OBJECTIVES: This study aims to explore the effect of improving clinical efficiency by replacing traditional impression workflow with centralized digital impression workflow. METHODS: The department of prosthodontics in Center of Stomatology, Peking University Shenzhen Hospital has improved the clinical workflow by replacing the traditional impression made by doctors using impression materials for each patient with a centralized digital impression made by one technician for all patients in the department. This cross-sectional study recorded the chairside time required for impression taking in patients undergoing single posterior zirconia full crown restoration before clinical process improvement; the time required for centralized digital impression production; the comfort level of patients; and the adjacency relationship, occlusal contact relationship, and time required for prostheses adjusting (i.e., whether centralized digital impressions would compromise the quality of pro-stheses and increase the time of prostheses adjusting). RESULTS: The average time to make a traditional impression was (9.98±1.41) min, and the average time required for each patient to make a centralized digital impression was (5.98±1.49) min, which was shorter than that to used make a traditional impression (P<0.05). Centralized digital impression made patients feel more comfortable compared with traditional impression (P<0.05). The adjacency relationship of restorations by centralized digital impression was more appropriate (P<0.05), and no significant difference in occlusal relationship was found (P>0.05). The time required for adjusting prostheses also had no significant differences (P>0.05). CONCLUSIONS Centralized digital impression can improve clinical efficiency for patients undergoing single posterior zirconia crown restoration. The time for impression taking is shorter, and patients feel more comfortable without compromising the quality of the prostheses.
Humans ; Cross-Sectional Studies ; Dental Impression Technique ; Crowns ; Zirconium ; Workflow ; Computer-Aided Design ; Time Factors ; Dental Impression Materials

OBJECTIVES: Digitally collect data on the preparation space of the molar occlusal surface for full crown restoration and analyze the minimum preparation spaces and areas prone to insufficient preparation. METHODS: A total of 846 molars (excluding third molars) designated for repair with zirconium dioxide crowns were selected. All molars were prepared by using the fixed-depth groove method under visual guidance. A digital impression was collected, and the occlusal surface of the preparation was divided into regions: mesiobuccal area, mesiolingual area, distobuccal area, distolingual area, mesial marginal ridge, and distal marginal ridge. Image measurement software (3Shape Unite) was employed to record the smallest preparation space on the molar occlusal surface, and a space of <1 mm was defined as insufficient preparation. The chi-square test was utilized for the statistical analysis of data. RESULTS: Significant differences were observed in the areas with the smallest preparation space on the occlusal surface of molars across different quadrants (P<0.05). Notably, the area with the smallest preparation space on the occlusal surface of the maxillary first molar was most frequently found in the mesiobuccal area, whereas the smallest preparation spaces on other molars were predominantly located in the distolingual area. The insufficient preparation of the occlusal surface occurred in 41.0% (347 cases) of teeth. The distribution of prone areas corresponded with the distribution of the smallest spatial areas. CONCLUSIONS Although the fixed-depth groove method is employed, the preparation space on the molar surface unavoidably remains uneven under visual guidance. The identification of the areas prone to minimum preparation spaces can serve as a valuable guide for clinicians to prevent insufficient preparation.
Humans ; Molar/anatomy & histology* ; Crowns ; Zirconium

OBJECTIVE: To study microstructure, friction and wear behaviors of silicon-lithium spray coating on the surface of zirconia ceramics and to preliminarily evaluate its esthetic so as to provide support and guidance for the clinical application. METHODS: Zirconia ceramic specimens were randomly divided into three groups: coating group (two subgroups), polishing group (two subgroups), and glazing group (four subgroups), with 10 samples in each subgroup. The two subgroups of coating group were the zirconia ceramics with the untreated and preliminary polishing surfaces sprayed with silicon-lithium coating, respectively. The two subgroups of polishing group were preliminary polishing and fine polishing of zirconia ceramics, respectively. The four subgroups of glazing group were preliminarily polished zirconia ceramics glazed with Biomic and Stain/Glaze products, respectively; and untreated zirconia ceramics glazed with Biomic and Stain/Glaze products, respectively. The above 8 subgroups of zirconia ceramic specimens were used as friction pairs with 80 steatite ceramics for 50 000 chewing cycles under 50 N vertical load and artificial saliva lubrication using chewing simulation. Scanning electron microscope was used to observe the microstructure of the surface and section of the coating group, and the thickness of the coating and glazing were measured. The linear roughness of the coating and polishing groups was mea-sured using a laser confocal scanning microscope. Vickers hardness was measured using a microhardness tester and the esthetic of zirconia ceramic full crown sprayed with silicon-lithium coating was preliminarily evaluated. White light interferometer was used to measure the width, the maximum depth and the volume of the wear scars of each group, and the wear depth of steatite ceramics and wear rate of zirconia ceramic specimens were calculated. Kruskal-Wallis nonparametric test and Dunn's multiple comparisons test were used to analyze the wear depth of each group (α=0.05). RESULTS: The microstructures of the silica-lithium spray coatings on the untreated and preliminarily polished zirconia ceramic surfaces showed the protruding defects, and the line roughness of coating group was larger than that of the polishing group. The median thickness of the silica-lithium spray coating on the preliminarily polished zirconia ceramic was 13.0 μm (interquartile range, IQR: 11.6, 17.9), while that of the silica-lithium spray coating on the untreated zirconia ceramic was 4.4 μm (IQR: 4.1, 4.7). The Vickers hardness and wear rate of the coating group were between the polishing group and the glazing group. The wear depths of the wear scars of steatite ceramics were the glazing group, coating group, and polishing group in descending order, and there was statistically significant difference between glazing and polishing groups (P < 0.05). With the increase of polishing procedure, the wear depth of steatite ceramics decreased in each subgroups. The orders of maximum depth and volume of wear scars of zirconia ceramic were the glazing group, coating group, and polishing group in descending order, and there was statistically significant difference in the maximum depth of wear scars between glazing and polishing groups (P < 0.05). CONCLUSION The silica-lithium spray coating on the zirconia ceramic, can be used as a new method for zirconia ceramic surface treatment, because it can increase the esthetic of zirconia ceramics compared with polishing and reduce the wear of steatite ceramics compared with glazing.
Humans ; Silicon ; Materials Testing ; Friction ; Lithium ; Cicatrix ; Surface Properties ; Silicon Dioxide ; Zirconium/chemistry* ; Ceramics ; Dental Porcelain

Objective: To compare the clinical performance of posterior single implant-supported monolithic zirconia crowns fabricated by full digital workflow and that of those fabricated by conventional workflow. Methods: This is prospective clinical research. Thirty-five patients who participated in a previous study during August 2017 to October 2018 at Department of Prosthodontics, Peking University School and Hospital of Stomatology were included in this 3-year follow-up study. The 35 patients, 17 females and 18 males, aged (49.0±15.4) years (24-86 years old), was allocated into two groups. In the full digital workflow group, intraoral scanning was taken immediately after implant placement, and a full zirconia implant crown was fabricated using model-free computer aided design/computer aided manufacturing (CAD/CAM) procedure (n=14). In the conventional group, a conventional impression was taken 3 months after implant placement and the stone model was produced. A full zirconia implant crown was fabricated using conventional model-based procedure (n=21). Three years following crown delivery, all the prostheses were evaluated in the aspect of color, surface roughness, contour and marginal integrity using modified US Public Health Service criteria (MUSPHS criteria). The soft and hard tissue around implant was evaluated using modified plaque index, probing depth (PD), number of implants with bleeding on probing, marginal bone loss (MBL). The biological and mechanical complication were also recorded. Statistical analysis was performed using independent samples t test, Mann-Whitney U test and Fisher's exact test. Results: The total survival rate of prosthesis and implant was 100% (35/35). No significant difference in MUSPHS criteria ratings on color, surface roughness, contour and marginal integrity of these crowns were found between the full digital workflow group and the conventional group (P>0.05). Sixteen out of the 35 crowns had a contour score of B due to loss of interproximal contact. Ten out of the 35 crowns had the screw hole sealing resin sinking or falling off, four in the full digital workflow group and six in the conventional group. There was no significant difference in the rate of prostheses mechanical complications between the two groups (P=1.000). For all the implants, there was no significant difference in MBL, PD, the modified plaque index, and number of implants with bleeding on probing between the two groups (U=119.50,133.00,142.50, t=-0.53, P>0.05). Conclusions: The clinical performance of implant-supported posterior single monolithic zirconia crowns fabricated by full digital workflow was stable. There was no significant difference in the clinical performance of the single implant crowns between the full digital workflow group and the conventional group.
Adult ; Aged ; Aged, 80 and over ; Crowns ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; United States ; Workflow ; Young Adult ; Zirconium

Zirconia is widely used in the field of dentistry because of its superior mechanical and esthetic characteristics. However, the tetragonal zirconia polycrystal restorations commonly used in clinics will degrade at low temperatures in the oral environment, resulting in increased surface roughness, microcracks, and decreased mechanical properties. Low-temperature degradation of zirconia can be affected by grain size, stress, stabilizer content and type, surface treatment, sintering conditions, and other factors. Through a literature review and analysis, this review summarizes the research progress on the low-temperature degradation of zirconia in prosthetic dentistry to provide references for the improvement of zirconia in clinical and research applications.
Ceramics ; Dental Materials ; Esthetics, Dental ; Materials Testing ; Prosthodontics ; Surface Properties ; Temperature ; Yttrium/chemistry* ; Zirconium

Objective: To evaluate the effects of pre-sintering heating rate and powder size on dental recycled zirconia. Methods: Recycled zirconia powders were sieved to obtain the large (50 μm With the same particle size, the recycled zirconia pre-sintered at different heating rates showed no significant differences in the relative densities, and the open porosities (P>0.05). When the pre-sintering heating rates were 2 ℃/min, 5 ℃/min, and 8 ℃/min, the flexural strengths of the large-particle recycled zirconia were (421.2±54.7), (444.2±70.1) and (427.5±68.4) MPa, the flexural strengths of the small-particle recycled zirconia were (750.1±74.1), (777.2±95.5) and (746.7±73.0) MPa, respectively. The flexural strength of commercial zirconia was (988.4±129.8) MPa. The flexural strengths of the recycled zirconia were significantly lower than that of the commercial zirconia (P<0.05). At the same pre-sintering heating rate, the flexural strengths of the small-particle recycled zirconia were significantly higher than that of the large-particle recycled zirconia (P<0.05). Conclusions: Compared with the large particles, small-particle recycled zirconia powders can effectively improve the properties of recycled zirconia, while the pre-sintering heating rate has no effect on the properties of the recycled zirconia.
Ceramics ; Dental Materials/chemistry* ; Heating ; Materials Testing ; Powders ; Surface Properties ; Yttrium ; Zirconium

OBJECTIVE: To investigate the effect of porous surface morphology of zirconia on the proliferation and differentiation of osteoblasts. METHODS: According to different manufacturing and pore-forming methods, the zirconia specimens were divided into 4 groups, including milled sintering group (M-Ctrl), milled porous group (M-Porous), 3D printed sintering group (3D-Ctrl) and 3D printed porous group (3D-Porous). The surface micromorphology, surface roughness, contact angle and surface elements of specimens in each group were detected by scanning electron microscope (SEM), 3D laser microscope, contact angle measuring device and energy-dispersion X-ray analysis, respectively. MC3T3-E1 cells were cultured on 4 groups of zirconia discs. The cell morphology of MC3T3-E1 cells on zirconia discs was eva-luated on 1 and 7 days by SEM. The cell proliferation was detected on 1, 3 and 5 days by cell counting kit-8 (CCK-8). After osteogenic induction for 14 days, the relative mRNA expression of alkaline phosphatase (ALP), type Ⅰ collagen (Colla1), Runt-related transcription factor-2 (Runx2) and osteocalcin (OCN) in MC3T3-E1 cells were detected by real-time quantitative polymerase chain reaction. RESULTS: The pore size [(419.72±6.99) μm] and pore depth [(560.38±8.55) μm] of 3D-Porous group were significantly larger than the pore size [(300.55±155.65) μm] and pore depth [(69.97±31.38) μm] of M-Porous group (P < 0.05). The surface of 3D-Porous group appeared with more regular round pores than that of M-Porous group. The contact angles of all the groups were less than 90°. The contact angles of 3D-Ctrl (73.83°±5.34°) and M-Porous group (72.7°±2.72°) were the largest, with no significant difference between them (P>0.05). Cells adhered inside the pores in M-Porous and 3D-Porous groups, and the proliferation activities of them were significantly higher than those of M-Ctrl and 3D-Ctrl groups after 3 and 5 days' culture (P < 0.05). After 14 days' incubation, ALP, Colla1, Runx2 and OCN mRNA expression in 3D-Porous groups were significantly lower than those of M-Ctrl and 3D-Ctrl groups (P < 0.05). Colla1, Runx2 and OCN mRNA expressions in M-Porous group were higher than those of 3D-Porous group (P < 0.05). CONCLUSION The porous surface morphology of zirconia can promote the proliferation and adhesion but inhibit the differentiation of MC3T3-E1 cells.
Cell Differentiation ; Cell Proliferation ; Ceramics ; Osteoblasts ; Osteogenesis ; Porosity ; Zirconium

Objective: To evaluate the effect of shear bond strength between resin cement and zirconia using SiO₂-ZrO₂ slurry coating. Methods: One hundred and forty pre-sintered zirconia discs were randomly divided into seven groups (n=20) according to the surface treatments: AS (as-sintered), SB (sand blasting with Al₂O₃), 2SiO₂-1ZrO₂ (2∶1 mole ratio SiO₂-ZrO₂ coating), 1SiO₂-1ZrO₂ (mole ratio 1∶1 SiO₂-ZrO₂ coating), 1SiO₂-2ZrO₂ (mole ratio 1∶2 SiO₂-ZrO₂ coating), 1SiO₂-3ZrO₂ (mole ratio 1∶3 SiO₂-ZrO₂ coating), 1SiO₂-4ZrO₂ (mole ratio 1∶4 SiO₂-ZrO₂ coating). Each zirconia disc was bonded to composite resin cylinder using resin cement. All specimens were stored in distilled water (37 ℃, 24 h). Each group was divided into two subgroups in which half specimens were tested using universal testing machine and another half specimens accepted artificial aging of 5 000 times thermocycling then tested. Scaning electron microscopy (SEM) was used to observe the micro-morphology of coating surface etched by hydrofluoric acid,then the coating thickness was measured. Results: Before artificial aging, 1SiO₂-1ZrO₂ showed a higher shear bond strength [(41.69±6.28) MPa] than all the other group (P<0.05). 1SiO₂-2ZrO₂ gained a higher strength than AS, SB, 1SiO₂-3ZrO₂ and 1SiO₂-4ZrO₂ (P<0.05). However, 1SiO₂-2ZrO₂ did not get a significant higher shear bond strength than 2SiO₂-1ZrO₂ (P>0.05). No significant differences were found among SB, 2SiO₂-1ZrO₂ and 1SiO₂-3ZrO₂ (P>0.05). After artificial aging, shear bond strength of all groups were decreased significantly besides 2SiO₂-1ZrO₂. 2SiO₂-1ZrO₂, 1SiO₂-1ZrO₂ and 1SiO₂-2ZrO₂ [(24.13±5.50), (22.28±4.40), (23.11±4.80) MPa] showed higher shear bond strength than SB and 1SiO₂-3ZrO₂ (P<0.05),no intergroup differences were observed (P>0.05). Shear bond strength of AS and 1SiO₂-4ZrO₂ fell to 0 MPa approximately. The SEM images of etched coating surface showed contraction fissure due to different thermal expansion coefficient between SiO₂ and ZrO₂ and intercrystal pores of zirconia. The thickness of coating was measured to be less than 30 μm. Conclusions: Mole ratio 1∶1 SiO₂-1ZrO₂ slurry coating showed the highest shear bond strength of resin cement to zirconia.
Dental Bonding ; Materials Testing ; Resin Cements/chemistry* ; Silicon Dioxide ; Surface Properties ; Zirconium

OBJECTIVE: To evaluate the effects of different edge compensation angles on the fracture strength of multilayer zirconia all-ceramic crowns and traditional uniform zirconia all-ceramic crowns. METHODS: The resin tooth preparation specimen of the mandibular first molar with a knife-edge was fabricated. A 3D digital model of the specimen was obtained by scanning it with a 3D dental model scanner. The 3D digital model was imported into computer aided design (CAD) software, and three 3D digital models of the full crown with the same surface shape are designed with the edge compensation angles of 30°, 45° and 60°, respectively. Then, the designed 3D digital model is imported into computer aided manufacturing (CAM) software. Three kinds of multilayer and homogeneous zirconia all-porcelain crowns with different edge compensation angles were fabricated, 10 each for a total of 60. The fracture load of each crown was measured under the electronic universal testing machine. RESULTS: Fracture load of multilayer and uniform zirconia all-ceramic crowns, (4 322.86±610.07) N and (5 914.12±596.80) N in the 30° group, (5 264.82±883.76) N and (5 220.83±563.38) N in the 45° group and (4 900.42±345.41) N and (5 050.22±560.24) N in the 60° group, respectively. The fracture load of multi-layer zirconia all-ceramic crowns in the 30° group was significantly lower than that of homogeneous zirconia all-ceramic crowns(P < 0.05); there was no statistical significance in 45° group and 60° group(P>0.05). In the multi-layer zirconia all-ceramic crowns: the fracture load of the 30° group was significantly lower than that of the 45° group (P < 0.05); there was no significant difference between the 30° group and the 60° group, the 45° group and the 60° group (P>0.05).In uniform zirconia full crown group: the 30° group was higher than the 45° group, the 30° group was higher than the 60° group (P < 0.05), and there was no significant difference between the 45° group and the 60° group (P>0.05). CONCLUSION The fracture loads of three kinds of uniform and multilayer zirconia all ceramic crowns with different edge compensation angles can meet the clinical requirements. A smaller edge compensation angle is recommended when using traditional zirconia all-ceramic crowns, while 45° is recommended when using multi-layer zirconia all-ceramic crowns.
Ceramics ; Computer-Aided Design ; Crowns ; Dental Porcelain ; Dental Prosthesis Design ; Dental Restoration Failure ; Dental Stress Analysis ; Flexural Strength ; Materials Testing ; Zirconium

OBJECTIVE: To evaluate the effects of femtosecond laser treated microgrooved surface on microscopic topography, phase transformation, and three-points flexural strength of zirconia, and to provide reference for surface microstructure optimization of zirconia implant. METHODS: According to different surface treatment methods, 57 computer aided design/computer aided manufacture (CAD/CAM) zirconia bars (20.0 mm×4.0 mm×1.4 mm) were evenly divided into three groups: sintered group, no treatment after sintering, taken as control; sandblasted group, sandblasted with 110 μm aluminium oxide (Al₂O₃) after sintering; microgrooved group, femtosecond laser fabricated microgrooves with 50 μm width, 30 μm depth, and 100 μm pitch. Surface microscopic topography was observed with scanning electron microscope (SEM) and 3D laser microscope. Further, surface roughness in each group and microgroove size were measured. Crystal phase was analyzed with X-ray diffraction. Specimens were subjected to three- points flexural strength test, and Weibull distribution was used to analyze their strength characteristics. RESULTS: SEM showed that sintered surface was flat with clear grain structure; sandblasted surface exihibited bumps and holes with sharp margins and irregular shape; microgrooves were regularly aligned without evident defect, and nano-scale particles were observed on the surface inside of the microgrooves. Ra value of microgrooved group [(9.42±0.28)] μm was significantly higher than that of sandblasted group [(1.04±0.03) μm] and sintered group [(0.60±0.04) μm], and there was statistical difference between sandblasted group and sintered group (P < 0.001). The microgroove size was precise with (49.75±1.24) μm width, (30.85±1.02) μm depth, and (100.58±1.94) μm pitch. Crystal phase analysis showed that monoclinic volume fraction of sandblasted group (18.17%) was much higher than that of sintered group (1.55%), while microgrooved group (2.21%) was similar with sintered group. The flexural strength of sandblasted group (986.22±163.25) MPa had no statistical difference with that of sintered group (946.46±134.15) MPa (P=0.847), but the strength in microgrooved group (547.92±30.89) MPa dropped significantly compared with the other two groups (P < 0.001). Weibull modulus of sintered, sandblasted, microgrooved groups were 7.89, 6.98, and 23.46, respectively. CONCLUSION Femtosecond laser was able to form micro/nanostructured microgrooves on zirconia surface, which deleteriously affected the flexural strength of zirconia.
Ceramics ; Dental Materials ; Flexural Strength ; Humans ; Lasers ; Materials Testing ; Microscopy, Electron, Scanning ; Surface Properties ; Yttrium ; Zirconium