The Influence of Polishing on the Mechanical Properties of Zirconia-A Systematic Review

Purpose: To systematically review studies that investigated the consequences of various polishing protocols on the mechanical properties of zirconia. The effects on the roughness and crystalline phase transformation were also evaluated. Materials and methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed. The electronic searches were conducted via OVID MEDLINE (R) and Scopus for publications between 1996 and August 2022. The search strategy was limited to full texts in the English language and in vitro studies. The influences on flexural strength, hardness, fracture strength, fracture toughness, wear resistance, roughness and phase transformation were collected. Various methodologies to measure these properties were also outlined and compared. The risk of bias for included studies was evaluated according to a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Results: After removing duplicates, the systematic search identified a total of 419 studies. Nineteen studies satisfied the inclusion criteria and were selected for final analysis. Fifteen of the included studies observed the changes in surface roughness along with the mechanical properties and ten studies detected the tetragonal (T) to monoclinic (M) phase transformation. Eight studies also investigated the change in properties after polishing the ground surface. Testing parameters were not consistent among studies due to the varying methods. Conclusions: To a certain extent, polishing influences the strength, hardness, toughness and wear resistance. The damage in some mechanical properties, as well as the roughened surface, from grinding can be restored via an appropriate polishing treatment. The polishing process itself barely induces the transition from the tetragonal to monoclinic phase of zirconia, while this commonly occurs after grinding. If the subsequent polishing is adequate, the transformed monoclinic phase can be eliminated with the removal of the outermost surface layer. In dentistry, polishing is an imperative step to maintain the superior functions and service life of zirconia for patients.