Wjoud 14 688
Wjoud 14 688
Wjoud 14 688
A b s t r ac t
Aim: The objective of this study was to evaluate the wear of opposing natural teeth, hardness, and fracture toughness of all three generations
of zirconia.
Materials and methods: Three groups were divided based on the generation of zirconia (n = 12): groups I (first generation of zirconia), II (second
generation of zirconia), and III (third generation of zirconia). Wear of opposing tooth: the discs and extracted human premolars were placed
onto holders on a two-body wear machine under a constant load of 5 kg. Hardness was calculated using Vicker’s microhardness tester, Reichert
Austria Make. International Organization for Standardization (ISO) standardized chart was used to check the hardness number based on the
indentation length. Fracture toughness was calculated using Niihara’s formula.
Results: Statistical analysis was done using paired t-test and one-way analysis of variance (ANOVA). The maximum amount of wear was seen
with the first generation of translucent zirconia—group I (0.93 mm) followed by group II and III (0.76 and 0.22 mm, respectively). Hardness and
fracture toughness value from highest to lowest was in the following order group I > group II > group III.
Conclusion: Within the limitations of this in vitro study, it can be concluded that the third generation of zirconia (group III) showed the least
amount of wear of a natural opposing tooth, hardness, and fracture toughness values among all three generations of zirconia.
Clinical significance: Around 5% of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) monolithic translucent zirconia is clinically significant
in anterior aesthetic restorations since it is superior to glass ceramics in terms of mechanical properties and is almost similar in terms of
translucency. Good esthetic results can also be achieved in the posterior region with minimal occlusal reduction. Also, monolithic translucent
zirconia (third generation of zirconia) abrades the antagonist dentition less than other esthetic ceramics.
Keywords: Fracture toughness, Hardness, Translucent zirconia, Three generations of zirconia, Wear.
World Journal of Dentistry (2023): 10.5005/jp-journals-10015-2276
Introduction 1,2,4–6
Department of Prosthodontics and Crown and Bridge, M.A.
Achieving the complex optical characteristics and light-scattering Rangoonwala College of Dental Science & Research Centre, Pune,
properties that provide an extremely pleasing esthetic in an artificial Maharashtra, India
restoration is a demanding process that has led to a great shift in 3
Department of Prosthodontics, SDM College of Dental Sciences,
metal-free restorations.1–3 Many patients are choosing metal-free Dharwad, Karnataka, India
restorations because they mimic the light-scattering properties of Corresponding Author: Abid S Khan, Department of Prosthodontics
natural teeth, provide excellent esthetic results, and are well tolerated and Crown and Bridge, M.A. Rangoonwala College of Dental Science
biologically. Choosing the right framework material goes beyond & Research Centre, Pune, Maharashtra, India, Phone: +91 9860671696,
esthetics and biocompatibility. Dental ceramics such as zirconia have e-mail: [email protected]
high flexural strength and fracture toughness. The use of zirconia has How to cite this article: Khan AS, Musani S, Madanshetty P, et al.
been widespread in the dental laboratory for over 15 years, whether A Study of the Antagonist Tooth Wear, Hardness, and Fracture
as a framework material or an anatomical replacement material. Toughness of Three Different Generations of Zirconia. World J Dent
Due to its efficiency in production, there is increasing interest in this 2023;14(8):688–695.
type of restorative option for teeth.2 Being a tooth-colored material, Source of support: Nil
zirconia has several advantages like good esthetics, excellent Conflict of interest: None
mechanical and biological properties, is less expensive, and has a
wide application in prosthodontics and restorative treatment when
compared to precious alloys.4 The set-in of the digital era has led to between 1170 and 2370°C. At room temperature, to 1170°C
chairside milling, rapid sintering technology, and automated and occurs, the monoclinic phase, which is the weakest phase with a
precise fabrication. Yttria-stabilized tetragonal zirconia polycrystal deformed parallelepiped shape. On cooling after sintering, zirconia
(Y-TZP) is the most robust of all restorative ceramics.5 undergoes a phase transformation from tetragonal to monoclinic
Zirconia exists in three crystalline phases: monoclinic, phase, making the sintered material unstable and resulting in a
tetragonal, and cubic. At temperatures above 2370°C purest 3–5% expansion in the volume of the grain. This transformation
zirconia is found in cubic structures which possess moderate ensues in surface roughening, microcracking, and deterioration of
mechanical properties. The best mechanical properties are seen in mechanical characteristics.6,7 Main attraction towards zirconia is its
the tetragonal phase, which consists of crystals having the form of exceptional mechanical properties and resistance to corrosion. The
straight prisms with rectangular sides and occurs at temperatures match with existing dentition is the greatest challenge to achieving
© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Three Generations of Zirconia: Wear, Hardness, and Fracture Toughness
sufficient esthetics.5 Competition is between Y-TZP and lithia-based as the cubic crystals have a comparatively large volume; hence the
silicates; the latter is more translucent but weaker glass ceramic.8 light scatters less strongly at the grain boundaries and porosities.
Esthetic outcomes were hampered due to the opaque appearance The incident light is reflected uniformly in all directions due to
of zirconia; hence to mask this appearance, layering of zirconia the geometry of the cubic crystal structure, thereby increasing
was proposed.9 Bilayer structures are susceptible to chipping and the translucency additionally.2 5Y-TZP is resistant to hydrothermal
delamination, exacerbated by thermally induced residual stresses.5 aging. Zirconia with a cubical phase is brittle, and zirconia with
Chipping of porcelain is the most prevalent technical problem, a higher yttria content has a lower ability of transformation
with annual rates ranging from 0 to 54% in veneered zirconia.10 toughening. The lower ability of transformation toughening,
Phenomenon of chipping may occur due to adhesive failure along with the larger grain size of 5Y-TZP, resulted in a much
(the weak link between core and veneering) or cohesive failure lower strength.18
(fracture within the veneering porcelain body)and is common in The difference in structure and physical properties of tooth
the molar region.11–13 Full-contoured monolithic zirconia could be and dental restorative materials results in their differential wear.19
a solution to reduce porcelain chipping.14,15 Translucent monolithic Hardness is commonly used to estimate the degree of wear of
zirconia was introduced in 2011 to overcome the problem of poor restorative dental materials and natural enamel. The greater the
optical properties and chipping. This material has good esthetic hardness more will be the wear. Enamel generally has a Vickers
properties with high load-bearing capacity at minimal occlusal hardness of 320–380 kg/mm2. Zirconia has a high surface hardness
reduction.16 It may require only 1.0 mm of occlusal thickness, that is, in comparison with other low-fusing feldspathic porcelains.20
minimal occlusal reduction and 0.5 mm of margin thickness, while One major drawback of zirconia is the irreversible loss of
providing a functional and aesthetic solution.17 Hence, there is a opposing tooth structure. According to several investigations,
recent push toward monolithic restorations, focusing mainly on ceramic substrates cause greater abrasive wear of human enamel.
counterbalancing durability, conservation of tooth structure, and A ceramic with a combination of good strength and decreased
esthetic requirements.5 enamel wear would be a significant addition to dental practice.21
Highly translucent zirconia (compared with zirconia for Since the hardness of zirconia is more, more will be the loss of
copings and frameworks) may serve as a conservative tooth- enamel. In this study, the wear of teeth was studied, as there is no
colored alternative in the posterior quadrants for crowns and fixed literature comparing all three generations of zirconia with respect
dental prostheses.17 Color (hue, value, and chroma), translucency, to the wear of opposing teeth.
opalescence, fluorescence, and iridescence are the necessary The zirconia most commonly found in the market is 3% Y-TZP.
optical properties of both teeth and dental materials. One of the The proportion of yttrium oxide has been increased in the third
most important factors which make the tooth appear life-like is generation of zirconia. This has led to the formation of a metastable
translucency, and it has a great role in the selection of restorative tetragonal phase and more of a cubic phase simultaneously. This
material.1 The size and shape of the constituent crystals, the quantity mixed structure is known as fully stabilized zirconia and represents
and type of additives, the heating methods, temperature, and the third generation. In the third-generation cubical phase is
atmospheric conditions used for sintering, and the inclusion of more; hence, tetragonal to monoclinic transformation will be less.
pores that influence light scattering determines the translucency From this, we can hypothesize the fracture toughness of the third
of zirconia.1 generation will be less.2
Modification of sintering temperature and molecules gave rise Therefore, this in vitro study was carried out to select the
to different generations of zirconia. most beneficial generation of zirconia with respect to the wear of
The first generation of zirconia (3Y-TZP): The number and opposing natural teeth, hardness, and fracture toughness of three
grain size of the aluminum oxide (Al2O3) grains were more in generations of zirconia.
the first generation. Changes in sintering temperature rendered
more translucency. Higher will be translucency when the integral
area of the sintering temperature is larger. Studies show that the
M at e r ia l s and Methods
translucency is also affected by the duration of the dwell time, Ethical clearance was obtained from the Ethics committee of the
the temperature increase, and cooling. There is a tetragonal to institute, reference no–mces/Ethics/488/2018. The study was
monoclinic phase transformation in this generation.2 conducted over a period of 18 months after the approval of the
The second generation of zirconia (3Y-TZP)—changes at Ethics Committee was obtained.
the molecular level resulted in a second generation from 2012
to 2013. Reduction in the number and grain size of Al2O3 was Designing and Milling of Disk-shaped Zirconia
done. Al2O3 grains were relocated in the zirconia framework. Samples and Sampling
Refraction occurs on the grain boundaries of zirconia, which Software (Autodesk Tinkercad) was used to design the STL file
means a higher transmittance of light. Tetragonal to monoclinic of disks measuring 10 mm in diameter and 1.2 mm in thickness.
phase transformation is present. 2 Third generation of zirconia This file was then sent from hyperDENT Lava™ Edition software to
(5Y-TZP)—the International Dental Show 2015 witnessed the computer-aided manufacturing (CAM) for milling (Yenadent D43).
introduction of the third-generation zirconia. It contains 53% cubic A total of 36 disk-shaped samples of 10 mm diameter and
phase proportion. 1.2 mm thickness were milled with the help of computer-aided
The tetragonal crystals have a lower volume compared to design (CAD)/CAM devices from commercially available zirconia
the cubic ones. Tetragonal to monoclinic phase transformation blanks. A total of 12 samples were milled from each of the following
is absent. zirconia blanks 3Y-TZP zirconia disk specimens of first generation
The third generation, when compared to the first and second (3M™ Lava™ Frame, 3M, United States of America), which made up
generations, exhibits higher translucency due to its specific the group I, 3Y-TZP zirconia disc specimen of second generation
(mixed cubic/tetragonal) structure. Material is more translucent, (3M™ Lava™ Plus, 3M, United States of America) which made up
the group II and 5Y-TZP zirconia disc specimen of 3rd generation Determination of wear of opposing tooth: Prewear three dimensional
(3M™ Lava™ Esthetic, 3M, United States of America) which made (3D) scans (before wear test)—contrast spray (EASY SCAN
up the group III. contrast spray, Alphadent, Korea) was sprayed on the extracted
The total sample size for the study was 36 (n = 36). Samples were tooth mounted on the acrylic block and was then placed inside
divided into three groups. the extraoral laboratory scanner (Dental Wings, DWOS, 3 Series
Each group had a sample size of 12 (n = 12). scanner). Contrast spray helped in increasing the accuracy of the
• Group I: 1st generation of translucent zirconia (n = 12). scan; it was extremely thin in layer and easily washable with water.
The prewear scanned image of the 3D object was obtained in
• Group II: 2nd generation of translucent zirconia (n = 12).
stereolithography (.stl) format (Fig. 1).
• Group III: 3rd generation of translucent zirconia (n = 12).
Wear test: The tooth embedded in an acrylic block was placed
A total of 36 freshly ex trac ted premolars indicated for
onto the upper holder of a two-body wear machine. The zirconia
orthodontic extraction were collected and randomly divided into
disc was placed on the lower holder of two body wear machines.
three groups of 12 each. Teeth were embedded into an acrylic
The cusp tips and ceramic discs were positioned under a constant
block. Inclusion criteria for teeth: vital premolars indicated for
load of 5 kg. The specimens were made to rub against one another
orthodontic extraction, unrestored tooth, fully developed tooth,
in a circular motion, and 10,000 cycles were carried out for each
caries-free surfaces, and patients who gave consent/assent to
sample. Artificial saliva was sprayed in between to simulate the
use their tooth for study. Exclusion criteria for teeth: attrition of
oral conditions.
tooth, carious tooth, nonvital tooth, restored tooth, root canal
treated, and the patient refused to give consent/assent to use Postwear 3D scan (after wear test): After completion of 10,000 cycles
their tooth for study. of wear, contrast spray was sprayed again to prepare it for postwear
extraoral 3D scanning. The tooth embedded in an acrylic block was
again placed inside the extraoral laboratory scanner, and the scanned
image of the 3D object was obtained in stereolithography (.stl)
format (Fig. 2). Now, both the prewear and the postwear 3D object
stereolithography (.stl) files were exported to a software (Geomagic®
Control X™ 64 Bit Build version 2018, Copyright© 3D Systems) for
superimposing both the images. Superimposition of images helped
in the easy comparison of prewear and postwear scans. The difference
between prewear and postwear 3D scans was calculated, and the
amount of wear that occurred was determined (Fig. 3).
Determination of Hardness: After wear testing was completed, the
same samples were used to check for the hardness of zirconia. Using
Vicker’s microhardness tester (Reichert Austria Make), a 100 gm
load for a dwell time of 20 seconds was applied to the zirconia disc
surface to obtain an indentation (Fig. 4). The length of the diagonals
formed by this indentation was measured, and the hardness
number was evaluated using the reference standard: International
Organization for Standardization (ISO) 6507.22
Determination of fracture toughness: Fracture toughness was
Fig. 1: Scanned images of a tooth before subjecting it to the wear cycle calculated using Niihara’s formula:
KIC = 0.203(c/a)−3/2Ha1/2
where KIC is the fracture toughness value (MPam1/2); a is the half of followed by the second generation of translucent zirconia—group II
indentation diagonal length (mm); c is the half of the crack length (0.76 mm), and least amount of wear was seen in the third generation
(mm); and H is the Vickers hardness (Hv). of translucent zirconia—group III (0.22 mm) (Table 1 and Fig. 6).
Crack initiation: An initial load of 19.6N (2 kg) was applied using an
Comparison of Hardness among Three Groups
universal testing machine (Star Testing System, India. Model no.
STS-248) with Vicker’s indenter (diamond)—136° and increased The mean score of hardness in group I was 1424.75 ± 56.64 VHN,
subsequently until a crack developed on the zirconia disc sample. in group II was 1303.83 ± 72.91 VHN, and in group III was 1194.08 ±
The load holding time was of 20 seconds. The load was increased 32.83 VHN. All groups showed statistically significant differences
to 294 N (30 kg). (p = 0.001); group I demonstrated the highest value of hardness,
where the least was with group III. Group II showed a higher
Measurement of crack length: Visual inspec tion system
hardness value than group III but lesser than group I (Tables 2 and 3).
(100× magnification) with geometrical DRO was used for
measuring the crack length and the length of diagonals (Fig. 5).
Hardness value was already obtained for each sample. Once the
value of crack length and the diagonal length was obtained, it
was substituted into Niihara’s formula. Statistical analysis of tooth
height before and after the wear cycle was compared using paired
t-test post hoc Tukey test. Values of hardness and fracture toughness
were subjected to one-way analysis of variance (ANOVA) test for
statistical analysis. Statistical Package for the Social Sciences version
22.0 (IBM Analytics, New York, United States of America) was used
to carry out the statistical analysis; p < 0.05 was considered to be
statistically significant.
R e s u lts
Comparison of Change in Tooth Height Before and
After the Wear Cycle
The results revealed that there was a statistically significant difference
(p = 0.001) in all three groups. The maximum amount of wear was seen
with the first generation of translucent zirconia—group I (0.93 mm), Fig. 5: Geometrical DRO for measuring the crack length
Table 1: Comparison of change in tooth height before and after the wear cycle
Height of tooth before wear cycle Height of tooth after wear cycle Actual loss of tooth structure/wear
Groups (in mm) (in mm) (in mm) t-value p-value
Group I 9.36 ± 0.68 8.43 ± 0.61 0.93 16.576 0.001*
Group II 9.17 ± 0.80 8.41 ± 0.79 0.76 30.750 0.001*
Group III 9.35 ± 0.90 9.13 ± 0.84 0.22 7.678 0.001*
*Indicates a significant difference at p ≤ 0.05
Fig. 6: Pairwise comparison of tooth height before and after the wear cycle
Comparison of Fracture Toughness among Three saliva, masticatory pattern, and opposing restorative materials,
Groups are involved in tooth wear making it a complex process. 23 The
The mean score of fracture toughness in group I was 5.34 ± 0.22 progressive wear of natural teeth is a normal physiological
MPam1/2, in group II was 4.97 ± 0.06 MPam1/2, and in group III was phenomenon that can be affected if restorative materials with
3.61 ± 0.22 MPam1/2. All groups showed statistically significant different hardness from that of enamel are used for restoring
differences (p = 0.001). The fracture toughness value from highest the teeth.24,25 Higher wear rate value of restorative material will
to lowest was in the following order group I > group II > group III significantly wear down the opposing natural tooth and cause
(Tables 2 and 3). hypersensitivity and articular imbalance.26 The aim of this study
was to investigate the wear of opposing natural teeth, hardness,
and fracture toughness of three different generations of zirconia.
Discussion Studying wear directly is challenging. Wear can be determined
Numerous factors, such as the food, non-functional habits, based on indirect factors such as volume loss, vertical loss, and
thickness and hardness of enamel, neuromuscular force, pH of topography on the worn surface.23,27–29 Vertical loss was studied in
this in vitro study on the two-body wear test.30 Functioning of the (t to m) phase transformation can be harmful by increasing the
two-body wear test is based on the simulation of attrition during surface roughness and decreasing the hardness.39–41
mastication and grinding, which is created by direct occlusal contact The hardness of enamel is in the range from 270 to 360 VHN for
or teeth or restorative material. Hence a two-body wear test was enamel; results obtained in this study showed the hardness of third-
used in this in vitro study.31,32 generation zirconia as 1194.08 ± 32.83 VHN. The first generation
Two-body wear test machines combined the action of impact, of zirconia showed the highest value for hardness (1424.75 ± 56.64
closure, and grinding of teeth during the masticatory cycle of VHN), the second generation of zirconia showed more hardness
maxillary and mandibular teeth by a total of 10,000 cycles under (1303.83 ±72.91 VHN) than the third generation but was lesser than
a constant load of 5 kg (49 N).23 Lubrication is an important role of the first generation. Values were subjected to the post hoc Tukey
saliva and natural teeth are greatly protected by this lubricating test in a pairwise comparison of hardness in all three groups. All the
property, hence spraying artificial saliva greatly reduces the risk of pairwise comparisons showed statistically significant differences
excess wear and burn of tooth texture.33 (p = 0.001). Intergroup comparison of the first generation of zirconia
Pairwise comparison was done to evaluate the difference in vs second generation of zirconia, the first generation of zirconia vs
wear of natural opposing tooth among all three groups; values third generation of zirconia, and the second generation of zirconia
were subjected to post hoc Tukey test. The results of this study vs third generation of zirconia gave a difference of 120.92, 230.67,
indicate that all three groups showed statistically significant and 109.75 VHN, respectively. On comparing the hardness of all
difference with respect to the wear of natural opposing tooth and three generations of zirconia, the third generation showed the
was dependent on the yttria content of zirconia. When the first least value of hardness. The null hypothesis for hardness was also
generation of zirconia was compared with the second generation, rejected, which stated that there is no difference between the
the difference was 0.17 mm (p = 0.011), suggesting increased wear hardness among the three generations of zirconia. In this study,
of opposing teeth in the first generation. Further comparing the the third generation showed the least, the second generation
first generation with the third generation, it showed a difference of showed moderate, and the first generation showed the maximum
0.71 mm (p = 0.001), which again indicated more wear of opposing value of hardness.
natural teeth against the first generation. Comparison of the second According to Curtis et al., 3% yttria-stabilized zirconia samples,
generation with the third generation gave a difference of 0.54 mm which were abraded using different particles, had values of
(p = 0.001), indicating that the least wear of the natural opposing hardness ranged in between 1524 and 1734 VHN.42 According to
tooth was caused by the third generation of zirconia. So, the order Emam et al., polished ultratranslucent monolithic zirconia was
of most to least amount of wear of natural opposing tooth caused more wear friendly to the antagonist enamel than both the glazed
by zirconia is first generation of zirconia > second generation of ultratranslucent monolithic zirconia and natural enamel. 38 This
zirconia > third generation of zirconia. study also supports that surface roughness plays an important
The null hypothesis was rejected, which stated that no there role in the hardness of the material in terms of wear of opposing
was no difference between the wear of natural opposing teeth natural teeth.
against all three generations of zirconia. The study carried out Seghi et al. reported that wear rates of human enamel and of
by Lambrechts et al. accounted that 20–40 µm vertical wear of restorative material should be more or less similar to each other.43
enamel per year is normal. 34 This study showed that the wear of Harder the restorative material more it will be worn. Recent studies
the natural opposing tooth was greatly dependent on the yttria have shown that the surface roughness of ceramic determines
content, cubic phase, monoclinic phase, tetragonal phase, and the wear of opposing teeth and not the hardness of the material.
Al2O3 of zirconia. It has been reported that hydrothermal aging Aboushahba et al. concluded that surface property (hardness) was
is absent in the third generation of zirconia, which means that high in zirconia. He recommended polishing the surface of zirconia
the material can retain its strength and microstructure even with restorations because this polishing favors the surface properties
increasing wearing time. Also, no phase transformation (tetragonal (wear and hardness) of opposing natural teeth. Highly polished
to monoclinic) takes place in the structure when placed under zirconia with high hardness has shown lesser wear of opposing
induced stresses, which means that more of cubic phase is teeth.44
retained than the tetragonal phase in the third generation of Increased proportion of yttrium oxide is a striking feature of
zirconia making it less hard. 2 Highest wear was seen with the first the new generation of zirconia. This has resulted in the formation
generation of zirconia, this could be attributed to the tetragonal not only of metastable tetragonal phase but also of the cubic phase
phase and the Al2O3 particles which increases the mechanical structure simultaneously. The first and second generations are
properties of zirconia. 35–37 partially stabilized zirconia, whereas fully stabilized zirconia is the
According to Stawarczyk et al., the polished monolithic third generation and has a mixed structure consisting of metastable
translucent zirconia shows a lower wear rate on enamel antagonists tetragonal and cubic phases. There is no transformation of structure
as well as within the material itself.15 in this generation, even under induced stresses.4
Emam et al. studied wear behavior and surface roughness of Stawarczyk et al. stated that increased cubic phase enhanced
enamel when opposed by ultratranslucent monolithic zirconia the translucency of zirconia but had an adverse effect on material
with two surface finishing procedures (glazed or polished); within strength; further, they stated that fully stabilized zirconia offered
the limitations of his study, polished ultratranslucent monolithic fewer mechanical advantages due to the absence of transformation
zirconia was more wear friendly to the antagonist enamel than toughening.4
both the glazed ultra-translucent monolithic zirconia and natural Ceramics being brittle material produces a very small amount
enamel.38 of deformation when loaded with stress, and it fractures before
Y-TZP zirconia becomes clinically usable after sintering which the plastic deformation.45 In the single-edge precracked beam
leads to monoclinic phase to tetragonal phase transformation, method, it is difficult to get experimental cracks, and also Young’s
enhancing its hardness. Conversely, the tetragonal to monoclinic modulus needs to be obtained from different experiments. Thus,
because of its ease and simplicity, the indentation fracture method results. Keeping the range of indications in mind, it is, therefore, very
was used in this study. crucial for us to select and use the correct material. Further research
A semicircular or semielliptical and vertical crack is generated is needed to know whether monolithic zirconia can be used as a
around the indentation when the indenter is pressed onto the veneer and its adhesion to the tooth structure after subjecting it
surface.45 Fracture toughness is calculated by substituting the value to different surface treatments.
of hardness, indentation length, and the diagonal crack length in
Niihara’s formula.46 The results obtained were subjected to the post References
hoc Tukey test, and all three groups showed statistically significant
1. Manziuc MM, Gasparik C, Negucioiu M, et al. Optical properties
difference (p = 0.001) in relation to fracture toughness. The of translucent zirconia: a review of the literature. EuroBiotech J
difference between the first generation and second generation was 2019;3(1):45–51. DOI: 10.2478/ebtj-2019-0005
0.37 MPam1/2, which indicated that fracture toughness was almost 2. Stawarczyk B, Keul C, Eichberger M, et al. Three generations of
similar. Comparing the first generation with the third generation zirconia: from veneered to monolithic. Part I. Quintessence Int
and the second generation with third generation showed a great 2017;48(5):369–380. DOI: 10.3290/j.qi.a38057
difference of 1.73 and 1.36 MPam1/2, respectively. Results of this 3. Zhang Y, Kelly JR. Dental ceramics for restoration and metal
study indicated that fracture toughness was more in the first veneering. Dent Clin North Am 2017;61(4):797–819. DOI: 10.1016/j.
cden.2017.06.005
generation of zirconia (group I) and least in the third generation
4. Ghodsi S, Jafarian Z. A review on translucent zirconia. Eur J Prosthodont
of zirconia (group III). Restor Dent 2018;26(2):62–74. DOI: 10.1922/EJPRD_01759Ghodsi13
Lange reported in his study that fracture toughness for yttria- 5. Zhang Y, Lawn BR. Novel zirconia materials in dentistry. J Dent Res
stabilized zirconia seemed to be inversely proportional to the 2018;97(2):140–147. DOI: 10.1177/0022034517737483
content of yttria; the greater the yttria content lesser will be the 6. Helvey GA, Cam CAD. Zirconia and computer-aided design/
fracture toughness.47 He stated that the fracture toughness value computer-aided manufacturing (CAD/CAM) dentistry. Editorial
dropped from 6.5 to 3 MPam1/2 as the yttria content was increased Categories 2018. https://www.aegisdentalnetwork.com/special-
from 3 to 7%.47 issues/2007/10/zirconia-and-cad-cam-dentistry
7. Chevalier J, Gremillard L, Virkar AV, et al. The tetragonal-monoclinic
Alkadi and Ruse carried out the study in which they determined
transformation in zirconia: lessons learned and future trends.
the fracture toughness of IPS e.max CAD and IPS e.max Press which J Am Ceram Soc 2009;92(9):1901–1920. DOI: 10.1111/j.1551-
turned out to be 1.79 and 2.50 MPam1/2, respectively.48 When we 2916.2009.03278.x
compare the values of group III (3rd generation zirconia) with the 8. Pieger S, Salman A, Bidra AS. Clinical outcomes of lithium
values obtained by Akladi and Ruse, third-generation zirconia has disilicate single crowns and partial fixed dental prostheses: a
a higher value of fracture toughness than both IPS e.max CAD and systematic review. J Prosthet Dent 2014;112(1):22–30. DOI: 10.1016/j.
IPS e.max Press justifying the use of a new translucent material prosdent.2014.01.005
with greater strength than the glass ceramic in the esthetic zone. 9. Tsukuma K, Yamashita I, Kusunose T. Transparent 8 mol% Y2O3–ZrO2
(8Y) Ceramics. J Am Ceram Soc 2008;91(3):813–818. DOI: 10.1111/j.1551-
Comparing translucency and strength on the graph, Zhang et al.
2916.2007.02202.x
stated that translucent zirconia could fill the gap between the 10. Marchack BW, Sato S, Marchack CB, et al. Complete and partial
conventional 3% yttria-stabilized zirconia and lithium disilicate contour zirconia designs for crowns and fixed dental prostheses:
glass-ceramic.49 a clinical report. J Prosthet Dent 2011;106(3):145–152. DOI: 10.1016/
Within the limitation of this in vitro study, results show that S0022-3913(11)60112-1
the increase in yttria content of monolithic zirconia reduces the 11. Cattani-Lorente M, Durual S, Amez-Droz M, et al. Hydrothermal
hardness and fracture toughness of monolithic zirconia. In simple degradation of a 3Y-TZP translucent dental ceramic: A comparison of
words, an inverse correlation was found between zirconia’s numerical predictions with experimental data after 2 years of aging.
Dent Mater 2016;32(3):394–402. DOI: 10.1016/j.dental.2015.12.015
translucency and strength.
12. Wang G, Zhang S, Bian C, et al. Fracture mechanics analyses
of ceramic /veneer inter face under mixed-mode loading.
C o n c lu s i o n s J Mech Behav Biomed Mater 2014;39:119–128. DOI: 10.1016/j.
jmbbm.2014.07.019
Within the limitations of this in vitro study, it can be concluded that 13. Rinke S, Fischer C. Range of indications for translucent zirconia
the third generation of zirconia showed the least amount of wear of modifications: clinical and technical aspects. Quintessence Int
a natural opposing tooth, the least value of hardness, and the least 2013;44(8):557–566. DOI: 10.3290/j.qi.a29937
fracture toughness values among all three generations of zirconia. 14. Johansson C, Kmet G, Rivera J, et al. Fracture strength of monolithic
The third generation of zirconia is 5% Y-TZP monolithic translucent all-ceramic crowns made of high translucent yttrium oxide-stabilized
zirconia is clinically significant in anterior esthetic restorations since zirconium dioxide compared to porcelain-veneered crowns and
lithium disilicate crowns. Acta Odontol Scand 2014;72(2):145–153.
it is superior to glass ceramics in terms of mechanical properties
DOI: 10.3109/00016357.2013.822098
and is almost similar in terms of translucency. 15. Stawarczyk B, Özcan M, Schmutz F, et al. Two-body wear of
monolithic, veneered and glazed zirconia and their corresponding
Clinical Significance enamel antagonists. Acta Odontol Scand 2013;71(1):102–112.
Good esthetic results can be achieved in the anterior aesthetics DOI: 10.3109/00016357.2011.654248
restorations and also a posterior region with minimal occlusal 16. Harianawala HH, Kheur MG, Apte SK, et al. Comparative analysis of
reduction. Also, monolithic translucent zirconia (third generation of transmittance for different types of commercially available zirconia
and lithium disilicate materials. J Adv Prosthodont 2014;6(6):456–461.
zirconia) abrades the antagonist dentition less than other esthetic
DOI: 10.4047/jap.2014.6.6.456
ceramics. 17. Harada K, Raigrodski AJ, Chung KH, et al. A comparative evaluation
An increase in the translucency of zirconia is not always of the translucency of zirconias and lithium disilicate for monolithic
advantageous; in the case of a discolored tooth, there is reduced restorations. J Prosthet Dent 2016;116(2):257–263. DOI: 10.1016/j.
masking potential in monolithic zirconia, which can give negative prosdent.2015.11.019
18. Zhang F, Inokoshi M, Batuk M, et al. Strength, toughness and aging 34. Lambrechts P, Braem M, Vuylsteke-Wauters M, et al. Quantitative
stability of highly-translucent Y-TZP ceramics for dental restorations. in vivo wear of human enamel. J Dent Res 1989;68(12):1752–1754.
Dent Mater 2016;32(12):e327–e337. DOI: 10.1016/j.dental.2016.09.025 DOI: 10.1177/00220345890680120601
19. Yip KH, Smales RJ, Kaidonis JA. Differential wear of teeth and 35. Tsubakino H. Isothermal tetragonal-to -monoclinic phase
restorative materials: clinical implications. Int J Prosthodont transformation in a zirconia–y t tria system. Mater Trans
2004;17(3):350–356. PMID: 15237885. 2005;46(7):1443–1451. DOI: 10.2320/matertrans.46.1443
20. Mundhe K, Jain V, Pruthi G, et al. Clinical study to evaluate the 36. Masaki T. Mechanical properties of Y2O3-stabilized tetragonal ZrO2
wear of natural enamel antagonist to zirconia and metal ceramic polycrystals after ageing at high temperature. J Am Ceram Soc
crowns. J Prosthet Dent 2015;114(3):358–363. DOI: 10.1016/j. 1986;69(7):519–522. DOI: 10.1111/j.1151-2916.1986.tb04786.x
prosdent.2015.03.001 37. Masaki T. Mechanical properties of toughened ZrO2-Y2O3 ceramics.
21. Rupawala A, Musani SI, Madanshetty P, et al. A study on the wear of J Am Ceram Soc 2021;69(8):638–640. DOI: 10.1111/j.1151-2916.1986.
enamel caused by monolithic zirconia and the subsequent phase tb04823.x
transformation compared to two other ceramic systems. J Indian 38. Emam SA, Koheil SA, Afif RR. Wear of human enamel opposing
Prosthodont Soc 2017;17(1):8–14. DOI: 10.4103/0972-4052.194940 ultra-translucent zirconia with two surface finishing procedures.
22. ISO - ISO 6507-2:2018 - Metallic materials — Vickers hardness test — Alexandria Dent J 2020. DOI: 10.21608/adjalexu.2020.21675.1033
Part 2: Verification and calibration of testing machines 39. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials
23. Elmaria A, Goldstein G, Vijayaraghavan T, et al. An evaluation of wear 1999;20(1):1–25. DOI: 10.1016/s0142-9612(98)00010-6
when enamel is opposed by various ceramic materials and gold. J 40. Denry I, Kelly JR. State of the art of zirconia for dental applications.
Prosthet Dent 2006;96(5):345–53. DOI: 10.1016/j.prosdent.2006.09.002 Dent Mater 2008;24(3):299–307. DOI: 10.1016/j.dental.2007.05.007
24. Monasky GE, Taylor DF. Studies on the wear of porcelain, enamel, 41. Candido LM, Fais LMG, Reis JMDSN, et al. Surface roughness and
and gold. J Prosthet Dent 1971;25(3):299–306. DOI: 10.1016/0022- hardness of yttria stabilized zirconia (Y-TZP) after 10 years of
3913(71)90191-0 simulated brushing. Rev Odontol da UNESP 2014;43(6):379–383.
25. Jagger DC, Harrison A. An in vitro investigation into the wear effects of DOI: 10.1590/1807-2577.1049
unglazed, glazed, and polished porcelain on human enamel. J Prosthet 42. Curtis AR, Wright AJ, Fleming GJ. The influence of surface modification
Dent 1994;72(3):320–323. DOI: 10.1016/0022-3913(94)90347-6 techniques on the performance of a Y-TZP dental ceramic. J Dent
26. Jacobi R, Shillingburg HT Jr, Duncanson MG Jr. A comparison of 2006;34(3):195–206. DOI: 10.1016/j.jdent.2005.06.006
the abrasiveness of six ceramic surfaces and gold. J Prosthet Dent 43. Seghi RR, Rosenstiel SF, Bauer P. Abrasion of human enamel by
1991;66(3):303–309. DOI: 10.1016/0022-3913(91)90254-t different dental ceramics in vitro. J Dent Res 1991;70(3):221–225.
27. Hahnel S, Schultz S, Trempler C, et al. Two-body wear of dental DOI: 10.1177/00220345910700031301
restorative materials. J Mech Behav Biomed Mater 2011;4(3):237–244. 44. Aboushahba M, Katamish H, Elagroudy M. Evaluation of wear and
DOI: 10.1016/j.jmbbm.2010.06.001 hardness of zirconia with different surface treatment protocols a
28. DeLong R. Intra-oral restorative materials wear: rethinking the current systematic review. Indian J Sci Technol 2016;9(39):1–15. DOI: 10.17485/
approaches: how to measure wear. Dent Mater 2006;22(8):702–711. ijst/2016/v9i39/88542
DOI: 10.1016/j.dental.2006.02.003 45. Harada K, Shinya A, Yokoyama D, et al. Effect of loading conditions
29. Condon JR, Ferracane JL. Evaluation of composite wear with a new on the fracture toughness of zirconia. J Prosthodont Res 2013;57(2):
multi-mode oral wear simulator. Dent Mater 1996;12(4):218–226. 82–87. DOI: 10.1016/j.jpor.2013.01.005
DOI: 10.1016/s0109-5641(96)80026-1 46. Niihara K, Morena R, Hasselman DPH. Evaluation of KIc of brittle solids
30. Lambrechts P, Debels E, Van Landuyt K, et al. How to simulate wear? by the indentation method with low crack-to-indent ratios. J Mater
Overview of existing methods. Dent Mater 2006;22(8):693–701. Sci Lett 1982;1(1):13–16. DOI: 10.1007/BF00724706
DOI: 10.1016/j.dental.2006.02.004 47. Lange FF. Transformation toughening - Part 3 Experimental
31. Kadokawa A, Suzuki S, Tanaka T. Wear evaluation of porcelain observations in the ZrO2-Y 2O3 system. J Mater Sci 1982;17(1):
opposing gold, composite resin, and enamel. J Prosthet Dent 240–246. DOI: 10.1007/BF00809059
2006;96(4):258–265. DOI: 10.1016/j.prosdent.2006.08.016 48. Alkadi L, Ruse ND. Fracture toughness of two lithium disilicate dental
32. Harrison A. Wear of combinations of acrylic resin and porcelain, glass ceramics. J Prosthet Dent 2016;116(4):591–596. DOI: 10.1016/j.
on an abrasion testing machine. J Oral Rehabil 1978;5(2):111–115. prosdent.2016.02.009
DOI: 10.1111/j.1365-2842.1978.tb01202.x 49. Zhang F, Reveron H, Spies BC, et al. Trade-off between fracture
33. Li H, Zhou ZR. Wear behaviour of human teeth in dry and artificial resistance and translucency of zirconia and lithium-disilicate glass
saliva conditions. Wear 2001;249(10–11):980–984. DOI: 10.1016/S0043- ceramics for monolithic restorations. Acta Biomater 2019;91:24–34.
1648(01)00835-3 DOI: 10.1016/j.actbio.2019.04.043