I. L. Denry

Effects of External Bleaching on Indentation and Abrasion Characteristics of Human Enamel in vitro

The application of home-bleaching procedures as a means of lightening multiple teeth has become increasingly popular. Very few studies, however, have determined the effect of this treatment upon dental hard tissues. This in vitro study evaluated the effects of a 10% carbamide peroxide gel on the apparent fracture toughness, hardness, and abrasion characteristics of human enamel. The apparent fracture toughness of enamel was reduced by about 30% after bleaching for a period of 12 hours with no significant change in surface hardness. Enamel treated with the bleaching gels also exhibited a small but significant decrease in abrasion resistance. This behavior was most likely due to an alteration of the organic matrix of enamel under the chemical action of hydrogen peroxide. Further investigation of the clinical significance of this process is needed.

Relative fracture toughness and hardness of new dental ceramics

Dental ceramics can fail through growth of microscopic surface flaws that form during processing or from surface impact during service. New restorative dental ceramic materials have been developed to improve resistance to crack propagation. Eleven of these improved materials with the common feature of a considerable amount of crystalline phase in the glassy matrix were evaluated. The ceramic materials studied included fluormica-, leucite-, alumina-, and zirconia-reinforced glasses. The relative hardness and fracture toughness were determined by indentation technique. Alumina-reinforced materials resulted in the highest fracture toughness values, whereas the fluormica- and leucite-reinfoced materials showed more moderate but statistically significant greater values compared with those of control materials. The hardness values of ceramic materials with improved fracture toughness were both substantially higher or lower than those of the control groups and suggested a lack of direct correlation between these two properties. Selection of appropriate restorative materials depends on clinical application and requires consideration of several physical properties including fracture toughness.

Ceramics for Dental Applications: A Review

Over the past forty years, the technological evolution of ceramics for dental applications has been remarkable, as new materials and processing techniques are steadily being introduced. The improvement in both strength and toughness has made it possible to expand the range of indications to long-span fixed partial prostheses, implant abutments and implants. The present review provides a state of the art of ceramics for dental applications.

Recent Advances in Ceramics for Dentistry

For the last ten years, the application of high-technology processes to dental ceramics allowed for the development of new materials such as heat-pressed, injection-molded, and slip-cast ceramics and glass-ceramics. The purpose of the present paper is to review advances in new materials and processes available for making all-ceramic dental restorations. Concepts on the structure and strengthening mechanisms of dental ceramics are provided. Major developments in materials for all-ceramic restorations are addressed. These advances include improved processing techniques and greater mechanical properties. An overview of the processing techniques available for all-ceramic materials is given, including sintering, casting, machining, slip-casting, and heat-pressing. The most recent ceramic materials are reviewed with respect to their principal crystalline phases, including leucite, alumina, forsterite, zirconia, mica, hydroxyapatite, lithium disilicate, sanidine, and spinel. Finally, a summary of flexural strength data available for all-ceramic materials is included.

Emerging Ceramic-based Materials for Dentistry

Our goal is to give an overview of a selection of emerging ceramics and issues for dental or biomedical applications, with emphasis on specific challenges associated with full-contour zirconia ceramics, and a brief synopsis on new machinable glass-ceramics and ceramic-based interpenetrating phase composites. Selected fabrication techniques relevant to dental or biomedical applications such as microwave sintering, spark plasma sintering, and additive manufacturing are also reviewed. Where appropriate, the authors have added their opinions and guidance.

Comparison of three fracture toughness testing techniques using a dental glass and a dental ceramic

OBJECTIVES Various methods aimed at determining the fracture toughness of ceramics in mode I (KIc) have been described in the literature. The accuracy, scatter and the interexaminer reproducibility of KIc depend strongly on the procedural approach, the test parameters used and the conditioning of the specimens. The purpose of the present study was to compare fracture toughness values obtained using two indentation methods as well as a newly established fracture mechanics test. METHODS The following methods for KIc determination were applied: (1) indentation fracture (IF), (2) indentation strength (IS) and (3) the single-edge-V-notched-beam test (SEVNB). The materials tested were a low-fusing dental glass (Duceram LFC) and a feldspar-based porcelain (IPS classic). Data were compared by ANOVA and Tukeys multiple comparison test (p < or = 0.05). RESULTS For both materials, KIc coefficients of variation ranged between 10 and 14% for IF and 7 and 10% for IS. The IS technique demonstrated a load dependency for the IPS porcelain which was not observed when using the IF method. The SEVNB test provided consistent results with coefficients of variation between 1 and 3%. SEVNB toughness values for the IPS porcelain were in agreement with the IS technique. However, halfpenny shaped cracks were observed at the tip of the notch of all LFC specimens thus leading to underestimated KIc values. SIGNIFICANCE The overall aim of this type of study is to select testing procedures that are as expedient and reliable as possible. This study has shown that all three methods agreed within 10%. However none of the procedures proved absolutely straightforward. Decision on which method to use should be based on a sound understanding of the conceptual limitations and technical difficulties inherent to each technique.

Effect of coloring with various metal oxides on the microstructure, color, and flexural strength of 3Y-TZP.

The purpose of this study was to investigate the effect of cerium and bismuth coloring salts solutions on the microstructure, color, flexural strength, and aging resistance of tetragonal zirconia for dental applications (3Y-TZP). Cylindrical blanks were sectioned into disks (2-mm thick, 25-mm in diameter) and colored by immersion in cerium acetate (CA), cerium chloride (CC), or bismuth chloride (BC) solutions at 1, 5, or 10 wt %. The density, elastic constants, and biaxial flexural strength were determined after sintering at 1350 degrees C. The crystalline phases were analyzed by X-ray diffraction before and after aging in autoclave for 10 h. The results showed that the mean density of the colored groups was comparable with that of the control group (6.072 +/- 0.008 g/cm(3)). XRD confirmed the presence of tetragonal zirconia with a slight increase in lattice parameters for the colored groups. A perceptible color difference was obtained for all groups (DeltaE* = 2.57 +/- 0.48 to 14.22 +/- 0.98), compared with the control. The mean grain size increased significantly for the groups colored with CC or CA at 10 wt %, compared with the control group (0.318 +/- 0.029 mm). The mean biaxial strength of CA1%, CA5%, and BC1% groups was not significantly different from that of the control group (1087.5 +/- 173.3 MPa). The flexural strength of all other groups decreased linearly with increasing concentration for both cerium salts (860.7 +/- 172 to 274.4 +/- 67.3 MPa). The resistance to low temperature degradation was not affected by the coloring process. Coloring with cerium or bismuth salts produced perceptible color differences even at the lowest concentrations. A decrease in flexural strength at the higher concentrations was attributed to an increase in open porosity.

Effect of Cubic Leucite Stabilization on the Flexural Strength of Feldspathic Dental Porcelain

Previous studies (Mackert and Evans, 1993) have shown that, when feldspathic dental porcelain is cooled, leucite undergoes a transformation from cubic to tetragonal, associated with a 1.2% volume contraction. This contraction leads to the formation of microcracks in and around the crystals and the development of tangential compressive stresses around the crystals. Our aim was to stabilize increasing amounts of the cubic form of leucite in a leucite-reinforced dental porcelain, evaluate its effect on the flexural strength, and characterize its microstructure. The hypothesis was that in the absence of crystallographic transformation, the contraction of the leucite crystals would be lower, thereby limiting the formation of microcracks and minimizing the development of tangential compressive stresses around the leucite particles. We prepared 8 porcelain compositions by mixing increasing amounts of either leucite (KAlSi 2O6) or pollucite (CsAlSi2O6) with Optec HSP porcelain (Jeneric/Pentron Inc., Wallingford, CT). Porcelain disks were made from each composition (n = 10 per group). X-ray diffraction analyses showed that the amount of stabilized leucite increased with the amount of pollucite added. The microstructure of the specimens containing tetragonal leucite was characterized by twinned leucite crystals, whereas no twinning was observed in the specimens containing cubic leucite. The evaluation of crack deflection showed that significantly less deflection occurred in the specimens containing cubic leucite. The mean biaxial flexural strength for the group corresponding to 22.2 wt% added pollucite, fired at 1038°C, was significantly lower than that for the control group. The group corresponding to 22.2 wt% added leucite fired at 1150°C exhibited a mean biaxial flexural strength significantly higher than that of all other groups that were not significantly different from the control group. Overall, the stabilization of cubic leucite reduced the flexural strength and the number of crack deflections in leucite-reinforced porcelain. Apparently, the development of tangential compressive stresses around the leucite crystals when cooled is responsible for a significant amount of strengthening of feldspathic dental porcelain.

Design and characterization of calcium phosphate ceramic scaffolds for bone tissue engineering.

OBJECTIVES Our goal is to review design strategies for the fabrication of calcium phosphate ceramic scaffolds (CPS), in light of their transient role in bone tissue engineering and associated requirements for effective bone regeneration. METHODS We examine the various design options available to meet mechanical and biological requirements of CPS and later focus on the importance of proper characterization of CPS in terms of architecture, mechanical properties and time-sensitive properties such as biodegradability. Finally, relationships between in vitro versus in vivo testing are addressed, with an attempt to highlight reliable performance predictors. RESULTS A combinatory design strategy should be used with CPS, taking into consideration 3D architecture, adequate surface chemistry and topography, all of which are needed to promote bone formation. CPS represent the media of choice for delivery of osteogenic factors and anti-infectives. Non-osteoblast mediated mineral deposition can confound in vitro osteogenesis testing of CPS and therefore the expression of a variety of proteins or genes including collagen type I, bone sialoprotein and osteocalcin should be confirmed in addition to increased mineral content. CONCLUSIONS CPS are a superior scaffold material for bone regeneration because they actively promote osteogenesis. Biodegradability of CPS via calcium and phosphate release represents a unique asset. Structural control of CPS at the macro, micro and nanoscale and their combination with cells and polymeric materials is likely to lead to significant developments in bone tissue engineering.

How and when does fabrication damage adversely affect the clinical performance of ceramic restorations

OBJECTIVES As compared to factory-processed ceramic parts, one unique trait of all-ceramic dental restorations is that they are custom-fabricated, which implies a greater susceptibility to fabrication defects. A variety of processing techniques is now available for the custom fabrication of all-ceramic single and multi-unit restorations, these include sintering, heat-pressing, slip-casting, hard machining and soft machining, all in combination with a final staining or veneering step. All these fabrication techniques, from shaping to firing, are associated with the production of flaws of various shapes and sizes, in conjunction with thermal residual stresses, all of which are capable of inducing failure. METHODS This review will examine the various types of fabrication damage inherent to each technique and attempt to establish a relationship between fabrication defects and clinical performance of all-ceramic dental restorations with particular attention to their longevity in vivo. RESULTS Failure mechanisms in dental ceramics can be very complex and often involve the combination of physical factors, to which are added patient and clinician-related variables such as restoration design and in vivo conditions. SIGNIFICANCE Tremendous progress has been made in understanding the failure mechanisms of all-ceramic dental restorations over the past thirty years. It remains that there is still a need for laboratory tests that usefully simulate clinical conditions.