Erik Adolfsson

Towards long lasting zirconia-based composites for dental implants: Transformation induced plasticity and its consequence on ceramic reliability

Zirconia-based composites were developed through an innovative processing route able to tune compositional and microstructural features very precisely. Fully-dense ceria-stabilized zirconia ceramics (84vol% Ce-TZP) containing equiaxed alumina (8vol%Al2O3) and elongated strontium hexa-aluminate (8vol% SrAl12O19) second phases were obtained by conventional sintering. This work deals with the effect of the zirconia stabilization degree (CeO2 in the range 10.0-11.5mol%) on the transformability and mechanical properties of Ce-TZP-Al2O3-SrAl12O19 materials. Vickers hardness, biaxial flexural strength and Single-edge V-notched beam tests revealed a strong influence of ceria content on the mechanical properties. Composites with 11.0mol% CeO2 or above exhibited the classical behaviour of brittle ceramics, with no apparent plasticity and very low strain to failure. On the contrary, composites with 10.5mol% CeO2 or less showed large transformation-induced plasticity and almost no dispersion in strength data. Materials with 10.5mol% of ceria showed the highest values in terms of biaxial bending strength (up to 1.1GPa) and fracture toughness (>10MPa√m). In these ceramics, as zirconia transformation precedes failure, the Weibull modulus was exceptionally high and reached a value of 60, which is in the range typically reported for metals. The results achieved demonstrate the high potential of using these new strong, tough and stable zirconia-based composites in structural biomedical applications. STATEMENT OF SIGNIFICANCE Yttria-stabilized (Y-TZP) zirconia ceramics are increasingly used for developing metal-free restorations and dental implants. Despite their success related to their excellent mechanical resistance, Y-TZP can undergo Low Temperature Degradation which could be responsible for restoration damage or even worst the failure of the implant. Current research is focusing on strategies to improve the LTD resistance of Y-TZP or to develop alternative composites with better stability in vivo. In this work the mechanical characterization of a new type of very-stable zirconia-based composites is presented. These materials are composed of ceria-stabilized zirconia (84vol%Ce-TZP) containing two second phases (α-alumina and strontium hexa-aluminate) and exhibit exceptional strength, toughness and ductility, which may allow the processing of dental implants with a perfect reliability and longer lifetime.

Initial Bacterial Adhesion on Different Yttria-Stabilized Tetragonal Zirconia Implant Surfaces in Vitro

Bacterial adhesion to implant biomaterials constitutes a virulence factor leading to biofilm formation, infection and treatment failure. The aim of this study was to examine the initial bacterial adhesion on different implant materials in vitro. Four implant biomaterials were incubated with Enterococcus faecalis, Staphylococcus aureus and Candida albicans for 2 h: 3 mol % yttria-stabilized tetragonal zirconia polycrystal surface (B1a), B1a with zirconium oxide (ZrO2) coating (B2a), B1a with zirconia-based composite coating (B1b) and B1a with zirconia-based composite and ZrO2 coatings (B2b). Bovine enamel slabs (BES) served as control. The adherent microorganisms were quantified and visualized using scanning electron microscopy (SEM); DAPI and live/dead staining. The lowest bacterial count of E. faecalis was detected on BES and the highest on B1a. The fewest vital C. albicans strains (42.22%) were detected on B2a surfaces, while most E. faecalis and S. aureus strains (approximately 80%) were vital overall. Compared to BES; coated and uncoated zirconia substrata exhibited no anti-adhesive properties. Further improvement of the material surface characteristics is essential.

Influence of Resin Composition on the Defect Formation in Alumina Manufactured by Stereolithography

Stereolithography (SL) is a technique allowing additive manufacturing of complex ceramic parts by selective photopolymerization of a photocurable suspension containing photocurable monomer, photoinitiator, and a ceramic powder. The manufactured three-dimensional object is cleaned and converted into a dense ceramic part by thermal debinding of the polymer network and subsequent sintering. The debinding is the most critical and time-consuming step, and often the source of cracks. In this study, photocurable alumina suspensions have been developed, and the influence of resin composition on defect formation has been investigated. The suspensions were characterized in terms of rheology and curing behaviour, and cross-sections of sintered specimens manufactured by SL were evaluated by SEM. It was found that the addition of a non-reactive component to the photocurable resin reduced polymerization shrinkage and altered the thermal decomposition of the polymer matrix, which led to a reduction in both delamination and intra-laminar cracks. Using a non-reactive component that decomposed rather than evaporated led to less residual porosity.

Long-term stability of an injection-molded zirconia bone-level implant: A testing protocol considering aging kinetics and dynamic fatigue

OBJECTIVE Separately addressing the fatigue resistance (ISO 14801, evaluation of final product) and aging behavior (ISO 13356, standardized sample) of oral implants made from yttria-stabilized zirconia proved to be insufficient in verifying their long-term stability, since (1) implant processing is known to significantly influence transformation kinetics and (2) aging, up from a certain level, is liable to decrease fatigue resistance. Therefore, the aim of this investigation was to apply a new testing protocol considering environmental conditions adequately inducing aging during dynamic fatigue. METHODS Zirconia implants were dynamically loaded (107 cycles), hydrothermally aged (85°, 60 days) or subjected to both treatments simultaneously. Subsequent, monoclinic intensity ratios (Xm) were obtained by locally resolved X-ray microdiffraction (μ-XRD2). Transformation propagation was monitored at cross-sections by μ-Raman spectroscopy and scanning electron microscopy (SEM). Finally, implants were statically loaded to fracture. Linear regression models (fracture load) and mixed models (Xm) were used for statistical analyses. RESULTS All treatments resulted in increased fracture load (p≤0.005), indicating the formation of transformation induced compressive stresses around surface defects during all treatment modalities. However, only hydrothermal and combinational treatment were found to increase Xm (p<0.001). No change in Xm was observed for solely dynamically loaded samples (p≥0.524). Depending on the variable observed, a monoclinic layer thickness of 1-2μm (SEM) or 6-8μm (Raman spectroscopy) was measured at surfaces exposed to water during treatments. SIGNIFICANCE Hydrothermal aging was successfully induced during dynamic fatigue. Therefore, the presented setup might serve as reference protocol for ensuring pre-clinically long-term reliability of zirconia oral implants.

Design and development of dental ceramics: Examples of current innovations and future concepts

Abstract Ceramics for restorative dentistry should satisfy some major requirements: biocompatibility, esthetic properties, and mechanical performance, to ensure proper reliability and lifetime to the dental devices. By keeping in mind such requirements and related applications, this chapter aims to provide some guidelines for the design and development of innovative ceramics for the next generation of dental products and to indicate the direction for future developments. Three main strategies are illustrated here concerning the design of new dental restorative materials. The first strategy focuses on strong, tough, and stable zirconia-based ceramics, needed for dental parts and implants subjected to the highest stresses. The second is the biomimetic approach, in which the design of dental ceramics is inspired by the human tooth architecture and functions. Functionally graded ceramics as well as mineralized tissue-based hierarchical structures have recently been designed and developed to this aim. The third ambitious strategy relates to tissue engineering in dentistry, showing the most recent advances for regenerating the whole-tooth complex in a biological manner.

Stability and aging resistance of a zirconia oral implant using a carbon fiber-reinforced screw for implant-abutment connection

OBJECTIVE To investigate the long-term stability of a metal-free zirconia two-piece implant assembled with a carbon fiber-reinforced (CRF) screw by means of transformation propagation, potential changes in surface roughness, the gap size of the implant-abutment connection, and fracture load values. METHODS In a combined procedure, two-piece implants made from alumina-toughened zirconia were dynamically loaded (107 cycles) and hydrothermally aged (85°, 60days). Implants made from titanium (Ti) and a titanium-zirconium (TiZr) alloy with a titanium abutment screw served as control. Transformation propagation (ATZ) and gap size of the IAC were monitored at cross-sections by scanning electron microscopy (SEM). Furthermore, changes in surface roughness of ATZ implants were measured. Finally, implants were statically loaded to fracture. Linear regression models and pairwise comparisons were used for statistical analyses. RESULTS Independent of the implant bulk material, dynamic loading/hydrothermal aging did not decrease fracture resistance (p=0.704). All test and control implants fractured at mean loads >1100N. Gap size of the IAC remained stable (<5μm) or decreased. None of the CFR screws fractured during static or dynamic loading. Monoclinic layer thickness of ATZ implants increased by 2-3μm at surfaces exposed to water, including internal surfaces of the IAC. No changes in surface roughness were observed. SIGNIFICANCE Combined hydrothermal aging and dynamic loading did not affect the above-mentioned parameters of the evaluated two-piece ATZ implant. Mean fracture loads >1100N suggest a reliable clinical application.