Q U I N T E S S E N C E I N T E R N AT I O N A L
RESTORATIVE DENTISTRY Enamel wear opposing different surface conditions of different CAD/CAM ceramics Sheila Pestana Passos, DDS, MSc, PhD1/Anderson P. de Freitas, DDS, MSc, PhD2/Gabriel Iorgovan3/Amin Sami Rizkalla, MSc, PhD4/ Maria Jacinta Coelho Santos, DDS, MSc, PhD5/Gildo Coelho Santos Júnior, DDS, MSc, PhD6
Objective: The aim of this study was to evaluate bovine enamel wear opposed to four different ceramic substrates (CEREC) in the glazed and polished conditions. Method and Materials: Sixty-three ceramic (IPS Empress CAD, Paradigm C, Vitablocs Mark II) and fourteen composite resin (MZ100) styli were prepared. Ceramics were subdivided into three surface conditions (n = 7), unpolished, polished, and glazed, and the composite resin (n = 7) into unpolished and polished. All styli were used as wear antagonists opposing bovine enamel blocks (8 mm × 9 mm) in an oral wear simulator. Wear tests were conducted at 30 N abrasion and 70 N attrition forces applied at 1.7 Hz for 5,000 simulated mastication cycles. Abrasion and attrition wear were evaluated using an automatic profilometer. Statistical analyses were conducted using Tukey’s B rank order test, P = .05. Results: For bovine enamel opposing glazed Vitablocs, abrasion and attrition wear showed a volume loss significantly higher than bovine enamel opposing polished Vitablocs (P < .05). For attrition wear, bovine enamel opposing glazed Vitablocs and untreated Paradigm C showed a volume loss higher than bovine enamel opposing the other ceramic conditions. Conclusion: Abrasion and attrition wear of bovine enamel opposing antagonist ceramic was affected according to the ceramic surface condition and the ceramic material. Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel. In addition, the glaze layer presented as a protection, exhibiting fewer cracks and less loss of material on the ceramic surface. (Quintessence Int 2013;10:743–751; doi: 10.3290/j.qi.a29750)
Key words: abrasion wear, attrition wear, bovine enamel, ceramic antagonist, composite resin antagonist
Gradual wear of teeth is a normal mecha-
sion, abrasion, corrosion, and surface
nism in the human dentition,1 and wear
fatigue, since all of these processes result
occurs when two materials slide against
in degradation of the surface and disparity
each other. Wear can be attributed to adhe-
of opposing occlusal surface materials.2 Several factors are involved in clinical wear,
1
Postdoctoral Fellow, University of Alberta, Edmonton, AB,
such as the abrasive nature of food, chew-
Canada.
ing patterns, parafunctional habits, neuro-
Adjunct Professor, Federal University of Bahia, Salvador, Bahia,
muscular force, and antagonist restorative
Brazil.
material.3,4
2
Undergraduate Student, Schulich School of Medicine and Den-
Restorative materials with different abra-
tistry, The University of Western Ontario, London, ON, Canada.
sive behavior opposing teeth may acceler-
Associate Professor, Schulich School of Medicine & Dentistry,
ate the wear process in comparison with
The University of Western Ontario, London, ON, Canada.
natural dentition.5 It was reported by Oh et
Assistant Professor, Schulich School of Medicine & Dentistry,
al6 that the wear mechanism of enamel
3
4
5
The University of Western Ontario, London, ON, Canada. 6
Associate Professor and Chair, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
Correspondence: Professor Gildo Coelho Santos Júnior, UWO
opposing ceramic might be more closely related to the ceramic microstructure, the roughness of contacting surfaces, and oral environmental influences. Therefore, there
Schulich School of Medicine & Dentistry, DSB 0147 London, ON,
are difficulties in correlating data from in
Canada. Email:
[email protected]
vitro and in vivo studies.7-9
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Abrasion and attrition are two main wear
Modified ceramic systems such as cast-
mechanisms in dental materials.10 Abrasion
able glass-ceramics, CAD/CAM machin-
takes place in normal function in the pres-
able ceramics, and pressable ceramics
ence of a third body, such as food bolus
have been reported to be less abrasive
during mastication, and may occur due to
than conventional porcelains.15,23 There was
tooth brushing as well.
11,12
Attrition results
no agreement with regard to the influence
from the direct contact of opposing teeth
of polishing versus glazing on wear. There-
with increased load level which produces
fore, the purpose of this study was to evalu-
abrasion. During function, in the presence
ate bovine enamel wear when opposed by
of saliva, the action of these two mecha-
three different CAD/CAM ceramic sub-
nisms together promotes changes on the
strates and a composite resin. The specific
antagonist surfaces as a result of the wear
aim was to evaluate in vitro enamel wear of
process.
three
different
surface
conditions
The ideal restorative material possesses
(untreated, polished, and glazed) for each
wear resistance close to the enamel2 and
of the three ceramic substrates, and two
minimum abrasiveness. There are several in
different surface conditions (untreated and
vivo and in vitro studies of durability, wear
polished) for the composite resin substrate.
resistance, and the abrasive property of
The hypotheses were that (1) the enamel
porcelain when opposing human enamel or
wear would show no difference between
other dental restorative materials.13-23 These
different surface conditions of the compos-
investigations reported that dental porcelain
ite resin antagonist, (2) the enamel wear
has been described to be wear resistant
would show difference among different sur-
against opposing restorative materials and
face conditions of the ceramic antagonist,
enamel. Improvements in adhesive den-
and (3) the enamel wear would show differ-
tistry have driven the development of new
ence among different ceramic antagonists.
materials designed to be used in anterior and posterior crowns, including blocks to be used with computer-aided design/com-
METHOD AND MATERIALS
puter-assisted manufacture (CAD/CAM) technology. These ceramic materials have
Seventy-seven all-ceramic and composite
been improved in recent years; however,
resin styli were prepared by milling from a
when in contact with natural teeth they may
single design with the CEREC 3D system
cause wear. When porcelain surfaces
(Sirona Dental Systems). The stylus design
oppose enamel, wear resistance and abra-
had a convex surface and was produced
siveness of the porcelain are clinical con-
specifically for this study. The wear surface
cerns once the occlusal patterns should be
of the styli was designed by replication of a
maintained. Surface finishing of ceramic
hemispherical
restorations has been studied to minimize
Twenty-one styli were milled from each of
antagonist enamel wear.17,24
three ceramic materials: IPS Empress CAD
shape
(r = 3.28 mm).
According to Preis et al, 22 porcelain
(Ivoclar Vivadent), Paradigm C (3M ESPE),
showed comparable or lower wear than
and Vitablocs Mark II (Vident). Fourteen
enamel. On the other hand, several investi-
styli were milled from Paradigm MZ100 (3M
gators have demonstrated that, in general,
ESPE) composite resin material. A summary
ceramic substrates cause destructive abra-
of product specifications is shown in
sive wear of enamel.16-18,20,21,23,24 In addition,
Table 1.
the wear of the antagonist depends on the
The ceramic styli were subdivided into
ceramic material as reported by some in
three equal subgroups (n = 7) according to
vivo studies.25-27 Therefore, material charac-
different surface finishing: no treatment,
teristics may contribute to the accelerated
polished, and glazed. Composite resin styli
loss of opposing enamel, such as fracture
were subdivided into only two subgroups
toughness, internal porosities, and surface
(n = 7): no treatment and polished. Polish-
defects.6 Monasky and Taylor5 reported that
ing of the specimen surfaces was per-
rough-ground porcelain surfaces promoted
formed by a single operator, using an
excessive antagonist tooth wear.
OptraFine ceramic polishing system (Ivo-
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Table 1
Description of restorative materials tested
Materials
Material type
ID
Manufacturer
Shade, block size
Paradigm C
Leucite-reinforced glass ceramic
PC
3M ESPE
A3.5, I14
VITA Vitablocs Mark II
Fine-particle feldspar ceramic
V2
Vident
A3C, I14
IPS Empress CAD Multi
Leucite-reinforced glass ceramic
EC
Ivoclar Vivadent
A3.5, C14L
Paradigm MZ100
Composite resin
PM
3M ESPE
A3.5, I14
clar Vivadent), following the manufacturer’s
track. The abrasion and attrition forces put
recommendations: OptraFine F finishers
out by each of the four solenoids were cali-
(light blue) were used with water to smooth
brated with a digital readout force trans-
the ceramic surface. OptraFine P polishers
ducer (Interface). Wear testing was con-
(dark blue) were used with water to polish
ducted
the ceramic surface. Finally the OptraFine
attrition forces applied at 1.7 Hz (1.7
HP high polishing brushes and paste were
Hz = 102 cycles per minute) for 5,000 simu-
used without water to obtain a high luster
lating mastication cycles. Before each test,
gloss on the ceramic surface. Glazing was
3 ml of deionized water were added per
performed by a single operator, following
chamber to help clearing of debris away
the manufacturer’s instructions. All speci-
from the wear interface.
with
30 N
abrasion
and
70 N
mens were placed on the steel styli with
Enamel abrasion and attrition wear
LePage Epoxy Gel Syringe Glue (Henkel
depth measurements were determined
Corp) and fitted into the oral simulator as
using an Automated Profilometer (Proto-
the wear antagonists.
tech). The measurement of each enamel
Seventy-seven enamel specimens were
bovine sample was performed from the
prepared using bovine incisors extracted
noncontact area crossing the contact area
from 18-month-old animals. The extracted
to the noncontact area on the opposite
teeth were cleaned with curettes and stored
side.
in a 0.1% thymol solution at 5°C. Enamel
Data were analyzed statistically using
fragments approximately 8 mm × 9 mm
one-way ANOVA and a Tukey’s B rank
were obtained from the flattest portion of
order test at P = .05.
the facial surface of each incisor and cut
The ceramic samples were cleaned in
with a diamond disk (Isomet 1000, Buehler).
an ultrasonic bath with distilled water for 10
Enamel specimens were mounted with
minutes and then dried with compressed
Triad TruTray light-setting acrylic (Dentsply)
air. The specimens were fixed on an alumi-
into cylindrical polymethyl methacrylate
num stub and sputter coated with a thin
(PMMA) holders designed to fit the oral sim-
Pd-Au layer (80 Å), performed with a spe-
ulator. The enamel surface of the blocks
cific machine (K550X Sputter Coater, Emi-
was then ground flat with water-cooled car-
tech) (time: 1.5 minutes, 15 mA) for scan-
borundum disks (320, 600, and 1200
ning electron microscopy (SEM; S-2600N,
grades of Al2O3 papers; Buehler), and pol-
Hitachi) examination. The ceramic and
ished with felt papers with diamond spray
composite resin surfaces were analyzed
(1 mm; Buehler).
using SEM at contact and noncontact areas
Wear tests were conducted using a fourchamber Oral Wear Simulator (Proto-tech).
and
photomicrographs
recorded
at
1,000× magnification.
This dual-axis chewing simulator combines horizontal and vertical movements to slide an antagonist held by a steel stylus against
RESULTS
a flat specimen along a 5 mm track. The machine uses precision solenoids to pro-
The mean volume loss of the specimens
duce an abrasion force initially, followed by
after abrasion and attrition cycles and the
an attrition force at the endpoint of the
results of comparisons of means are sum-
VOLUME 44 • NUMBER 10 • NOVEMBER/DECEMBER 2013
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Q U I N T E S S E N C E I N T E R N AT I O N A L Pa s s o s e t a l
marized in Fig 1. After 5,000 loading cycles,
and Figs 3c and 3d), cracks were observed,
bovine enamel opposing all ceramic groups
and the surface topography strongly sug-
showed a volume loss higher than bovine
gests that there has been loss of material.
enamel opposing both composite resins
The surface presented more texture when
untreated and polished. There was no dif-
compared to the areas that were not tested,
ference on abrasion and attrition wear on
mainly for the glazed specimens (Fig 2c)
the
and for the polished composite resin
bovine
enamel
surface
between
untreated and polished composite resins
(Fig 3b). All ceramics showed superficial cracks
(P > .05). Regarding the ceramic materials, the
after testing, similar to those observed in
abrasion wear of bovine enamel opposing
the dental enamel. Loss of material and
Empress CAD and Paradigm C showed no
some cracks were found in some areas,
statistical difference among the different
although these effects were lower than
surface
ceramic.
those found on the untreated specimens.
Regarding the Empress CAD, the attrition
The ceramic materials were not quantita-
wear of bovine enamel showed no statisti-
tively evaluated.
conditions
for
each
cal difference among the different surface conditions. The attrition wear of bovine enamel opposing polished Paradigm C
DISCUSSION
showed statistical difference compared to the untreated condition. The abrasion and
The first hypothesis, that the abrasion and
attrition wear of bovine enamel against
attrition enamel wear would show no differ-
glazed Vitablocs showed a volume loss sig-
ence between the different surface condi-
nificantly higher than bovine enamel oppos-
tions of the composite resin antagonist, was
ing polished Vitablocs (P < .05) and no dif-
validated. The second and third hypothe-
ference was observed comparing glazed
ses, that the abrasion and attrition enamel
Vitablocs to untreated Vitablocs.
wear would show difference among different
Figures 2 and 3 show the SEM images
ceramic surface conditions and different
of a ceramic material and composite resin,
ceramic antagonists were partially accepted,
respectively. After testing (Figs 2d to 2f,
depending on the ceramic material.
MZ100 Untreated
MZ100 Untreated
MZ100 Polished
MZ100 Polished
Paradigm C Polished
Vitablocs Polished
Empress CAD Glazed
Empress CAD Polished
Empress CAD Polished
Empress CAD Glazed
Vitablocs Polished
Paradigm C Polished
Empress CAD Untreated
Empress CAD Untreated
Paradigm C Glazed
Paradigm C Glazed
Paradigm C Untreated
Vitablocs Untreated
Vitablocs Untreated
Vitablocs Glazed
Vitablocs Glazed
Paradigm C Untreated
0
10 20 30 40 50 60 70 80 90 100 110 120 0
Abrasion Wear (μm ± SD)
10 20 30 40 50 60 70 80 90 100 110 120
Attrition Wear (μm ± SD)
Fig 1 Rate of abrasion and attrition for the bovine enamel antagonist against the composite and ceramic materials. Vertical lines indicate insignificant differences.
746
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Q U I N T E S S E N C E I N T E R N AT I O N A L Pa s s o s e t a l
Two-body
wear 28,29
three-body
used as a result of direct contact between
wear30,31 are accepted models for in vitro
and
the test material and its antagonist, involv-
wear testing, and both have been reported
ing mixed wear of adhesion, attrition, and
in the literature. The difference between
fatigue.34 Wear of bovine enamel against
them is that three-body wear simulators use
three different ceramics and a composite
some abrasive slurry between the test
resin was tested.
specimen and the antagonist specimen.32,33
There was a large variation among stud-
In the present study, two-body wear was
ies regarding applied force, the used force
a
b
c
d
e
f
Fig 2 Representative SEM images of (a) untreated Vitablocs, (b) polished Vitablocs (polishing marks are visible), and (c) glazed Vitablocs. Representative SEM images of wear area of (d) untreated Vitablocs, (e) polished Vitablocs, (f) and glazed Vitablocs, opposing bovine enamel after 5,000 loading cycles.
a
b
c
Fig 3 Representative SEM images of (a) untreated MZ100, and (b) polished MZ100. Representative SEM images of wear area of (c) untreated MZ100, and (d) polished MZ100, opposing bovine enamel after 5,000 loading cycles.
d
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Q U I N T E S S E N C E I N T E R N AT I O N A L Pa s s o s e t a l
actuator, the number of cycles, the fre-
porcelain. However, several studies have
quency of cycles, the number of speci-
reported that porcelain against enamel
mens,24 and the simulator settings.35 Differ-
causes more antagonistic wear than zirco-
ences in study designs make it difficult to
nia,37,39,40 which has much higher fracture
compare the data of the present study with
toughness than porcelain. Low wear on the
others on a quantitative level according to
antagonist seems to be correlated with low
the wear of enamel opposing restorative
wear on high-strength substructure ceram-
materials.
ics.
According to the in vivo studies, the
In the present study, the teeth were
enamel wear rate (enamel/enamel and
loaded with 5,000 mastication cycles.
enamel/ceramic) was between 18 and
According to the results, glazed Vitablocs
261 μm.1,19,27,36 The minimum wear rate was
ceramic
attributed to enamel/enamel, which ranged
higher abrasion and attrition wear of bovine
from 18 to 38 μm.1 In the present study, the
enamel antagonist compared to polished
ceramics studied presented low abrasive
Vitablocs ceramic surfaces (Fig 1). Krejci et
wear
approximately
al23 and Heintze et al24 reported that the pol-
100 μm) when opposing bovine enamel.
ished surface of a glass ceramic promoted
This finding could be explained based on
significantly less antagonist wear than the
the fact that several other factors influence
glazed surface. Polishing has been sug-
the complex wear interaction between the
gested as a viable alternative to glazing by
antagonists and opposing substrates in the
several investigators.8,17,21,24,41-43 Further-
(maximum
mean
surfaces
caused
significantly
oral environment. These factors are the
more, reglazing or repeated firing of the
abrasive nature of food, chewing behavior,
surface requires additional time and may
parafunctional habits and neuromuscular
also lead to devitrification, resulting in
forces, and the antagonistic material (thick-
esthetic problems.44 It has also been sug-
ness, roughness, and hardness).
3,32,37
gested that the treatment of the ceramic
According to the results of the present
surface, whether it is glazed or polished,
study, different ceramic material with the
may influence only the early stages of the
same surface condition caused different
wear process.24 According to the present
opposing enamel abrasion wear. The three
study, the wear rate of enamel depends on
ceramic materials significantly differed in all
the texture and surface finish of the oppos-
of the physical and mechanical proper-
ing restoration. Aggressive wear of the
ties.38 However, such differences only could
opposing enamel by a glazed surface
be observed for the glazed specimens
(especially
except between both glazed leucite-re-
observed. This is likely to be attributable to
inforced glass ceramics (Paradigm C and
the fact that after removing the glaze layer
Empress CAD). This is likely to be attribut-
from
able to the fact that the glaze is removed
ceramic surface exhibits a rough surface
during the wear process, which exposes
once it is usually not polished. This phe-
the ceramic surface under the glaze layer.
nomenon accelerates the enamel wear.
Different ceramic materials affect the wear
Otherwise, no difference was observed on
mechanism, which could be observed
the bovine enamel surface for different
according to the findings of this investiga-
opposing Empress CAD surface conditions.
tion. The abrasion and attrition wear of
Kunzelmann et al45 could not find a sig-
bovine enamel opposing glazed Vitablocs
nificant difference in the wear of the human
the
in
wear
glazed
Vitablocs)
process,
the
was
exposed
were significantly higher compared to
enamel antagonists opposing similar CAD/
glazed Empress CAD. Additionally, glazed
CAM and laboratory-processed ceramic
Vitablocs caused higher antagonist abra-
materials. In the present study, no differ-
sion wear than glazed Paradigm C. This
ence among bovine samples opposing
can be explained based on the fact that
Empress CAD ceramic was observed. How-
Vitablocs is the hardest of the three ceramic
ever, Rosentritt et al 46 reported that the
materials evaluated, and has the lowest
abrasive rate is material-dependent.
fracture toughness.38 For example, more
On the other hand, Schuh et al47 com-
wear was expected from zirconia than from
pared SEM images of glazed and polished
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Q U I N T E S S E N C E I N T E R N AT I O N A L Pa s s o s e t a l
ceramics after in vitro wear testing, and the glazed surfaces demonstrated fewer cracks and less loss of material than the polished ceramics, indicating that the glazing process provided some surface protection during the time of testing.48 These findings are in accordance with the present study (Figs 2d to 2f), which demonstrated more cracks and more loss of material for untreated and polished ceramics. The images of untreated, polished, and glazed specimens suggest that one of the wear processes involved fatigue as a result of the repeated cycles. The wear processes were characterized by the propagation of the
Fig 4 Anterior view of ceramic crowns on the maxillary arch and natural dentition on the mandibular arch. Note the abrasion caused by the ceramic restorations on the mandibular anterior teeth.
microcracks on the surface and the loss of material (Fig 4). Imai et al25 also claim that after 50,000 cycles the glaze layer on their samples had not yet worn off.18 Thus, it is essential to evaluate the wear
and attrition wear on the bovine enamel surface, for the composite resins studied.
behavior of ceramic restorations opposing
Abrasion and attrition wear of ceramic
natural teeth. The wear process is complex
antagonist influenced the wear of bovine
and is influenced by the surface character-
enamel depending on the ceramic surface
istics of ceramic restorations. Taking the
condition and the ceramic material: the
results of the present study into account
abrasion wear of bovine enamel opposing
and from a clinical point of view, the ade-
Empress CAD and Paradigm C showed no
quate finishing procedure of the ceramic
difference between different surface condi-
restoration surface contributes to minimize
tions for each ceramic. In addition, the
the wear of the tooth antagonist. Addition-
abrasion and attrition wear of bovine
ally, occlusal intraoral restoration adjust-
enamel opposing glazed Vitablocs showed
ments affect the abrasiveness of a ceramic
a volume loss significantly higher than
restoration, which results in high wear of the
bovine enamel opposing polished Vita-
enamel antagonist. For that reason, the
blocs.
repolishing procedure49 is strongly recommended. Nevertheless, clinical studies are still required to test the performance of different
Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel.
ceramic materials in the oral environment
According to the qualitative analysis of
over time. Since ceramic materials undergo
the restorative materials, the glaze layer
constant improvements, new studies are
presented as a protection, exhibiting fewer
needed to evaluate the features of the new
cracks and less loss of material on the
systems.
ceramic surface.
CONCLUSION
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