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Received: 11 December 2017 | Accepted: 22 January 2018

DOI: 10.1111/jerd.12370

REVIEW ARTICLE

A literature review on the new polymer-infiltrated


ceramic-network material (PICN)

lia Cadorim Facenda DDS, MS | Marcia Borba DDS, PhD |


Ju
Pedro Henrique Corazza DDS, MS, PhD

Post-graduation Program in Dentistry,


Dental School, University of Passo Fundo,
Abstract
Passo Fundo, Brazil
Objectives: Ceramics and composites are the most used materials for dental application. Recently,
Correspondence the characteristics of both were combined on the called “polymer-infiltrated ceramic-network”
Pedro Henrique Corazza, Post-graduation (PICN). The aim of this review is to report the behavior of PICN, comparing the findings that may
Program in Dentistry, Dental School, support the correct clinical application.
University of Passo Fundo., Campus I,
BR 285, Km 171, Passo Fundo 99001-970, Overview: The PICN material is a structure with a sintered ceramic matrix infiltrated with a
Brazil polymer matrix. Studies evaluated this material microstructure and composition, mechanical
Email: pedrocorazza@yahoo.com.br
properties and adhesive behavior. The most cited mechanical properties are flexural strength,
compressive strength, elastic modulus, Weibull modulus, hardness, fracture toughness and
fatigue resistance. Most studies compared PICN with feldspathic porcelain, lithium disilicate
glass–ceramic, lithium silicate, zirconia-reinforced glass–ceramic, leucite reinforced glass–
ceramic, polycrystalline alumina and zirconia. Other studies evaluated a similar material (a
nanoceramic resin).

Clinical Significance
The mechanical properties of the PICN are equivalent to the properties of nanoceramic resins,
lower to lithium disilicate glass ceramic and superior to feldspathic porcelain. Yet, the findings sug-
gest a highly resistant material to degradation at low loads (close to physiological situation) when
cemented on a substrate.

1 | INTRODUCTION esthetic and wear resistance compared with ceramics.4 Stronger


ceramics with high crystalline content are more opaque than vitre-
Resin composites and ceramics are the most used materials to pro- ous ceramics, such as porcelains.5 However, the low KIC and high
duce dental restorations. The first, resin composite, is basically con- susceptibility to slow crack growth of the porcelains limit their clini-
stituted by an organic matrix reinforced with inorganic filler cal application.3
1,2
particles. The amount of filler particles is directly related to the For optimizing the performance of these restorative materials,
2
Young’s modulus and hardness of the material. On the other hand, ceramics and resin composites were combined in a single material by a
the polymerization shrinkage is determined by the monomers of the manufacturer. This fact seems to be a good alternative to associate the
matrix, and the most common are Bis-GMA, UDMA, UTMA, and Bis- elastic modulus of resin composite, which is similar to the dentin, with
1
EMA. Development of filler technology has resulted in considerable the long-term esthetic stability of ceramics.4 This material, called
improvements on the resin composite properties. However, the 2
“polymer-infiltrated ceramic-network (PICN)” was recently introduced
clinical performance of direct resin composites is still inferior to the and called a hybrid material. Thus, PICN consists of a structure with a
indirect ceramic restorations considering marginal adaptation, color sintered ceramic matrix (86% in weight) infiltrated with a polymer
match and anatomic shape.3 Besides, the comparison between indi- matrix (14% in weight).6 The indications are: minimally invasive restora-
rect ceramics and indirect composites, both manufactured in a CAD- tions and posterior crowns, veneers, inlays and onlays for posterior
CAM, revealed that indirect composite restorations have inferior teeth and implant-supported crowns.7

J Esthet Restor Dent. 2018;1–6. wileyonlinelibrary.com/journal/jerd V


C 2018 Wiley Periodicals, Inc. | 1
2 | FACENDA ET AL.

2 | COMPOSITION mentioned study Coldea et al.,6 where the greatest values were found
in the groups Y-TZP and lithium disilicate glass–ceramic.11,13,15 How-
The composition and microstructure of dental materials rules their ever, the PICN showed the greatest Weibull modulus among the mate-
mechanical and physical properties. Especially for ceramics, the micro- rials (19.7), suggesting high structure reliability.
structure depends on the sintering and significantly influences the Other mechanical properties of PICN such as fracture toughness,
coefficient of thermal expansion, resistance values, chemical solubility, edge chipping resistance, and surface damage tolerance were also eval-
translucency and optical appearance.5 Compositional analysis of PICN uated and compared with other dental ceramics.12,14 Fracture tough-
showed a dominant ceramic-network with leucite as the major phase ness is one of the main properties associated with the clinical
and zirconia as a minor phase interconnected with a polymer-based performance of dental materials. This mechanical property is an indica-
network. A large amount of carbon was found in the polymer phase. tion of the stress required to propagate a preexisting flaw, resulting in
Some microcracks were observed between the phases of the the catastrophic fracture. Della Bona et al.4 evaluated fracture tough-
material.4,8,9 ness of PICN by single edge V-notch beam (SEVNB) method (ISO
6872) and the mean value obtained was 1.09 MPa冑m. Another study
Coldea et al.,15 which compared fracture toughness of PICN with other
3 | MECHANICAL AND ADHESIVE
PROPERTIES ceramic materials, showed values of 1.51 MPa冑m for PICN, 1 MPa冑m
for feldspathic porcelains (Mark II and VM9), 3.73 MPa冑m for glass-
Because PICN is a heterogeneous material, it can be displaced (condi- infiltrated alumina-based ceramic, 2.37 MPa冑m for lithium disilicate
tion known as phase separation) during compression and flexure.6 glass–ceramic, and 4.94 MPa冑m for Y-TZP.
The advantages of PICN for the patient are similar to those of resin Homaei et al.16 evaluated the fracture toughness and Vicker hard-
composites, such as less abrasion in opposing teeth surfaces, possibility ness of restorative materials, which were measured by SEVNB and
of material repair and chemical compatibility with adhesive resin microindentation methods, respectively. The mean values of fracture
cements. 7
In a laboratory study, 10
PICN showed similar flexural toughness and Vickers hardness were 6.6 MPa冑m and 1641.7 Hv for

strength values to dentin tissue, but lower compressive strength Y-TZP, 2.8 MPa冑m and 676.7 Hv for lithium disilicate glass–ceramic

values. and 1.4 MPa冑m and 261.7 Hv for PICN. These results, similarly to Col-
dea et al.,15 showed better mechanical properties for Y-TZP.
Considering edge chipping resistance, Argyrou et al.12 compared
3.1 | Mechanical properties
PICN material with other restorative materials (nanoceramic resin, feld-
Evidences on the mechanical properties of PICN and their comparisons spathic porcelain and leucite reinforced glass–ceramic). All restorative
with other restorative materials are controversial, mostly when flexural materials were cemented to a composite resin substrate and the edge
strength was evaluated.11-14 chippings were produced using a diamond indenter. The results
According to Albero et al.11 3-point flexural strength values of showed the greatest value for nanoceramic resin (275 N/mm), followed
PICN (Vita Enamic: 180.9 MPa) were similar to the values obtained by a by feldspathic porcelain (179 N/mm) and leucite reinforced glass–
nanoceramic resin (Lava Ultimate: 164.3 MPa). However, PICN showed ceramic (169 N/mm), with no statistical difference between them. The
lower values compared with lithium disilicate glass–ceramic (IPS e.max: lowest value of edge chipping resistance was found for PICN (120 N/
271.6 MPa) and greater values than feldspathic porcelain (Mark II: mm).12
13 12,13
137.8 MPa). Other studies showed greater 3-point flexural Coldea et al.15 evaluated damage tolerance of some materials by
strength values for the nanoceramic resin when compared with PICN. Vickers indentation. Two experimental PICN1 and PICN2 were tested
Argyrou et al.12 showed no statistical difference between the mean val- and seven Vickers indentation loads (1.96, 4.9, 9.81, 19.61, 29.42,
ues of the nanoceramic resin (170 MPa) and a leucite reinforced glass– 49.03, and 98.07 N) were applied for each bending bar. Before the
ceramic (159 MPa), both presenting greater values compared with PICN test, the initial flexure strength was obtained. As result, the flexure
(124 MPa) and feldspathic ceramic (120 MPa). Choi et al.13 also found strength of the materials decreased with the increase of the indenta-
greater values of 3-point flexural strength for the nanoceramic resin tion load. The material with the highest strength degradation (81%) at
(159.1 MPa) when compared with PICN (140.1 MPa). an applied load of 98.07 N was Y-TZP, followed by VM9 porcelain
Coldea et al.15 compared the PICN material with different classes (77%), lithium disilicate glass–ceramic (72%), Mark II porcelain (64%),
of ceramics. They obtained the greatest values of 3-point flexural PICN1 (62%), glass-infiltrated alumina-based ceramic (56%) and
strength for the yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) PICN2 (51%). PICN2 showed the lowest strength degradation. PICN 2
(1358 MPa), followed by glass-infiltrated alumina-based ceramic (402 and glass-infiltrated alumina-based ceramic maintained their intrinsic
MPa), lithium disilicate glass–ceramic (344 MPa), PICN (158 MPa) and flexural strength until a Vickers indentation load of 4.9 N. The initial
feldspathic porcelains (Mark II: 137 MPa and VM9: 121 MPa). strength of all other materials decreased significantly at the minimum
Three-point flexural strength followed by Weibull analysis were indentation load of 1.96 N. PICN2 showed higher damage tolerance
evaluated by Homaei et al.16 The flexural strength values were 886.9 to indentation than lithium disilicate glass–ceramic. Thus, introduced
MPa for Y-TZP, 356.7 MPa for lithium disilicate glass–ceramic and flaws by grinding adjustment or chewing are expected to have lower
135.8 MPa for PICN. These results were similar than the previous impact on the strength of PICN 2.
FACENDA ET AL. | 3

TA BL E 1 Properties of the material and their corresponding values and/or range of values, according to the literature

Properties Values References

Flexural strength (3-point bending) 213.1 (659.9) MPa Petrini et al.7

Flexural strength (3-point bending) 124 Mpa Argyrou et al.12

Compressive strength of implant-supported crowns 2386–1935 N Kok et al.18

Compressive strength of zirconia implant-supported crowns 0.22–0.26 kN Homaei et al.16

Weibull modulus 4.99 Swain et al.9

Weibull modulus 19.7 Homaei et al.16

Elastic modulus 27.26 GPa Argyrou et al.12

Elastic modulus 37.95 6 0.34 GPa Della Bona et al.4

Vickers hardness 1,70 GPa Albero et al.11

Vickers hardness 261.7 Hv Homaei et al.16

Fracture toughness 1.4 MPa m1/2 Homaei et al.16

Fracture toughness 1.09 6 0.05 MPa m1/2 Della Bona et al.4

Density 2.09 6 0.01 g/cm3 Della Bona et al.4

Fatigue resistance of crowns: load 198 N/1.2 millions of cycles 1.6 Hz No crowns failed Swain et al.9

Coldea et al.14 simulated CAD/CAM milling and adjustments pro- nanoceramic resin showed the greatest values of fracture load, when
cedures (grinding with diamond burs) performed by clinicians and tech- compared with Mark II porcelain and 2 types of glass–ceramics (Celtra
nicians, and related it to the damage tolerance of indirect materials. Duo and Empress CAD). The luting agents had no influence on the
Among the materials tested, only yttria-stabilized tetragonal zirconia crowns fracture load. Therefore, the compressive strength of PICN
polycrystal did not show strength degradation after grinding proce- cemented on titanium implant abutments followed the trend of flexural
dures. The initial strength of all tested materials, except Y-TZP, signifi- strength of the material, previously mentioned,11,13 that is, the material
cantly decreased after coarse, medium and extra fine diamond bur has superior mechanical properties compared with feldspathic
adjustments in both, transversal and longitudinal grinding directions. porcelain.
The greatest strength degradation was obtained for lithium disilicate Kok et al.18 evaluated mechanical performance of implant-
glass–ceramic after adjustments with diamond bur in the transversal supported posterior crowns cemented to abutments. The greatest val-
direction. In contrast, the lowest strength degradation values were ues were obtained for Y-TZP (Lava Plus: 6065 N), followed by lithium

obtained for PICN and feldspathic porcelain. PICN appears to exhibit disilicate glass–ceramic (IPS e.max: 2788 N) and hybrid materials (Pro-

the most damage tolerant behavior among the materials (except Y- temp, Telio CAD, Lava Ultimate and PICN Enamic: from 1935 N to

TZP), which can be associated with the polymer matrix. 2386 N). All restorative materials showed compressive load above the

The hardness of PICN was also compared with other materials. masticatory force of healthy young adults.
11
According to Albero et al. the greatest values of hardness were
obtained for lithium disilicate glass–ceramic (5.83 GPa), followed by 3.3 | Fatigue resistance
leucite-reinforced glass–ceramic (4.60 GPa) and feldspathic porcelain Aboushelib and Elsafi19 evaluated the influence of cyclic fatigue on a
(3.46 GPa). PICN and nanoceramic resin showed the lowest values PICN, a nanoceramic resin and three full ceramic crowns (leucite rein-
(1.70 GPa and 1.15 GPa, respectively), similar to dental tissues. The forced glass-ceramic, lithium disilicate glass-ceramic and a veneered
main properties of the material and their corresponding values and/or zirconia structure). The anatomically shaped crowns were cemented
range of values are shown in the Table 1. onto a resin substrate. Initial fracture load of half of the samples was
obtained using a compressive load until the initial crack. The other half
was subjected to 3.7 million chewing cycles (load range 50–200 N at 3
3.2 | Fracture load of restorations cemented on
Hz). A significant reduction of the initial fracture load was found after
implant abutments
cycling. Zirconia showed the highest fracture load degradation (34%),
According to the manufacturer, PICN material is also indicated to pro- followed by leucite (32.2%) and lithium disilicate glass–ceramic (27.1%).
duce implant-supported crowns. Thus, the fracture load of implant- Nano-ceramic resin (15.99%) and PICN (15.75%) showed the lowest
supported crowns made with PICN (and other indirect materials) fracture load degradation. None of the tested zirconia restorations frac-
cemented with seven different luting agents was evaluated Weyhrauch tured during cycling. However, chipping of the veneer ceramic was
17
et al. Lithium silicate zirconia-reinforced glass–ceramic, PICN and observed in 6 specimens. The lowest failure rate during cycling was for
4 | FACENDA ET AL.

lithium disilicate glass–ceramic crowns: 3 cases of minor chipping and 2 the effects of different surface treatments on the microtensile bond
fractures. Mechanical strength of PICN material was the least affected strength between resin cement and the hybrid material. Three treat-
by mechanical aging. This can be explained by the damage tolerance ments were tested: etching with 10% hydrofluoric acid for 60 seconds,
against propagation of cracks and the lower brittleness. Thus, the elas- etching with 37% phosphoric acid for 60 seconds and air abrasion with
tic deformation against a cyclic load seems to be positive for the mate- silica-coated alumina particles. After the surface treatments, all samples
rial mechanical behavior. were silanized and cemented to composite resin blocks. Half specimens
Promising strength results for PICN after cyclic fatigue were also were aged by thermocycling. Irrespectively of surface treatment, non-
found by Swain et al.9 Crowns made with different materials were aged samples showed the greatest microtensile bond strength values.
cemented to composite resin dies and loaded to failure after mechani- After aging process, only the group HA remained with the highest
cal aging (98 N, 1.2 millions cycles, 1.6 Hz). None of the PICN crowns bond strength values, which showed the bond stability of the group
failed during mechanical cycling. However, 6 crowns of lithium disili- HA. Comparing the bond strength of PICN with other restorative mate-
cate glass–ceramic presented minor cracks and twelve feldspathic por- rials, Hu et al.23 found that PICN had similar performance to feldspathic
celain crowns had significant cracks during aging. The wear generated porcelain (Vita Mark II) when shear bond strength test was applied.
on the PICN surface by the piston was greater than for the other However, the bond with the resin cement of the lithium silicate
ceramics. This is justified by the low elastic modulus and hardness of zirconia-reinforced glass–ceramic was superior to PICN and feldspathic
the material, which probably promote good tolerance for the contact porcelain. Thus, different surface treatment might be used for PICN.
with the opposing tooth. Although the air abrasion did not provide the best bond results on the
Different results were found by Homaei et al.16 and Homaei study of Campos et al.,22 another study24 found high-surface rough-
20
et al. about the fatigue resistance of PICN. These studies showed ness with this treatment, which suggests high micro retention.
lower values of fatigue resistance of PICN when compared with lithium Cekic-Nagas et al.25 evaluated the effect of hydrofluoric acid treat-
disilicate glass–ceramic. Homaei et al.16 evaluated the mechanical prop- ment on the micro-shear bond strength of 3 resin cements to 3 differ-
erties and fatigue behavior of crowns cemented to extracted human ent hybrid materials. 1.5-mm thickness samples of PICN (Vita Enamic),
bicuspids. The initial load for fatigue was 500 N, followed by a gradual nano-ceramic resin (Lava Ultimate) and nano-ceramic (Cerasmart) were
increase of 100 N per 100,000 cycles until the fracture, or until the divided into 2 groups, according to the surface treatment: wet-ground
limit of one million cycles. At the end of the fatigue, 70% of lithium dis- with silicon carbide abrasive papers or etching with hydrofluoric acid.
ilicate glass–ceramic crowns survived, while the survival rate of PICN Half of the samples were submitted to thermocycling. Restorative
was 0%. The mean failure load was 1400 N (904 728 cycles) for lithium material, cement, and storage condition showed significant effects on
disilicate glass–ceramic and 870 N (378 167 cycles) for PICN. Failures bond strength values. Hydrofluoric acid had no effect on bond strength
initiated from the contact point or central fossa. The other study20 values. PICN had the greatest mean bond strength values to resin
evaluated geometric bars in 3-point flexural strength. The fatigue limit cement (8.7 MPa) when compared with nano-ceramic (Cerasmart: 7.6
for one million cycles of zirconia (Cercon), lithium disilicate glass–
MPa) and nano-ceramic resin (Lava Ultimate: 7.2 MPa). PICN material
ceramic (IPS e.max CAD) and PICN (Enamic) were estimated, resulting
showed more surface irregularities than the other restorative materials.
in 500.1, 168.4, and 73.8 GPa, respectively.
Treatment with hydrofluoric acid had no effect on bond strength val-
El Zhawi et al.21 evaluated the fatigue strength and wear behavior
ues and thermocycling significantly decreased the bond strength values
of the PICN material (crown shape) cemented on a composite resin die
of resin cements to all materials, findings which do not agree with the
(Z 100). The specimens were submitted to 2 types of fatigue: acceler-
previous mentioned study.23
ated sliding-contact step-stress, and long-term sliding-contact with
Flury et al.26 investigated the bond strength by the shear test with
load of 200 N. Only 3 out of the 24 PICN crowns fractured after cyclic
the dentin of 2 hybrid materials (nanoceramic resin and PICN) with five
loading up to 1700 N. Contact damage was observed on the survived
resin cements after 24 hours and 6 months of storage. RelyX Ultimate,
crowns. PICN crowns showed good resistance to fracture and wear
Panavia F2.0, Variolink II, Allcem, and Ketac Cem Plus. The bond
after sliding contact fatigue.
strength was higher when the nanoceramic resin was cemented with
Although there are few studies on fatigue of PICN, the findings
Relyx Ultimate, and the PICN was cemented with RelyX Ultimate and
suggest a highly resistant material to degradation at low loads (close to
Variolink II.
physiological situation), up to 200 N, when cemented on a substrate.
The load increase (above 500 N) seems to favor other materials such as
4 | SURFACE ROUGHNESS
lithium disilicate and zirconia.

Surface roughness of different materials after milling by CAD/CAM


3.4 | Bond strength
were compared.26 Among ceramic, PICN and resin composites, the
The success of indirect restorations depends on the adhesion between rougher material was resin composite, followed by PICN and feld-
the material and the tooth structure. Etching with conventional 5% spathic porcelain. The polymer matrix of PICN (Enamic), which is the
hydrofluoric acid for 60 seconds is the surface treatment method rec- weakest component, is easily separated from the ceramic phase pro-
22
ommended by the manufacturer of PICN. Campos et al. evaluated ducing high roughness values. Della Bona et al.4 observed microcracks
FACENDA ET AL. | 5

between the phases of the material in SEM images with 20,0003 of DIS CLOSUR E
magnification. These phases displacement may increase the surface The author does not have any financial interest in any of the compa-
roughness over the time and affect the optical properties.27 nies whose products are included in this article.
Surface roughness is directly related to the optical properties of

the materials. Ozarslan et al.28 showed different values of surface
ORC ID
roughness and color changes when different finishing procedures were
performed on PICN. The manufacturer of PICN (Vita) suggests 3 differ- Pedro Henrique Corazza DDS, MS, PhD http://orcid.org/0000-0001-

ent finishing and polishing procedures (Technical Kit, Clinical Kit and 9480-1607

VITA Enamic Glaze), which were tested. The specimens were divided
into 8 groups according to the translucency (translucency and high R EFE R ENC E S
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can cause better performance of the PICN material.28
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