Japanese Dental Science Review (2016) 52, 2—13

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Review Article

Dental prostheses mimic the natural enamel

behavior under functional loading: A review
article
Ahmed A. Madfa a,∗, Xiao-Guang Yue b

a
Department of Conservative Dentistry, Faculty of Dentistry, University of Thamar, Yemen
b
Department of Safety Science and Engineering, Wuhan University of Technology, China

Received 23 January 2015; received in revised form 18 May 2015; accepted 23 July 2015

KEYWORDS Summary Alumina- and zirconia-based ceramic dental restorations are designed to repair
functionality as well as esthetics of the failed teeth. However, these materials exhibited several
Alumina;
performance deficiencies such as fracture, poor esthetic properties of ceramic cores (partic-
Zirconia;
ularly zirconia cores), and difficulty in accomplishing a strong ceramic—resin-based cement
Dental ceramics;
bond. Therefore, improving the mechanical properties of these ceramic materials is of great
Dentino-enamel
interest in a wide range of disciplines. Consequently, spatial gradients in surface composition
junction;
and structure can improve the mechanical integrity of ceramic dental restorations. Thus, this
Dental multilayer;
article reviews the current status of the functionally graded dental prostheses inspired by the
Functionally graded
dentino-enamel junction (DEJ) structures and the linear gradation in Young’s modulus of the
materials
DEJ, as a new material design approach, to improve the performance compared to traditional
dental prostheses. This is a remarkable example of nature’s ability to engineer functionally
graded dental prostheses. The current article opens a new avenue for recent researches aimed
at the further development of new ceramic dental restorations for improving their clinical
durability.
© 2015 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.

Contents

1. Introduction ................................................................................................................ 3
2. Natural human enamel......................................................................................................4
2.1. Microstructure and function of enamel...............................................................................4

∗ Corresponding author at: Department of Conservative Dentistry, Faculty of Dentistry, University of Thamar, Dhamar, Yemen.

Tel.: +967 6503255.

E-mail address: ahmed um [email protected] (A.A. Madfa).

http://dx.doi.org/10.1016/j.jdsr.2015.07.001
1882-7616/© 2015 Japanese Association for Dental Science. Published by Elsevier Ltd. All rights reserved.
Dental prostheses mimic the natural enamel behavior 3

2.2. Mechanical behavior of natural enamel .............................................................................. 4

3. Microstructure and behavior of dentino-enamel junction ................................................................... 5
4. Bioinspired functionally graded approach ................................................................................... 6
5. Dental prostheses mimic the dentino-enamel junction behavior ............................................................ 7
5.1. Graded glass-zirconia structures ..................................................................................... 7
5.2. Graded glass-alumina structures ..................................................................................... 8
6. Clinical implications ........................................................................................................ 9
7. Conclusions................................................................................................................10
Conflict of interest ........................................................................................................ 10
References ................................................................................................................ 10

1. Introduction a dense, high purity crystalline structure at the cemen-

tation surface that cannot be adhesively bonded to tooth
Teeth play a critically important role in our lives. Loss dentin support [29,30]. Even though some authors recom-
of function diminishes our capability to eat a stable diet, mended particle abrasion for surface roughening treatment
which has undesirable consequences for general health. Loss to enhance the ceramic-resin-based cements bond using
of esthetics can negatively influence social function. Both mechanical retention, particle abrasion also introduces sur-
function and esthetics can be reconstructed with dental face flaws or microcracks that can cause deterioration in the
prostheses. long-term flexural strength of ceramic prostheses [31—37].
Material selection for dental prostheses has turned out to Further, zirconia cores have a white opaque appearance
be a sizable field for researchers. Ceramics are frequently which needs a thick porcelain veneer with gradual change
used in load-bearing biomedical applications due to their in translucency to mask the zirconia and to achieve a better
excellent biocompatibility, wear resistance and esthetics esthetic outcome [38]. Further, the dental crowns generate
[1—3]. Ceramics are utilized as total hip and knee replace- over $2 billion in revenues each year, with 20% of crowns
ments [4—8] and adopted for dental restorations [9—11]. being all ceramic units. Also, aging populations will drive
Ceramic dental restorations are designed to repair function- the demand for all types of dental restorations even higher
ality as well as esthetics of the failed teeth. However these [39]. Moreover, occlusal contact induces the deformation
materials showed somewhat poor flexural strength, partic- and cracking of dental crowns, which can lead to the fail-
ularly when exposed to fatigue loading in wet environments ure of the structure [40]. Therefore, it is highly desirable
[1—3]. Subsequently, it can cause extensively discomfort to to develop ceramic prostheses that are more resistant to
patients and can reduce the durability for ceramic prosthe- cracking under occlusal contact in recent decade [17,18].
ses due to their flexural fracture [12—15]. Composite ceramics have been designed in an effort to
The failures of dental restorative systems are due to improve strength and toughness while expanding function-
incorrect selection of materials, incorrect design of the ality. Simple laminate materials have been developed for
component, the incorrect processing of materials, and pres- many years, in which a number of materials with different
ence of defects (e.g. cracks and pores) in the prostheses properties are bonded into a layered structure [41]. Though
[16—19]. Additionally, in metal—ceramic restorations there these composites do combine varying properties, the abrupt
are mismatches in the mechanical properties between the interfaces between the two materials often hold residual
veneering porcelain and metal core. The Young’s modu- stresses [42,43] and perhaps delaminate under load [44].
lus of the veneering porcelain is 60—80 GPa, while that of Recently, bioinspired functionally graded enamel struc-
the metal core is in the range of 80—230 GPa [20]. Fur- tures in the design of dental multi-layers have been
thermore, there are mismatches in the thermal properties proposed, as alternative technique, aiming the enhance-
between the veneering porcelain and metal core, where ment of the overall performance of metal—ceramic and
coefficient thermal expansion for metal core is usually all-ceramic dental restorative systems. This technique
higher than veneering porcelain. The significant mismatch allows the production of a material with very different char-
between both material properties concentrate stresses at acteristics within the same material at various interfaces.
the interfaces that may cause cracks at the metal—ceramic Bioinspired functionally graded approach is an innovative
interface and consequently to the failure of the restoration material technology, which has rapidly progressed both in
[21,22]. Lastly, metal core is more susceptible to corrosion terms of materials processing and computational modeling
in which its effect ranges from degradation of appearance in recent years. Bioinspired functionally graded structure
to loss of mechanical strength [23,24]. The corrosion prod- allows the integration of dissimilar materials without for-
ucts can produce a bluish-gray pigmentation of gingiva and mation of severe internal stress and combines diverse
oral mucosa. Furthermore, these products, particularly in properties into a single material system [45—47]. This inno-
immunologically susceptible individuals, can cause local and vative technology has been applied in medical and dental
systemic hypersensitivities [25—28]. fields [48—56].
Despite a continuous improvement in the dental pros- The graded structure eliminates the sharp interface
theses such as using a strong zirconia or alumina core to resulting from traditional core-veneer fabrication, eliminat-
support the esthetic porcelain veneer, ceramic prostheses ing the potential for delamination between the layers [57].
are still vulnerable to failure at a rate of approximately Graded transitions can also reduce stress concentrations at
1—3% each year [9]. Additionally, ceramics prostheses have the intersection between an interface and a free surface
4 A.A. Madfa, X.-G. Yue

[58,59]. Similarly, the local driving force for crack growth junction from dentin to the outer enamel surface. Crystal-
across an interface can be increased or reduced by alter- lite plates in the central part of the rod are parallel to the
ing the gradients in elastic and plastic properties across the rod axis while those near the edge of the rod usually have an
interface [60,61]. angle near 15—45◦ to the longitudinal axis of the rods [72].
The bioinspired functionally graded structure can be seen The rod unit is the most important level in understanding
as the precursor to recent studies. Thus, this article reviews the microstructure and function of enamel.
the current status of the functionally graded dental prosthe-
ses inspired by the dentino-enamel junction (DEJ) structures
and the linear gradation in Young’s modulus of the DEJ. 2.2. Mechanical behavior of natural enamel

As the outer cover of teeth, enamel must retain its shape as

2. Natural human enamel well as resist fracture and wear during load-bearing function
for the life of the individual. Understanding fracture proper-
2.1. Microstructure and function of enamel ties and crack propagation procedure of enamel is important
for both clinicians and material scientists.
A human tooth consists of pulp, enamel and dentin. The Anisotropic microstructure of the enamel, such as rod
natural tooth has superior overall properties to artificial orientation, and organic components, controlled the anti-
crowns [47]. Therefore, the knowledge of the structure of fracture ability of enamel. The dominant rods are primarily
the human tooth is very important for the design of artificial oriented so as to approach the outer tooth surface in an
dental crowns. approximately perpendicular orientation. This is in order
Human enamel contains on average 95% inorganic sub- to increase hardness and reduce wear. Interconnections
stance, 4% water and 1% organic substance by weight or 87% between rod and interrod, and complex cleavage planes
inorganic, 11% water and 2% organic component by volume limit critical crack size and uncontrolled crack propaga-
[63]. Hydroxyapatite substituted with carbonate and hydro- tion that would otherwise lead to premature fracture [73].
gen phosphate ions are the largest mineral constituent, The amount of anisotropy may not only reflect the balance
90—92% by volume. The remaining constituent is organic between wear and fracture resistance, but may also reflect
substance matter and water. a balance between differing vectors of functional stress as
Both enamel protein [64] and water [65] are more abun- well as the transfer of occlusal loads to the resilient sup-
dant in inner enamel close to the dentino-enamel junction. porting dentin [74]. Connections between adjacent rods via
Water in permanent enamel is in the form of free and the interrod region and the presence of interrod crystallites
bound water [66]. Free water refers to those components oriented in a plane different from the main rod direction
located in small spaces of enamel, while bound water means have been discerned in cross-sectional and long-sectional
those combined with peptide chains or crystal lattices. A scanning electron micrographs [75,76]. The variation of crys-
study with hydroxyapatite suggested that some of the water tal directions is the result of bio-fabrication process during
in enamel will be more firmly bound to the mineral [67]. the maturation of enamel, which is essential in shielding
Although it is only a minor part of enamel, water plays an the cracks. Rasmussen et al. [77] illustrated that fracture in
important role in enamel’s function, because dehydration enamel is anisotropic with respect to the orientation of the
changes the mechanical properties of enamel significantly enamel rods, with the work of fracture for fracture parallel
[68]. Water forms hydrogen-bond bridges across adjacent to the rods being 13 J/m2 but of the order of 200 J/m2 for
peptide chains and maintains functional conformation of fracture perpendicular to the rods; fractographs of enamel
protein remnants and collagen fibers in mature enamel [69]. showed that the enamel rods behaved as integral units dur-
Fox [70] proposed that the water fluid is essential in explain- ing controlled fracture. Xu et al. [78] illustrated that the
ing load-bearing behavior of enamel as, for instance, the cracks in the enamel axial section were significantly longer
‘‘stiff sponge’’ model, in which enamel was considered as a in the direction perpendicular to the occlusal surface than
stiff sponge from which liquid was expelled in compression parallel. The cracks propagating toward the dentino-enamel
and drawn in again when the load is released. junction were always arrested and unable to penetrate
The most organic substances are protein content, which dentin. The fracture toughness of enamel was not single-
changes dramatically during normal development ranging valued but varied by a factor of three as a function of enamel
from about 20% protein by weight during the secretory rod orientation. White et al. [76] found that enamel was
stage to 7% at the beginning of the maturation stages. Ulti- approximately three times tougher than geologic hydroxya-
mately, the ameloblasts remove almost the entire original patite demonstrating the critical importance of biological
matrix as mineralization progresses. As a result, fully devel- manufacturing. What is more, they suggested that enamel is
oped normal human enamel contains only ∼1% protein by a composite ceramic with the crystallites oriented in a com-
weight, which is the remnant component of the develop- plex three-dimensional continuum. Zhou and Hsiung [79]
ment matrix proteins [71]. The organic matrix in mature found that enamel demonstrated better resistance to pene-
enamel is a multi-component protein/peptide mix, which is tration. They indicated that the minor organic matrix does
lying between crystallites clearly and has the function of regulate the mechanical behavior of enamel significantly.
gluing hydroxyapatite crystallites together, thereby main- Although most of the enamel organic matrix is removed
taining the hierarchical structure of enamel. during mineralization and maturation, some protein,
Human enamel consists of ∼5 ␮m diameter rods encapsu- notably ameloblastin, is retained, primarily at the incisal
lated by ∼1 ␮m thick protein rich sheathes that are arranged edges and proximal sides of rod boundaries defining a rod
parallel in a direction perpendicular to the dentino-enamel sheath [75]. This prevents cracks from advancing straight
Dental prostheses mimic the natural enamel behavior 5

Figure 1 Models of biocomposites. (a) Perfectly staggered mineral inclusions embedded in protein matrix. (b) A tension—shear
chain model of biocomposites in which the tensile regions of protein are eliminated to emphasize the load transfer within the
composite structure. (c) The free body diagram of a mineral crystal.
From Ji and Gao [80].

through enamel to cause catastrophic macro-mechanical (E ∼ 20 GPa), allowing a smooth Young’s modulus transition
failure, but instead spreads the damage laterally and hence between the two structures (Fig. 2). Huang et al. [51] stud-
energy absorbed over a larger volume. Also, the presence ied the microstructure of the DEJ and they reported that
of minute quantities of protein remnants could allow lim- collagen fibrils from the dentin gather into coarse bun-
ited differential movement between adjacent rods. Limited dles and penetrate across the junction, anchoring into the
slippage could reduce stresses without crack growth. The enamel. The hydroxyapatite is continuous across the junc-
minor components of enamel, protein remnants and water, tion. The interface is not smooth, but instead is a series
have a profound plasticizing effect. As mentioned previ- of linked semi-circles, or scallops, that increase contact
ously, the protein matrix behaves like a soft wrap around the area, and thus the adhesion when DEJ serves as the bond-
mineral platelets and protects them from the peak stresses ing between dentin and enamel. It also resists cracks that
caused by the external load and homogenizes stress distribu- originate in enamel from penetrating into the dentin. Lin
tion within the composite structure. At the most elementary and Douglas [99] noticed that there was an extensive plastic
structure level, natural biocomposites exhibit a generic deformation, 8%, collateral to the fracture process in the
microstructure consisting of staggered mineral bricks. It was DEJ. Correspondingly, microscopic analysis revealed clear
proposed that under an applied tensile stress, the mineral evidence of crack-tip blunting and crack deflection. The
platelets carry the tensile load while the protein matrix parallel-oriented coarse collagen bundles at the DEJ may
transfers the load between mineral crystals via shear [80]. play a significant role in resisting the crack. Likewise, White
The strength of the protein phase in a biological material et al. [100] investigated the DEJ failure mechanisms by per-
is amplified by the large aspect ratio of mineral platelets. forming micro-indentation tests across the DEJ. Their results
Besides, the larger volume concentration of protein sig- exhibited that DEJ does not undergo catastrophic interfacial
nificantly reduces impact damage to the protein—mineral delamination and the damage was distributed over a broad
interface (Fig. 1). zone instead.
By comparison with dense hydroxyapatite material, Marshall et al. [92] and Fong et al. [93] used nanoinden-
White et al. [76] found that enamel was approximately tation tests to measure the Young’s modulus of the natural
three times tougher than geologic hydroxyapatite, which DEJ area. Their results showed that, within the DEJ region,
only demonstrates the critical importance of biological man- the Young’s modulus varies from ∼70 GPa for enamel to
ufacturing. The inorganic substances have been reported to ∼20 GPa for dentin. The fracture results [85] once again
vary from the outer enamel surface to dentino-enamel junc- demonstrated that it is extremely difficult to initiate cracks
tion. Many investigators reported that the mineral content in dentin at the DEJ, or to propagate cracks from enamel
[64,81] and the density [66] were decreased toward the to dentin across the DEJ. Featherstone et al. [102] and
dentino-enamel junction. Some studies on the mechanical Meredith et al. [103] reported that hardness and modulus
properties of human enamel are presented in Table 1. of elasticity were the highest at the outer surface of the
enamel and decreases toward the DEJ. He and Swain [104]
reported that inner enamel has lower stiffness and hard-
3. Microstructure and behavior of ness but higher creep and stress redistribution abilities than
dentino-enamel junction their outer counterpart. They attributed this observation to
the gradual compositional change throughout the enamel
Natural teeth are composed by layered structures, dentin from the outer region near the occlusal surface to the inner
and enamel, that are bonded by a functionally graded region near EDJ. The gradients in the elastic modulus of
dentino-enamel junction (DEJ) layer [97—99]. Marshall et al. tooth have been attributed to the distribution of the mineral
[92] stated the DEJ acts as a bridge between the hard brit- phase, while different toughening mechanisms in the natural
tle enamel (E ∼ 70 GPa) and the softer durable dentin layer tooth have been attributed to collagen microstructure and
6 A.A. Madfa, X.-G. Yue

Table 1 Some studies on the mechanical properties of the human dental enamel.

Author(s) Surface and site Hardness (GPa) Elastic modulus (GPa)

Stanford et al. [82] Variable (cusp) — 47.5

Cross section (side) 30.3
Top surface (occlusal) 8.96
Stanford et al. [83] Canine: —
Variable (cusp) 47.5 ± 5.5
Cross section (side) 33 ± 2.1
Variable (cusp) 20 ± 6.2
Molar:
Variable (cusp) 46.2 ± 4.8
Cross section (side) 32.4 ± 4.1
Top surface (side) 9.65 ± 3.45
Craig et al. [84] Top surface — 84.1 ± 6.2
Cross section 77.9 ± 54.8
Tyldesley [85] — — 131 ± 16
Reich et al. [86] Top surface — 76.5
Staines et al. [87] Top surface — 83 ± 8
Xu et al. [78] Top surface 3.23 ± 0.38 —
Cross section 3.03 ± 0.09
Cuy et al. [88] Cross section: 2.7—6.4 47—120
Outer enamel >6 >115
EDJ <3 <70
Zhou et al. [89] Top surface 5.7—3.6 104—70
Ge et al. [90] Top surface: 4.3 ± 0.8 83.4 ± 7.1
Rod 1.1 ± 0.3 39.5 ± 4.1
Interrod
Mahoney et al. [91] Cross section (primary molar) 4.9 ± 0.4 80.4 ± 7.7
Marshall et al. [92] Cross section (EDJ area) 3.51 ± 0.13 63.55 ± 1.46
Fong et al. [93] Top surface 4.78 ± 0.36 98.3 ± 5.9
Cross section 4.53 ± 0.26 95.6 ± 4.9
Habelitz et al. [94] Top surface 3.8 ± 0.31 87.5 ± 2.1
Cross section 3.3 ± 0.35 72.7 ± 4.4
Head of rod 4.3 ± 0.4 88.0 ± 8.6
Tail of rod 3.7 ± 0.4 80.3 ± 7.2
Interrod 3.9 ± 0.4 86.4 ± 11.7
Habelitz et al. [95] Cross section 3.2 ± 0.4 74 ± 4
3.7 ± 0.5 80 ± 9.1
Barbour et al. [96] Top surface 4.81 ± 0.15 99.6 ± 1.8
4.77 ± 0.13 101.9 ± 1.6
4.75 ± 0.12 105.2 ± 1.3

water content. They suggested that enamel can be regarded microstructural features of dental enamel are important to
as a functionally graded natural biocomposite. The natural understanding stress dissipation in the tooth, for developing
tooth is a remarkable example of nature’s ability to design biomimetic restorative materials and for the execution of
a complex and functional composite. clinical dental preparations.
In order to replace the mechanical function of tooth from
a restorative perspective, it is not only important to study its
localized tissue properties but also its bulk structural behav- 4. Bioinspired functionally graded approach
ior. Nonetheless, more research is necessary to comprehend
the mechanisms by which tooth structures resist functional Learning from nature, materials scientists increas-
forces in the mouth. Thus, the mechanical properties and ingly aim to engineer graded materials that are more
Dental prostheses mimic the natural enamel behavior 7

Figure 2 Elastic modulus distribution in natural dentino-enamel junction.

From Marshall et al. [92] and Huang et al. [51].

Although the efficacy of FGMs has been recognized since

the early 1970s [114], the field of FGM did not take off until
the mid-1980s, probably due to a lack of suitable fabrica-
tion methods until that time. This concept has been later
expanded for different application such as coatings, pack-
ing, optical, biomedical, etc. In the biomedical field, several
approaches have been used to develop functionally graded
biomaterials for implants [115—120].
With established methods currently available to syn-
thesize and process materials, gradations in composition,
structure, and properties could be engineered over a
wide range of length scales ranging from nanometers to
meters. There are a wide range of process technolo-
gies that are now available for fabrication FGMs such as
powder metallurgical process [121], layer stacking [56],
glass infiltration [122], centrifugation [123], electrophoretic
deposition [124], plasma spray [125], direct-write assembly
[126] and rapid prototype color ink-jet printing [127].
Figure 3 Morphology of the graded zone. (a) Schematic of
graded structure. (b) Section view of graded zone of glass- 5. Dental prostheses mimic the
infiltrated yttria stabilized zirconia. dentino-enamel junction behavior
From Zhang et al. [108].

Among the previously mentioned processing methods, the

glass infiltration technology is particularly suitable for the
damage-resistant than their conventional homogeneous fabrication of all-ceramic restorations [128]. It combines an
counterparts. This is particularly important at surfaces or esthetic, low modulus, and low hardness glass ‘‘veneer’’
at interfaces between dissimilar materials, where contact with a high strength ceramic ‘‘core’’, without a sharp
failure commonly occurs. Therefore, many engineered interface between the materials (Fig. 4). The lack of inter-
materials are graded in some manner, but functionally face due to grading improves interfacial bond strengths,
graded materials (FGMs) are often characterized by a reduces residual stresses, and eliminates delaminations. The
gradient purposefully formed using compositional or processing of these structures is simple and straightfor-
microstructural design. FGM is a material with engineered ward, and can be readily adapted to CAD/CAM technology
gradients of composition, structure and/or specific proper- [128,130,131].
ties aiming to become superior over homogeneous material
composed of same or similar constituents [105—108]. The
aim of producing FGM is to obtain a material with two 5.1. Graded glass-zirconia structures
different characteristics in its two opposite faces, Fig. 3.
The properties of this innovative FGM can mimic the natural Glass-zirconia structures with gradual elastic modulus may
gradients occur, including a graded elastic modulus in be created by using infiltration method [128]. Comparing to
hard tissues such as the human enamel and dentin—enamel the sintering temperature of zirconia, zirconia templates
junction [109]. This novel technology is designed to improve with somewhat low heat-treatment temperature are used
the performance of the materials [110—113]. for combining glass infiltration and zirconia densification
8 A.A. Madfa, X.-G. Yue

Figure 4 Schematic of the conventional sharp restoration and the new graded approach.
From Henriques [129].

into a single process [128,132]. This way the glass infiltra- 5.2. Graded glass-alumina structures
tion depth can be tailored by manipulating the porosity
of the zirconia templates. Therefore, the grain growth Glass-alumina graded structures may be produced by infil-
and/or destabilizing of the tetragonal zirconia phase [133] trating dense alumina surfaces with silica-based glasses
associated with the post-sintering heat-treatment can [130,134,135]. Following a power-law relationship, the tran-
be prevented. As coefficient of thermal expansion and sition of elastic modulus from the graded glass-alumina
Poisson’s ratio of the infiltrating glass and zirconia (3Y-TZP) surface to the alumina core is continuous [136,137]. The
are relatively the same, no significant long-range thermal resultant structure consists of a thin, outer surface resid-
stresses are developed in the graded structure [134]. The ual glass layer followed by a graded glass-alumina layer,
resultant structure consists of a thin, outer surface residual sandwiching a dense alumina core (Fig. 5).
glass layer followed by a graded glass-zirconia layer at both Inspired by the microstructure and mechanical proper-
the top and bottom surfaces (Fig. 5). ties of natural teeth, synthetic functionally graded materials

Figure 5 Cross-sectional view of a graded glass-alumina in (a) and graded glass-zirconia structure (b), respectively.
From Zhang et al. [137].
Dental prostheses mimic the natural enamel behavior 9

were proposed to mimic the DEJ. Francis et al. [62] on the resistance to contact damage. They demonstrated
described a procedure to produce a DEJ-like interface and that veneer failure and bulk fracture may be substantially
enamel coating involved depositing slurries of oxide or glass mitigated by controlled gradients of elastic modulus within
powder by a draw-down blade method, drying at then higher the restoration layer. Such graded structures exhibit sig-
temperature heating. They used alumina-glass or alumina- nificantly higher resistance to fatigue sliding-contact and
polymer composite to mimic the dentin and a calcium flexural damage relative to veneered and monolithic core
phosphate-based coating to mimic the enamel. Bonding ceramics. This is because the gradient diminishes the inten-
between the two materials was accomplished by a eutectic sity of tensile stresses and simultaneously transfers these
melt in the CaO—Al2 O3 —SiO2 system. The interpenetration stresses from the layer surface into the interior, away from
in this DEJ-like interface originates from a solidified melt the source of failure-inducing surface flaws [128,130—141].
phase penetrating into the dentin. Huang et al. [51] added
bioinspired FGM layer between the dental ceramic and the
dental cement and investigated the effects of the func- 6. Clinical implications
tionally graded layer on the stress in the crown and its
surrounding structures. From their results, the functionally In clinical applications, these graded alumina materials can
graded layer was shown to promote significant stress reduc- be used as monolithic crowns and bridges. Although the
tion and improvements in the critical crack size. From their graded alumina has limited translucency, the external glass
study, they concluded that the low stress concentrations layer and the graded glass-alumina layer provide neces-
were associated with the graded distributions in the DEJ. sary shade options. In addition, color stains can be applied
This provided new insights into the design of functionally to the surface of the external glass layer using powdered
graded crown architecture that can increase the durabil- glass slurry that has similar composition to the infiltrated
ity of future dental restorations. Rahbar and Soboyejo [54] glass. This staining technique has been used on the Empress
used computational and experimental effort to develop system to improve the esthetic outcome of a single color
crack-resistant multilayered crowns that are inspired by the pressed block of glass ceramic and is well established in
functionally graded DEJ structure. The computed stress dis- esthetic dentistry [146—148]. Also, the cementation surface
tributions showed that the highest stress was concentrated of graded restorations can be etched with hydrofluoric acid
at the ceramic outer layer of crown and reduced signifi- and silanized to facilitate a resin—cement bond.
cantly toward the DEJ when bioinspired functionally graded Use of zirconia in crowns and bridges has increased
architecture was used. They reported that the bioinspired over recent years, owing to esthetic and biocompatibility
functionally graded layers were also shown to promote demands. However, the fact remains that porcelain-
improvements in the critical crack size. Suresh [122] estab- veneered zirconia restorations suffer unexpectedly high
lished that controlled gradients in mechanical properties chipping rates, regardless of the manufacturer [149—153].
offer unprecedented opportunities for the design of surfaces Additionally, dental crowns generate over $2 billion in rev-
with resistance to contact deformation and damage that enues each year, with 20% of crowns being all ceramic
cannot be realized in conventional homogeneous materials. units [39]. Also, aging populations will drive the demand
Graded dental restorations have been shown to display for all types of dental restorations even higher [34]. If these
improved features relative to conventional ones, namely chipping rates could be reduced, zirconia-based all-ceramic
higher resistance to contact and sliding [122,138,139]; prostheses would become more widely used, addressing a
higher adhesion of porcelain to the substructure (metal quality of life issue [154]. A great demand for the devel-
or ceramic) [140—142]; improved esthetical properties and opment of improved dental crowns has been stimulated by
improved behavior under fatigue conditions [142]. Another the large and ever growing market of the dental crowns
important point to which the FGM design can address is [155].
the reduction of thermal residual stresses that remains Graded glass-zirconia structures offer a simple rem-
at the metal—ceramic interface during the cooling cycles edy. Zirconia cores are, however, only a portion of the
after the porcelain firing. These stresses are further mag- all-ceramic restoration. Alternative monolithic graded glass-
nified when there is a significant difference between the zirconia restorations are recommended without porcelain
thermal expansion behavior of the metal and the porce- veneer, which could be successfully and economically used in
lain. Depending on the thermal residual stress level that posterior applications. These restorations are suggested to
remains in the crown and together with those arising from eliminate the vulnerable porcelain veneer, while providing
occlusal loads, a catastrophic failure of the restoration can superior strength and esthetics. The color characterization
occur. FGMs have been shown to decrease significantly the of these graded glass-zirconia restorations is achieved by
thermal residual stresses formed at the interface between external residual glass and subsequent staining. Therefore,
metals and ceramics in other fields of applications [143]. many studies developed a straightforward protocol for fab-
Some studies demonstrated that when the contact surface ricating anatomically correct zirconia crowns and bridges
of alumina or silicon nitride was infiltrated with aluminosil- with graded surfaces [136—144]. These findings found that
icate or oxynitride glass, respectively, they noticed that restorations made from graded glass-zirconia are orders
the graded glass/ceramic surfaces produced in this manner of magnitude more resistant to sliding-contact damage
offered much better resistance to contact damage with and than the current porcelain-veneered zirconia systems. The
without a sliding action than either constituent ceramic or graded layer also enhances the flexural fracture resistance
glass [136,144,145]. of zirconia, allowing the utilization of thinner restorations
A number of the studies investigated the effects of for highly conservative restorative protocols that preserve
increasing elasticity as a function of depth from the surface tooth structure. Additionally, the cementation surface of
10 A.A. Madfa, X.-G. Yue

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