It has been observed in recent years that zirconia (Zr) is being increasingly used for a wide range of clinical applications. There are several reasons for this, but the most significant one is its excellent mechanical properties, specifically its transformation toughening properties compared to other dental ceramics and its improved natural appearance when compared to ceramometal restorations. As a result of the advancement of chairside milling and developments in rapid-sintering technology, the fabrication of dental restorations has become more computerized, time-saving, and accurate over the past few decades. However, a main disadvantage of conventional Zr restorations is that they lack the translucency of glass–ceramics, although they are extremely strong. Recently, by increasing the yttrium %, changing the grain size, and reducing the impurities, the ultra-translucent monolithic zirconia “5-mol%-yttria-stabilized tetragonal zirconia polycrystals” has been introduced, with successful attempts to make translucent Zr an aesthetically attractive option for minimally invasive veneer restorations. It is important to note that veneer restorations do not possess the mechanical retentive features of the tooth preparations and rely primarily on bonding to resin cement. This presents a great challenge for the inert Zr since it does not bond chemically with resin cement, unlike glass–ceramic materials that establish chemical adhesion with resin cement, favoring their use for indirect veneer restorations. Taking this into account, this article aims to review the progressive development of ultra-translucent monolithic Zr materials as they are available today and, in the future, represents a concerted drive toward maximum translucency and strength, which renders them a viable treatment option for esthetic veneer restorations.

The optical qualities of cutting-edge aesthetic dental ceramics are crucial for great aesthetics and may be impacted by various bleaching methods. The objectives of this study were to evaluate how home bleaching affected the translucency parameter (TP), contrast ratio (CR), total color difference (ΔE), and surface roughness (Ra) of various aesthetic dental ceramics, including innovative ultra-translucent zirconia. The three varieties of ceramics that were tested—IPS e.max-Press (IPS); classic zirconia with feldspathic layering (LZr); and translucent zirconia (TZr)—were each represented by seven samples. The samples were bleached at home using 15% carbamide peroxide for six hours a day for seven days. Each specimen’s pre- and post-bleaching CIE L*a*b* values were measured using a spectrophotometer, and the TP, CR, and ΔE were determined. Ra values were measured via 3D profilometry. In comparison to the pre-stage results, statistical analysis showed a significant decrease in TP and increase in CR for LZr and TZr in the post-stage (p < 0.05), but not for IPS (p = 0.398). The results also showed substantial variations in ΔE for the three ceramics (p = 0.020). Ra readings during the post-stage were noticeably greater than those at the pre-stage (p = 0.018). Home bleaching had an impact on the optical characteristics and surface texture of the dental ceramics. Additionally, IPS had greater color stability than LZr and TZr.

Alrabeah G, et al. J Adv Prosthodont. 2023 Oct;15(5):238-247. https://doi.org/10.4047/jap.2023.15.5.238

The use of vaping or electronic cigarette devices (ECDs) has recently increased as an alternative to conventional tobacco smoking products. By recording the CIELAB coordinates (L*a*b*) and computing the total color difference (ΔE) values using a spectrophotometer, the effect of ECDs on contemporary aesthetic dental ceramics was investigated in this in-vitro study. A total of seventy-five (N = 75) specimens from five different (n = 15) dental ceramic materials (Pressable ceramics (PEmax); Pressed and layered ceramics (LEmax); Layered zirconia (LZr); Monolithic zirconia (MZr) and Porcelain fused to metal (PFM)) were prepared and exposed to aerosols produced by the ECDs. The color assessment was performed using a spectrophotometer at six time intervals (0 = baseline; 250-puff exposures; 500-puff exposures; 750-puff exposures; 1000-puff exposures; 1250-puff exposures; and 1500-puff exposures). By recording L*a*b* and computing total color difference (ΔE) values, the data were processed. A one-way ANOVA and Tukey procedure for pairwise comparisons were used to assess color differences between tested ceramics (p < 0.05). All test materials demonstrated significant color differences (ΔE) after exposure to vaping (p < 0.05). The LZr group displayed noticeably high ΔE values at all the distinct puff exposure intervals, with the highest ΔE value of (13.67) after 1500 puffs. The lowest (ΔE) values were observed in the PFM group after 250 and 500 puffs (0.85 and 0.97, respectively). With the exception of the group PEmax (p = 0.999), all groups produced readings of “ΔE” that indicated significant differences (p < 0.05) at various degrees of puff exposures. ECDs can noticeably alter the color of the dental ceramics affecting the esthetics of the patients. All the materials tested demonstrated significant color changes (ΔE > 3.33) above the clinically acceptable threshold, except for the PFM and PEmax group (ΔE < 3.33) which showed color stability after exposure to the ECDs.

The aim of this study was to evaluate the effect of thermocycling on shear bond strength (SBS) of several resin cement materials to different types of zirconia dental ceramics. 120 square shaped disc specimens were fabricated using two types of zirconia blocks (Sagemax and Sirona). Each zirconia group was divided into three sub-groups based on the resin cement bonded to the specimens. Three different self-adhesive resin cements were used (Calibra, Breeze and RelyX). The specimens were further grouped into experimental and control groups (n = 10). The experimental specimens were exposed to a thermo-cycling protocol of 1500 cycles in water bath at 5c and 55c. Specimens were then stored at 37c for 24 h then all specimens underwent SBS test with an Instron machine. Mode of failure was inspected visually and microscopically. Data were statistically analyzed using multivariate analysis of variance followed by one-way analysis of variance, Tukey’s multiple comparison test, student’s t-test for independent samples were used to compare the mean values of SBS in relation to the categorical study variables. The mean SBS values of experimental groups were significantly lower than control groups for all the 6 combinations of Zirconia and cement types (p < 0.0001). The higher mean difference (14.29 MPa) was observed in the combination of Sagemax and Rely-X. Rely-X displayed the highest SBS among all the cements while no significant difference was found in mean SBS values of Calibra and Breez cements in all groups. The mean SBS values of Sagemax zirconia were significantly higher than the Sirona with all three types of cements (p < 0.0001) within control groups. Microscopic and visual analysis demonstrated a majority of adhesive mode of failure. Thermocycling significantly reduced the SBS between the zirconia materials and self-adhesive resin cements tested. The amount of reduction varies according to cement and zirconia types.

Cement film thickness may have an impact on the shear bond strength (SBS) of lithium disilicate dental ceramics luted to human enamel with resin cement. The objective of this study was to evaluate SBS of lithium disilicate ceramics adhered to enamel using resin cement at different thicknesses. In total, 50 ceramic specimens (3 × 3 × 3 mm) and 50 premolar teeth were prepared and randomly assigned to 5 groups (n = 10 each). Ceramic specimens were designed with five cement film thicknesses (50 μm; 100 μm; 150 μm; 200 μm; and 300 μm). Teeth surfaces (4 × 4 mm) were prepared with a high-speed handpiece mounted on a dental surveyor. Ceramic specimens were cemented to teeth with resin cement (3M^TM RelyX^TM U200, Resin-Self-Adhesive-Cement). The specimens were then thermocycled for 6000 cycles with a 30 s dwell time and a 5 s transfer time in water (5 °C and 55 °C). A Universal-Testing-Machine was used to measure SBS (MPa). Statistical analysis in SPSS included Anova and Tukey’s tests. The SBSs of ceramics adhered to teeth revealed significantly different values across all test groups (p = 0.000). The findings showed that as cement layer thickness increased, so did the SBS. The cement spaces at 50 and 300 μm had the lowest SBS (9.40 + 1.15 MPa) and maximum SBS (21.98 + 1.27 MPa), respectively. The SBS of the lithium disilicate ceramic luted to natural human enamel increased along with the cement layer thickness.