Abstract
Background: To overcome the esthetic limitations of dental monolithic zirconia restorations, multichromatic systems were developed to combine improved structural integrity with a natural shade gradient that mimics the optical properties of natural teeth. In response to the clinical demand for time-efficient, i.e., chairside fabrication of zirconia restorations, rapid sintering protocols have become necessary to adjust clinical efficiency along with material performance. This study addresses the challenges of a rapid sintering protocol related to optical performance and phase transformation of the final restoration and the zirconia-cell interaction. Methods: The influence of a rapid sintering protocol on the color stability of the final dental restoration was evaluated by the CIE L*a*b* color space. Phase transformation was assessed through X-ray diffraction analysis. Cellular behavior was evaluated by measuring wettability, the material's surface energy, and a cell mitochondrial activity assay on human gingival fibroblasts. Results: Optical measurements demonstrated that the total color change in all layers after rapid sintering was above the perceptibility threshold (ΔE* > 1.2), while only the polished enamel layer (ΔE* = 3.01) exceeded the acceptability threshold (ΔE* > 2.7), resulting in a clinically perceptible mismatch. Results of X-ray diffraction analysis, performed for fixed occupancy at Z(0.935)Y(0.065)O(0.984), revealed that rapid sintering caused a decrease in the cubic (C-) phase and an increase in the total amount of tetragonal (T-) phases. Conventionally sintered zirconia consists of 54% tetragonal (T-) and 46% cubic (C-) phase, whereas in the speed-sintered specimens, an additional T1 phase was detected (T = 49%; T1 = 27%), along with a reduced cubic fraction (C = 24%). Additionally, a small amount of the monoclinic (M) phase is noticed. Although glazing as a surface finishing procedure resulted in increased hydrophilicity, both polished and glazed surface-treated specimens showed statistically comparable cell adhesion and proliferation (p > 0.05). Conclusions: Rapid sintering induced perceptible color changes only in the enamel layer of multichromatic zirconia, suggesting that even layer-specific alterations may have an impact on the overall esthetic outcome of the final prosthetic restoration. Five times higher heating and cooling rates caused difficulty in reaching equilibrium, leading to changes in lattice parameters and the formation of the metastable T1 phase.