Does Luting Strategy Affect the Fatigue Behavior of Bonded Y-TZP Ceramic?

Purpose: To evaluate the effect of different luting strategies on the fatigue failure load (FFL) and stress distribution of Y-TZP disks luted to epoxy resin substrate. Materials and Methods: Y-TZP disks (diameter = 10 mm; thickness = 0.7 mm) were assigned to five groups according to the luting strategy (n = 15): CC: no zirconia surface treatment, composite cement; G_CC: application of a thin glaze layer on zirconia followed by hydrofluoric acid etching and silanization, composite cement; Al_CC: air abrasion of the zirconia surface with 125-µm Al2O3 particles, composite cement; Si_CC: tribochemical silica coating (30-µm SiO2 particles), composite cement; ZP: air abrasion of the zirconia surface with 125-µm Al2O3 particles, zinc-phosphate cement. The disks were luted to the epoxy resin substrate. The FFL was evaluated by the step-test method. The load was applied in stages of 10,000 cycles, starting with 600 N, followed by increments of 200 N. Samples were loaded until fracture or to a maximum of 100,000 cycles. FFL data were submitted to Kaplan-Meier (α = 0.05) and Weibull analyses. Conditions simulating a strong and a weak bond between Y-TZP and epoxy resin were evaluated in the finite element analysis (FEA). Results: Luting strategy influenced the FFL (p 0.001) and the stress distribution of Y-TZP disks. Al_CC (2227 ± 149 N) and Si_CC (2133 ± 235 N) showed the highest FFL values, followed by CC (1800 ± 293 N) and G_CC (1280 ± 147 N), while ZP showed the lowest FFL value (680 ± 101 N). The highest Weibull modulus occurred in Al_CC (18.2). A strong bond reduced the tensile stress concentration in the Y-TZP luting surface, while a weak bond between Y-TZP and the epoxy resin favored the concentration of tensile stresses. Conclusion: Air abrasion with aluminum oxide and silica-coated alumina particles improves the FFL of bonded Y-TZP. Zinc-phosphate cement should be used very carefully in the cementation of zirconia restorations, since it results in lower values of FFL than composite cements. Keywords: fatigue, zirconia, surface treatment, cementation technique, survival analysis, Weibull