Yeni Nesil Zirkonya Seramikler
Özet
Estetik dental beklentilerin artmasıyla birlikte, geleneksel metal destekli seramiklerin yerini alan zirkonya altyapılı restorasyonlarda en büyük sorun, üst yapı porseleninin (veneer) ufalanması ve kırılmasıdır. Bu klinik teknik komplikasyonların önüne geçebilmek adına veneer porselen gerektirmeyen, doğrudan anatomik formda kullanılabilen monolitik zirkonya restorasyonlar geliştirilmiştir. Monolitik zirkonyanın geliştirilme sürecinde temel hedef, materyalin ışık geçirgenliğini (translusensi) artırarak estetik görünümü iyileştirmek olmuştur. Bu doğrultuda kimyasal bileşimleri, özellikle de yapılarındaki itriyum oksit (Y₂O₃) oranları ve kristal faz içerikleri değiştirilerek mekanik ve optik özelliklerine göre dört farklı nesil zirkonya seramik üretilmiştir. Birinci ve ikinci nesiller yüksek kırılma dayanımına sahip ancak opak iken; üçüncü ve dördüncü nesillerde artırılan itriyum içeriği ve kübik kristal fazı sayesinde ışık geçirgenliği ve estetik optimize edilmiş, buna karşın mekanik dayanım bir miktar azalmıştır. Günümüzde üreticiler, monokromatik blokların yanı sıra estetik geçiş sağlayan multilayer (katmanlı) ve hibrit zirkonya bloklar da sunmaktadır. Cam içermeyen kimyasal yapıları nedeniyle zirkonyanın rezin simanlarla adeziv bağlanması için Al₂O₃ ile kumlama gibi mekanik ön işlemler ile 10-MDP içeren fonksiyonel monomerlerin kimyasal etkileşiminden yararlanılan sistemler kombine olarak önerilmektedir. Monolitik zirkonyanın antagonist dişlerde oluşturabileceği aşınmayı en aza indirmek için klinik uyumlamaların ardından yüzeyin ideal şekilde cilalanması ve glaze edilmesi kritik öneme sahiptir. Klinisyenlerin uzun dönemli klinik başarı için bu nesillerin endikasyonlarını ve kimyasal yapılarını iyi bilmesi gerekmektedir.
With the increasing aesthetic dental expectations, the biggest problem in zirconia-based restorations, which have replaced traditional metal-supported ceramics, is the chipping and fracturing of the veneering porcelain. To prevent these clinical technical complications, monolithic zirconia restorations that do not require veneering porcelain and can be used directly in anatomical form have been developed. In the development process of monolithic zirconia, the main objective has been to improve the aesthetic appearance by increasing the translucency of the material. In this direction, four different generations of zirconia ceramics have been produced according to their mechanical and optical properties by modifying their chemical compositions, especially the yttrium oxide (Y₂O₃) ratios and crystal phase contents. While the first and second generations have high fracture toughness but are opaque, the increased yttrium content and cubic crystal phase in the third and fourth generations have optimized translucency and aesthetics, although mechanical strength has decreased to some extent. Today, manufacturers offer monochromatic blocks as well as multilayer and hybrid zirconia blocks providing aesthetic transitions. Due to their glass-free chemical structure, systems combining mechanical pretreatments like sandblasting with Al₂O₃ and the chemical interaction of functional monomers containing 10-MDP are recommended for adhesive bonding of zirconia with resin cements. To minimize the wear that monolithic zirconia can cause on antagonist teeth, ideal polishing and glazing of the surface after clinical adjustments are of critical importance. Clinicians must be well-informed about the indications and chemical structures of these generations for long-term clinical success.
Referanslar
Jerman E, Lumkemann N, Eichberger M, et al. Evaluation of translucency, Marten's hardness, biaxial flexural strength and fracture toughness of 3Y-TZP, 4Y-TZP and 5Y-TZP materials. Dental Materials 2021;37(2):212-22.
Zhang F, Inokoshi M, Batuk M, et al. Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations. Dental Materials 2016;32(12):e327-e37.
Chen Y-M, Smales RJ, Yip KH-K, et al. Translucency and biaxial flexural strength of four ceramic core materials. Dental Materials 2008;24(11):1506-11.
Scarano A, Di Carlo F, Quaranta M, et al. Bone response to zirconia ceramic implants: an experimental study in rabbits. Journal of Oral Implantology 2003;29(1):8-12.
Baldissara P, Llukacej A, Ciocca L, et al. Translucency of zirconia copings made with different CAD/CAM systems. Journal of Prosthetic Dentistry 2010;104(1):6-12.
Tong H, Tanaka CB, Kaizer MR, et al. Characterization of three commercial Y-TZP ceramics produced for their high-translucency, high-strength and high-surface area. Ceramics International 2016;42(1 Pt B):1077-85.
Vichi A, Louca C, Corciolani G, et al. Color related to ceramic and zirconia restorations: A review. Dental Materials 2011;27(1):97-108.
Zarone F, Russo S, Sorrentino R. From porcelain-fused-to-metal to zirconia: clinical and experimental considerations. Dental Materials 2011;27(1):83-96.
Zadeh PN, Lümkemann N, Sener B, et al. Flexural strength, fracture toughness, and translucency of cubic/tetragonal zirconia materials. Journal of Prosthetic Dentistry 2018;120(6):948-54.
Hannink RH, Kelly PM, Muddle BC. Transformation toughening in zirconia‐containing ceramics. Journal of the American Ceramic Society 2000;83(3):461-87.
Stawarczyk B, Keul C, Eichberger M, et al. Three generations of zirconia: From veneered to monolithic. Part I. Quintessence International 2017;48(5):369-80.
Zhang Y, Lawn B. Novel zirconia materials in dentistry. Journal of Dental Research 2018;97(2):140-7.
Shen J, Xie H, Wu X, et al. Evaluation of the effect of low-temperature degradation on the translucency and mechanical properties of ultra-transparent 5Y-TZP ceramics. Ceramics International 2020;46(1):553-9.
Chen Y-W, Moussi J, Drury JL, et al. Zirconia in biomedical applications. Expert Review of Medical Devices 2016;13(10):945-63.
Elvers B. Ullmann's encyclopedia of industrial chemistry: Verlag Chemie; 1991.
Guth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirconia and its novel compositions: What do clinicians need to know? Quintessence International 2019;50(7):512-20.
Heintze SD, Rousson V. Survival of zirconia-and metal-supported fixed dental prostheses: a systematic review. International Journal of Prosthodontics 2010;23(6).
Rinke S, Gersdorff N, Lange K, Roediger M. Prospective evaluation of zirconia posterior fixed partial dentures: 7-year clinical results. International Journal of Prosthodontics 2013;26(2).
Kim H-K. Effect of a rapid-cooling protocol on the optical and mechanical properties of dental monolithic zirconia containing 3–5 mol% Y2O3. Materials 2020;13(8):1923.
Kelly JR, Denry I. Stabilized zirconia as a structural ceramic: an overview. Dental Materials 2008;24(3):289-98.
Volpato CÂM, Garbelotto L, Fredel MC, Bondioli F. Application of zirconia in dentistry: biological, mechanical and optical considerations. Advances in Ceramics-Electric and Magnetic Ceramics, Bioceramics, Ceramics and Environment. 2011;25.
Chevalier J. What future for zirconia as a biomaterial? Biomaterials 2006;27(4):535-43.
Anselmi‐Tamburini U, Woolman JN, Munir ZA. Transparent nanometric cubic and tetragonal zirconia obtained by high‐pressure pulsed electric current sintering. Advanced Functional Materials 2007;17(16):3267-73.
Malkondu Ö, Tinastepe N, Akan E, et al. An overview of monolithic zirconia in dentistry. Biotechnology & Biotechnological equipment. 2016;30(4):644-52.
Klimke J, Trunec M, Krell A. Transparent tetragonal yttria‐stabilized zirconia ceramics: influence of scattering caused by birefringence. Journal of American Ceramic Society 2011;94(6):1850-8.
Denry I, Kelly JR. State of the art of zirconia for dental applications. Dental Materials 2008;24(3):299-307.
Filser F, Kocher P, Weibel F, et al. Reliability and strength of all-ceramic dental restorations fabricated by direct ceramic machining (DCM). International Journal of Computarized Dentistry 2001;4(2):89-106.
Stawarczyk B, Özcan M, Hallmann L, et al. The effect of zirconia sintering temperature on flexural strength, grain size, and contrast ratio. Clinal Oral Investigations 2013;17(1):269-74.
Shahmiri R, Standard OC, Hart JN, et al. Optical properties of zirconia ceramics for esthetic dental restorations: A systematic review. Journal of Prosthetic Dentistry 2018;119(1):36-46.
Khanlar LN, Takagaki T, Abdou A, et al. Effect of Air-Particle Abrasion Protocol and Primer on The Topography and Bond Strength of a High-Translucent Zirconia Ceramic. Journal of Prosthodontics 2022;31(3):228-38.
Kwon SJ, Lawson NC, McLaren EE, et al. Comparison of the mechanical properties of translucent zirconia and lithium disilicate. Journal of Prosthetic Dentistry 2018;120(1):132-137.
Ebeid K, Wille S, Hamdy A, et al. Effect of changes in sintering parameters on monolithic translucent zirconia. Dental Materials 2014:419-24.
Pereira GK, Guilardi LF, Dapieve KS, et al. Mechanical reliability, fatigue strength and survival analysis of new polycrystalline translucent zirconia ceramics for monolithic restorations. Journal of the Mechanical Behavior of Biomedical Materials. 2018;85:57-65.
Carrabba M, Keeling AJ, Aziz A, et al. Translucent zirconia in the ceramic scenario for monolithic restorations: A flexural strength and translucency comparison test. Journal of Dentistry 2017;60:70-6.
Inokoshi M, Vanmeensel K, Zhang F, et al. Aging resistance of surface-treated dental zirconia. Dental Materials 2015;31(2):182-94.
Zhang F, Reveron H, Spies BC, et al. Trade-off between fracture resistance and translucency of zirconia and lithium-disilicate glass ceramics for monolithic restorations. Acta Biomaterialia 2019;91:24-34.
Jansen JU, Lumkemann N, Letz I, et al. Impact of high-speed sintering on translucency, phase content, grain sizes, and flexural strength of 3Y-TZP and 4Y-TZP zirconia materials. Journal of Prosthetic Dentistry 2019;122(4):396-403.
Matsui K, Yoshida H, Ikuhara Y. Grain-boundary structure and microstructure development mechanism in 2–8 mol% yttria-stabilized zirconia polycrystals. Acta Materialia 2008;56(6):1315-25.
Kolakarnprasert N, Kaizer MR, Kim DK, et al. New multi-layered zirconias: Composition, microstructure and translucency. Dental Materials 2019;35(5):797-806.
Ban S. Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures. Materials 2021;14(17):4879.
Otani A, Amaral M, May LG, et al. A critical evaluation of bond strength tests for the assessment of bonding to Y-TZP. Dental Materials 2015;31(6):648-56.
Kern M, Wegner SM. Bonding to zirconia ceramic: adhesion methods and their durability. Dental Materials 1998;14(1):64-71.
Inokoshi M, De Munck J, Minakuchi S, et al. Meta-analysis of bonding effectiveness to zirconia ceramics. Journal of Dental Research 2014;93(4):329-34.
Özcan M, Bernasconi M. Adhesion to Zirconia Used for Dental Restorations: A Systematic Review and Meta-Analysis. Journal of Adhesive Dentistry 2015;17(1).
Tzanakakis EG, Tzoutzas IG, Koidis PT. Is there a potential for durable adhesion to zirconia restorations? A systematic review. Journal of Prosthetic Dentistry 2016;115(1):9-19.
da Silva EM, Miragaya L, Sabrosa CE, et al. Stability of the bond between two resin cements and an yttria-stabilized zirconia ceramic after six months of aging in water. Journal of Prosthetic Dentistry 2014;112(3):568-75.
Zhang Y, Lawn BR, Rekow ED, et al. Effect of sandblasting on the long‐term performance of dental ceramics. Journal of Biomedical Materials Research Part B: Applied Biomaterials 2004;71(2):381-6.
Hallmann L, Ulmer P, Lehmann F, et al. Effect of surface modifications on the bond strength of zirconia ceramic with resin cement resin. Dental Materials 2016;32(5):631-9.
Hallmann L, Ulmer P, Wille S, et al. Effect of surface treatments on the properties and morphological change of dental zirconia. Journal of Prosthetic Dentistry 2016;115(3):341-9.
Blatz MB, Conejo J. The current state of chairside digital dentistry and materials. Dental Clinics 2019;63(2):175-97.
Mao L, Kaizer M, Zhao M, et al. Graded ultra-translucent zirconia (5Y-PSZ) for strength and functionalities. Journal of Dental Research 2018;97(11):1222-8.
Aurelio IL, Marchionatti AME, Montagner AF, et al. Does air particle abrasion affect the flexural strength and phase transformation of Y-TZP? A systematic review and meta-analysis. Dental Materials 2016;32(6):827-45.
Inokoshi M, Shimizu H, Nozaki K, et al. Crystallographic and morphological analysis of sandblasted highly translucent dental zirconia. Dental Materials 2018.
Valandro LF, Ozcan M, Amaral R, et al. Effect of testing methods on the bond strength of resin to zirconia-alumina ceramic: Microtensile versus shear test. Dental Materials Journal 2008;27(6):849-55.
Papanagiotou HP, Morgano SM, Giordano RA, et al. In vitro evaluation of low-temperature aging effects and finishing procedures on the flexural strength and structural stability of Y-TZP dental ceramics. Journal of Prosthetic Dentistry 2006;96(3):154-64.
Guazzato M, Albakry M, Quach L, et al. Influence of surface and heat treatments on the flexural strength of a glass-infiltrated alumina/zirconia-reinforced dental ceramic. Dental Materials 2005;21(5):454-63.
McLaren EA, Maharishi A, White SN. Influence of yttria content and surface treatment on the strength of translucent zirconia materials. Journal of Prosthetic Dentistry 2021.
AlMutairi R, AlNahedh H, Maawadh A, et al. Effects of Different Air Particle Abrasion Protocols on the Biaxial Flexural Strength and Fractography of High/Ultra-Translucent Zirconia. Materials 2021;15(1):244.
Zhang Y, Lawn BR, Malament KA, et al. Damage accumulation and fatigue life of particle-abraded ceramics. International Journal of Prosthodontics 2006;19(5).
Inokoshi M, Poitevin A, De Munck J, et al. Bonding effectiveness to different chemically pre-treated dental zirconia. Clin Oral Investigations 2014;18(7):1803-12.
Papia E, Larsson C, du Toit M, et al. Bonding between oxide ceramics and adhesive cement systems: a systematic review. Journal of Biomedical Materials Research Part B: Applied Biomaterials. 2014;102(2):395-413.
Le M, Larsson C, Papia E. Bond strength between MDP-based cement and translucent zirconia. Dental Materials Journal 2019:2018-194.
Kontonasaki E, Rigos AE, Ilia C, et al. Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance. Dentistry Journal (Basel) 2019;7(3).
Aljomard YR, Altunok EÇ, Kara HB. Enamel wear against monolithic zirconia restorations: A meta‐analysis and systematic review of in vitro studies. Journal of Esthetic and Restorative Dentistry 2022;34(3):473-89.
Fathy SM, Al-Zordk W, Grawish ME, et al. Flexural strength and translucency characterization of aesthetic monolithic zirconia and relevance to clinical indications: A systematic review. Dental Materials 2021;37(4):711-30.
Heller H, Sreter D, Arieli A, et al. Survival and Success Rates of Monolithic Zirconia Restorations Supported by Teeth and Implants in Bruxer versus Non-Bruxer Patients: A Retrospective Study. Materials 2022;15(3):833.
Solá-Ruíz MF, Rico-Coderch A, Fons-Badal C, et al. Influence of the chemical composition of monolithic zirconia on its optical and mechanical properties. Systematic review and meta-regression. Journal of Prosthodontic Research 2022;66(2):193-207.
Hajhamid B, Alfrisany N, Somogyi-Ganss E. The effect of accelerated aging on crystalline structures and optical properties of different monolithic zirconia: A qualitative systematic review. Dental Materials 2022.
