• Journal of the Korean Academy of Esthetic Dentistry
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• v.25 no.2
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• pp.109-126
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• 2016

According of the development and spread of CAD/CAM, a number of prostheses we have done had been replaced. Dental technicians have a difficulty reproducing natural color when producing these zirconia crowns. Difficulty reproducing natural color when producing these zirconia crowns. In my case, in the beginning of experimenting with zirconia, I had a hard time dealing with zirconia and I have tried solve these problems. Therefore, I would like to share Ko's coloring technique made of my effort with you.

• The Journal of Advanced Prosthodontics
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• v.7 no.4
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• pp.271-277
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• 2015

PURPOSE. This study was to evaluate the marginal fit of two CAD-CAM anatomic contour zirconia crown systems compared to lithium disilicate glass-ceramic crowns. MATERIALS AND METHODS. Shoulder and deep chamfer margin were formed on each acrylic resin tooth model of a maxillary first premolar. Two CAD-CAM systems (Prettau$^{(R)}$Zirconia and ZENOSTAR$^{(R)}$ZR translucent) and lithium disilicate glass ceramic (IPS e.max$^{(R)}$press) crowns were made (n=16). Each crown was bonded to stone dies with resin cement (Rely X Unicem). Marginal gap and absolute marginal discrepancy of crowns were measured using a light microscope equipped with a digital camera (Leica DFC295) magnified by a factor of 100. Two-way analysis of variance (ANOVA) and post-hoc Tukey's HSD test were conducted to analyze the significance of crown marginal fit regarding the finish line configuration and the fabrication system. RESULTS. The mean marginal gap of lithium disilicate glass ceramic crowns (IPS e.max$^{(R)}$press) was significantly lower than that of the CAD-CAM anatomic contour zirconia crown system (Prettau$^{(R)}$Zirconia) (P<.05). Both fabrication systems and finish line configurations significantly influenced the absolute marginal discrepancy (P<.05). CONCLUSION. The lithium disilicate glass ceramic crown (IPS e.max$^{(R)}$press) had significantly smaller marginal gap than the CAD-CAM anatomic contour zirconia crown system (Prettau$^{(R)}$Zirconia). In terms of absolute marginal discrepancy, the CAD-CAM anatomic contour zirconia crown system (ZENOSTAR$^{(R)}$ZR translucent) had under-extended margin, whereas the CAD-CAM anatomic contour zirconia crown system (Prettau$^{(R)}$Zirconia) and lithium disilicate glass ceramic crowns (IPS e.max$^{(R)}$press) had overextended margins.

• The Journal of Advanced Prosthodontics
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• v.9 no.4
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• pp.252-256
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• 2017

PURPOSE. This in vitro study aimed to analyze and compare the reproducibility of zirconia and lithium disilicate crowns manufactured by digital workflow. MATERIALS AND METHODS. A typodont model with a prepped upper first molar was set in a phantom head, and a digital impression was obtained with a video intraoral scanner (CEREC Omnicam; Sirona GmbH), from which a single crown was designed and manufactured with CAD/CAM into a zirconia crown and lithium disilicate crown (n=12). Reproducibility of each crown was quantitatively retrieved by superimposing the digitized data of the crown in 3D inspection software, and differences were graphically mapped in color. Areas with large differences were analyzed with digital microscopy. Mean quadratic deviations (RMS) quantitatively obtained from each ceramic group were statistically analyzed with Student's t-test (${\alpha}=.05$). RESULTS. The RMS value of lithium disilicate crown was $29.2\;(4.1){\mu}m$ and $17.6\;(5.5){\mu}m$ on the outer and inner surfaces, respectively, whereas these values were $18.6\;(2.0){\mu}m$ and $20.6\;(5.1){\mu}m$ for the zirconia crown. Reproducibility of zirconia and lithium disilicate crowns had a statistically significant difference only on the outer surface (P<.001). The outer surface of lithium disilicate crown showed over-contouring on the buccal surface and under-contouring on the inner occlusal surface. The outer surface of zirconia crown showed both over- and under-contouring on the buccal surface, and the inner surface showed under-contouring in the marginal areas. CONCLUSION. Restoration manufacturing by digital workflow will enhance the reproducibility of zirconia single crowns more than that of lithium disilicate single crowns.

• The Journal of Advanced Prosthodontics
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• v.6 no.6
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• pp.444-450
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• 2014

PURPOSE. To compare the accuracy of marginal and internal adaptation of zirconia (Zr) copings fabricated on anatomic (A), semi-anatomic (SA) and non-anatomic (NA) occlusal surface preparations. MATERIALS AND METHODS. 45 extracted bicuspid teeth were prepared for receiving zirconia crowns, with different occlusal preparation designs A=15, SA=15 & NA=15. The Zr copings were fabricated by using CAD4DENT, CAD/CAM. The copings were adjusted, cemented and were cross sectioned centrally from buccal cusp tip to lingual cusp tip into mesial and distal halves. The copings were examined under electron microscope at ${\times}200$ magnification and the measurements were recorded at 9 predetermined areas in micrometers. RESULTS. Overall mean gap values for the three groups was found to be $155.93{\pm}33.98{\mu}m$ with Anatomical Occlusal preparation design having the least gap value of $139.23{\pm}30.85{\mu}m$ showing the best adaptation among the groups. Post Hoc Tukey's test showed a statistically significant difference (P=.007) between the means of gap for A & NA preparation designs. Measurements recorded at 9 predetermined points showed variations for the three groups. CONCLUSION. Anatomical occlusal preparation designs resulted in better marginal and internal adaptation of Zr copings. There is a considerable variation between the measured marginal and internal gap values for the Zr copings fabricated by the (CAD4DENT-CAD/CAM). This variation may be associated with the lack of standardization of the preparation of teeth, computerized designing of the coping for each tooth, cement used, uniform pressure application during the cementation of the copings, sectioning of the copings and the microscopic measurements.

• The Journal of Advanced Prosthodontics
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• v.11 no.6
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• pp.324-330
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• 2019

PURPOSE. The aim of the study was to evaluate and compare the fracture resistance and modes of fracture of monolithic zirconia crowns with two preparation designs. MATERIALS AND METHODS. Forty human maxillary first premolar teeth were extracted for orthodontic purposes and divided into two main groups (n=20): Group A: monolithic traditional zirconia; Group B: monolithic translucent zirconia. The groups were further subdivided into two subgroups (n=10): (A1, B1) shoulder margin design; (A2, B2) feather-edge margin design. Teeth were prepared with either a 1 mm shoulder margin design or a feather-edge margin design. The prepared teeth were scanned using a digital intraoral scanner. The crowns were cemented using self-adhesive resin cement. All cemented teeth were stored in water for 7 days and thermocycling was done before testing. All samples were subjected to compressive axial loading until fracture. The fractographic analysis was done to assess the modes of fracture of the tested samples. RESULTS. The highest mean values of fracture resistance were recorded in kilo-newton and were in the order of subgroup A1 (2.903); subgroup A2 (2.3); subgroup B1 (1.854) and subgroup B2 (1.523). One-way ANOVA showed a statistically significant difference among the 4 subgroups. Concerning modes of fracture, the majority of samples in subgroups A1 and B1 were fracture of restoration and/or tooth, while in subgroups A2 and B2, the majority of samples fractured through the central fossa. CONCLUSION. Even though all the tested crowns fractured at a higher level than the maximum occlusal forces, the shoulder margin design was better than the feather-edge margin design and the monolithic traditional zirconia was better than the monolithic translucent zirconia in terms of fracture strength.

• The Journal of Advanced Prosthodontics
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• v.10 no.2
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• pp.79-84
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• 2018

PURPOSE. All-ceramic restorations required extensive tooth preparation. The purpose of this in vitro study was to investigate a minimally invasive preparation and thickness of monolithic zirconia crowns, which would provide sufficient mechanical endurance and strength. MATERIALS AND METHODS. Crowns with thickness of 0.2 mm (group 0.2, n=32) or of 0.5 mm (group 0.5, n=32) were milled from zirconia and fixed with resin-based adhesives (groups 0.2A, 0.5A) or zinc phosphate cements (groups 0.2C, 0.5C). Half of the samples in each subgroup (n=8) underwent thermal cycling and mechanical loading (TCML)(TC: $5^{\circ}C$ and $55^{\circ}C$, $2{\times}3,000cycles$, 2 min/cycle; ML: 50 N, $1.2{\times}10^6cycles$), while the other samples were stored in water ($37^{\circ}C/24h$). Survival rates were compared (Kaplan-Maier). The specimens surviving TCML were loaded to fracture and the maximal fracture force was determined (ANOVA; Bonferroni; ${\alpha}=.05$). The fracture mode was analyzed. RESULTS. In both 0.5 groups, all crowns survived TCML, and the comparison of fracture strength among crowns with and without TCML showed no significant difference (P=.628). Four crowns in group 0.2A and all of the crowns in group 0.2C failed during TCML. The fracture strength after 24 hours of the cemented 0.2 mm-thick crowns was significantly lower than that of adhesive bonded crowns. All cemented crowns provided fracture in the crown, while about 80% of the adhesively bonded crowns fractured through crown and die. CONCLUSION. 0.5 mm thick monolithic crowns possessed sufficient strength to endure physiologic performance, regardless of the type of cementation. Fracture strength of the 0.2 mm cemented crowns was too low for clinical application.

• The Journal of Advanced Prosthodontics
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• v.12 no.4
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• pp.181-188
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• 2020

PURPOSE. The effect of core design on the fracture resistance of zirconia-lithium disilicate (LS2) bilayered crowns for anterior teeth is evaluated by comparing with that of metal-ceramic crowns. MATERIALS AND METHODS. Forty customized titanium abutments for maxillary central incisor were prepared. Each group of 10 units was constructed using the same veneer form of designs A and B, which covered labial surface to approximately one third of the incisal and cervical palatal surface, respectively. LS2 pressed-on-zirconia (POZ) and porcelain-fused-to-metal (PFM) crowns were divided into "POZ_A," "POZ_B," "PFM_A," and "PFM_B" groups, and 6000 thermal cycles (5/55 ℃) were performed after 24 h storage in distilled water at 37 ℃. All specimens were prepared using a single type of self-adhesive resin cement. The fracture resistance was measured using a universal testing machine. Failure mode and elemental analyses of the bonding interface were performed. The data were analyzed using Welch's t-test and the Games-Howell exact test. RESULTS. The PFM_B (1376. 8 ± 93.3 N) group demonstrated significantly higher fracture strength than the PFM_A (915.8 ± 206.3 N) and POZ_B (963.8 ± 316.2 N) groups (P<.05). There was no statistically significant difference in fracture resistance between the POZ_A (1184.4 ± 319.6 N) and POZ_B groups (P>.05). Regardless of the design differences of the zirconia cores, fractures involving cores occurred in all specimens of the POZ groups. CONCLUSION. The bilayered anterior POZ crowns showed different fracture resistance and fracture pattern according to the core design compared to PFM.

• The Journal of Advanced Prosthodontics
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• v.9 no.3
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• pp.152-158
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• 2017

PURPOSE. The purpose of this study was to evaluate the influence of different coping thicknesses and veneer ceramic cooling rates on the failure load of zirconia-ceramic crowns. MATERIALS AND METHODS. Zirconia copings of two different thicknesses (0.5 mm or 1.5 mm; n=20 each) were fabricated from scanning 40 identical abutment models using a dental computer-aided design and computer-aided manufacturing system. Zirconia-ceramic crowns were completed by veneering feldspathic ceramics under different cooling rates (conventional or slow, n=20 each), resulting in 4 different groups (CONV05, SLOW05, CONV15, SLOW15; n=10 per group). Each crown was cemented on the abutment. 300,000 cycles of a 50-N load and thermocycling were applied on the crown, and then, a monotonic load was applied on each crown until failure. The mean failure loads were evaluated with two-way analysis of variance (P=.05). RESULTS. No cohesive or adhesive failure was observed after fatigue loading with thermocycling. Among the 4 groups, SLOW15 group (slow cooling and 1.5 mm chipping thickness) resulted in a significantly greater mean failure load than the other groups (P<.001). Coping fractures were only observed in SLOW15 group. CONCLUSION. The failure load of zirconia-ceramic crowns was significantly influenced by cooling rate as well as coping thickness. Under conventional cooling conditions, the mean failure load was not influenced by the coping thickness; however, under slow cooling conditions, the mean failure load was significantly influenced by the coping thickness.

• The Journal of Advanced Prosthodontics
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• v.7 no.2
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• pp.146-150
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• 2015

PURPOSE. This in vitro study aimed to compare the failure load and failure characteristics of two different zirconia framework designs of premolar crowns when subjected to static loading. MATERIALS AND METHODS. Two types of zirconia frameworks, conventional 0.5 mm even thickness framework design (EV) and 0.8 mm cutback of full contour crown anatomy design (CB), were made for 10 samples each. The veneer porcelain was added on under polycarbonate shell crown made by vacuum of full contour crown to obtain the same total thickness of the experiment crowns. The crowns were cemented onto the Cobalt-Chromium die. The dies were tilted 45 degrees from the vertical plane to obtain the shear force to the cusp when loading. All crowns were loaded at the lingual incline of the buccal cusp until fracture using a universal testing machine with cross-head speed 0.5 mm/min. The load to fracture values (N) was recorded and statistically analyzed by independent sample t-test. RESULTS. The mean and standard deviations of the failure load were $1,170.1{\pm}90.9$ N for EV design and $1,450.4{\pm}175.7$ N for CB design. A significant difference in the compressive failure load was found (P<.05). For the failure characteristic, the EV design was found only cohesive failures within veneering porcelain, while the CB design found more failures through the zirconia framework (8 from 10 samples). CONCLUSION. There was a significant difference in the failure load between two designs, and the design of the framework influences failure characteristic of zirconia crown.

• The Journal of Advanced Prosthodontics
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• v.5 no.2
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• pp.187-197
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• 2013

PURPOSE. The purpose of this study was to evaluate various core designs on stress distribution within zirconia crowns. MATERIALS AND METHODS. Three-dimensional finite element models, representing mandibular molars, comprising a prepared tooth, cement layer, zirconia core, and veneer porcelain were designed by computer software. The shoulder (1 mm in width) variations in core were incremental increases of 1 mm, 2 mm and 3 mm in proximal and lingual height, and buccal height respectively. To simulate masticatory force, loads of 280 N were applied from three directions (vertical, at a $45^{\circ}$ angle, and horizontal). To simulate maximum bite force, a load of 700 N was applied vertically to the crowns. Maximum principal stress (MPS) was determined for each model, loading condition, and position. RESULTS. In the maximum bite force simulation test, the MPSs on all crowns observed around the shoulder region and loading points. The compressive stresses were located in the shoulder region of the veneer-zirconia interface and at the occlusal region. In the test simulating masticatory force, the MPS was concentrated around the loading points, and the compressive stresses were located at the 3 mm height lingual shoulder region, when the load was applied horizontally. MPS increased in the shoulder region as the shoulder height increased. CONCLUSION. This study suggested that reinforced shoulder play an essential role in the success of the zirconia restoration, and veneer fracture due to occlusal loading can be prevented by proper core design, such as shoulder.