ZIRCONIA

R E S TO R AT I O N S :
EVOLUTION
A N D I N N O VAT I O N
By Dennis J. Fasbinder, D.D.S.
Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N

CONTENTS
4

12

14

16

18

20

8
22

24

25

A L L C O N T E N T S © 2 0 2 0 S P E A R E D U C AT I O N
Introduction

Zirconia Mircostructure

Monolithic Restorations

Strength

Esthetics

Zirconia Surface Wear

Conclusion

References

About the Author

About Spear
INTRODUCTION
Interest in ceramic materials has
continued to increase over the past
few decades as higher strength
ceramics have afforded expanded
clinical applications. Optimal goals
for ceramic materials would be
to deliver superior esthetics,
with predictable, cost effective
fabrication, and long-term durability.
Glass ceramic materials have
consistently provided enamel-like
appearance; however, they are also
brittle materials. Clinical research
has consistently reported that the
primary failure mechanism of glass
ceramics is chipping and fracture.
(Pjetursson, 2007)
While there is a wide range of
material options available for crowns,
a survey of more than 1,700 dentists
in the National Dental Practice-Based
Research Network indicated that
monolithic zirconia is the most
common choice of material for a
posterior crown. (Makhija et al 2016)
Several factors were suggested as
influencing the shift toward monolithic
zirconia crowns, including increased
patient demand for esthetic
restorations, the cost effectiveness
of zirconia, and that zirconia has
significantly greater strength than
glass ceramic materials and offers the
additional advantage of allowing for
more conservative tooth preparations.
Zirconia was initially introduced for
clinical use as a more esthetic core
material compared to metal. Early
zirconia crowns were veneered with
feldspathic porcelain to improve the
esthetic appearance of the crown
because zirconia is relatively opaque
with a higher value. However, the
chipping of the veneer porcelain led
many dentists to be discouraged with
its use. One meta-analysis of single
crowns with a zirconia core reported
a 91.2% survival rate, which was
significantly lower than that of
metal-ceramic crowns at five years.
(Sailer 2015)

Full-contour, monolithic zirconia
crowns are preferred due to the
simple fact that the surface of a
full-contour zirconia crown is
resistant to chipping or fracture.
(Lawson, Burgess 2014) They
also exhibit high flexural strength,
allow for more conservative dental
preparation, and minimize wear to
antagonist dentition. (Albashaireh,
2010; Grin, 2013)
5
Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N
While zirconia is often presented
as a single material, different
formulations have evolved with
considerably different polycrystalline
structures and physical properties.
An understanding of the various
types of zirconia materials will aid
in making informed clinical decisions
to promote the desired clinical
outcome for the case.
ZIRCONIA MICROSTRUCTURE
Zirconium is a soft, silver-colored
metal recovered as a mineral called
Zircon (ZrSiO4). It is mined primarily
from large deposits in Australia and
South Africa and shipped to plants
for processing. The mined Zircon is
purified, and metal oxides are added to
the refined powder such as yttrium to
stabilize the metastable crystal form,
aluminum to prevent water corrosion,
and other coloring components. The
Tosoh Corporation in Japan supplies
the vast majority of the raw zirconia
powders for dental manufacturers. So
essentially almost all dental zirconia
materials are fabricated from the same
zirconia raw material. (Helvey 2017)
Zirconia is a polycrystalline material
that does not contain glass particles
even though it is commonly described
as a “ceramic” material. Although the
various brands of zirconia may be
manufactured from the same raw
zirconia powder, the quality and
properties of a specific brand of zirconia
are a function of the processing of the
raw materials by the manufacturer to
minimize porosity, enhance density,
and ensure a homogenous material.
Zirconia is referred to as metastable
since it can occur in three different
crystalline phases depending on
temperature and pressure parameters.
(Zhang 2018) Zirconia exists in the
monoclinic phase in its naturally
occurring state at room temperature
and pressure. A uniform monoclinic
zirconia would not be of use in dentistry
since it has poor strength properties.
At an elevated temperature of ~1170° C
the monoclinic phase transforms into
the tetragonal phase.
The tetragonal phase can be stabilized
at room temperatures by adding small
amounts of additives, called dopants,
to the zirconia. Yttria has become the
most effective dopant in amounts
of 3 weight% to 5 weight% that is
equivalent to 3 mol%. The third phase
of zirconia transforms at temperatures
above 2,300° C into the cubic phase. A
greater amount of yttria is required to
stabilize it (> 9.3 weight%) at room
temperature resulting in compositions
5 mol% (about 50% cubic phase).
(Helvey 2017)
Compared with other dental ceramics,
3 mol% zirconia has higher flexural
strength, fracture toughness, and
hardness, mainly derived from the
mechanism called “transformation
toughening.” (Pittayachawan 2009)

The tetragonal phase accounts for the
high strength properties of 3 mol%
zirconia. As a result of externally applied
stresses, such as a crack initiation, the
energy at the leading edge of the crack
causes the tetragonal crystals to locally
phase shift to monoclinic crystals.
The monoclinic crystals are volumetrically
larger than the tetragonal crystals and
this expansion results in a localized
compressive force applied to the leading
edge of the crack. The compressive
forces essentially prevent the crack
from propagating. This t > m
transformation, or transformation
toughening, is a major contributor to
the high strength of zirconia and its
ability to resist fracture under loading.
While the term “full contour zirconia”
is often used to describe a monolithic,
high strength, tooth-colored material,
there is considerable variation in
zirconia. The original zirconia materials
introduced prior to ~2014 were 3 mol%
that were 90%-100% tetragonal
polycrystals and had very high strength
properties. However, it tends to be
relatively opaque, with a high value,
and less esthetic than glass ceramics
for matching natural tooth structure.
7
Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N
It generally requires a porcelain veneer
to create the desired esthetic outcomes.
Examples of these include: Lava
Zirconia (3M), BruxZir (Glidewell), Cercon
(Dentsply Sirona), and IPS e.max ZirCAD
MT (Ivoclar Vivadent). (Zhang 2018)
The challenge for manufacturers of 3
mol% zirconia was to improve the
esthetic appearance of the material
while maintaining the desired high
strength properties. This fostered the
introduction of “anterior zirconia” or
“translucent zirconia.” Development
of translucent zirconia has included
techniques such as increasing the
amount of yttria, reducing the c
oncentration of alumina, eliminating
porosity by sintering at higher
temperatures, reducing the crystalline
grain size, and increasing the amount
of cubic phase in the material.
(Zhang 2018)
The challenge for manufacturers
of 3 mol% zirconia was to improve
the esthetic appearance of the
material while maintaining the
desired high strength properties.
Two early initiatives to improve
translucency of these materials were
to significantly reduce the amount
of alumina dopant added and
reducing porosity by sintering
at higher temperatures. These
improvements paved the way for
monolithic full-contour zirconia
restorations. Material examples of
this were Lava Plus (3M), Vita YZ
HT (Vita), BruxZir Full Strength
(Glidewell), Katana HT/ML (Kuraray
Noritake), and InCoris TZI (Dentsply
Sirona). (Zhang 2018)

This modest improvement in the

appearance of zirconia still limited
its application in full contour
restorations to posterior teeth with
lower esthetic demands.

Figures 1-3: CEREC zirconia crowns (3 mol%)

delivered for teeth #19 and #20.
 Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N

The most recent attempt to increase

the translucency of zirconia is to
significantly increase the cubic
crystalline phase to >25% and stabilize
it with 5 mol% yttria. (McLaren 2017)
The cubic crystalline phase decreases
light scattering that occurs at grain
boundaries and the zirconia appears
more translucent.

However, this approach also reduces

the flexural strength and fracture
toughness because stabilized cubic
zirconia does not transform at room
temperature. (Zhang 2016) This results
in a 35%-40% reduction of the flexural
strength compared to 3 mol% zirconia.
Recently introduced zirconia of this
type include Lava Esthetic (3M), Katana
Zirconia UTML/STML (Kuraray
Noritake), BruxZir Anterior (Glidewell
Laboratories), and ArgenZ Anterior
(Argen Corp.). (Zhang 2016, McLaren
et al 2017)

Figures 4-6: Pre-operative #3 with stained, caries under ceramic

crown replaced with full contour polished Katana zirconia crown
(5 mol%).

9
 As the composition of zirconia
materials has evolved, it can be helpful
to consider some sort of general
classification system to provide a basis
to understand differences in materials.
One simple categorization of zirconia
materials is based on the mol% of
yttria. (Burgess 2018) 3 mol% zirconia
are the early zirconia materials that
are 85-90% tetragonal phase with
flexural strengths in excess of 1100
MPa. They are also relatively opaque
with a high value that limits the
esthetic applications.
4 mol% zirconia has about 25% cubic
phase with improved translucency
and flexural strengths in the 750-900
MPa range. 5 mol% zirconia has about
50% cubic phase with significantly
increased translucency. The flexural
strength is further decreased to the
650-800 MPa range.
The changing physical properties of different
types of zirconia is directly related due to the
different proportions of the polycrystalline phase
At this point, one may be thinking
that this may be more information on
zirconia structure than really needed.
This categorization obviously reveals
the changing physical properties of
different types of zirconia is directly
related due to the different proportions
of the polycrystalline phase. There can
be considerable variation in material
properties within each category as
yttria is actually measured in tenths
of a mole percent.
However, the trend in improving the
translucency of the zirconia is evident
moving from 3 mol% to 5 mol%. A
similar trend is also noted in the
decreasing physical strength properties
from 3 mol% to 5 mol% zirconia.
The Gateway to Great Dentistry
Dentistry’s Most Innovative Online Learning Resource

Membership to Spear Online provides your entire practice team with:

PATIENT EDUCATION TEAM TRAINING AND

Make chairside case presentation more
engaging with our new tablet app, or stream
animated videos to your lobby monitors via
Fire TV Stick and Apple TV — options designed
to empower even the most hesitant patient to
take ownership of their oral health.
MEETING RESOURCES
Utilize tools designed for your front office,
hygienists and assistants. When your staff
understands and communicates the value
of the dentistry you provide, patients are
better informed and more receptive to
accepting treatment.

CLINICIAN EDUCATION SPEAR TALK

Increase your skills and earn continuing
education credits on your own schedule
with more than 1,500 clinical and practice
management lessons presented by dentistry’s
most respected clinicians.
Connect with thousands of like-minded
colleagues in a safe, supportive, clinician-
only environment meticulously monitored by
Spear faculty and contributing authors to find
answers to any clinical or practice challenge.

Discover how Spear Online impacts your entire practice:

855.625.2333 | online@speareducation.com | speareducation.com/spear-online
M O N O L I T H I C R E S T O R AT I O N S
The primary advantage of early zirconia
materials was superior strength
compared to other restorative
materials. However, the high value
and relative opaque appearance of
3 mol% zirconia did not offer the
esthetic appearance required for more
anteriorly positioned restorations.
Bilayer restorations consisting of a high
strength, relatively opaque zirconia
core with a more translucent porcelain
veneer became preferred for improved
esthetic results. But clinical research
has reported that the chipping/
fracture of the veneering porcelain is
a significant problem. (Sailer 2015)
The introduction of translucent
zirconia materials offered an
opportunity for monolithic esthetic
restorations and avoid the potential
for surface chipping/fracture of
veneered zirconia crowns. (Lawson,
Burgess 2014)
Zirconia restorations are fabricated
with a CAD/CAM process regardless
of the impression technique used to
record the tooth preparation. Zirconia
blanks (pucks or blocks) are available
from manufacturers in a partially fired
or pre-sintered state. This allows for
easier machining of the volume shape
of the computer designed restoration
with very good margin fidelity. A
post-machining oven sintering process
at very high temperature, ~1,350° C to
1,500° C, is required to fully sinter the
zirconia. The oven sintering process
results in a volumetric shrinkage of
zirconia between 21% and 24%.
Manufacturers bar code the zirconia
blanks to record the specific
shrinkage percentage of the blank.
The bar code is input to the design
software to mathematically expand the
design by the blank shrinkage factor.
The milled restoration is obviously
considerably larger than the desired
final restoration. The milled restoration
volumetrically shrinks to the correct
volumetric size during oven sintering
to create the fully crystallized
zirconia restoration.
Introducing Virtual Seminars
New format provides the same dynamic CE content
as campus seminars – but with online flexibility

The new virtual Spear Seminar format

allows you to refine your clinical skills
following the same lessons that you would at
the Spear Campus in Scottsdale — but from
anywhere, as a safe online alternative to
large-attendance campus events.

Experience the same clinical dental CE

seminars as you would in Scottsdale
but in a virtual format that provides the
comfort of intimate online engagement
with faculty from your home or office.

What would your practice team like

to accomplish next? Take part in a
virtual seminar and you will be invited
to return to experience the seminar
in person when we reopen the
Spear Campus.

Check upcoming dates and register for the Spear Virtual Seminar that works best for your schedule at
CAMPUS.SPEAREDUCATION.COM/SEMINARS
STRENGTH
Material strength is often compared
by flexural strength and fracture
toughness as it may be rationalized
that higher strength may reduce the
potential for chipping and fracture. The
veneering porcelain on the surface of
porcelain fused to metal (PFM) crowns
has a flexural strength in the range of
90-100 MPa.
High strength ceramics such as lithium
disilicate or zirconia-reinforced lithium
silicates have flexural strengths in the
range of 350-475 MPa with a fracture
toughness of 3.2 to 3.5 MPa/m2.
Zirconia (3 mol%) has a flexural
strength in excess of 900 MPa and a
fracture toughness of 5.5 to 7.4 MPa/
m2. The significant increase in strength
of zirconia is perceived to be an
advantage for longevity, however
this still needs to be supported by
long-term clinical evidence.
The strength of the ceramic material is
often cited as a critical element in the
success of the restoration. A laboratory
study illustrates an important point
about material strength. (Nakamura
2015) The minimum occlusal reduction
for 3 mol% zirconia is generally 1.0
mm and for 4 mol% zirconia 1.2-1.5
mm thick due to the reduced flexural
strength. The fracture rate of
monolithic zirconia crowns (Lava Plus)
were compared to lithium disilicate
crowns (e. max Press) at different axial
(0.5, 0.7, and 1.0 mm) and occlusal
thicknesses (0.5, 1.0, and 1.5 mm).
Axial reduction did not significantly
influence the fracture rate of either
type of crown. However, there was a
significant difference in the strength
of the monolithic zirconia crowns
based on the occlusal thickness.
Reducing the occlusal thickness of
the crowns resulted in a significant
decrease in fracture resistance. This
illustrates that one must consider the
minimum thickness or volume of
material required to maintain the
desired strength of a material.
 Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N

In essence, strength is a conditional
property, meaning it depends on an
adequate thickness or volume to have
the reported strength. Use of the
material without regard to its
recommended dimensional thickness
does not ensure the expected level of
material strength and may compromise
the clinical outcome.
While the small sample size from each
dental laboratory was not statistically
significant, the results lend credence
to the importance of material and
processing relative to expected
strengths of zirconia materials.

A study done by investigators at the Strength is a conditional

American Dental Association compared
the flexural strengths of zirconia from property, meaning it
dental laboratories. (Liao 2018) Dental depends on an adequate
laboratories were asked to submit two
zirconia samples. One sample was thickness or volume to have
of the laboratory’s anterior (high the reported strength
translucency) zirconia and one sample
from the laboratory’s posterior (low
translucency) zirconia.

Posterior zirconia samples had a mean

flexural strength of 492 + 199 MPa and
anterior zirconia samples had a mean
flexural strength of 563 + 136 MPa. The
authors speculated that the variation
in flexural strengths was due to
differences in zirconia materials,
differences in processing techniques
or a combination of both.

15
ESTHETICS
The translucency of a material is an
important contributor to its potential
esthetic applications.
When light strikes a polycrystalline
material (zirconia), a portion of the
light is reflected away from the
surface, a portion is transmitted
through the material, and a portion is
scattered or absorbed into the bulk
of the material. The amount of light
that is transmitted is a measure of
translucency and is related to the
reflectivity of the surface with
smoother surfaces reflecting more
light. It is also related to how much
light is scattered as it passes through
the material with more scattering
causing a more opaque appearance.
Light scattering occurs as it passes
through a material and it changes
direction. This may be caused by
impurities, defects, different crystalline
phases, and grain boundaries. To make
monolithic zirconia more translucent
and aesthetic, the light scattering from
the zirconia must be significantly
eliminated. (Kontonaski 2019)
One disadvantage of 3 mol% zirconia
is that the larger grain size of the
tetragonal crystalline particles leads
to greater light scattering and less
translucency. (Sulaiman 2015) The
lack of translucency also limits 3 mol%
zirconia chameleon effect of absorbing
surrounding tooth color as well as more
translucent glass ceramic restorations.
The increased zirconia opacity also
lends a brighter appearance to the
zirconia crown. It can be somewhat
problematic to decrease the value of
the crown with surface stains and glaze.
And the increased opacity of the
zirconia also prevents the cement color
from influencing the final shade of
the crown. The addition of a higher
proportion of cubic crystalline phase
in translucent or anterior zirconia
(5 mol%) effectively reduces the grain
sizes and decreased scattering of the
light, which allows more light to be
transmitted, improving the translucency.
 Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N

Translucency of ceramic materials has
been well documented in laboratory
studies. One study measured the
translucency of zirconia core materials
compared to lithium disilicate ceramic
in equal thicknesses. The translucency
of zirconia copings was significantly
less than that of the lithium disilicate
glass-ceramic control as one would
expect of 3 mol% zirconia.
(Balidissar 2010)
A more recent study compared the
translucency of lithium disilicate
ceramic (IPS e.max CAD HT) to four
different high translucency zirconia in
0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm
thick specimens. (Church 2017) Lithium
disilicate had significantly higher
translucency than translucent zirconia
materials at similar thickness. The
translucencies of the zirconia materials
were fairly similar at each thickness,
however translucency significantly
decreased for each zirconia material
at each increase in thickness.
These results are consistent with the
general perception that zirconia is
a more opaque material than glass
ceramics at the same thickness. But
ceramic materials are recommended
to be 1.5 mm thick occlusally while
zirconia materials are recommended to
be 1.0 mm thick occlusally. The authors
noted that at clinically recommended
thicknesses, the translucency parameters
of the translucent zirconia materials
were not only similar to those of the
lithium disilicate ceramic material but
also comparable to the translucency
parameters reported for 1.0 mm of
dentin or enamel.

Light scattering occurs as it passes

through a material and it changes
direction. This may be caused by
impurities, defects, different crystalline
phases, and grain boundaries.

17
Z I R C O N I A S U R FA C E W E A R
Occlusal surface wear is often
perceived as a function of material
hardness. Basically, the harder the
material, the greater the opposing
abrasive wear potential. Zirconia is
a very hard material that has been
thought to be very abrasive to
opposing tooth structure. However,
wear is actually a function of material
smoothness. (Miyazaki 2013)
Any material surface magnified enough
will appear as a series of peaks and
valleys rather than a mirror-like surface.
The peaks act as abrasive areas for
the opposing dentition. The smoother
the material surface, fewer peaks as it
were, the less abrasive wear against
the opposing dentition. The clinical
goal for zirconia would be to create
a smooth surface to prevent abrasive
wear of the opposing dentition.
There are several points of view as to
the optimum technique to create a
smooth zirconia restoration. Oven
firing a ceramic glaze to the zirconia
may create a smooth surface since
the ceramic glaze will flow across the
valleys of a rough surface, self-leveling
into a smooth surface once it is fired.
However, the glass-containing glaze
is a thin layer of about 100 microns
and will wear over time in function.
This would expose a potentially rough
surface of the zirconia, possibly
leading to abrasive wear of the
opposing dentition.
For this reason, it has been
recommended to polish the occlusal
surface of the zirconia prior to
glazing it. This would remove the
peaks and valleys and maintain the
smooth surface in spite of the wear
of the glass-containing glaze layer.
Polishing proximal surfaces may not
be as critical due to the lack of
functional wear on these areas.

A second point of view holds that
even if the surface of the zirconia is
polished, it will also wear, resulting in
the same surface profile as if the glaze
were applied and degraded during
function. However, zirconia is relatively
resistant to wear due to its high
fracture toughness.
Surface wear of materials generally
involve some degree of degradation
of the material as it is slowly worn
down through microfractures of the
material surface. Zirconia has a high
fracture toughness, preventing these
microfractures of the surface, and
thereby maintaining its rough and
potentially abrasive surface once the
glaze has been worn away.
Laboratory studies have demonstrated
that polished monolithic zirconia
has the least abrasive surface and
sandblasted and glazed zirconia
causes the highest functional abrasion
of the opposing enamel. (Stawarczyk
2013, Mitov 2012) Additional studies
have reported that polished monolithic
zirconia is less abrasive compared to
classic veneering ceramic (Jung 2010,
Park 2014) or lithium disilicate.
(Rosentritt 2012)
19
Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N
A second aspect of the surface finishing
is concerning an occlusal adjustment of
a zirconia crown post-cementation. Any
adjustment to the occlusal surface of
the zirconia must be repolished to
return the smooth surface to the
restoration. Failure to do so may result
in abrasive wear of the opposing
dentition. (Sabrah 2013, Chong 2015)
Most of the evidence for the wear
caused by zirconia is a result of
laboratory studies with simulated
occlusal function systems. One recent
systematic review of clinical studies
related to the antagonist enamel wear
of monolithic zirconia posterior crowns
included five clinical studies after review
of 198 potential publications. (Gou 2019)
The results reported by these studies
varied widely but in general the
antagonist wear due to zirconia was
similar to that of natural teeth and less
than that of metal-ceramics. Additional
long-term clinical research is needed
to confirm these findings for newer
translucent zirconia.
CONCLUSION
The evolution of full contour zirconia
illustrates the continued effort to
improve the material for expanding
clinical applications. The high strength
properties of the initial 3 mol% zirconia
are very desirable to clinicians since it
prevents the most common failure of
glass ceramics: chipping and fracture.

It may be an advantage in high-stress

clinical situations with potentially limited
inter-arch space to create the occlusal
reduction required for glass ceramic
restorations. However, the esthetic
properties required improvement. Newer
zirconia materials continue to improve
the translucency and esthetic outcomes.
However, it is also obvious that there
is a significant difference in the
ensuing physical properties of newer
zirconia formulations.

Physical properties and laboratory

studies do not provide sufficient evidence
of clinical success. But the differences
in physical property values between 3
mol%, 4 mol%, and 5 mol% zirconia offer
reasonable evidence that they should
not be considered equivalent materials.
Clinical evidence needs to be collected
to provide insight as to the optimum
applications of these materials.
 Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N

21
REFERENCES
Pjetursson BE, Sailer I, Zwahlen M, Hämmerle
CHF. A systematic review of the survival and
complication rates of all-ceramic and
metal-ceramic reconstructions after an
observation period of at least 3 years. Part I:
Single Crowns. Clin Oral Implants Res 2007
Jun;18 Suppl 3:73-85. doi: 10.1111/j.1600-
0501.2007.01467.
Makhija SK, Lawson NC, Gilbert GH, Litaker
MS, McClelland JA, Louis DR. Dentist material
selection for single-unit crowns: Findings from
the National Dental Practice-Based Research
Network. J Dent 2016;55:40-7.
Sailer I, Makarov NA, Thoma DS, Zwahlen
M, Pjetursson BE. All-ceramic or metal-
ceramic tooth-supported fixed dental
prostheses (FDPs)? A systematic review of
the survival and complication rates. Part I:
Single crowns (SCs). Dent Mater.
2015 Jun;31(6):603-23. doi: 10.1016/
j.dental.2015.02.011.
Lawson NC, Burgess JO. Dental ceramics: a
current review. Compend Contin Educ Dent
2014 35(3):161-166.
Albashaireh, ZSM. Ghazal M, Kern M. Two-body
wear of different ceramic materials opposed
to zirconia ceramic. J Prosthet Dent 2010
104:105–113.
Grin, J.D. Combining monolithic zirconia
crowns, digital impressioning, and regenerative
cement for a predictable restorative alternative
to PFM. Compend. Contin. Educ. Dent. 2013,
34, 212–222. [PubMed]
Helvey GA. What is in your zirconia?
Compendium Apr 2017, 38(4): 213-217.
Zhang Y and Lawn BR. Novel Zirconia Materials
in Dentistry. Journal of Dental Research 2018
Vol. 97(2) 140–147.
Pittayachawan P, McDonald A, Young A,
Knowles JC. Flexural strength, fatigue life, and
stress-induced phase transformation study of
Y-TZP dental ceramic. J Biomed Mater Res B
Appl Biomater 2009 88:366–77.
Zhang F, Inokoshi M, Batuk M, Hadermann
J, Naert I, VanMeerbeek B, Vleugels J. 2016.
Strength, toughness and aging stability of
highly-translucent Y-TZP ceramics for dental
restorations. Dent Mater. 32:e327–e337.
McLaren EA, Lawson N, Choi J, Kang J,
Trujillo C. New high-translucent cubic-
phase–containing zirconia: clinical and
laboratory considerations and the effect of
air abrasion on strength Compend Contin
Educ Dent. 2017 Jun;38(6):e13-e16.
Burgess JO. Zirconia: the material, its evolution,
and composition. Compendium Oct 2018, Vol
39, Spec issue 4, pgs 4-8.
Nakamura K, Harada A, Inagaki R et al Fracture
Resistance of monolithic zirconia molar crowns
with reduced thickness. Acta Odontol Scand
2015; 73(8):602-608.
Liao Y, Lukic H, McLees J, Boghosian A,
Megremis S. Survey of flexural strength
consistency of zirconia specimens from
multiple dental laboratories. J Dent Res 97
(Spec Issue A): abstract #1302, 2018
Kontonasaki E, Rigos AE, Ilia C, Istantsos T.
Monolithic zirconia: An update to current
knowledge. optical properties, wear, and
clinical performance. Dent J. 2019 Sep
2;7(3):90. doi: 10.3390/dj7030090.

Sulaiman TA, Abdulmajeed AA, Donovan
TE, et al. Optical properties and light
irradiance of monolithic zirconia at variable
thicknesses. Dent Mater. 2015;31(10):1180-1187.
Baldissara P, Llukacej A, Ciocca L, Valandro
FL, Scotti R. Translucency of zirconia copings
made with different CAD/CAM systems. J
Prosthet Dent. 2010;104(1):6-12.
Church TD, Jessup JP, Guillory VL,
Vandewalle KS. Translucency and strength
of high-translucency monolithic zirconium
oxide materials. Gen Dent 2017 Jan/Feb:
48-52.
Miyazaki T, Nakamura T, Matsumura H, et al.
Current status of zirconia restoration.
J Prosthodont Res 2013;57:236-261.
Stawarczyk B, Ozcan M, Schmutz F, et al.
Two-body wear of monolithic, veneered and
glazed zirconia and their corresponding
enamel antagonists. Acta Odontol Scand
2013; 71: 102-112.
Mitov G, Heintze SD, Walz S, Woll K,
Muecklich F, Pospiech P. Wear behavior of
dental Y-TZP ceramic against natural enamel
after different finishing procedures. Dent
Mater. 2012 Aug 1;28(8):909–18.
Jung YS, Lee JW, Choi YJ, et al. A study on
the in-vitro wear of the natural tooth struc-
ture by opposing zirconia or dental
porcelain. J Adv Prosthodont 2010; 2: 111-115.
23
Z I R C O N I A R E S T O R AT I O N S : E V O L U T I O N A N D I N N O VAT I O N
Park JH, Park S, Lee K, et al. Antagonist
wear of three CAD/ CAM anatomic
contour zirconia ceramics. J Prosthet Dent
2014;111:20-29.
Rosentritt M, Preis V, Behr M, et al. Two-body
wear of dental porcelain and substructure oxide
ceramics. Clin Oral Investig 2012;16:935-943.
Sabrah AH, Cook NB, Luangruangrong P, et al.
Full-contour Y-TZP ceramic surface roughness
effect on synthetic hydroxyapatite wear. Dent
Mater 2013;29:666-673.
Chong BJ, Thangavel AK, Rolton SB, et al.
Clinical and laboratory surface finishing
procedures for zirconia on opposing human
enamel wear: A laboratory study. J Mech
Behav Biomed Mater 2015;50:93-103.
Gou M, Chen H, Kang J, Wang H. Antagonist
enamel wear of tooth-supported monolithic
zirconia posterior crowns in vivo: A systematic
review. J Prosthet Dent. 2019 Apr;121(4):
598-603. doi: 10.1016/j.prosdent.2018.06.005.
Epub 2018 Dec 1.
ABOUT THE

AUTHOR
Dr. Fasbinder is currently the Director
of the Computerised Dentistry
Program and a clinical professor
in the Department of Cardiology,
Restorative Sciences and Endodontics,
University of Michigan, School of
Dentistry. He is board certified in
general dentistry and maintains a
part-time private practice in Ann
Arbor, Michigan.

Dr. Fasbinder directs the Computerised

Dentistry Unit at the University of
Michigan School of Dentistry that is
dedicated to research and education
on CAD/CAM dental systems. The
CompuDent Unit has been a leader in
Dennis J. Fasbinder, D.D.S.
education and research with the
chairside CAD/CAM systems and
digital impression systems since 1993
resulting innumerous publications.
Dr. Fasbinder is a frequent speaker on
ceramic-based dentistry and digital
dental systems at meetings and
conferences in North America
and abroad.
Based in Scottsdale, Arizona, Spear Education is an innovative dental education
company that includes the following practice-building, member-based services:

Spear Online
The “Gateway to Great Dentistry” includes more than 1,500 video lessons spanning
restorative, esthetics, occlusion, worn dentition, treatment planning and more. But
access is not only for dentist continuing education. Membership provides the entire
office team with staff training, team meeting and patient communication tools — like
the Patient Education platform and native apps, in addition to “Conversation
Essentials” video vignettes — to align the entire practice on patient care.

Spear Study Club

Involves small groups of peers that meet locally as many as eight times a year to
collaborate on real-world cases, improve their clinical expertise and discuss growing
practice profitability. Spear has the largest network of study clubs, with active clubs in
more than 40 states and six countries.

Spear Masters Program Specialist Workshops

With 2½-day workshops for both endodontists and surgical specialists tailored to
meet the needs of doctors and their teams, you will learn how to strengthen
relationships with your referring practices, develop your team for growth and build
the leadership skills necessary to streamline case flow.

Spear Practice Solutions

The technology-enabled business and clinical solutions platform blends custom
education, personalized coaching and real-time analytics to help your practice reach
its full potential.

Spear Campus
Thousands of dentists visit Spear’s scenic Scottsdale campus annually for seminars
and workshops. Members attend sessions in a state-of-the-art, 300-person lecture
hall and receive hands-on training in Spear labs.

Spear Faculty Club

Designed as a prestigious community of doctors who share the journey to Great
Dentistry with others. While all Faculty Club members demonstrate a commitment
to continued learning, professional growth and providing the best patient care, many
also serve as Visiting Faculty and mentor attendees during campus seminars
and workshops.

25