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Influence of core design, production technique, and material selection on fracture behavior of yttria-stabilized tetragonal zirconia polycrystal fixed dental prostheses produced using different multilayer techniques: split-file, over-pressing, and manually built-up veneers
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0002-9387-5222
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0003-2957-1133
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0001-6593-0151
2016 (English)In: Clinical, Cosmetic and Investigational Dentistry, E-ISSN 1179-1357, Vol. 8, p. 15-27Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate and compare the fracture strength and fracture mode in eleven groups of currently, the most commonly used multilayer three-unit all-ceramic yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) fixed dental prostheses (FDPs) with respect to the choice of core material, veneering material area, manufacturing technique, design of connectors, and radii of curvature of FDP cores. Materials and methods: A total of 110 three-unit Y-TZP FDP cores with one intermediate pontic were made. The FDP cores in groups 1–7 were made with a split-file design, veneered with manually built-up porcelain, computer-aided design-on veneers, and over-pressed veneers. Groups 8–11 consisted of FDPs with a state-of-the-art design, veneered with manually built-up porcelain. All the FDP cores were subjected to simulated aging and finally loaded to fracture. Results: There was a significant difference (P<0.05) between the core designs, but not between the different types of Y-TZP materials. The split-file designs with VITABLOCS® (1,806±165 N) and e.max® ZirPress (1,854±115 N) and the state-of-the-art design with VITA VM® 9 (1,849±150 N) demonstrated the highest mean fracture values. Conclusion: The shape of a split-file designed all-ceramic reconstruction calls for a different dimension protocol, compared to traditionally shaped ones, as the split-file design leads to sharp approximal indentations acting as fractural impressions, thus decreasing the overall strength. The design of a framework is a crucial factor for the load bearing capacity of an all-ceramic FDP. The state-of-the-art design is preferable since the split-file designed cores call for a cross-sectional connector area at least 42% larger, to have the same load bearing capacity as the state-of-the-art designed cores. All veneering materials and techniques tested in the study, split-file, over-press, built-up porcelains, and glass–ceramics are, with a great safety margin, sufficient for clinical use both anteriorly and posteriorly. Analysis of the fracture pattern shows differences between the milled veneers and over-pressed or built-up veneers, where the milled ones show numerically more veneer cracks and the other groups only show complete connector fractures.

Place, publisher, year, edition, pages
Nakladatelstvi Lidove noviny, 2016. Vol. 8, p. 15-27
Keywords [en]
all-ceramic FDPs, connector design radius, state-of-the-art, CAD/CAM, multilayer technique, veneering ceramic techniques
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-5660DOI: 10.2147/CCIDE.S94343ISI: 000381874700002PubMedID: 26929667Scopus ID: 2-s2.0-84959348850Local ID: 20493OAI: oai:DiVA.org:mau-5660DiVA, id: diva2:1402529
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2026-05-27Bibliographically approved
In thesis
1. On core and bi-layered all-ceramic fixed dental prostheses, design and mechanical properties: studies on stabilized zirconiumdioxide
Open this publication in new window or tab >>On core and bi-layered all-ceramic fixed dental prostheses, design and mechanical properties: studies on stabilized zirconiumdioxide
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Loss of teeth can affect a person’s self-esteem, social life, appearance and oral function. Reconstruction of a missing tooth has scientifically been shown to increase self-esteem and quality of life and to maintain oral function. For many patients a fixed dental prostheses (FDP) is preferred, either tooth- or implant-supported. Improvement and development of all-ceramic materials have made them preferable to other alternatives. However, despite properties of dental ceramics’ well known biocompatibility, good chemical and mechanical, the materials have their weaknesses, such as brittleness and some difficulties with the layering porcelain. Many all-ceramic materials cannot withstand minor flexure; more than 0.1 - 0.3 %, will lead to fracture. Oxide-ceramic, specifically yttria stabilized tetragonal zirconia polycrystals (Y-TZP) has become the most commonly used all-ceramic material. This material has the potential to be used for larger restorations. In addition, one of many challenges is to ensure durable zirconia-based restorations in the oral cavity. In the clinical situation, crowns and bridges are supported by a combination of different structures with differing properties, i.e. bone, dentine and enamel. The complexity of the supporting tissues in the oral cavity creates stress patterns in the prosthetic material, which need to be considered when designing a dental restoration. The durability of all-ceramic FDPs is dependent on knowledge of the material and design of the FDPs. In particular the design, shape of the connector and the radius of curvature at the gingival embrasure play a significant role in the load-bearing capacity of FDPs. The overall aim of this thesis is to evaluate design of zirconia-based restorations in relation to achieving increased fracture resistance. Another aim is related to how the choice of material used for supporting tooth analogues in the test set-up and how this influences test results relating to fracture strength of all-ceramic FDPs. Study I evaluates different radii (0.60 and 0.90 mm) of curvature in the embrasure of the connector area and different connector dimensions (2 x 2, 3 x 2 and 3 x 3 mm) and their effects on the fracture resistance of 3-unit all-ceramic FPDs made of Y-TZP. The results show that by increasing the radius of the gingival embrasure from 0.6 to 0.9 mm, the fracture strength for a Y-TZP FPD with connector dimension 3 x 3 mm will increase by 20%. Study II investigated how the choice of material (aluminium, polymer and DuraLay) used for supporting tooth analogues and support complexity influence test results concerning the fracture strength of FDPs made of a brittle material Y-TZP. The outcome of the study demonstrated that Y-TZP FDPs cemented on tooth analogues made of aluminium, with high E-modulus showed a significantly higher load at fracture and a different fracture mode than shown in clinical situations. Study III evaluates how factors as different default settings for connector design of two different CAD/CAM systems and different radii of curvature in the embrasure area of the connector will affect the fracture strength and the fracture mode of 3-unit, i.e. 4-unit allceramic FDPs made from Y-TZP and further to investigate how the number of pontics affect the fracture strength of Y-TZP. The results showed that the most crucial factor for the load-bearing capacity is the design of the radius of the gingival embrasures. Increasing the number of pontics from three to four decreases the load-bearing capacity nearly twice. Study IV investigate and compare the fracture strength and fracture mode in 11 groups of the currently most used multilayer all-ceramic systems for Y-TZP FDPs, with respect to the choice of core material, veneering material area, manufacturing technique (split-file, overpress, built-up porcelains and glass-ceramics), design of connectors and radius of curvature of FDP cores. The results show that the design of a framework is a crucial factor for the load bearing capacity of an all-ceramic FDP. The state-of-the-art designs are preferable, since the split-file designed cores call for a cross-sectional connector area, at least 42% larger, to have the same load bearing capacity as the state-of-the-art designed cores. Analyses of the fracture patterns demonstrated differences between the milled veneers and over-pressed or built-up veneers, where the milled ones showed numerically more veneer cracks whereas the other groups only showed complete connector fractures. All veneering materials/techniques tested were found, with great safety margin to be sufficient for clinical use both anteriorly and posteriorly.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2015. p. 102
Series
Doctoral Dissertation in Odontology
Keywords
Y-TZP, Zirconia, All-ceramic FDPs, connector design, radius, state-of-the-art, CAD/CAM, multi-layer technique, veneering ceramic, split-file, over-pressing, dental porcelain, MECHANICAL PROPERTIES
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7703 (URN)18473 (Local ID)9789171044051 (ISBN)9789171044068 (ISBN)18473 (Archive number)18473 (OAI)
Note

Note: The papers are not included in the fulltext online.

Paper IV in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2025-01-08Bibliographically approved

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Mahmood, DeyarLinderoth, Ewa HWennerberg, AnnVult von Steyern, Per

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