Zirconia Structures for Dentistry

Zirconia structures used for dental purposes are fabricated using CAD-CAM (computer-aided design and computer-aided manufacturing) technology in two possible ways. One method mills the fully sintered block of zirconia with no distortion (shrinkage) to the final structure. The disadvantages are the great wear of the grinding tools (burs) and the population of flaws produced during the machining that may lower the mechanical reliability of the structure. In the other method, the zirconia structure is milled from a pre-sintered block, reaching its final mechanical properties after sintered, which produces structural shrinkage that can be partly compensated at the designing stage, and the fit of the zirconia restoration will be warranted. Both CAD-CAM processes have three main steps: acquisition of digital data, computer processing and designing, and fabrication of the zirconia structure. Most importantly, the CAD-CAM technique has the ability to produce zirconia restorations with sufficient precision for dental use.
Traditionally, zirconia is dull white in color and its opacity can mask the underneath structure. Most dental zirconia systems indicate structural dyeing (coloring) to enhance the esthetic. Currently, full-contoured (anatomical-shaped) monolithic zirconia dental restorations are offered, which could abbreviate or extinguish the dental laboratory work on zirconia-based restorations. Several studies reported, however, that Y-TZP would lose its stability in wet environment, leading to strength degradation mostly because of the crystallographic transformation from metastable tetragonal phase to monoclinic phase (T-M transformation) and inherent cyclic fatigue from chewing and para-functional habits (e.g., bruxism and clenching). Nevertheless, the influence of low temperature degradation (LTD) on dental zirconia is still in need of further investigation.
Even so, the most popular zirconia-based restorations have a zirconia infrastructure that is porcelain veneered to adequate anatomic contour and esthetic. There are two main ways of veneering zirconia infrastructures: the traditional layering technique and the hot pressing method . Both methods require some sort of porcelain to zirconia bonding. Some studies have observed an exchange of certain chemical elements at the porcelain-zirconia interface, which may contribute to bonding, but whether a true chemical bonding has formed is yet to be verified. Therefore, micro-or nano-mechanical interlocking is regarded as the major mechanism of porcelain zirconia bonding . On this basis, and with some dispute, sandblasting the zirconia surface before porcelain veneering or resin bonding appears to be the most popular method to promote mechanical interlocking and most reports recommend moderate pressure (around 0.4 MPa) and small particle size. Other studies suggest that sandblasting induces monoclinic phase transformation, but it can be reversed by the veneering process. In addition, primers and liners have been suggested to improve wetting and bonding to zirconia.
Nonetheless, one of the most important reasons for introducing monolithic zirconia restorations is the significant rate of porcelain fracture from porcelain veneered zirconia-based restorations (6%–25% after three years), which is greater than the fracture rate reported for porcelain fused-to-metal (PFM) systems. This subject challenged many researchers and triggered few review publications on the fracture rate of all-ceramic restorations, indicating that delamination (failure at porcelain-zirconia interface) and chipping (failure within the veneering porcelain) are the most common modes of failure. Studies suggested several possible causes for porcelain failure on zirconia-based restorations.
The mismatch in some mechanical and thermal properties such as fracture toughness, flexural strength, coefficient of thermal expansion, and elastic modulus affect the bonding between porcelain and zirconia. One study emphasized the effect of strength misfit on the development of delamination, showing that the mode of failure changes according to the porcelain strength and suggesting the use of veneering material with a high flexural strength (over 300 MPa) to improve the reliability of zirconia-based restorations.
Significant differences on the coefficient of thermal expansion between the zirconia and porcelain influence in the residual stress distribution during the cooling process affecting the reliability of zirconia-based restorations. The veneering porcelain will experience a change from a viscoelastic state to a solid form when its temperature is reduced and when it passes through the glass transition temperature (Tg from 480 °C to 610 °C). During cooling after sintering, residual stresses might be generated and influence both the strength of porcelain and interfacial integration. Therefore, most manufacturers recommend slow cooling processes.
The initiation and propagation of delamination was also reported to be related to the misfit in elastic moduli and fracture toughness of porcelain and zirconia.
Pressable veneering porcelains were thought to improve bonding between porcelain and zirconia, but studies are controversial on this matter and most of them showed no significant difference between the traditional and pressing methods. New veneering methods using CAD-CAM technology seem to improve wetting and bond strength between zirconia and porcelain.