Monolithic CAD/CAM Lithium Disilicate Versus Veneered Y-TZP Crowns: Comparison of Failure Modes and Reliability After Fatigue

Purpose: The aim of this research was to evaluate the fatigue behavior and reliability of monolithic computer-aided design/computer-assisted manufacture (CAD/CAM) lithium disilicate and hand-layer-veneered zirconia all-ceramic crowns. Materials and Methods: A CAD-based mandibular molar crown preparation, fabricated using rapid prototyping, served as the master die. Fully anatomically shaped monolithic lithium disilicate crowns (IPS e.max CAD, n = 19) and hand-layer-veneered zirconia-based crowns (IPS e.max ZirCAD/Ceram, n = 21) were designed and milled using a CAD/CAM system. Crowns were cemented on aged dentinlike composite dies with resin cement. Crowns were exposed to mouth-motion fatigue by sliding a WC-indenter (r = 3.18 mm) 0.7 mm lingually down the distobuccal cusp using three different step-stress profiles until failure occurred. Failure was designated as a large chip or fracture through the crown. If no failures occurred at high loads (> 900 N), the test method was changed to staircase r ratio fatigue. Stress level probability curves and reliability were calculated. Results: Hand-layer-veneered zirconia crowns revealed veneer chipping and had a reliability of < 0.01 (0.03 to 0.00, two-sided 90% confidence bounds) for a mission of 100,000 cycles and a 200-N load. None of the fully anatomically shaped CAD/CAM-fabricated monolithic lithium disilicate crowns failed during step-stress mouth-motion fatigue (180,000 cycles, 900 N). CAD/CAM lithium disilicate crowns also survived r ratio fatigue (1,000,000 cycles, 100 to 1,000 N). There appears to be a threshold for damage/bulk fracture for the lithium disilicate ceramic in the range of 1,100 to 1,200 N. Conclusion: Based on present fatigue findings, the application of CAD/CAM lithium disilicate ceramic in a monolithic/fully anatomical configuration resulted in fatigue-resistant crowns, whereas hand-layer-veneered zirconia crowns revealed a high susceptibility to mouth-motion cyclic loading with early veneer failures. Int J Prosthodont 2010; 23: 434-442.

Effect of hydrofluoric acid etching duration on the roughness and flexural strength of a lithium disilicate-based glass ceramic

The aim of this study was to examine the effect of different acid etching times on the surface roughness and flexural strength of a lithium disilicate-based glass ceramic. Ceramic bar-shaped specimens (16 mm x 2 mm x 2 mm) were produced from ceramic blocks. All specimens were polished and sonically cleaned in distilled water. Specimens were randomly divided into 5 groups (n=15). Group A (control) no treatment. Groups B-E were etched with 4.9% hydrofluoric acid (HF) for 4 different etching periods: 20 s, 60 s, 90 s and 180 s, respectively. Etched surfaces were observed under scanning electron microscopy. Surface profilometry was used to examine the roughness of the etched ceramic surfaces, and the specimens were loaded to failure using a 3-point bending test to determine the flexural strength. Data were analyzed using one-way ANOVA and Tukey's test (α=0.05). All etching periods produced significantly rougher surfaces than the control group (p<0.05). Roughness values increased with the increase of the etching time. The mean flexural strength values were (MPa): A=417 ± 55; B=367 ± 68; C=363 ± 84; D=329 ± 70; and E=314 ± 62. HF etching significantly reduced the mean flexural strength as the etching time increased (p=0.003). In conclusion, the findings of this study showed that the increase of HF etching time affected the surface roughness and the flexural strength of a lithium disilicate-based glass ceramic, confirming the study hypothesis.

Stress distribution in ceramic restorations over natural tooth using finite element analysis. lithium disilicate x aluminum oxide material

Background: Data on stress distribution in tooth-restoration interface with different ceramic restorative materials are limited. The aim of this chapter was to assess the stress distribution in the interface of ceramic restorations with laminate veneer or full-coverage crown with two different materials (lithium dissilicate and densely sintered aluminum oxide) under different loading areas through finite element analysis. Materials and Methods: Six two-dimensional finite element models were fabricated with different restorations on natural tooth: laminate veneer (IPS Empress, IPS Empress Esthetic and Procera AllCeram) or full-coverage crown (IPS e.max Press and Procera AllCeram). Two different loading areas (L) (50N) were also determined: palatal surface at 45° in relation to the long axis of tooth (L1) and perpendicular to the incisal edge (L2). A model with higid natural tooth was used as control. von Mises equivalent stress (σ vM) and maximum principal stress (σ max) were obtained on Ansys software. Results: The presence of ceramic restoration increased σ vM and σ max in the adhesive interface, mainly for the aluminum oxide (Procera AllCeram system) restorations. The full-coverage crowns generated higher stress in the adhesive interface under L1 while the same result was observed for the laminate veneers under L2. Conclusions: Lithium dissilicate and densely sintered aluminum oxide restorations exhibit different behavior due to different mechanical properties and loading conditions. © 2011 Nova Science Publishers, Inc.

Effect of Resin Cement Type on the Microtensile Bond Strength to Lithium Disilicate Ceramic and Dentin Using Different Test Assemblies

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Surface degradation of lithium disilicate ceramic after immersion in acid and fluoride solutions

Purpose: To analyze whether immersion in sodium fluoride (NaF) solutions and/or common acidic beverages (test solutions) would affect the surface roughness or topography of lithium disilicate ceramic. Methods: 220 ceramic discs were divided into four groups, each of which was subdivided into five subgroups (n = 11). Control group discs were immersed in one of four test beverages for 4 hours daily or in artificial saliva for 21 days. Discs in the experimental groups were continuously immersed in 0.05% NaF, 0.2% NaF, or 1.23% acidulated phosphate fluoride (APF) gel for 12, 73, and 48 hours, respectively, followed by immersion in one of the four test beverages or artificial saliva. Vickers microhardness, surface roughness, scanning electron microscopy (SEM) associated with energy dispersive spectroscopy, and atomic force microscopy (AFM) assessments were made. Data were analyzed by nested analysis of variance (ANOVA) and Tukey's test (alpha = 0.05). Results: Immersion in the test solutions diminished the microhardness and increased the surface roughness of the discs. The test beverages promoted a significant reduction in the Vickers microhardness in the 0.05% and 0.2% NaF groups. The highest surface roughness results were observed in the 0.2% NaF and 1.23% APF groups, with similar findings by SEM and AFM. Acidic beverages affected the surface topography of lithium disilicate ceramic. Fluoride treatments may render the ceramic surface more susceptible to the chelating effect of acidic solutions.

Surface characterization of lithium disilicate ceramic after nonthermal plasma treatment

Statement of problem. Surface transformation with nonthermal plasma may be a suitable treatment for dental ceramics, because it does not affect the physical properties of the ceramic material.Purpose. The purpose of this study was to characterize the chemical composition of lithium disilicate ceramic and evaluate the surface of this material after nonthermal plasma treatment.Material and methods. A total of 21 specimens of lithium disilicate (10 mm in diameter and 3 mm thick) were fabricated and randomly divided into 3 groups (n=7) according to surface treatment. The control group was not subjected to any treatment except surface polishing with abrasive paper. In the hydrofluoric acid group, the specimens were subjected to hydrofluoric acid gel before silane application. Specimens in the nonthermal plasma group were subjected to the nonthermal plasma treatment. The contact angle was measured to calculate surface energy. In addition, superficial roughness was measured and was examined with scanning electron microscopy, and the chemical composition was characterized with energy-dispersive spectroscopy analysis. The results were analyzed with ANOVA and the Tukey honestly significant difference test (alpha=.05).Results. The water contact angle was decreased to 0 degrees after nonthermal plasma treatment. No significant difference in surface roughness was observed between the control and nonthermal plasma groups. Scanning electron microscopy and energy-dispersive spectroscopy images indicated higher amounts of oxygen (O) and silicon (Si) and a considerable reduction in carbon (C) in the specimens after nonthermal plasma treatment.Conclusions. Nonthermal plasma treatment can transform the characteristics of a ceramic surface without affecting its surface roughness. A reduction in C levels and an increase in 0 and Si levels were observed with the energy-dispersive spectroscopy analysis, indicating that the deposition of the thin silica film was efficient.

Stiffness, Strength, and Failure Modes of Implant-Supported Monolithic Lithium Disilicate Crowns: Influence of Titanium and Zirconia Abutments

PURPOSE The objective of this study was to evaluate stiffness, strength, and failure modes of monolithic crowns produced using computer-aided design/computer-assisted manufacture, which are connected to diverse titanium and zirconia abutments on an implant system with tapered, internal connections. MATERIALS AND METHODS Twenty monolithic lithium disilicate (LS2) crowns were constructed and loaded on bone level-type implants in a universal testing machine under quasistatic conditions according to DIN ISO 14801. Comparative analysis included a 2 × 2 format: prefabricated titanium abutments using proprietary bonding bases (group A) vs nonproprietary bonding bases (group B), and customized zirconia abutments using proprietary Straumann CARES (group C) vs nonproprietary Astra Atlantis (group D) material. Stiffness and strength were assessed and calculated statistically with the Wilcoxon rank sum test. Cross-sections of each tested group were inspected microscopically. RESULTS Loaded LS2 crowns, implants, and abutment screws in all tested specimens (groups A, B, C, and D) did not show any visible fractures. For an analysis of titanium abutments (groups A and B), stiffness and strength showed equally high stability. In contrast, proprietary and nonproprietary customized zirconia abutments exhibited statistically significant differences with a mean strength of 366 N (Astra) and 541 N (CARES) (P < .05); as well as a mean stiffness of 884 N/mm (Astra) and 1,751 N/mm (CARES) (P < .05), respectively. Microscopic cross-sections revealed cracks in all zirconia abutments (groups C and D) below the implant shoulder. CONCLUSION Depending on the abutment design, prefabricated titanium abutment and proprietary customized zirconia implant-abutment connections in conjunction with monolithic LS2 crowns had the best results in this laboratory investigation.

Effect Of Platform Connection And Abutment Material On Stress Distribution In Single Anterior Implant-supported Restorations: A Nonlinear 3-dimensional Finite Element Analysis.

Although various abutment connections and materials have recently been introduced, insufficient data exist regarding the effect of stress distribution on their mechanical performance. The purpose of this study was to investigate the effect of different abutment materials and platform connections on stress distribution in single anterior implant-supported restorations with the finite element method. Nine experimental groups were modeled from the combination of 3 platform connections (external hexagon, internal hexagon, and Morse tapered) and 3 abutment materials (titanium, zirconia, and hybrid) as follows: external hexagon-titanium, external hexagon-zirconia, external hexagon-hybrid, internal hexagon-titanium, internal hexagon-zirconia, internal hexagon-hybrid, Morse tapered-titanium, Morse tapered-zirconia, and Morse tapered-hybrid. Finite element models consisted of a 4×13-mm implant, anatomic abutment, and lithium disilicate central incisor crown cemented over the abutment. The 49 N occlusal loading was applied in 6 steps to simulate the incisal guidance. Equivalent von Mises stress (σvM) was used for both the qualitative and quantitative evaluation of the implant and abutment in all the groups and the maximum (σmax) and minimum (σmin) principal stresses for the numerical comparison of the zirconia parts. The highest abutment σvM occurred in the Morse-tapered groups and the lowest in the external hexagon-hybrid, internal hexagon-titanium, and internal hexagon-hybrid groups. The σmax and σmin values were lower in the hybrid groups than in the zirconia groups. The stress distribution concentrated in the abutment-implant interface in all the groups, regardless of the platform connection or abutment material. The platform connection influenced the stress on abutments more than the abutment material. The stress values for implants were similar among different platform connections, but greater stress concentrations were observed in internal connections.

Slow crack growth and reliability of dental ceramics

Objective. To determine the slow crack growth (SCG) and Weibull parameters of five dental ceramics: a vitreous porcelain (V), a leucite-based porcelain (D), a leucite-based glass-ceramic (E1), a lithium disilicate glass-ceramic (E2) and a glass-infiltrated alumina composite (IC). Methods. Eighty disks (empty set 12mm x 1.1mm thick) of each material were constructed according to manufacturers` recommendations and polished. The stress corrosion susceptibility coefficient (n) was obtained by dynamic fatigue test, and specimens were tested in biaxial flexure at five stress rates immersed in artificial saliva at 37 degrees C. Weibull parameters were calculated for the 30 specimens tested at 1MPa/s in artificial saliva at 37 degrees C. The 80 specimens were distributed as follows: 10 for each stress rate (10(-2), 10(-1), 10(1), 10(2) MPa/s), 10 for inert strength (10(2) MPa/s, silicon oil) and 30 for 10(0) MPa/s. Fractographic analysis was also performed to investigate the fracture origin. Results. E2 showed the lowest slow crack growth susceptibility coefficient (17.2), followed by D (20.4) and V (26.3). E1 and IC presented the highest n values (30.1 and 31.1, respectively). Porcelain V presented the lowest Weibull modulus (5.2). All other materials showed similar Weibull modulus values, ranging from 9.4 to 11.7. Fractographic analysis indicated that for porcelain D, glass-ceramics E1 and E2, and composite IC crack deflection was the main toughening mechanism. Significance. This study provides a detailed microstructural and slow crack growth characterization of widely used dental ceramics. This is important from a clinical standpoint to assist the clinician in choosing the best ceramic material for each situation as well as predicting its clinical longevity. It also can be helpful in developing new materials for dental prostheses. (c) 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Effect of processing induced particle alignment on the fracture toughness and fracture behavior of multiphase dental ceramics

Objective. To investigate the processing induced particle alignment on fracture behavior of four multiphase dental ceramics (one porcelain, two glass-ceramics and a glass-infiltrated-alumina composite). Methods. Disks (empty set12mm x 1.1 mm-thick) and bars (3 mm x 4 mm x 20 mm) of each material were processed according to manufacturer instructions, machined and polished. Fracture toughness (K(IC)) was determined by the indentation strength method using 3-point bending and biaxial flexure fixtures for the fracture of bars and disks, respectively. Microstructural and fractographic analyses were performed with scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction. Results. The isotropic microstructure of the porcelain and the leucite-based glass-ceramic resulted in similar fracture toughness values regardless of the specimen geometry. On the other hand, materials containing second-phase particles with high aspect ratio (lithium disilicate glass-ceramic and glass-infiltrated-alumina composite) showed lower fracture toughness for disk specimens compared to bars. For the lithium disilicate glass-ceramic disks, it was demonstrated that the occurrence of particle alignment during the heat-pressing procedure resulted in an unfavorable pattern that created weak microstructural paths during the biaxial test. For the glass-infiltrated-alumina composite, the microstructural analysis showed that the large alumina platelets tended to align their large surfaces perpendicularly to the direction of particle deposition during slip casting of green preforms. Significance. The fracture toughness of dental ceramics with anisotropic microstructure should be determined by means of biaxial testing, since it results in lower values. (C) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.