Dental composite and ceramic restorative materials are designed to closely mimic the aesthetics and function of natural tooth tissue, and their longevity in the oral environment depends to a large degree on their fatigue and wear properties. The purpose of this review is to highlight some recent advances in our understanding of fatigue and wear mechanisms, and how they contribute to restoration failures in the complex oral environment. Overall, fatigue and wear processes are found to be closely related, with wear of dental ceramic occlusal surfaces providing initiation sites for fatigue failures, and subsurface fatigue crack propagation driving key wear mechanisms for composites, ceramics, and enamel. Furthermore, both fatigue and wear of composite restorations may be important in enabling secondary caries formation, which is the leading cause of composite restoration failures. Overall, developing a mechanistic description of fatigue, wear, and secondary caries formation, along with understanding the interconnectivity of all three processes, are together seen as essential keys to successfully using in vitro studies to predict in vivo outcomes and develop improved dental restorative materials.

Recent advances in understanding the fatigue and wear behavior of dental composites and ceramics

Nowadays, all-ceramic materials are routinely used within the treatment of patients in dentistry. The objective of this prospective clinical trial was the evaluation of chair-side generated monolithic lithium disilicate crowns after 10 years. Forty-one posterior full contour crowns made of lithium disilicate ceramics were inserted with a self-adhesive resin cement in 34 patients (20 university/14 private practice) using a chair-side CAD/CAM technique. One crown per patient was randomly selected for evaluation according to the modified US Public Health Service criteria. After a mean examination time of 10.1 years, 26 crowns were available for re-examination. Within the observation period, five failures occurred due to one crown fracture after 2.9 years, an abutment fracture after 6.0 years, one severe endodontic problem after 6.1 years, a root fracture after 7.0 years, and a replacement of one crown caused by a carious lesion after 10 years. Complications occurred as retention loss of one crown, two carious lesions, and a change in sensibility perception of two abutment teeth. All events were associated with molars. The Kaplan-Meier analysis revealed a survival rate of 83.5% and a complication-free rate of 71.0% after 10 years. Due to the small amount of technical complications and failures, the clinical performance of monolithic lithium disilicate crowns was completely satisfying. The insertion of chair-side fabricated monolithic lithium disilicate crowns can be recommended for long-term use in the posterior region.

Clinical survival of chair-side generated monolithic lithium disilicate crowns:10-year results.

High-translucent yttria-stabilized zirconia ceramics are wear-resistant and antagonist-friendly.

Glass-ceramics in dentistry: Fundamentals, technologies, experimental techniques, applications, and open issues

In-vitro wear of natural tooth surface opposed with zirconia reinforced lithium silicate glass ceramic after accelerated ageing

Objectives This study evaluated the wear performance and wear mechanisms of four dental glass-ceramics, based on the microstructure and mechanical properties in the progressive wear process. Methods Bar (N = 40, n = 10) and disk (N = 32, n = 8) specimens were prepared from (A) lithium disilicate glass-ceramic (LD), (B) leucite reinforced glass-ceramic (LEU), (C) feldspathic glass-ceramic (FEL), and (D) fluorapatite glass-ceramic (FLU). The bar specimens were tested for three-point flexural strength, hardness, fracture toughness and elastic modulus. The disk specimens paired with steatite antagonists were tested in a pin-on-disk tribometer with 10 N up to 1000,000 wear cycles. The wear analysis of glass-ceramics was performed using a 3D profilometer after every 200,000 wear cycles. Wear loss of steatite antagonists was calculated by measuring the weight and density using sensitive balance and Archimedes’ method. Wear morphologies and microstructures were analyzed by scanning electron microscopy (SEM). The crystalline phase compositions were determined using X-ray diffraction (XRD). One-way analysis of variance (ANOVA) was used to analyze the data. Multiple pair-wise comparison of means was performed by Tukey's post-hoc test. Results LD showed the highest fracture toughness, flexural strength, elastic modulus and crystallinity, followed by LEU and FEL, and FLU showed the lowest. However, the hardness of LD was lower than all the other three types of ceramics. For steatite antagonists, LD produced the least wear loss of antagonist, followed by LEU and FEL, and FLU had the most wear loss. For glass-ceramic materials, LD exhibited similar wear loss as LEU, but more than FLU and FEL did. Moreover, fracture occurred on the wear surface of FLU. Conclusions In the progressive wear process, veneering porcelains showed better wear resistance but fluorapatite veneering porcelains appeared fracture surface. Monolithic lithium disilicate glass-ceramics with higher mechanical properties showed more wear loss, however, they did not fracture and produced less wear loss of antagonists.

A comparative study of progressive wear of four dental monolithic, veneered glass-ceramics.

Aim Ceramic restoration experiences the non-linear wear process during the chewing simulation, which contains running-in, steady and severe wear stages. However since various levels of contact stress may be applied on the occlusal surface during chewing, the cycle-dependent wear behaviors of ceramic crowns may differ. The aim of this study was to investigate the effect of contact stress on the development of wear behavior, as tested in a chewing simulator. Materials and methods Thirty-six anatomical metal-ceramic crowns using Ceramco III as the veneering porcelain were randomly assigned to two groups based on the contact stress applied in the wear testing. Stainless steel balls served as antagonists. The specimens were dynamically loaded in a chewing simulator up to 2.4×106 loading cycles, with additional thermal cycling between 5 and 55℃. For each group, several checkpoints were employed to measure the substance loss of the crowns’ occlusal surfaces and to evaluate the microstructure of the worn areas. Results After 2.4×106 cycles, the ceramic restorations with lower contact stress demonstrated a long steady wear stage following the running-in, but without the severe wear stage. And a slowly microstructural degradation was observed that the subsurface defect could not be seen until final. With higher contact stress, however, the ceramic restorations experienced a faster transition from running-in to severe wear stage that the steady wear stage nearly disappeared. And an early formation of subsurface defects and the deterioration of microstructure were observed. Conclusions Contact stress is a key factor affecting the wear development of ceramic restoration. The higher contact stress promotes the veneering porcelain to evolve into severe wear stage. In contrast, lower contact stress is prone to keep the veneering porcelain operating in steady wear stage, which delays the arrival of severe wear region.

Effect of contact stress on the cycle-dependent wear behavior of ceramic restoration.

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A comparative study of progressive wear of four dental monolithic, veneered glass-ceramics.

Effect of contact stress on the cycle-dependent wear behavior of ceramic restoration.