E. Dianne Rekow

Conventional and modified veneered zirconia vs. metalloceramic: fatigue and finite element analysis.

PURPOSE The purpose of this study was to test the hypothesis that all-ceramic crown core-veneer system reliability is improved by modifying the core design and as a result is comparable in reliability to metal-ceramic retainers (MCR). Finite element analysis (FEA) was performed to verify maximum principal stress distribution in the systems. MATERIALS AND METHODS A first lower molar full crown preparation was modeled by reducing the height of proximal walls by 1.5 mm and occlusal surface by 2.0 mm. The CAD-based preparation was replicated and positioned in a dental articulator for specimen fabrication. Conventional (0.5 mm uniform thickness) and modified (2.5 mm height, 1 mm thickness at the lingual extending to proximals) zirconia (Y-TZP) core designs were produced with 1.5 mm veneer porcelain. MCR controls were fabricated following conventional design. All crowns were resin cemented to 30-day aged composite dies, aged 14 days in water and either single-loaded to failure or step-stress fatigue tested. The loads were positioned either on the mesiobuccal or mesiolingual cusp (n = 21 for each ceramic system and cusp). Probability Weibull and use level probability curves were calculated. Crack evolution was followed, and postmortem specimens were analyzed and compared to clinical failures. RESULTS Compared to conventional and MCRs, increased levels of stress were observed in the core region for the modified Y-TZP core design. The reliability was higher in the Y-TZP-lingual-modified group at 100,000 cycles and 200 N, but not significantly different from the MCR-mesiolingual group. The MCR-distobuccal group showed the highest reliability. Fracture modes for Y-TZP groups were veneer chipping not exposing the core for the conventional design groups, and exposing the veneer-core interface for the modified group. MCR fractures were mostly chipping combined with metal coping exposure. CONCLUSIONS FEA showed higher levels of stress for both Y-TZP core designs and veneer layers compared to MCR. Core design modification resulted in fatigue reliability response of Y-TZP comparable to MCR at 100,000 cycles and 200 N. Fracture modes observed matched with clinical scenarios.

Bond strength to high-crystalline content zirconia after different surface treatments

The aim of this study was to evaluate the effect of primers, luting systems and aging on bond strength to zirconium oxide substrates. Eighteen zirconia discs (19.5 x 4 mm) were polished and treated (n = 3) either with a MDP primer (Md) or with a MDP and VBATDT primer (MV). In the control group (n = 3) no surface chemical treatment was performed. Zirconia specimens were cemented to prepolymerized composite discs utilizing resin cements - RelyX Unicem or Panavia 21 (RU and Pa, respectively). After 24 h, samples were sectioned for microtensile testing and returned to water at 37 degrees C for two different periods before being tested: 72 h or 60 days + thermocycling (5-55 degrees C/5000 cycles). Bond strength testing was performed at 1 mm/min. Values in MPa were analyzed through ANOVA and Tukeys Studentized Range (HSD) (p > 0.05). The application of MV primer resulted in the highest bond strength (22.77 MPa), statistically superior to Md primer (12.78 MPa), and control groups presented the lowest values (9.17 MPa). When luting systems were compared, RU promoted the highest bond strength (16.07 MPa) in comparison with Pa (13.75 MPa). The average bond strength decrease after aging (9.35 MPa) when compared with initial values (20.46 MPa). The results presented by this in vitro study suggest that a chemical surface treatment based on the MDP and VBATDT combination may improve bond strength between zirconia and luting system, without any previous mechanical treatment, depending on the luting system used. This chemical treatment may result in a reliable alternative to achieve adequate and durable bond strength.

Effects of geometry on fracture initiation and propagation in all-ceramic crowns

The complex and patient-unique geometry of posterior all-ceramic dental crowns represents a particularly interesting set of challenges to understanding stress concentration and fracture evolution in response to loading. A series of numerical and physical experiments, with both single cycle and fatigue loading, show that geometry profoundly influences the stress concentration and fracture initiation and propagation. In stylized crowns with uniform axial wall height, stresses concentrate beneath the indenter. As the height of the axial wall increases, loads to cause failure increase linearly. In crowns with variation in axial wall height around the periphery, stresses concentrate both beneath the indenter and at the margin of the core ceramic. The magnitude of the stress concentration at the margin is directly related to the amount of variation in axial wall height around the periphery of the crown. Anatomically correct veneered zirconia core crowns subjected to single-cycle loads, fracture in areas of greatest stress concentration identified by finite element models. Fractures and stress concentrations that occur in response to single-cycle loading are important indicators of initiation sites for fatigue failure. (c) 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2009.

Competition of Fracture Mechanisms in Monolithic Dental Ceramics: Flat Model Systems

Monolithic (single layer) glass-ceramic restorations often fail from chipping and fracture. Using blunt indentation of a model flat porcelain-like brittle layer bonded onto a dentin-like polymer support system, a variety of fatigue fracture modes has been identified and analyzed: outer cone, inner cone, and median cracks developing in the near-contact region at the occlusal surface; radial cracks developing at the internal cementation surface along the loading axis. Our findings indicate that monolithic glass-ceramic layers are vulnerable to both occlusal surface damage and cementation internal surface fracture. Clinical issues in the longevity of ceramic restorations are discussed in relation to biting force, physical properties of ceramic crowns and luting cement, and thicknesses of ceramic and cement layers.

Failure modes of Y-TZP crowns at different cusp inclines

OBJECTIVES To compare the reliability of the disto-facial (DF) and mesio-lingual (ML) cusps of an anatomically correct zirconia (Y-TZP) crown system. The research hypotheses tested were: (1) fatigue reliability and failure mode are similar for the ML and DF cusps; (2) failure mode of one cusp does not affect the failure of the other. METHODS The average dimensions of a mandibular first molar crown were imported into CAD software; a tooth preparation was modelled by 1.5 mm marginal high reduction of proximal walls and occlusal surface by 2.0 mm. The CAD-based tooth preparation was milled and used as a die to fabricate crowns (n=14) with porcelain veneer on a 0.5 mm Y-TZP core. Crowns were cemented on composite reproductions of the tooth preparation. The crowns were step-stress mouth motion fatigued with sliding (0.7 mm) a tungsten-carbide indenter of 6.25 mm diameter down on the inclines of either the DF or ML cusps. Use level probability Weibull curve with use stress of 200 N and the reliability for completion of a mission of 50,000 cycles at 200 N load were calculated. RESULTS Reliability for a 200 N at 50,000 cycles mission was not different between tested cusps. SEM imaging showed large cohesive failures within the veneer for the ML and smaller for the DF. Fractures originated from the contact area regardless of the cusp loaded. CONCLUSION No significant difference on fatigue reliability was observed between the DF compared to the ML cusp. Fracture of one cusp did not affect the other.