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      Multilayer Super-Translucent Zirconia for Chairside Fabrication of a Monolithic Posterior Crown

      case-report
      1 , 2 , , 1 , 1
      Case Reports in Dentistry
      Hindawi

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          Abstract

          This case report describes the chairside fabrication of a monolithic posterior crown using a multilayer super-translucent zirconia material. According to the manufacturer's information, the newly introduced multilayer zirconia (4-YTZP) offers a unique combination of fracture strength (>850 MPa with speed-sintering) and improved optical properties, thus allowing a reduced minimum material thickness and optional temporary luting. By using up-to-date components of the CEREC system, including superfast dry-milling and a speed-sintering process, the fabrication of a monolithic zirconia crown is possible within an acceptable timeframe for the chairside workflow (60-75 min). The usage of a multilayer super-translucent material allows for the individualization of the restoration, typically in a single combined stain and glaze firing. However, it should be noted that clinical data for this type of restoration are still sparse. Therefore, manufacturer recommendations regarding indication, preparation, and cementation must be followed very strictly.

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          Most cited references34

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          Current status on lithium disilicate and zirconia: a narrative review

          Background The introduction of the new generation of particle-filled and high strength ceramics, hybrid composites and technopolymers in the last decade has offered an extensive palette of dental materials broadening the clinical indications in fixed prosthodontics, in the light of minimally invasive dentistry dictates. Moreover, last years have seen a dramatic increase in the patients’ demand for non-metallic materials, sometimes induced by metal-phobia or alleged allergies. Therefore, the attention of scientific research has been progressively focusing on such materials, particularly on lithium disilicate and zirconia, in order to shed light on properties, indications and limitations of the new protagonists of the prosthetic scene. Methods This article is aimed at providing a narrative review regarding the state-of-the-art in the field of these popular ceramic materials, as to their physical-chemical, mechanical and optical properties, as well as to the proper dental applications, by means of scientific literature analysis and with reference to the authors’ clinical experience. Results A huge amount of data, sometimes conflicting, is available today. Both in vitro and in vivo studies pointed out the outstanding peculiarities of lithium disilicate and zirconia: unparalleled optical and esthetic properties, together with high biocompatibility, high mechanical resistance, reduced thickness and favorable wear behavior have been increasingly orientating the clinicians’ choice toward such ceramics. Conclusions The noticeable properties and versatility make lithium disilicate and zirconia materials of choice for modern prosthetic dentistry, requiring high esthetic and mechanical performances combined with a minimal invasive approach, so that the utilization of such metal-free ceramics has become more and more widespread over time.
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            The Effect of Resin Bonding on Long-Term Success of High-Strength Ceramics

            Digital manufacturing, all-ceramics, and adhesive dentistry are currently the trendiest topics in clinical restorative dentistry. Tooth- and implant-supported fixed restorations from computer-aided design (CAD)/computer-aided manufacturing (CAM)–fabricated high-strength ceramics—namely, alumina and zirconia—are widely accepted as reliable alternatives to traditional metal-ceramic restorations. Most recent developments have focused on high-translucent monolithic full-contour zirconia restorations, which have become extremely popular in a short period of time, due to physical strength, CAD/CAM fabrication, and low cost. However, questions about proper resin bonding protocols have emerged, as they are critical for clinical success of brittle ceramics and treatment options that rely on adhesive bonds, specifically resin-bonded fixed dental prostheses or partial-coverage restorations such as inlays/onlays and veneers. Resin bonding has long been the gold standard for retention and reinforcement of low- to medium-strength silica-based ceramics but requires multiple pretreatment steps of the bonding surfaces, increasing complexity, and technique sensitivity compared to conventional cementation. Here, we critically review and discuss the evidence on resin bonding related to long-term clinical outcomes of tooth- and implant-supported high-strength ceramic restorations. Based on a targeted literature search, clinical long-term studies indicate that porcelain-veneered alumina or zirconia full-coverage crowns and fixed dental prostheses have high long-term survival rates when inserted with conventional cements. However, most of the selected studies recommend resin bonding and suggest even greater success with composite resins or self-adhesive resin cements, especially for implant-supported restorations. High-strength ceramic resin-bonded fixed dental prostheses have high long-term clinical success rates, especially when designed as a cantilever with only 1 retainer. Proper pretreatment of the bonding surfaces and application of primers or composite resins that contain special adhesive monomers are necessary. To date, there are no clinical long-term data on resin bonding of partial-coverage high-strength ceramic or monolithic zirconia restorations.
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              Glass–Ceramics in Dentistry: A Review

              In this review, we first briefly introduce the general knowledge of glass–ceramics, including the discovery and development, the application, the microstructure, and the manufacturing of glass–ceramics. Second, the review presents a detailed description of glass–ceramics in dentistry. In this part, the history, property requirements, and manufacturing techniques of dental glass–ceramics are reviewed. The review provided a brief description of the most prevalent clinically used examples of dental glass–ceramics, namely, mica, leucite, and lithium disilicate glass–ceramics. In addition, we also introduce the newly developed ZrO2–SiO2 nanocrystalline glass–ceramics that show great potential as a new generation of dental glass–ceramics. Traditional strengthening mechanisms of glass–ceramics, including interlocking, ZrO2–reinforced, and thermal residual stress effects, are discussed. Finally, a perspective and outlook for future directions in developing new dental glass–ceramics is provided to offer inspiration to the dental materials community.
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                Author and article information

                Contributors
                Journal
                Case Rep Dent
                Case Rep Dent
                CRID
                Case Reports in Dentistry
                Hindawi
                2090-6447
                2090-6455
                2022
                23 March 2022
                : 2022
                : 4474227
                Affiliations
                1Dental Clinic Prof. Dr. S. Rinke, Dr. M. Jablonski & Dr. H. Ziebolz, Hanau, Germany
                2University Medical Center Göttingen, Department of Prosthodontics, Göttingen, Germany
                Author notes

                Academic Editor: Andrea Scribante

                Author information
                https://orcid.org/0000-0003-3804-6410
                Article
                10.1155/2022/4474227
                8967591
                85b10cdf-16c9-4143-8e9a-2e0f63fa12bd
                Copyright © 2022 Sven Rinke et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 January 2022
                : 7 March 2022
                Categories
                Case Report

                Dentistry
                Dentistry

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