Translucency of zirconia copings made

with different CAD/CAM systems

Paolo Baldissara, DDS,a Altin Llukacej, DDS,b Leonardo Ciocca,

DDS,c Felipe L. Valandro, MSD, PhD,d and Roberto Scotti, MD,
DDSe
School of Dentistry, Alma Mater Studiorum University of
Bologna, Bologna, Italy; Federal University of Santa Maria, Santa
Maria, Brazil
Statement of problem. Zirconia cores are reported to be less translucent than glass, lithium disilicate, or alumina
cores. This could affect the esthetic appearance and the clinical choices made when using zirconia-based restorations.

Purpose. The purpose of this in vitro study was to evaluate the translucency of zirconia copings for single crowns fab-
ricated using different CAD/CAM systems, using lithium disilicate glass ceramic as a control.

Material and methods. Using impressions made from a stainless steel complete-crown master die, 9 stone cast rep-
licas were fabricated, numbered, and distributed into 8 ceramic ZrO2 CAD/CAM system groups (Lava Frame 0.3 and
0.5, IPS e.max ZirCAD, VITA YZ, Procera AllZircon, Digizon, DC Zircon, and Cercon Base) and to a lithium disilicate
glass-ceramic control group (IPS e.max Press) using a simple computer-generated randomization method. From each
die, the manufacturer’s authorized milling centers supplied 5 copings per group without applying any dying technique
to the ceramic base material. The copings were prepared to allow for a 40-µm cement layer and were of different
thicknesses according to system specifications. Translucency was measured by the direct transmission method with
a digital photoradiometer mounted in a dark chamber. The light source was a 150-W halogen lamp beam. Measure-
ments were repeated 3 times for each specimen. Data obtained were analyzed using 1-way ANOVA and the Bonferroni
multiple comparison test (α=.05).

Results. Among ZrO2 copings, Lava (0.3 mm and 0.5 mm thick) showed the highest (P<.05) values of translucency
measured as light flow units (3.572 ±018 x 103 lx and 3.181 ±0.13 x 103 lx, respectively). These values represent 71.7%
and 63.9%, respectively, of the glass-ceramic control group (4.98 x 103 lx).

Conclusions. All ZrO2 copings demonstrated different levels of light transmission, with the 2 Lava specimens showing
the highest values. Translucency of zirconia copings was significantly lower (P=.001) than that of the lithium disilicate
glass-ceramic control. (J Prosthet Dent 2010;104:6-12)

Clinical Implications
The results of this study may be helpful in determining which zirconia coping material
is most translucent and where it can be used to improve esthetic appearance when
considering zirconia-based restorations. Lava Frame with a 0.3-mm thickness dem-
onstrated the highest translucency of the materials tested and may be more suitable
for anterior applications. The least translucent of the zirconia cores could be used for
masking purposes. The masking effect can be increased using larger coping thicknesses.

a
Professor, Department of Oral Sciences, Section of Prosthodontics, Alma Mater Studiorum University of Bologna.
b
Granted Tutor, School of Dentistry, Department of Oral Sciences, Section of Prosthodontics, Alma Mater Studiorum University of
Bologna.
c
Clinical Assistant Professor, Department of Oral Sciences, Section of Prosthodontics, Alma Mater Studiorum University of Bologna.
d
Associate Professor, Division of Prosthodontics, Department of Restorative Dentistry, Federal University of Santa Maria.
e
Chief and Professor of Prosthodontics, Department of Oral Sciences, Section of Prosthodontics, Alma Mater Studiorum University
of Bologna.
The Journal of Prosthetic Dentistry Baldissara et al
July 2010 7
The esthetic value of a ceramic light is generated by many factors, ramic frameworks seems adequate
crown is based on its ability to har- such as different refractive indexes even for prostheses that are heavily
monize with the natural tooth. Key among ceramic phases,6 voids and stressed, such as posterior multi-unit
optical factors that permit a pleasing porosities, high crystalline content,9 FPDs.12,20,21 Consequently, research
harmony are color, surface texture, and crystal number and size, espe- into computer-aided design/comput-
and translucency.1 Translucency oc- cially when the crystal particles are er-aided manufacturing (CAD/CAM)
curs when a light beam, in passing slightly larger than the wavelength of technologies associated with this
through a material, is partly scattered, the incident light.6 Zirconia and alumi- material is widespread. Zirconia
reflected, and transmitted through na ceramics, with their high degree of ceramics present an alternative to
the object: the greater the quantity of crystalline content, have a maximum metal ceramic restorations and other
light that passes through the object, scattering effect. Thus, they appear ceramic systems for posterior teeth or
the higher the translucency. The hu- relatively opaque to visible light. highly stressed FPDs.22,23
man eye is able to correctly perceive Ceramic materials more satisfac- The purpose of this study was to
minimal variations in color, equal to torily address the demand for esthetic analyze and compare the translucen-
at least 2 ΔE of the CIE L*a*b* stan- restorations than metal ceramic res- cy levels of different zirconia-based
dard.2,3 The CIE (Commission Interna- torations with opaque cores.10 How- ceramic CAD/CAM systems, with
tionale de l’Éclairage) L*a*b* system ever, the translucency of the most du- lithium disilicate glass ceramic serv-
is an approximately uniform color rable zirconia-based ceramic crowns ing as a control group.10,11 The null
scale in which the differences between is reported to be less than that of hypothesis was that there would be
points plotted in the color space cor- glass ceramics,6,9 for which excellent no difference in the translucency of
respond to visual differences (ΔE) esthetic results are documented.11,12 the ceramic copings evaluated.
between the colors plotted. The CIE In-Ceram Zirconia (VITA Zahnfabrik,
L*a*b* color space has a cubic shape: Bad Säckingen, Germany), an alumi- MATERIAL AND METHODS
the L* axis runs from top to bottom num oxide-based ceramic with 35%
and represents the value (or bright- zirconium dioxide, has a relatively low A stainless steel, complete crown
ness) of the color. On the horizontal translucency, equal to that of metal die with a 10-degree taper, 6.3-mm
plane: on the a* axis, red is a positive ceramic crowns when evaluated using height, 9.1-mm apical diameter, 7.1-
value and green is negative; on the b* the contrast ratio method.6 This could mm coronal diameter, and a feath-
axis, yellow is positive, whereas blue is be an obstacle to achieving an esthet- er-edge margin was replicated us-
negative. The eye is able, therefore, to ically acceptable restoration. Among ing a polyether impression material
easily distinguish between a natural nonzirconia core materials, an opti- (Permadyne Light Body; 3M ESPE,
tooth and an artificial one, even when mal esthetic result has been reported Seefeld, Germany) and type IV gyp-
there are minute differences in color with Procera AllCeram (Nobel Bio- sum (ResinRock; Whip Mix Corp,
and translucency. Translucency and care AB, Göteborg, Sweden), which Louisville, Ky) following the manu-
color are highly correlated properties is a 99.9% aluminum oxide densely facturer’s instructions. The feather
of a ceramic crown.4,5 sintered ceramic,13 and IPS Empress edge allowed for better adaptation
For a ceramic crown, the greater (Ivoclar Vivadent AG, Schaan, Liech- of the coping to the rubber O-ring
the translucency of the core, the more tenstein) lithium disilicate glass ce- sealer during the translucency mea-
the colors of the deepest layers of the ramic.14 The latter evolved in 2005 to surements. The margin was in close
tooth are transmitted to the surface. IPS e.max Press (Ivoclar Vivadent AG), contact with the rubber, so negligible
Thus, in a sufficiently translucent ce- with improved translucency and me- effects of the margin shape on light
ramic crown used with a colorless chanical properties.12,15 Alumina and transmission were expected at that
cement, the reflected light contains glass ceramic have, respectively, fair location. The surface of each replica
the dominant color of the dentin, to high relative translucency6; never- was examined at x3.75 magnification
creating a natural-looking, esthetic theless, their mechanical properties to locate surface defects. Only repli-
restoration that blends harmoniously are lower than ZrO2 ceramics. Flex- cas free of voids or bubbles were se-
with the surrounding teeth and tis- ural strengths of 500 to 650 MPa for lected and sent to the milling center
sues. The translucency and color of alumina16 and 350 to 400 MPa for of each manufacturer.
a ceramic restoration depend on the lithium disilicate17 limit their applica- With the exception of Cercon
various characteristics of the core and tion to single crowns or 3-unit fixed Base, all systems evaluated (Table I)
veneer ceramics.6 Translucency is in- partial dentures (FPDs) in the ante- scanned the stone die directly. The
versely related to the thickness of the rior and premolar regions. Cercon system scanned a wax pat-
ceramic layer to be traversed by the Zirconia ceramics are reported to tern of the coping made by a dental
light beam7 and is strongly influenced have the highest mechanical proper- laboratory technician. DC Zircon and
by light scattering.8 Scattering of the ties.12,18,19 The strength of ZrO2 ce- Digizon are fully sintered materials,
Baldissara et al
8 Volume 104 Issue 1

Table I. Materials and CAD/CAM systems evaluated for translucency

Groups Minimal CAD/CAM
(n=5) Material Manufacturer Thickness (mm) System and Manufacturer

EMP IPS e.max Press Ivoclar Vivadent AG, 0.5 Cerec; Sirona Dental Systems GmbH,
(lithium disilicate Schaan, Liechtenstein Bensheim, Germany
control group)

LF3 Lava Frame 0.3 3M ESPE, 0.3 Lava; 3M ESPE

St. Paul, Minn

LF5 Lava Frame 0.5 3M ESPE 0.5 Lava; 3M ESPE

EMZ IPS e.max ZirCAD Ivoclar Vivadent AG 0.5 Cerec; Sirona Dental Systems GmbH

YZ VITA YZ VITA Zahnfabrik, 0.5 Cerec; Sirona Dental Systems GmbH

Bad Säckingen, Germany

PRO Procera AllZircon Nobel Biocare AB, 0.6 Procera; Nobel Biocare AB
Göteborg, Sweden

DGZ Digizon Amman Girrbach AG, 0.6 Digident; Digident GmbH,

Koblach, Austria Pforzheim, Germany

DCZ DC Zircon DCS Dental AG 0.5 DCS Precident; DCS Dental AG

Allschwil, Switzerland

CB Cercon Base DeguDent GmbH, 0.4 Cercon; DeguDent GmbH

Hanau, Germany

whereas all the other systems milled Lava Frame System provides copings Germany) placed at the entrance to
the zirconia in a partially sintered in both 0.3-mm and 0.5-mm thick- a dark chamber (sealed black box)
state. Five copings per group were nesses. The Cerec system supplied 5 was passed through the ceramic cop-
obtained from each replica. Sample copings made of VITA YZ, 5 made of ings. The copings were mounted so
size was determined on the basis of IPS e.max ZirCad, and 5 made of IPS that their edges were sealed by black
preliminary measurements on similar e.max Press lithium disilicate glass ce- rubber O-rings (BER-PA Srl, Brescia,
copings, which showed a standard ramic. The latter was used as the con- Italy) to exclude penetration of any
deviation lower than 0.07. Entering trol group. All Cerec copings were 0.5 light other than through the ceramic
a test power of 0.8 and a minimum mm thick. Procera and Cercon cop- (Fig. 1). The internal diameter of the
detectable difference among groups ings were 0.6 mm and 0.4 mm thick, O-rings was 7.4 mm. The sensor of a
of 0.2, calculations for 9 groups with respectively. All copings except the digital photoradiometer (model HD
1-way ANOVA indicated 5 specimens Cercon copings were spaced 40 µm 9221/S3; Delta Ohm Srl, Padua, Ita-
per group with α=.05. No coloring apart to allow for a correct cement ly) with a spectrum range of 400 to
techniques were used for the copings, layer thickness using the appropriate 900 nm was placed just behind the
since variations in dye pigments and software option. Cercon copings were entrance of the dark chamber light
techniques between systems may af- spaced by hand using a die spacer lac- inlet to detect the quantity of light
fect translucency.24 The manufacturers quer (Cergo Die Spacer; Degudent transmitted by the surfaces of the
selected the thickness of the copings GmbH, Hanau, Germany). coping (Figs. 2 and 3). Measurements
based on their software, milling pro- The translucency was determined were expressed in light units, Lux (lx).
cedures, and internal specifications, by direct transmission,8 in which a The measurement system was veri-
considering that they were intend- band of light generated by an incan- fied before each test run of 5 copings.
ed for a molar ceramic crown. Two descent halogen lamp (XENOPHOT First, a negative control test was per-
Lava groups were analyzed, as the HLX 64634; Osram GmbH, Munich, formed using a 0.5-mm-thick metal
The Journal of Prosthetic Dentistry Baldissara et al
July 2010 9
by the ceramic copings. Subsequent-
ly, each specimen was analyzed for
translucency, with the measurement
repeated 3 times; the first 10 seconds
after the lamp was lit, the second af-
ter 20 seconds, and the third after 30
seconds. The data were statistically
analyzed using 1-way ANOVA and the
Bonferroni multiple comparison test
(α=.05).

RESULTS

The translucency values obtained

1 Nobel Procera zirconia coping. Margin lies on rubber O-ring used for each group are summarized in
to seal light passage once specimen is positioned in dark chamber Table II. The light flow values during
inlet. No color modification was applied to ceramic material. the positive control tests without cop-
ing interference had a mean value of
28.4 ±0.08 x 103 lx. The data are also
expressed as a translucency percent-
age related to both the glass-ceramic
control group and the positive control
mean light flow.
The glass-ceramic IPS e.max Press
group showed the highest translu-
cency value (4.98 ±0.066 x 103 lx).
The translucency of the IPS e.max
Press group was significantly differ-
ent compared to all of the other zir-
conia groups (P=.001). Among ZrO2
ceramics, Lava 0.3-mm and 0.5-mm
2 Coping positioned in light inlet of dark chamber before groups demonstrated the highest
translucency test. translucency values. The translucency
of Lava 0.3-mm copings was signifi-
cantly higher than that of any other
ZrO2 material analyzed, including
Lava 0.5 mm (P<.022). The translu-
cency value of the Cercon group was
significantly lower than that of all of
the other groups evaluated (Table II).
The translucency of the Lava 0.5-mm
specimens was not significantly dif-
ferent from that of Procera AllZircon,
Digizon, DC Zircon, VITA YZ, and IPS
e.max ZirCad (Table II).

3 Sensor of photoradiometer inside dark chamber. Light inlet is DISCUSSION

coaxial to sensor light-sensitive surface (white circle). Only light
passing through coping is measured by instrument. The data obtained in this study
support rejection of the null hypoth-
disk gently pressed into the O-ring, which the light beam was allowed to esis, as the translucency of all of the
and the instrument was evaluated for pass through the dark chamber inlet zirconia groups was found to be sta-
a zero light reading. Next, 3 positive without interference. These data were tistically different from the lithium dis-
control tests without copings were recorded and used as reference values ilicate control. The translucency mea-
performed at 10-second intervals, in for the light flow reduction generated sured directly on a coping could be of
Baldissara et al
10 Volume 104 Issue 1

Table II. Translucency values obtained using direct transmission method

Nominal Mean Translucency Translucency
Ceramic Thickness Translucency Related to Positive Related to
System (mm) (Lux x 103) Control Light Flow Control Group P

Control group: 0.5 4.98 (±0.07) 17.5% 100% <.001

IPS e-max PressA
(lithium disilicate)

Lava Frame 0.3B 0.3 3.572 (±0.18) 12.5% 71.7% .022

Lava Frame 0.5C 0.5 3.181 (±0.14) 11.2% 63.9% .165

Procera AllZirconC,D 0.6 2.878 (±0.19) 10.1% 57.8% .865

DigizonD 0.6 2.725 (±0.14) 9.59% 54.7% .990

DC ZirconD 0.5 2.631 (±0.21) 9.26% 53.8% .991

VITA YZD 0.5 2.609 (±0.12) 9.18% 52.4% .995

IPS e.max ZirCADD 0.5 2.548 (±0.17) 8.97% 51.2% .009

Cercon BaseE 0.4 2.098 (±0.26) 7.38% 42.1% <.009

Ceramics with same superscripted uppercase letter are not statistically different. Data analyzed with 1-way ANOVA and Bonferroni multiple
comparison test: df = 36; F=122.95; P<.001

greater clinical relevance when com- study, translucency was determined Lava 0.3-mm copings demon-
pared to measurements performed on with the direct transmission method strated the highest translucency val-
specimens with simple shapes, such and light flow (Lux) as a unit of mea- ue, probably due to the thin ceramic
as discs or tablets. The effects of the sure, allowing the use of copings in- walls and the intrinsic optical proper-
variables related to the production pro- stead of discs or tablets. The method ties of the material. Lava 0.5 mm also
cess for an abutment-shaped coping, demonstrated that all zirconia cop- showed a high translucency value,
such as grinding, sintering, finishing, ings allowed the light to pass through which was significantly higher than
and definitive ceramic thickness, are the material, in contrast to the results other groups with the same minimal
incorporated in the specimens. Since of a study by Chen et al,19 who found thickness, such as DC Zircon, IPS
this study evaluated and compared the that Cercon Base Zirconia (Cercon) e.max ZirCAD, and VITA YZ. Differ-
translucency of a definitive product was opaque, with values equal to ences in translucency, therefore, can
having a specified shape and func- those of metal ceramics (contrast be explained by slight differences in
tion, the actual thickness of the cop- ratio=1.0). Even the 33%-volume zir- the ceramic structure and chemis-
ing was not determined. Only the conia-toughened alumina (In-Ceram try of the copings, and by the effect
minimum thickness recommended Zirconia; VITA Zahnfabrik) has been of different milling and processing
by the manufacturer was considered, reported by Heffernan et al6,9 to lack methods on the crystalline structure
and the value obtained when measur- the same translucency when evalu- of the ceramics. In fact, necessary
ing light transmission through that ated using the contrast ratio method conditions for a translucent ceramic
thickness is here referred to as the (ratio=1.0). Therefore, although the are that it does not absorb radiation
translucency value. quantity of light transmitted is not re- in the visible spectrum (0.4- to 0.7-
In previous studies, CAD/CAM ce- markable when compared to the value µm wavelength) and that light diffu-
ramic translucency was evaluated us- of the positive control light flow, all of sion is reduced to a minimum. There
ing flat specimens of a standardized the materials evaluated in the present are various causes of diffusion within
thickness by applying the contrast study may be considered translucent polycrystalline ceramic materials.6,7
ratio method.5-7,9,19,25 In the current to a certain degree. Irregularities in the distribution of
The Journal of Prosthetic Dentistry Baldissara et al
July 2010 11
the phases, defects and voids at grain approximately 0.2 μm seems to limit needs to be reduced or masked using
boundaries, optical anisotropy of the the use of smaller dimensions.30 Ca- coloring salts or oxides. Zirconia can
grains, grain size larger than the light solco et al26 recently described a tech- be colored by infiltration, precolored
wavelength, different refractive in- nique to obtain translucent zirconia at the microcrystalline powder state,
dexes among the particles, and their ceramics colored from amber to ruby or surface colored by means of apply-
chemical nature may result in light using both partially (ZrO2-3 mol% ing a liner.31 The coloring techniques
scattering.6 Y2O3) and fully stabilized (ZrO2-8 may reduce the translucency and the
Of the materials evaluated, Lava mol% Y2O3) nanostructured powders. mechanical properties of the zirconia;
0.3 mm and 0.5 mm appeared to be The resulting materials have a grain however, infiltration with cerium ac-
the most translucent CAD/CAM zirco- size of 55 nm, and in the partially sta- etate 5 wt% and bismuth chloride 1%
nia copings for esthetic restorations. bilized form are translucent and am- solutions may allow for ceramic col-
Since the manufacturing process was ber colored; the fracture toughness of oration without reducing the ceramic
exactly the same for both Lava cop- 8.1 MPa∙m1/2 suggests that these ma- flexural strength.31
ing types, the difference between the terials could be further developed for In vitro studies on ceramic trans-
mean values is likely due to the differ- dental applications. lucency may be limited due to a lack
ent thicknesses of the copings. The Cercon group also showed of clear clinical relevance. Even if the
In spite of a nominal thickness of the highest standard deviation. This research designs generally allow for
only 0.4 mm, Cercon Base copings is probably due to the manufacturing determining optical properties, the
showed the lowest mean value of process, in which the CAD phase is re- conversion of these data in terms of
translucency, suggesting that, regard- placed by a wax pattern that has been clinical outcomes poses great dif-
less of this parameter, the basic ma- handmade by a dental technician. The ficulty. The esthetic appearance of a
terial is the least translucent among pattern is then laser scanned and ma- ceramic restoration is a multifactorial
those analyzed in the current study. chined during the subsequent CAM phenomenon. The effect of the frame-
High opacity was also reported for milling phase. Since the copings de- work translucency can be altered
Cercon using the contrast ratio meth- pend on the dental technician’s skill by the thickness, color, and surface
od.19 Apart from the coping thickness, rather than on CAD software, the texture of the veneering ceramic,1,9
increased opacity could be the result thickness, shape, and design of the framework coloring technique,31–33
of minor dimensional, structural, and copings are less standardized than and opacity and color of the luting
chemical differences in the grains and those of other systems. cement.34
grain boundaries, which yield higher Nonetheless, even the least trans- As Heffernan et al9 suggest, it
levels of light absorption and scatter- lucent zirconia ceramics could be would be interesting to know if the
ing,26 rather than the direct effect of useful for posterior teeth, or anterior differences in translucency found in
grain size. In fact, the size of 3 mol% teeth when a masking effect of the in vitro studies have clinically percep-
Y-TZP (3Y-TZP) dental zirconia grains underlying tooth structure is desired, tible effects on the esthetics of the
is in the range of 0.2 to 0.5 µm.27 Cer- such as when the prepared teeth are restoration. Only the materials with
con grains are 0.3 µm, on average,28 darkly colored or when carbon fiber the greatest differences in translu-
and appear to be sufficiently small so and metal posts are used for the sup- cency values, such as IPS e.max Press
as to negate the hypothesis that they porting core. lithium disilicate, Lava Frame 0.3,
influence Cercon’s optical properties Another variable that could modify and Cercon Base, would likely dem-
in comparison to the other groups. the core translucency is the shading of onstrate differences in the definitive
It is possible that zirconia translu- the framework by means of different restoration that are perceptible to the
cency could be improved in the future. coloring techniques.31 Zirconia, with human eye. Further clinical studies
Many traditional ceramic materials its high refractive index, is consid- are necessary to determine the effect
show interesting optical properties ered an opaque material and is largely of the optical properties of the ceram-
when the grain size of sintered ce- used as opacifier in ceramic glazes ic core on the esthetic appearance of
ramics is nanosized.29 One example and composite resin fillers. In dental zirconia crowns.
is alumina, which is known to be- restorations, unshaded zirconia cop-
come transparent when the grain size ings and frameworks are directly ve- CONCLUSIONS
is small enough.29 Zirconia grain size neered with translucent ceramic to
could be modified by the manufactur- provide esthetic results. The zirconia Within the limitations of this study,
er using dopants and by varying sin- core may simulate the opaque den- the following conclusions were drawn:
tering conditions (sintering pressure, tin effect of natural teeth, allowing 1. Light transmission through zir-
temperature, and times).27 However, a pleasing appearance; nevertheless, conia was significantly lower than
the impossibility of the phase transi- the high value of the opaque white or through the control, which was repre-
tion when the grain size is less than ivory color of this ceramic sometimes sented by a new generation of lithium
Baldissara et al
12 Volume 104 Issue 1
disilicate glass ceramics. 11.Raptis NV, Michalakis KX, Hirayama H. 24.Cho MS, Lee YK, Lim BS, Lim YJ. Changes
Optical behavior of current ceramic sys- in optical properties of enamel porcelain
2. Lava 0.3 mm and 0.5 mm demon- tems. Int J Periodontics Restorative Dent after repeated external staining. J Prosthet
strated 71.7% and 63.9% of the translu- 2006;26:31-41. Dent 2006;95:437-43.
cency of 0.5-mm-thick IPS e.max Press 12.Conrad HJ, Seong WJ, Pesun IJ. Current 25.Nakamura T, Saito O, Fuyikawa J, Ishigaki
ceramic materials and systems with clinical S. Influence of abutment substrate and
specimens, respectively. recommendations: a systematic review. J ceramic thickness on the colour of heat-
3. Lava 0.3 mm demonstrated the Prosthet Dent 2007;98:389-404. pressed ceramic crowns. J Oral Rehabil
highest translucency as compared to 13.Odman P, Andersson B. Procera AllCeram 2002;29:805-9.
crowns followed for 5 to 10.5 years: a 26.Casolco SR Jr, Xu J, Garay JE. Transparent/
the other zirconia copings (P=.022). prospective clinical study. Int J Prosthodont translucent polycrystalline nanostructured
The translucency of the Lava 0.5- 2001;14:504-9. yttria stabilized zirconia with varying colors.
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S, Gerds T, Strub JR. All-ceramic partial Selective infiltration-etching technique for
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Masticatory fatigue loading and fracture to zirconia-based materials. J Prosthet Dent
resistance. Am J Dent 2007;20:21-6. 2007;98:379-88.
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