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Novel Zirconia Materials Applied in Dental Prostheses

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A special issue of Prosthesis (ISSN 2673-1592). This special issue belongs to the section "Prosthodontics".

Deadline for manuscript submissions: closed (30 May 2023) | Viewed by 20220

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Prof. Dr. Fernando Zarone

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Scientific Unit of Digital Dentistry (SUDD), Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Napoli, 80138 Napoli, NA, Italy
Interests: prosthodontics; esthetics; dental materials; ceramics; digital dentistry; scanners; 3D printing; implant prosthodontics
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Prof. Dr. Roberto Sorrentino

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Guest Editor

Department of Neurosciences, Reproductive and Odontostomatological Sciences, University “Federico II” of Naples, 80131 Naples, Italy
Interests: prosthodontics; adhesive dentistry; dental materials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

On the rails of digital dentistry, the implementation of the latest technologies in daily practice has received a synergic impulse from the enhanced mechanical and fabrication characteristics of the latest generation of dental materials. These include high-strength silica-based ceramics, polycrystalline cores and hybrid materials. Among these, CAD-CAM ceramics, similarly to polycrystalline zirconia and zirconia-reinforced lithium silicates, offer undeniable advantages such as high esthetic potential, excellent optical characteristics, outstanding mechanical properties, reliable consistency in terms of accuracy and precision due to manufacturing technologies and more convenient production timing.

These improvements have dramatically widened restorative options using zirconia-based materials in tooth- and implant-supported prosthodontics, since distinct allotropic configurations of zirconia present with different mechanical and optical properties that can be exploited differently.

Zirconia-based dental cores are amongst the most versatile materials available for the “digital prosthodontic environment”. Over the last decade, increasing in vitro and in vivo data have been shedding light on the guidelines for restorative rational use of zirconia. Furthermore, the world of industry is intensively working on innovative strategies aimed at further enhancing the microstructural properties of these materials, together with the introduction of novel manufacturing technologies, mainly based on additive processes.

This Special Issue is aimed at collecting original manuscripts related to novel and innovative applications of zirconia-based materials in prosthodontics.

Prof. Dr. Fernando Zarone
Prof. Dr. Roberto Sorrentino
Guest Editors

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Keywords

zirconia
cubic zirconia
monoclinic zirconia
tetragonal zirconia
dental prosthesis
prosthodontics
adhesive dentistry
digital dentistry
metal-free, all-ceramic

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Published Papers (7 papers)

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Research

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12 pages, 1434 KiB

Open AccessArticle

Screwed Monolithic Zirconia Crowns for Mono-Implant Posterior Rehabilitation: A Prospective Clinical Study on 41 Patients with a 7-Year Follow-Up

by Giuseppe Barile, Saverio Capodiferro, Giovanni De Rosa, Giovannino Muci, Alessandro Vanzanelli and Massimo Corsalini

Prosthesis 2023, 5(4), 1037-1048; https://doi.org/10.3390/prosthesis5040072 - 17 Oct 2023

Cited by 4 | Viewed by 1490

Abstract

The usage of monolithic zirconia has been increasing in daily practice in dentistry for the last 20 years. Monolithic zirconia is mainly used for posterior sector rehabilitation, as it lacks optical properties and has good technical properties; it does not chip and reduces antagonist wear compared to metal–ceramic prostheses. However, monolithic zirconia may present some issues, mainly low-temperature degradation (LTD), also known as “aging”, which must be considered and investigated in clinical studies with prolonged follow-up periods. The aim of this study was the aesthetic and functional evaluation of single monolithic zirconia crowns that were screwed onto implants for posterior dental rehabilitation using USPHS parameters and a long follow-up period of 7 years. The results showed that the USPHS scoring reduces year by year, passing from 100% excellence between the first and fourth years of observation, to 88% excellence and 12% success in the seventh year. Screw abutment loosening was the only technical adversity reported; no implant failure, crown fracture, or irreparable damage were additionally registered. Considering the emerging results and comparing them with the data available in the literature, the authors suggest that monolithic zirconia crowns could be considered as a valid alternative to classic metal–ceramic rehabilitations for the rehabilitation of posterior sectors. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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23 pages, 3529 KiB

Open AccessArticle

Color Stability, Physical Properties and Antifungal Effects of ZrO₂ Additions to Experimental Maxillofacial Silicones: Comparisons with TiO₂

by Mazen Alkahtany, Mark W. Beatty, Fahd Alsalleeh, Thomas M. Petro, Bobby Simetich, You Zhou, Dennis Feely and Grigoris Polyzois

Prosthesis 2023, 5(3), 916-938; https://doi.org/10.3390/prosthesis5030064 - 8 Sep 2023

Cited by 8 | Viewed by 1818

Abstract

(1) Background: Color changes, physical degradation, and fungal infections are challenges to the longevity of maxillofacial polydimethylsiloxane (PDMS) elastomers. This study aimed to evaluate color changes, physical properties, and antifungal properties of PDMS loaded with ZrO₂ and TiO₂ submicron- and nano-sized particles. (2) Methods: A 1% weight of 40 nm or 200 nm diameter ZrO₂ or TiO₂ nanoparticles was mixed into PDMS with 2% functional intrinsic yellow pigment and polymerized. Control materials contained 13% weight 200 nm silica. Samples were exposed to 3000 h of UVB radiation (200 µW/cm²) or darkness. Color parameters L*a*b* and ∆E_ab*, ultimate tensile strength, strain, elastic modulus, and Shore A hardness were measured. Candida albicans growth was measured using XTT and confocal microscopy, and data were analyzed with the Dunnett test (p < 0.01). (3) Results: TiO₂ 200 nm showed the least color change after 3000 h of UVB radiation, followed by TiO₂ 40 nm (p < 0.05). The silica-containing control group was superior in all physical property measurements due to higher additive content (p < 0.05). TiO₂-containing materials exhibited significantly lower C. albicans growth (p < 0.01) than those loaded with ZrO₂ or SiO₂. (4) Conclusions: TiO₂ nanoparticles of 40 nm and 200 nm, when added to pigmented PDMS at 1% weight, provided the best resistance to color change and significantly lowered C. albicans activity compared to silica- and zirconia-filled elastomers. Particle size differences rendered minor differences for most properties. The incorporation of low-level submicron- and nano-sized TiO₂ particles has the potential to improve color stability and antifungal activity in silicones designated for maxillofacial prostheses and may be extended to denture reline applications. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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13 pages, 6356 KiB

Open AccessArticle

Translucent and Highly Toughened Zirconia Suitable for Dental Restorations

by Seiji Ban, Yuta Yasuoka, Tsutomu Sugiyama and Yuzo Matsuura

Prosthesis 2023, 5(1), 60-72; https://doi.org/10.3390/prosthesis5010005 - 10 Jan 2023

Cited by 3 | Viewed by 1923

Abstract

Background: There is a limit to improving the characteristics of zirconia with only one kind of stabilizing element such as yttrium. The purpose of this study is to systematically evaluate the effects of various co-doped elements on mechanical and optical properties and to develop a novel composition of zirconia with enough properties to apply to dental restorations. Methods: Forty-four kinds of zirconia were prepared by combining trivalent cations yttrium (Y) and ytterbium (Yb), and pentavalent cations niobium (Nb) and tantalum (Ta) oxide as stabilizers. The combined contents ranged from 0 to 5.6 mol% for Y₂O₃, 0 to 4.2 mol% for Yb₂O₃, 0 to 1.5 mol% for Nb₂O₅, and 0 and 1.2 mol% for Ta₂O₅. These specimens were determined for fracture toughness and opacity. X-ray diffraction studies were undertaken to evaluate the microstructural change. Results: The present study revealed that adding of the trivalent cations Y and Yb reduced fracture toughness and opacity, whereas the addition of pentavalent cations Nb and Ta to zirconia stabilized with trivalent cations increased both properties. There was no clear difference in the effects of Y and Yb, Nb, and Ta. Conclusions: Considering many factors, the following composition is optimal: 3–4.2 mol% Y₂O₃ and/or Yb₂O₃ stabilized zirconia with up to 1.5 mol% Nb₂O₅ has sufficiently high fracture toughness values and sufficiently high translucency suitable for dental restorations. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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12 pages, 20272 KiB

Open AccessArticle

Mechanical Properties of Translucent Zirconia: An In Vitro Study

by Luan Mavriqi and Tonino Traini

Prosthesis 2023, 5(1), 48-59; https://doi.org/10.3390/prosthesis5010004 - 10 Jan 2023

Cited by 1 | Viewed by 2742

Abstract

Background: The introduction of translucent zirconia has improved mimetics: nevertheless, a reduction in the mechanical performance was registered. The study aim was to investigate the mechanical characteristics of a high-translucent zirconia used for monolithic restorations before and after the aging process compared to a low-translucent zirconia. Methods: A total of 23 specimens were used in the present study. Group A (n = 10) was made of a high-translucent Y-TZP; group B (n = 7) was made of a low-translucent Y-TZP and finally group C (n = 6) was an aged high-translucent Y-TZP. Flexural strength, fracture toughness, brittleness, microcrack’s propagation and grain size were analyzed. Results: The Vickers hardness was: 1483 ± 187 MPa (group C); 1102 ± 392 MPa (group A); 1284 ± 32 MPa (group B). The flexural strength was: 440 (±96.2) MPa (group C); 427 (±59.5) MPa (group A); 805 (±198.4) MPa (group B). The fracture toughness was: 5.1 (±0.7) MPa.m^1/2 (group C); 4.9 (±0.9) MPa.m^1/2 (group A); 8.9 (±1.1) MPa.m^1/2 (group B). The brittleness was: 295 (±42.8) (group C), 230.9 (±46.4) (group A) and 144.9 (±20.3) (group B). The grain size was: 2.75 (±1.2) µm² (group A); 0.16 (±0.05) µm² (group B); 3.04 (±1.1) µm² (group C). Conclusions: The significant reduction in the mechanical properties of high-translucent zirconia, compared to the traditional one, suggests their use in the anterior/lateral area (up to premolars). Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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13 pages, 2843 KiB

Open AccessArticle

Marginal and Internal Fit of Monolithic Zirconia Crowns Fabricated by Using Two Different CAD-CAM Workflows: An In Vitro Study

by Vahap Çin, Ayça Deniz İzgi, Ediz Kale and Burak Yilmaz

Prosthesis 2023, 5(1), 35-47; https://doi.org/10.3390/prosthesis5010003 - 5 Jan 2023

Cited by 4 | Viewed by 3884

Abstract

Objectives: Few studies have evaluated the marginal fit of computer-aided design—computer-aided manufacturing (CAD-CAM) monolithic zirconia crowns fabricated through completely digital workflow; however, the internal fit of these restorations is not well known. The purpose of this in vitro study was to evaluate the marginal and internal fit of monolithic zirconia crowns fabricated by using digital workflow, including intraoral scanner (IOS) scans, and compare the results to those of a semi-digital workflow, which combined conventional impressions, poured casts, and extraoral scanner (EOS) scanning. Materials and methods: A typodont right mandibular first molar was prepared for a complete-coverage ceramic crown and scanned using an IOS. The conventional impressions of the preparation were also made, and stone casts were poured and scanned by using an EOS. Virtual models were generated for both workflows, and identical virtual anatomic contour crowns were designed using CAD software. Monolithic zirconia crowns were fabricated for both IOS (ZI; n = 10) and EOS (ZE; n = 10) groups. The silicon replica technique was used to evaluate the marginal and internal fit of the crowns. Measurements were made at 13 points on buccolingual and mesiodistal cross-sections per specimen with a ×6.5 to ×50 zoom stereo microscope. The results from both groups were statistically compared using the Independent Samples t-tests and the Mann–Whitney U test (α = 0.05). Results: Mean gap values at all measurement locations for ZE were significantly higher than those for ZI (p ≤ 0.002). Overall mean values ranged between 29 and 43 µm (median: 28–42 µm) for ZI and 42 and 75 µm (median: 43–77 µm) for ZE. Conclusion: Completely digital workflow through intraoral scans provided significantly better marginal and internal fit for CAD-CAM monolithic zirconia crowns compared with the semi-digital workflow, where stone casts obtained from conventional impressions were scanned with an EOS. Yet, both workflows provided an acceptable marginal and internal fit for CAD-CAM monolithic zirconia molar crowns (<120 µm). Clinical Relevance: Completely digital workflow using IOS scans may be advantageous for the fabrication of CAD-CAM monolithic zirconia crowns as favorable results can be obtained with less material waste and potentially shortened overall treatment time as the impression files can be transferred to the production facility electronically. The results need to be corroborated with clinical studies. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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11 pages, 756 KiB

Open AccessArticle

Clinical Evaluation of Cement-Retained Implant-Supported CAD/CAM Monolithic Zirconia Single Crowns in Posterior Areas: Results of a 6-Year Prospective Clinical Study

by Roberto Sorrentino, Gennaro Ruggiero, Eralda Toska, Renato Leone and Fernando Zarone

Prosthesis 2022, 4(3), 383-393; https://doi.org/10.3390/prosthesis4030031 - 27 Jul 2022

Cited by 8 | Viewed by 3238

Abstract

Background: Different technologies and materials can be used for implant-supported restorations in posterior areas. Our study aimed to evaluate the clinical performance of CAD/CAM implant-supported monolithic zirconia single crowns (ZrSCs) cemented onto titanium abutments with a dual-curing resin cement after 6 years of use. Methods: Fifty patients in need of one single crown in posterior regions were enrolled. The patients were recalled for a follow-up after 6 months and then yearly for a total observation period of 6 years. The biological and technical complications were examined using criteria set by the United States Public Health Service (USPHS), whereas visual analogue scales (VASs) were used to evaluate the patients’ aesthetic and functional satisfaction. Results: No patient was lost at follow-up; both the survival and success rates were 100%. No fractures, decementation, peri-implantitis, or soft tissue inflammation were recorded. Forty-six restorations were rated Alpha in each evaluated parameter of the USPHS’s criteria. According to the patients’ VASs assessments, the overall function of the ZrSCs was 8.4 (±2.1), whereas the overall aesthetic was 8.7 (±0.7). Conclusions: Monolithic zirconia single crowns cemented with dual-curing resin cements onto titanium abutments can be considered an effective clinical option in posterior regions after 6 years of function. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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Review

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12 pages, 1337 KiB

Open AccessReview

The Success and Complications of Complete-Arch Implant-Supported Fixed Monolithic Zirconia Restorations: A Systematic Review

by Ludovico Maria Vozzo, Luís Azevedo, Juliana Campos Hasse Fernandes, Patrícia Fonseca, Filipe Araújo, Wendel Teixeira, Gustavo Vicentis Oliveira Fernandes and André Correia

Prosthesis 2023, 5(2), 425-436; https://doi.org/10.3390/prosthesis5020029 - 19 Apr 2023

Cited by 26 | Viewed by 4075

Abstract

In full-arch rehabilitation with implant-supported fixed prostheses, using monolithic zirconia seems to have several advantages regarding function and esthetics. However, the current scientific evidence is still limited. Thus, the aim of this investigation was to systematically review the literature on monolithic zirconia restorations for full-arch rehabilitation, particularly pursuing the survival rate and mechanical and biological complications. This study’s protocol was registered in PROSPERO (CRD42022301799). The primary literature search was performed in PubMed/MedLine and Web of Science, and a manual search was performed (checking cross-references). The focused question was, “In an adult population with one or both edentulous arches (P), the oral rehabilitation with implant-supported fixed-monolithic zirconia (full arch) (I), compared with oral rehabilitation using fixed-metal-ceramic prosthesis on implants (C), did show superior clinical results (O) in a minimum follow-up of 1 year (T)?” Inclusion and exclusion criteria were defined. Joana Briggs Institute tools were used to evaluate the quality of the studies. Meta-analysis was performed for the variable survival rate (%), applying the specific continuous moderator (follow-up). Data heterogeneity (I²) was assessed. From the initial search, 327 references were obtained. After eliminating duplicates and applying the inclusion/exclusion criteria by reading the titles, abstracts, and full text, seven articles were included. All included articles were observational longitudinal retrospective studies, with a number of prostheses between 7 and 2039. The mean age was 60 years, and the mean follow-up was 49.7 months. They had mandibular, maxillary, or bimaxillary rehabilitations, always with screw-retained retention, with an average survival rate of 97.23%. The number of implants ranged between four and eight. The quality of the articles was over 70%, and the heterogeneity was considered low (I² = 28.64%). Within a mean follow-up of around four years, full-arch implant-supported monolithic zirconia rehabilitations had a high survival rate and minimal complications. Full article

(This article belongs to the Special Issue Novel Zirconia Materials Applied in Dental Prostheses)

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