Gabriel Kalil Rocha Pereira

Low-temperature degradation of Y-TZP ceramics: A systematic review and meta-analysis

The aim of this study was to systematically review the literature to assess if low-temperature degradation (LTD) simulation in autoclave promotes deleterious impact on the mechanical properties and superficial characteristics of Y-TZP ceramics compared to the non-aged protocol. The MEDLINE via PubMed electronic database was searched with included peer-reviewed publications in English language and with no publication year limit. From 413 potentially eligible studies, 49 were selected for full-text analysis, 19 were included in the systematic review with 12 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analysis was performed using RevMan 5.1, with random effects model, at a significance level of p<0.05. Descriptive analysis of monoclinic phase content data showed that aging in autoclave promotes an increase in m-phase content (ranging from 0% up to 13.4% before and 2.13% up to 81.4% after aging) with intensity associated to the material susceptibility and to the aging parameters (time, pressure and temperature). Risk of bias analysis showed that only 1 study presented high risk, while the majority showed medium risk. Five meta-analyzes (factor: aging×control) were performed considering global and subgroups analyzes (pressure, time, temperature and m-phase % content) for flexural strength data. In the global analysis a significant difference (p<0.05) was observed between conditions, favoring non-aging group. Subgroup analysis revealed statistical difference (p<0.05) favoring non-aging, for aging time >20h. However, for shorter aging times (≤20h), there was no difference between groups. Pressure subgroup analysis presented a statistical difference (p<0.05) only when a pressure ≥2bar was employed, favoring non-aging group. Temperature subgroup analysis showed a statistical difference (p<0.05) only when temperature=134°C was used, favoring the non-aging group. M-phase % content analysis presented statistical difference (p<0.05) when more than 50% of m-phase content was observed, favoring non-aging group. High heterogeneity was found in some comparisons. Aging in autoclave promoted low-temperature degradation, impacting deleteriously on mechanical properties of Y-TZP ceramics. However, the effect of LTD depends on some methodological parameters indicating that aging time higher than 20h; pressure ≥2bar and temperature of 134°C are ideal parameters to promote LTD effects, and that those effect are only observed when more than 50% m-phase content is observed.

Effect of grinding with diamond-disc and -bur on the mechanical behavior of a Y-TZP ceramic

This study compared the effects of grinding on the surface micromorphology, phase transformation (t→m), biaxial flexural strength and structural reliability (Weibull analysis) of a Y-TZP (Lava) ceramic using diamond-discs and -burs. 170 discs (15×1.2mm) were produced and divided into 5 groups: without treatment (Ctrl, as-sintered), and ground with 4 different systems: extra-fine (25µm, Xfine) and coarse diamond-bur (181µm, Coarse), 600-grit (25µm, D600) and 120-grit diamond-disc (160µm, D120). Grinding with burs was performed using a contra-angle handpiece (T2-Revo R170, Sirona), while for discs (Allied) a Polishing Machine (Ecomet, Buehler) was employed, both under water-cooling. Micromorphological analysis showed distinct patterns generated by grinding with discs and burs, independent of grit size. There was no statistical difference for characteristic strength values (MPa) between smaller grit sizes (D600 - 1050.08 and Xfine - 1171.33), although they presented higher values compared to Ctrl (917.58). For bigger grit sizes, a significant difference was observed (Coarse - 1136.32>D120 - 727.47). Weibull Modules were statistically similar between the tested groups. Within the limits of this study, from a micromorphological point-of-view, the treatments performed did not generate similar effects, so from a methodological point-of-view, diamond-discs should not be employed to simulate clinical abrasion performed with diamond-burs on Y-TZP ceramics.

Loading frequencies up to 20 Hz as an alternative to accelerate fatigue strength tests in a Y-TZP ceramic

Considering the interest of the research community in the fatigue behavior of all-ceramic restorations and the time consumed in low-frequency cyclic fatigue tests, this study aimed to investigate the influence of the loading frequency on the zirconia fatigue strength. The biaxial flexural fatigue strength of Y-TZP discs was determined by the staircase approach after 500,000 cycles. The investigated frequencies were 2Hz (control-simulation of the chewing activity; n=20), 10Hz (n=20), 20Hz (n=20), and 40Hz (n=21). The fatigue strength data were analyzed using one-way ANOVA and post-hoc Tukey׳s test (α=0.05). Pearson coefficient (r) was calculated to assess the existence of a correlation between fatigue strength and loading frequency. X-ray diffraction analysis was used to determine the relative amount of monoclinic phase under each fatigue test condition. The fatigue strength was significantly higher for 40Hz group (630.7±62.1MPa) and did not differ among the groups 2Hz (550.3±89.7MPa), 10Hz (574.0±47MPa) and 20Hz (605.1±30.7MPa). Pearson correlation coefficient indicated a significantly moderate correlation (r=0.57) between fatigue strength and loading frequency. The percentage of monoclinic phase was similar among the groups. Therefore, the use of loading frequencies up to 20Hz seems a good alternative to expedite the cycling strength fatigue tests in polycrystalline ceramics without significantly changing the fatigue behavior showed by zirconia in tests employing the frequency of the masticatory cycle.

Effects of two grading techniques of zirconia material on the fatigue limit of full-contour 3-unit fixed dental prostheses

OBJECTIVE This study evaluated the effects of two grading techniques of zirconia material on the fatigue limit of full-contour 3-unit fixed dental prostheses (FDPs). METHODS Presintered blocks of 3Y-TZP were milled to obtain sixty-nine 3-unit FDPs, which were divided into three groups (n=23). The control group (CTL) was sintered and glazed following manufacturers instructions. In the two experimental groups presintered FDPs received a surface silica/glass infiltration treatment before the sintering process. Silica sol-gel group (SSG) was graded by the sol-gel processing route, while the glass-zirconia-glass group (GZG) was graded by an enameling technique. Graded groups did not receive a glaze layer after sintering. All FDPs were then luted with a dual-curing resin cement on composite abutments, embedded in polyurethane and stored in water for five days. The initial load of the fatigue test was calculated based on the results of the monotonic testing applied on three specimens of each group. To determine the fatigue limit, 20 samples of each group were subjected to staircase testing (100,000 cycles/5Hz). RESULTS The fatigue limits (in Newtons) were CTL=1607.27, SSG=1824.31, and GZG=2006.57, and the Dixon and Mood test indicated statistically significant differences among groups (95% confidence interval) (GZG > SSG > CTL). SIGNIFICANCE The infiltration of silica and glass on bulk zirconia, by two different grading methods, increased the fatigue limits of monolithic zirconia FDPs.

The effect of grinding on the mechanical behavior of Y-TZP ceramics: A systematic review and meta-analyses

The aim of this study was to systematically review the literature to assess the effect of grinding on the mechanical properties, structural stability and superficial characteristics of Y-TZP ceramics. The MEDLINE via PubMed and Web of Science (ISI - Web of Knowledge) electronic databases were searched with included peer-reviewed publications in English language and with no publication year limit. From 342 potentially eligible studies, 73 were selected for full-text analysis, 30 were included in the systematic review with 20 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analyses were performed using RevMan 5.1, with random effects model, at a significance level of 0.05. A descriptive analysis considering phase transformation, Y-TZP grain size, Vickers hardness, residual stress and aging of all included studies were executed. Four outcomes were considered in the meta-analyses (factor: grinding x as-sintered) in global and subgroups analyses (grinding tool, grit-size and cooling) for flexural strength and roughness (Ra) data. A significant difference (p<0.05) was observed in the global analysis for strength, favoring as-sintered; subgroup analyses revealed that different parameters lead to different effects on strength. In the global analysis for roughness, a significant difference (p<0.05) was observed between conditions, favoring grinding; subgroup analyses revealed that different parameters also lead to different effects on roughness. High heterogeneity was found in some comparisons. Generally grinding promotes decrease in strength and increase in roughness of Y-TZP ceramics. However, the use of a grinding tool that allows greater accuracy of the movement (i.e. contra angle hand-pieces coupled to slowspeed turbines), small grit size (<50μm) and the use of plenty coolant seem to be the main factors to decrease the defect introduction and allow the occurrence of the toughening transformation mechanism, decreasing the risk of deleterious impact on Y-TZP mechanical properties.

Effect of grinding and heat treatment on the mechanical behavior of zirconia ceramic

The present study investigated the effect of grinding on roughness, flexural strength, and reliability of a zirconia ceramic before and after heat treatment. Seven groups were tested (n = 15): a control group (labeled CG, untreated), and six groups of samples ground with diamond discs, simulating diamond burs, with grits of 200 µm (G80); 160 µm (G120), and 25 µm (G600), either untreated or heat-treated at 1200°C for 2 h (labeled A). Yttria tetragonal zirconia polycrystal discs were manufactured, ground, and submitted to roughness and crystalline phase analyses before the biaxial flexural strength test. There was no correlation between roughness (Ra and Rz) and flexural strength. The reliability of the materials was not affected by grinding or heat treatment, but the characteristic strength was higher after abrasion with diamond discs, irrespective of grit size. The X-ray diffraction data showed that grinding leads to a higher monoclinic (m) phase content, whereas heat treatment produces reverse transformation, leading to a fraction of m-phase in ground samples similar to that observed in the control group. However, after heat treatment, only the G80A samples presented strength similar to that of the control group, while the other groups showed higher strength values. When zirconia pieces must be adjusted for clinical use, a smoother surface can be obtained by employing finer-grit diamond burs. Moreover, when the amount of monoclinic phase is related to the degradation of zirconia, the laboratory heat treatment of ground pieces is indicated for the reverse transformation of zirconia crystals.

Fatigue failure load of zirconia-reinforced lithium silicate glass ceramic cemented to a dentin analogue: Effect of etching time and hydrofluoric acid concentration

This study aimed to evaluate the effect of etching time and hydrofluoric acid (HF) concentration on the fatigue failure load and surface characteristics of zirconia-reinforced lithium silicate glass (ZLS) ceramic cemented to a dentin-like, fiber reinforced epoxy resin. Ceramic (Suprinity, VITA) (1.0mm thick) and epoxy resin (2.5mm thick) discs (10mm diameter) were produced. The bonding surface of the ceramic samples was nonetched (control group), or etched for 30, 60 or 90s by 5% or 10% HF. The epoxy resin discs were etched by 10% HF for 30s followed by the application of an adhesive material (Single Bond Universal, 3M ESPE). Pairs of ceramic/epoxy resin discs were cemented with a dual cure resin cement. The fatigue failure load was determined by the staircase method (500,000 cycles at 20Hz; initial load = 925N; step size = 45N). In 10% HF the etching time was shown to influence the fatigue failure load, which increased as the etching time increased (30s < 60s < 90s), and in 5% HF the fatigue failure load was not shown to be affected by the etching time; the lowest fatigue failure loads were produced in the control group without ceramic etching followed by 10% HF acid etching for 30s. Topography analysis showed variations based on the etching protocols. All fractures (radial cracks) were shown to originate from defects at the ceramic surface on the cementing interface. For fatigue loading improvements of ZLS ceramic, 10% HF acid etching for 90s and silanization of the ceramic surface is recommended.

CAD/CAM machining Vs pre-sintering in-lab fabrication techniques of Y-TZP ceramic specimens: Effects on their mechanical fatigue behavior

This study evaluated the effects of different pre-sintering fabrication processing techniques of Y-TZP ceramic (CAD/CAM Vs. in-lab), considering surface characteristics and mechanical performance outcomes. Pre-sintered discs of Y-TZP ceramic (IPS e.max ZirCAD, Ivoclar Vivadent) were produced using different pre-sintering fabrication processing techniques: Machined- milling with a CAD/CAM system; Polished- fabrication using a cutting device followed by polishing (600 and 1200 SiC papers); Xfine- fabrication using a cutting machine followed by grinding with extra-fine diamond bur (grit size 30 μm); Fine- fabrication using a cutting machine followed by grinding with fine diamond bur (grit size 46 μm); SiC- fabrication using a cutting machine followed by grinding with 220 SiC paper. Afterwards, the discs were sintered and submitted to roughness (n=35), surface topography (n=2), phase transformation (n=2), biaxial flexural strength (n=20), and biaxial flexural fatigue strength (fatigue limit) (n=15) analyses. No monoclinic-phase content was observed in all processing techniques. It can be observed that obtaining a surface with similar characteristics to CAD/CAM milling is essential for the observation of similar mechanical performance. On this sense, grinding with fine diamond bur before sintering (Fine group) was the best mimic protocol in comparison to the CAD/CAM milling.

The effect of hydrofluoric acid concentration on the fatigue failure load of adhesively cemented feldspathic ceramic discs

OBJECTIVE This study investigated the influence of hydrofluoric acid (HF) etching at different concentrations on the fatigue failure load of adhesively cemented feldspathic ceramic discs (Vita Mark II). Besides, their effect on the micromorphology of ceramic surface was investigated. METHODS Eighty ceramic discs (ϕ=10 mm; thickness=1.5 mm) were cemented to epoxy supporting discs (ϕ=10 mm; thickness=2.0mm) using different surface conditioning methods (n=20): nonetched control (CTRL), or etched for 60s with different HF concentrations: 1% (HF1), 5% (HF5), or 10% (HF10). All the ceramic discs received a silane application (Monobond Plus). The epoxy discs were etched with 10% HF for 60s and received a primer coating (Multilink Primer A+B). Adhesively cementation was performed (Multilink Automix), and the assemblies (ceramic discs/epoxy discs) were subjected to cyclic loads in water by a staircase approach (500,000 cycles; 20Hz; initial load=290N; step size=30N). Fatigue failure load data were analyzed using 1-way ANOVA and post-hoc Tukeys tests (α=.05). RESULTS Mean failure load of the HF5 group (255.0±23.0N) was significantly lower; HF1 group (301.7±71.0N) presented intermediate values, and the highest values were achieved in CTRL (351.7±13.4N) and HF10 (341.7±20.6N) groups. All the failures were radial cracks starting from the bonding surface. SIGNIFICANCE In terms of fatigue failure load, etching with 1% and 5% HF had a deleterious effect on the fatigue behavior of an adhesively cemented feldspathic ceramic, while 10% HF had no negative influence.

Mechanical behavior of yttria-stabilized tetragonal zirconia polycrystalline ceramic after different zirconia surface treatments

This study investigated the effects of different zirconia surface conditioning methods on the biaxial flexure strength, surface characteristics and fractographic analysis of a Y-TZP ceramic. Disc-shaped specimens were manufactured according to ISO 6872-2008 for biaxial flexure strength testing, and then randomly assigned into seven groups (n=30). Control (CTRL): without treatment; Tribochemical silica coating (TBS): specimens were sandblasted with silica-coated aluminum oxide particles (CoJet-Sand) for 10s; Silica nanofilm (SNF): specimens were silica coated with a 5nm SiO2 nanofilm; and four protocols of low-fusing porcelain glaze (GLZ): etching with 10% hydrofluoric acid gel (HF) for 1min (GLZ1), 5min (GLZ5), 10min (GLZ10) and 15min (GLZ15). Phase transformation, roughness, micro-morphological, flexural analysis tests, and fractographic analyses were performed. X-ray diffraction (XRD) analysis showed that the TBS promoted the highest m-phase content (20.35). However, for the GLZ groups, XRD analysis was not sensitive enough to obtain an accurate reading for phase transformation. The GLZ group had the highest roughness values. The TBS group had the highest characteristic strength (1291.38MPa), followed by SNF (999.26MPa). These results suggest that (TBS) and (SNF) treatments did not reduce the mechanical properties, while (GLZ) led to a degradation in the mechanical properties.