[en] Background: Recent introduction of computer-aided design/computer-aided manufacturing (CAD/CAM)
monolithic zirconia dental prostheses raises the issue of material low thermal degradation (LTD), a wellknown
problem with zirconia hip prostheses. This phenomenon could be accentuated by masticatory
mechanical stress. Until now zirconia LTD process has only been studied in vitro. This work introduces an
original protocol to evaluate LTD process of monolithic zirconia prostheses in the oral environment and
to study their general clinical behavior, notably in terms of wear.
Methods/design: 101 posterior monolithic zirconia tooth elements (molars and premolars) are included
in a 5-year prospective clinical trial. On each element, several areas between 1 and 2 mm2 (6 on molars, 4
on premolars) are determined on restoration surface: areas submitted or non-submitted to mastication
mechanical stress, glazed or non-glazed. Before prosthesis placement, ex vivo analyses regarding LTD and
wear are performed using Raman spectroscopy, SEM imagery and 3D laser profilometry. After placement,
restorations are clinically evaluated following criteria of the World Dental Federation (FDI), complemented
by the analysis of fracture clinical risk factors. Two independent examiners perform the
evaluations. Clinical evaluation and ex vivo analyses are carried out after 6 months and then each year for
up to 5 years.
Discussion: For clinicians and patients, the results of this trial will justify the use of monolithic zirconia
restorations in dental practice. For researchers, the originality of a clinical study including ex vivo analyses
of material aging will provide important data regarding zirconia properties.
Research center :
d‐BRU - Dental Biomaterials Research Unit - ULiège [BE]
Disciplines :
Materials science & engineering Dentistry & oral medicine Biotechnology
Author, co-author :
KOENIG, Vinciane ; Centre Hospitalier Universitaire de Liège - CHU > Service prothèse fixée
Wulfman, Claudine; Université Paris Descartes
DERBANNE, Mathieu
DUPONT, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > Service prothèse fixée
LE GOFF, Stéphane
TANG, Mie-Leng
SEIDEL, Laurence ; Centre Hospitalier Universitaire de Liège - CHU > Service des informations médico économiques (SIME)
DEWAEL, Thibaut ; Centre Hospitalier Universitaire de Liège - CHU > Service prothèse fixée
VAN HEUSDEN, Alain ; Centre Hospitalier Universitaire de Liège - CHU > Service prothèse fixée
MAINJOT, Amélie ; Centre Hospitalier Universitaire de Liège - CHU > Service prothèse fixée
Language :
English
Title :
Aging of monolithic zirconia dental prostheses: Protocol for a 5-year prospective clinical study using ex vivo analyses
[1] Petersen, P.E., The world oral health report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO global oral health programme. Community Dent. Oral Epidemiol. 31:Suppl. 1 (2003), 3–23.
[2] Bagramian, R.A., Garcia-Godoy, F., Volpe, A.R., The global increase in dental caries. A pending public health crisis. Am. J. Dent. 22:1 (2009), 3–8.
[3] Koenig, V., et al. Clinical risk factors related to failures with zirconia-based restorations: an up to 9-year retrospective study. J. Dent. 41:12 (2013), 1164–1174.
[4] Batson, E.R., et al. Clinical outcomes of three different crown systems with CAD/CAM technology. J. Prosthet. Dent. 112:4 (2014), 770–777.
[5] Carames, J., et al. Clinical advantages and limitations of monolithic zirconia restorations full arch implant supported reconstruction: case series. Int. J. Dent., 2015, 2015, 392496.
[6] Cardelli, P., et al. Full-Arch, implant-supported monolithic zirconia rehabilitations: pilot clinical evaluation of wear against natural or composite teeth. J. Prosthodont 00 (2015), 1–5.
[7] Cheng, C.W., et al. Complete-mouth implant rehabilitation with modified monolithic zirconia implant-supported fixed dental prostheses and an immediate-loading protocol: a clinical report. J. Prosthet. Dent. 109:6 (2013), 347–352.
[8] Dhima, M., et al. Practice-based clinical evaluation of ceramic single crowns after at least five years. J. Prosthet. Dent. 111:2 (2014), 124–130.
[9] Moscovitch, M., Consecutive case series of monolithic and minimally veneered zirconia restorations on teeth and implants: up to 68 months. Int. J. Periodontics Restor. Dent. 35:3 (2015), 315–323.
[10] Mundhe, K., et al. Clinical study to evaluate the wear of natural enamel antagonist to zirconia and metal ceramic crowns. J. Prosthet. Dent. 114:3 (2015), 358–363.
[11] Stober, T., et al. Enamel wear caused by monolithic zirconia crowns after 6 months of clinical use. J. Oral Rehabil. 41:4 (2014), 314–322.
[12] Venezia, P., et al. Retrospective analysis of 26 complete-arch implant-supported monolithic zirconia prostheses with feldspathic porcelain veneering limited to the facial surface. J. Prosthet. Dent. 114:4 (2015), 506–512.
[13] Deville, S., Guenin, G., Chevalier, K., Martensitic transformation in zirconia - Part I. Nanometer scale prediction and measurement of transformation induced relief. Acta Mater. 52:19 (2004), 5697–5707.
[14] Cattani-Lorente, M., et al. Low temperature degradation of a Y-TZP dental ceramic. Acta Biomater. 7:2 (2011), 858–865.
[15] Chevalier, J., et al. Low-temperature degradation in zirconia with a porous surface. Acta Biomater. 7:7 (2011), 2986–2993.
[16] Hallmann, L., et al. The influence of grain size on low-temperature degradation of dental zirconia. J. Biomed. Mater Res. B Appl. Biomater. 100:2 (2011), 447–456.
[17] Kim, J.W., et al. Concerns of hydrothermal degradation in CAD/CAM zirconia. J. Dent. Res. 89:1 (2010), 91–95.
[18] Chevalier, J., What future for zirconia as a biomaterial?. Biomaterials 27:4 (2006), 535–543.
[19] Samodurova, A., et al. The combined effect of alumina and silica co-doping on the ageing resistance of 3Y-TZP bioceramics. Acta Biomater. 11 (2015), 477–487.
[20] Egilmez, F., et al. Factors affecting the mechanical behavior of Y-TZP. J. Mech. Behav. Biomed. Mater 37 (2014), 78–87.
[21] Ban, S., et al. Biaxial flexure strength and low temperature degradation of Ce-TZP/Al2O3 nanocomposite and Y-TZP as dental restoratives. J. Biomed. Mater Res. B Appl. Biomater. 87:2 (2008), 492–498.
[22] Roy, M.E., et al. Phase transformation, roughness, and microhardness of artificially aged yttria- and magnesia-stabilized zirconia femoral heads. J. Biomed. Mater Res. A 83:4 (2007), 1096–1102.
[23] Chowdhury, S., et al. Accelerating aging of zirconia femoral head implants: change of surface structure and mechanical properties. J. Biomed. Mater Res. B Appl. Biomater. 81:2 (2007), 486–492.
[24] Kosmac, T., et al. The effect of surface grinding and sandblasting on flexural strength and reliability of Y-TZP zirconia ceramic. Dent. Mater 15:6 (1999), 426–433.
[25] Kim, H.T., et al. The effect of low temperature aging on the mechanical property & phase stability of Y-TZP ceramics. J. Adv. Prosthodont 1:3 (2009), 113–117.
[26] Pereira, G.K., et al. Low-temperature degradation of Y-TZP ceramics: a systematic review and meta-analysis. J. Mech. Behav. Biomed. Mater 55 (2015), 151–163.
[27] ISO 13356-2008, Implants for surgery – ceramic materials based on yttria-stabilizes tetragonal zirconia (Y-TZP). Int. Organ. Stand., 2008.
[29] Flinn, B.D., et al. Accelerated aging characteristics of three yttria-stabilized tetragonal zirconia polycrystalline dental materials. J. Prosthet. Dent. 108:4 (2012), 223–230.
[30] Kohorst, P., et al. Low-temperature degradation of different zirconia ceramics for dental applications. Acta Biomater. 8:3 (2012), 1213–1220.
[31] Pereira, G., et al. Effect of low-temperature aging on the mechanical behavior of ground Y-TZP. J. Mech. Behav. Biomed. Mater 45 (2015), 183–192.
[32] Denry, I., Kelly, J.R., Emerging ceramic-based materials for dentistry. J. Dent. Res. 93:12 (2014), 1235–1242.
[33] Zhang, Y., Making yttria-stabilized tetragonal zirconia translucent. Dent. Mater 30:10 (2014), 1195–1203.
[34] Lim, C.S., Finlayson, T.R., Ninio, F., Griffiths, J.R., In-situ measurement of the stress-induced phase transformations in magnesia-partially-stabilized zirconia using Raman spectroscopy. J. Am. Ceram. Soc. 75:6 (1992), 1570–1573.
[35] Hickel, R., et al. Recommendations for conducting controlled clinical studies of dental restorative materials. Science Committee Project 2/98–FDI World Dental Federation study design (Part I) and criteria for evaluation (Part II) of direct and indirect restorations including onlays and partial crowns. J. Adhes. Dent. 9:Suppl. 1 (2007), 121–147.
[36] Hickel, R., et al. FDI World Dental Federation - clinical criteria for the evaluation of direct and indirect restorations. Update and clinical examples. J. Adhes. Dent. 12:4 (2010), 259–272.
[37] Scherrer, S.S., et al. Fractographic ceramic failure analysis using the replica technique. Dent. Mater 23:11 (2007), 1397–1404.
[38] Chevalier, J., et al. The tetragonal-monoclinic transformation in zirconia: lessons learned and future trends. J. Am. Ceram. Soc. 92:9 (2009), 1901–1920.
[39] Flinn, B.D., et al. Effect of hydrothermal degradation on three types of zirconias for dental application. J. Prosthet. Dent. 112:6 (2014), 1377–1384.
[40] Nakamura, K., et al. The influence of low-temperature degradation and cyclic loading on the fracture resistance of monolithic zirconia molar crowns. J. Mech. Behav. Biomed. Mater 47 (2015), 49–56.
[41] Chevalier, J., Cales, B., Drouin, J., Low-temperature aging of Y-TZP ceramics. J. Am. Ceram. Soc. 82:8 (1999), 2150–2154.
[42] Pezzotti, G., Porporati, A.A., Raman spectroscopic analysis of phase-transformation and stress patterns in zirconia hip joints. J. Biomed. Opt. 9:2 (2004), 372–384.
[43] Clarke, D.R.A.F., Measurement of the cristallographically transformed zone produced by fracture in ceramics containing tetragonal zirconia. J. Am. Ceram. Soc. 65:6 (1982), 284–288.
[44] Gremillard, L., et al. Modeling the aging kinetics of zirconia ceramics. J. Am. Ceram. Soc. 24:13 (2004), 3483–3489.