage‐free ZrSiO₄‐ceramic crowns in posterior tooth restorations cannot be recommended.     

Clinical trials in zirconia: a systematic review

Summary Zirconia is unique in its polymorphic crystalline makeup, reported to be sensitive to manufacturing and handling processes, and there is debate about which processing method is least harmful to the final product. Currently, zirconia restorations are manufactured by either soft or hard‐milling processes, with the manufacturer of each claiming advantages over the other. Chipping of the veneering porcelain is reported as a common problem and has been labelled as its main clinical setback. The objective of this systematic review is to report on the clinical success of zirconia‐based restorations fabricated by both milling processes, in regard to framework fractures and veneering porcelain chipping. A comprehensive review of the literature was completed for in vivo trials on zirconia restorations in MEDLINE and PubMed between 1950 and 2009. A manual hand search of relevant dental journals was also completed. Seventeen clinical trials involving zirconia‐based restorations were found, 13 were conducted on fixed partial dentures, two on single crowns and two on zirconia implant abutments, of which 11 were based on soft‐milled zirconia and six on hard‐milled zirconia. Chipping of the veneering porcelain was a common occurrence, and framework fracture was only observed in soft‐milled zirconia. Based on the limited number of short‐term in vivo studies, zirconia appears to be suitable for the fabrication of single crowns, and fixed partial dentures and implant abutments providing strict protocols during the manufacturing and delivery process are adhered to. Further long‐term prospective studies are necessary to establish the best manufacturing process for zirconia‐based restorations.     

Fracture load and chewing simulation of zirconia and stainless‐steel crowns for primary molars

Aesthetic alternatives to stainless‐steel crowns for restoring primary molars attain growing interest. We studied the mechanical properties of prefabricated zirconia crowns and conventional crowns. Three brands of prefabricated zirconia crowns were compared with computer‐aided design/computer‐aided manufacturing (CAD/CAM) zirconia crowns, preveneered stainless‐steel crowns, and conventional stainless‐steel crowns regarding: (i) fracture load under each of three conditions [no pretreatment, artificial aging in saliva for 12 wk, and after chewing simulation/thermocycling (1.68 × 10⁶ cycles/5–55°C)]; and (ii) survival rate during chewing simulation, considering decementation, fracture, chipping, fatigue cracks, and occlusal holes. Without pretreatment, the prefabricated zirconia crowns showed mean fracture load values between 893 N and 1,582 N, while the corresponding values for CAD/CAM zirconia crowns and preveneered stainless‐steel crowns were 2,444 N and 6,251 N. Preveneered stainless‐steel crowns showed significantly lower fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chewing simulation) than without artificial aging, whereas the fracture load of zirconia crowns was not influenced negatively. The survival rate of the different groups of zirconia crowns and preveneered stainless‐steel crowns during chewing simulation was 100%, but only 41.7% for the stainless‐steel crowns. These in‐vitro data suggest that prefabricated zirconia crowns are aesthetically and durable alternatives to stainless‐steel crowns for primary molars.     

The Effect of Multiple Firings on Microtensile Bond Strength of Core‐Veneer Zirconia‐Based All‐Ceramic Restorations

Purpose: Differences in core and veneer coefficients of thermal expansion, firing shrinkage, and speed of increasing and decreasing the temperature may generate stress in veneered all‐ceramic restorations. Given the necessity of performing multiple firing cycles to achieve improved contour, color, and esthetics, the purpose of this study was to determine the effect of multiple firing cycles on the microtensile bond strength (MTBS) of zirconia core to the porcelain veneer in zirconia‐based all‐ceramic restorations. Materials and Methods: Thirty blocks (12 × 12 × 4 mm³) of semi‐sintered zirconia were machined and sintered according to manufacturer's instruction. Specimens were placed in three groups based on the number of firing cycles (4, 6, 8) for the veneering process. After veneering, the specimens were sectioned into microbars with 8 mm length and 1 mm cross‐section. Twenty sound microbars in each group were stressed to failure in a microtensile tester machine at 1 mm/min. Fractured specimens were surveyed under a scanning electron microscope and classified as cohesive in core, cohesive in veneer, and mixed. MTBS data were analyzed using one‐way ANOVA and Tukey test (p < 0.05). Results: The mean MTBS (MPa) after 4, 6, and 8 firing cycles were 30.33 ± 2.13, 27.43 ± 1.79, and 25.06 ± 1.76, respectively. There was a statistically significant difference between the bond strengths of each of the three groups (p < 0.001). Conclusion: Increase in firing cycles decreased MTBS. Most of the failures (90–95%) in all three groups were cohesive in the veneering porcelain and did not change as the number of firing cycles increased.     

Fracture resistance of zirconia‐based all‐ceramic crowns after bur adjustment

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.     

The clinical success of tooth‐ and implant‐supported zirconia‐based fixed dental prostheses. A systematic review

The aim was to make an inventory of the current literature on the clinical performance of tooth‐ or implant‐supported zirconia‐based FDPs and analyse and discuss any complications. Electronic databases, PubMed.gov, Cochrane Library and Science Direct, were searched for original studies reporting on the clinical performance of tooth‐ or implant‐supported zirconia‐based FDPs. The electronic search was complemented by manual searches of the bibliographies of all retrieved full‐text articles and reviews, as well as a hand search of the following journals: International Journal of Prosthodontics, Journal of Oral Rehabilitation, International Journal of Oral & Maxillofacial Implants and Clinical Oral Implants Research. The search yielded 4253 titles. Sixty‐eight potentially relevant full‐text articles were retrieved. After applying pre‐established criteria, 27 studies were included. Twenty‐three studies reported on tooth‐supported and 4 on implant‐supported FDPs. Five of the studies were randomised, comparing Y‐TZP‐based restorations with metal–ceramic or other all‐ceramic restorations. Most tooth‐supported FDPs were FDPs of 3–5 units, whereas most implant‐supported FDPs were full arch. The majority of the studies reported on 3‐ to 5‐year follow‐up. Life table analysis revealed cumulative 5‐year survival rates of 93·5% for tooth‐supported and 100% for implant‐supported FDPs. For tooth‐supported FDPs, the most common reasons for failure were veneering material fractures, framework fractures and caries. Cumulative 5‐year complication rates were 27·6% and 30·5% for tooth‐ and implant‐supported FDPs, respectively. The most common complications were veneering material fractures for tooth‐ as well as implant‐supported FDPs. Loss of retention occurred more frequently in FDPs luted with zinc phosphate or glass–ionomer cement compared to those luted with resin cements. The results suggest that the 5‐year survival rate is excellent for implant‐supported zirconia‐based FDPs, despite the incidence of complications, and acceptable for tooth‐supported zirconia‐based FDPs. These results are, however, based on a relatively small number of studies, especially for the implant‐supported FDPs. The vast majority of the studies are not controlled clinical trials and have limited follow‐up. Thus, interpretation of the results should be made with caution. Well‐designed studies with large patient groups and long follow‐up times are needed before general recommendations for the use of zirconia‐based restorations can be provided.     

Effect of Veneering Techniques on Color and Translucency of Y‐TZP

Purpose: This study compared the color parameters and total luminous transmittance of disc specimens by different veneering techniques in order to examine the effect of veneering technique on esthetics of yttria‐stabilized tetragonal zirconia polycrystalline (Y‐TZP) all‐ceramic restorations. Materials and Methods: Thirty disc specimens (10‐mm diameter, 0.50 ± 0.01 mm thick) were fabricated of IPS e.max ZirCAD core material, and ZL1 IPS e.max ZirLiner (0.10‐mm thick) was layered. The specimens were randomly divided into three groups (n = 10/group). Group ZP (fully anatomical technique) was veneered 0.60 mm by heat‐pressing IPS e.max ZirPress fluorapatite glass‐ceramic ingots; Group ZC (traditional layering technique) was veneered 0.60 mm by condensing and sintering IPS e.max Ceram low‐fusing nano‐fluorapatite veneering porcelain; Group ZPC (cutback technique) was veneered by partially pressed ingots and subsequently layered 0.30 mm with veneering porcelain. Color parameters (L*, a*, b*) and total luminous transmittance (τ) of zirconia core discs and core and veneer specimens were measured with ShadeEye NCC dental colorimeter and spectrophotometer, respectively. Color saturation (C*ab) and color difference (ΔE) were calculated using color difference formula. One‐way analysis of variance (ANOVA) combined with a Tukey multiple‐range test were used to analyze the data (α= 0.05). Results: As to ZP, ZPC, and ZC groups, the value of a* increased (?1.35 ± 0.07, ?0.64 ± 0.06, ?0.36 ± 0.05, respectively) (p < 0.05); b* decreased (27.01 ± 0.07, 25.48 ± 0.11, 23.28 ± 0.25, respectively) (p < 0.05); and C*ab decreased (27.04 ± 0.08, 25.49 ± 0.11, 23.28 ± 0.25, respectively) (p < 0.05). L* value and total luminous transmittance were highest in ZP group (87.53 ± 0.48, 1.64 ± 0.03, respectively), and lowest in ZPC group (82.14 ± 0.18, 1.47 ± 0.01, respectively) (p < 0.05). Conclusions: Y‐TZP all‐ceramic restoration veneered by fully anatomical technique was the most transparent and lightest, while restorations veneered by cutback technique were the least translucent and the darkest.     

Porcelain Fracture Resistance of Screw‐Retained,Cement‐Retained,and Screw‐Cement‐Retained Implant‐Supported Metal Ceramic Posterior Crowns

Purpose: The purpose of this in vitro study was to compare the porcelain fracture resistance between screw‐retained, cement‐retained, and combined screw‐ and cement‐retained metal–ceramic (MC) implant‐supported posterior single crowns; and to investigate the effect of offsetting the occlusal screw‐access opening on porcelain fracture resistance of screw‐retained and cement‐retained MC implant‐supported posterior single crowns. Materials and Methods: Forty standardized MC molar‐shaped restorations were fabricated. The 40 restorations were divided into four groups (SRC, SRO, CRP, and CSC) of 10 specimens each. Group SRC: screw‐retained, screw‐access hole placed in the center of the occlusal surface; Group SRO: screw‐retained, screw access hole placed 1 mm offset from the center of the occlusal surface toward the buccal cusp; Group CRP: cement‐retained, zinc phosphate cement was used; Group CSC: cement‐retained with a screw‐access hole in the center of the occlusal surface. The screw‐retained restorations and abutments were directly attached to 3i implant fixtures embedded in acrylic resin blocks. Subsequently, all test specimens were thermocycled and vertically loaded in a universal testing machine at a crosshead speed of 2 mm/min until fracture. Mean values of load at fracture (in N) were calculated in each group and compared with a one‐way ANOVA and Tukey's Studentized test (α= 0.05). Results: Mean values of loads required to fracture the restorations were as follows (N): Group SRC: 1721 ± 593; Group SRO: 1885 ± 491; Group CRP: 3707 ± 1086; Group CSC: 1700 ± 526. Groups SRC, SRO, and CSC required a significantly lower force to fracture the porcelain than did the CRP group (p < 0.05). Conclusion: The cement‐retained restorations showed significantly higher mean fracture loads than the restorations having screw‐access openings in their occlusal surface. The position of the screw‐access hole within the occlusal surface did not significantly affect the porcelain fracture resistance.     

In vitro chipping behaviour of all‐ceramic crowns with a zirconia framework and feldspathic veneering: comparison of CAD/CAM‐produced veneer with manually layered veneer

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.     

Fracture strength of yttria-stabilized tetragonal zirconia polycrystals crowns with different design: an in vitro study

Objectives: The aim of this study was to evaluate the effect of different types and design of zirconia frameworks as well as the effect of different veneering ceramics on the fracture strength of crowns. The importance of different abutment materials was also evaluated. Materials and methods: Eighty cores, 40 in a fully‐sintered zirconia material and 40 in a pre‐sintered zirconia material were made. Twenty cores of each material were made with a core of even thickness shape (ES) and 20 were made with a core with anatomical shape (AS). The cores were divided into subgroups and veneered with one of two different veneering ceramics: a porcelain and a glass–ceramic material. In total eight groups of 10 crowns were made. They were all cemented onto abutments made of resin. One extra group of 10 AS, pre‐sintered zirconia cores veneered with glass–ceramic were made and cemented onto titanium abutments. All crowns underwent thermocycling and mechanical pre‐load and were finally loaded until fracture. Results: AS crowns withstood significantly higher loads than ES crowns (P‐value <0.001), and crowns with titanium abutments withstood significantly higher loads than crowns supported by abutments made of inlay pattern resin (P‐value <0.001). Three types of fracture were noted: minor and major fracture of the veneering ceramic, and complete fracture through core and veneer. ES crowns showed significantly more major fractures of the veneering ceramic than AS crowns. Conclusions: This in vitro study indicates that the design of the core, as well as the abutment support, significantly influences fracture load and fracture mode of yttria‐stabilized tetragonal zirconia polycrystals crowns. To cite this article :
Larsson C, El Madhoun S, Wennerberg A, Vult von Steyern P. Fracture strength of yttria‐stabilized tetragonal zirconia polycrystals crowns with different design: an in vitro study. Clin. Oral Impl. Res. 23 , 2012; 820–826.
doi: 10.1111/j.1600‐0501.2011.02224.x     

Residual Thermal Stress Simulation in Three‐Dimensional Molar Crown Systems: A Finite Element Analysis

Purpose: To simulate coefficient of thermal expansion (CTE)‐generated stress fields in monolithic metal and ceramic crowns, and CTE mismatch stresses between metal, alumina, or zirconia cores and veneer layered crowns when cooled from high temperature processing. Materials and Methods: A 3D computer‐aided design model of a mandibular first molar crown was generated. Tooth preparation comprised reduction of proximal walls by 1.5 mm and of occlusal surfaces by 2.0 mm. Crown systems were monolithic (all‐porcelain, alumina, metal, or zirconia) or subdivided into a core (metallic, zirconia, or alumina) and a porcelain veneer layer. The model was thermally loaded from 900°C to 25°C. A finite element mesh of three nodes per edge and a first/last node interval ratio of 1 was used, resulting in approximately 60,000 elements for both solids. Regions and values of maximum principal stress at the core and veneer layers were determined through 3D graphs and software output. Results: The metal‐porcelain and zirconia‐porcelain systems showed compressive fields within the veneer cusp bulk, whereas alumina‐porcelain presented tensile fields. At the core/veneer interface, compressive fields were observed for the metal‐porcelain system, slightly tensile for the zirconia‐porcelain, and higher tensile stress magnitudes for the alumina‐porcelain. Increasingly compressive stresses were observed for the metal, alumina, zirconia, and all‐porcelain monolithic systems. Conclusions: Variations in residual thermal stress levels were observed between bilayered and single‐material systems due to the interaction between crown configuration and material properties.     

Shear bond strength of veneering porcelain to zirconia and metal cores

STATEMENT OF PROBLEM

Zirconia-based restorations have the common technical complication of delamination, or porcelain chipping, from the zirconia core. Thus the shear bond strength between the zirconia core and the veneering porcelain requires investigation in order to facilitate the material''s clinical use.

PURPOSE

The purpose of this study was to evaluate the bonding strength of the porcelain veneer to the zirconia core and to other various metal alloys (high noble metal alloy and base metal alloy).

MATERIAL AND METHODS

15 rectangular (4×4×9mm) specimens each of zirconia (Cercon), base metal alloy (Tillite), high noble metal alloy (Degudent H) were fabricated for the shear bond strength test. The veneering porcelain recommended by the manufacturer for each type of material was fired to the core in thickness of 3mm. After firing, the specimens were embedded in the PTFE mold, placed on a mounting jig, and subjected to shear force in a universal testing machine. Load was applied at a crosshead speed of 0.5mm/min until fracture. The average shear strength (MPa) was analyzed with the one-way ANOVA and the Tukey''s test (α= .05). The fractured specimens were examined using SEM and EDX to determine the failure pattern.

RESULTS

The mean shear strength (± SD) in MPa was 25.43 (± 3.12) in the zirconia group, 35.87 (± 4.23) in the base metal group, 38.00 (± 5.23) in the high noble metal group. The ANOVA showed a significant difference among groups, and the Tukey''s test presented a significant difference between the zirconia group and the metal group. Microscopic examination showed that the failure primarily occurred near the interface with the residual veneering porcelain remaining on the core.

CONCLUSION

There was a significant difference between the metal ceramic and zirconia ceramic group in shear bond strength. There was no significant difference between the base metal alloy and the high noble metal alloy.     

Fractographic features of glass‐ceramic and zirconia‐based dental restorations fractured during clinical function

Fractures during clinical function have been reported as the major concern associated with all‐ceramic dental restorations. The aim of this study was to analyze the fracture features of glass‐ceramic and zirconia‐based restorations fractured during clinical use. Twenty‐seven crowns and onlays were supplied by dentists and dental technicians with information about type of cement and time in function, if available. Fourteen lithium disilicate glass‐ceramic restorations and 13 zirconia‐based restorations were retrieved and analyzed. Fractographic features were examined using optical microscopy to determine crack initiation and crack propagation of the restorations. The material comprised fractured restorations from one canine, 10 incisors, four premolars, and 11 molars. One crown was not categorized because of difficulty in orientation of the fragments. The results revealed that all core and veneer fractures initiated in the cervical margin and usually from the approximal area close to the most coronally placed curvature of the margin. Three cases of occlusal chipping were found. The margin of dental all‐ceramic single‐tooth restorations was the area of fracture origin. The fracture features were similar for zirconia, glass‐ceramic, and alumina single‐tooth restorations. Design features seem to be of great importance for fracture initiation.     

Reliability and Failure Modes of Implant‐Supported Y‐TZP and MCR Three‐Unit Bridges

Purpose: Chipping within veneering porcelain has resulted in high clinical failure rates for implant‐supported zirconia (yttria‐tetragonal zirconia polycrystals [Y‐TZP]) bridges. This study evaluated the reliability and failure modes of mouth‐motion step‐stress fatigued implant‐supported Y‐TZP versus palladium‐silver alloy (PdAg) three‐unit bridges. Materials and Methods: Implant‐abutment replicas were embedded in polymethylmethacrylate resin. Y‐TZP and PdAg frameworks, of similar design (n = 21 each), were fabricated, veneered, cemented (n = 3 each), and Hertzian contact‐tested to obtain ultimate failure load. In each framework group, 18 specimens were distributed across three step‐stress profiles and mouth‐motion cyclically loaded according to the profile on the lingual slope of the buccal cusp of the pontic. Results: PdAg failures included competing flexural cracking at abutment and/or connector area and chipping, whereas Y‐TZP presented predominantly cohesive failure within veneering porcelain. Including all failure modes, the reliability (two‐sided at 90% confidence intervals) for a “mission” of 50,000 and 100,000 cycles at 300 N load was determined (Alta Pro, Reliasoft, Tucson, AZ, USA). No difference in reliability was observed between groups for a mission of 50,000. Reliability remained unchanged for a mission of 100,000 for PdAg, but significantly decreased for Y‐TZP. Conclusions: Higher reliability was found for PdAg for a mission of 100,000 cycles at 300 N. Failure modes differed between materials.     

Influence of cooling rate on residual stress profile in veneering ceramic: Measurement by hole-drilling

Objectives

The manufacture of dental crowns and bridges generates residual stresses within the veneering ceramic and framework during the cooling process. Residual stress is an important factor that control the mechanical behavior of restorations. Knowing the stress distribution within the veneering ceramic as a function of depth can help the understanding of failures, particularly chipping, a well-known problem with Yttria-tetragonal-zirconia-polycrystal based fixed partial dentures. The objective of this study is to investigate the cooling rate dependence of the stress profile in veneering ceramic layered on metal and zirconia frameworks.

Methods

The hole-drilling method, often used for engineering measurements, was adapted for use with veneering ceramic. The stress profile was measured in bilayered disc samples 20 mm in diameter, with a 0.7 mm thick metal or Yttria-tetragonal-zirconia-polycrystal framework and a 1.5 mm thick veneering ceramic. Three different cooling procedures were investigated.

Results

The magnitude of the stresses in the surface of the veneering ceramic was found to increase with cooling rate, while the interior stresses decreased. At the surface, compressive stresses were observed in all samples. In the interior, compressive stresses were observed in metal samples and tensile in zirconia samples.

Significance

Cooling rate influences the magnitude of residual stresses. These can significantly influence the mechanical behavior of metal-and zirconia-based bilayered systems. The framework material influenced the nature of the interior stresses, with zirconia samples showing a less favorable stress profile than metal.     

Effect of finish line design on stress distribution in bilayer and monolithic zirconia crowns: a three‐dimensional finite element analysis study

This study evaluated the influence of different finish line designs and abutment materials on the stress distribution of bilayer and monolithic zirconia crowns using three‐dimensional finite element analysis (FEA). Three‐dimensional models of two types of zirconia premolars – a yttria‐stabilized zirconia framework with veneering ceramic and a monolithic zirconia ceramic – were used in the analysis. Cylindrical models with the finish line design of the crown abutments were prepared with three types of margin curvature radius (CR): CR = 0 (CR0; shoulder margin), CR = 0.5 (CR0.5; rounded shoulder margin), and CR = 1.0 (CR1.0; deep chamfer margin). Two abutment materials (dentin and brass) were analyzed. In the FEA model, 1 N was loaded perpendicular to the occlusal surface at the center of the crown, and linear static analysis was performed. For all crowns, stress was localized to the occlusal loading area as well as to the axial walls of the proximal region. The lowest maximum principal stress values were observed when the dentin abutment with CR0.5 was used under a monolithic zirconia crown. These results suggest that the rounded shoulder margin and deep chamfer margin, in combination with a monolithic zirconia crown, potentially have optimal geometry to minimize occlusal stress.     

Influence of the fabrication process on the in vitro performance of fixed dental prostheses with zirconia substructures

Chipping of the applied veneering ceramic is reported to be a main clinical failure type of computer-aided design/computer-aided manufacturing- or manually copy-milled zirconia restorations. The aim of this in vitro study was to investigate whether different substructure designs and veneering processes done by different dental technicians do significantly influence chipping in zirconia-based all-ceramic fixed dental prostheses during simulated oral service. Five groups (n = 8 per group) of three-unit zirconia substructures were fabricated in three different laboratories using copy-milling technique. Three series were veneered with identical porcelain (groups 1–3) and one with a second different porcelain (group 4). The fifth group was milled to final contour design without veneering. Dimensions of the connector areas were determined. All fixed partial dentures (FPDs) were adhesively boned on human teeth and thermally cycled and mechanically loaded (1.2 × 10⁶ × 50 N; 6,000 × 5°C/55°C) using human antagonists. Restorations were monitored during thermal cycling and mechanical loading (TCML). FPDs which survived were loaded to fracture. FPDs which failed during TCML were investigated with fractographic means. During TCML, chipping took place in groups 1 (two times), 2 (four times) and 3 (five times) (Table 1). Chipping areas varied between 2.3 mm² (group 3) and 58.7 mm² (group 2). Groups 4 and 5 provided no failures during TCML. Failure in all cases started from contact points, where superficial wear and disruption of the porcelain were found. No significant correlation could be determined between connector thickness and number of failures. Median fracture results varied between 1,011 N (group 3) and 2,126 N (group 2). The results show the necessity of considering individual design and manufacturing of restorations as well as contact situation. Advanced technical training on zirconia-based restorations is recommended.     

The effect of surface treatment of the interfacial surface on fatigue-related microtensile bond strength of milled zirconia to veneering porcelain

Purpose: The success of zirconia‐reinforced all‐ceramic crowns depends on the formation of a stable bond between the zirconia core and the veneering porcelain. The purpose of this study was to test the effects of liner application and airborne particle abrasion of a postsintered Y‐TZP core on the bond strength between the zirconia core and veneering porcelain with or without cyclic loading. Materials and Methods: Kavo Everest® Y‐TZP blank disks were sintered and divided into three treatment groups: airborne particle abrasion, IPS e.max® Ceram Zirliner application, or no surface treatment. The disks were then veneered with IPS e.max® ZirPress veneering porcelain. Half the veneered disks from each group were cyclically loaded. This created six experimental groups: three surface treatment groups cyclically loaded and three not loaded. The disks were then sectioned into microbars for microtensile bond strength (MTBS) testing (40 specimens per group). Specimens were luted to a fixture mount and loaded to failure using a universal testing machine (MTS Insight). The maximum force was measured and bond strength computed. Data were analyzed with a two‐way ANOVA and Tukey's HSD test (α= 0.05). Results: Airborne particle abrasion significantly decreased MTBS values (p= 0.043), and ZirLiner application did not have a significant effect on MTBS values compared to control. Cyclic loading did not have a significant effect on MTBS values. The predominant failure mode in all groups was mixed. Conclusions: Airborne particle abrasion of the interfacial surface of the Everest® Y‐TZP core significantly decreased the MTBS to ZirPress veneering porcelain when compared to no interfacial surface treatment. Application of ZirLiner to the interfacial surface of the Everest® Y‐TZP core did not significantly increase or decrease the MTBS to ZirPress veneering porcelain, compared to the other surface treatments. Cyclic loading did not affect bond strengths in any of the groups, regardless of surface treatment. Neither cyclic loading nor surface treatment affected the failure mode of the specimens.