Effect of preparation design on fracture resistance of molars restored with occlusal veneers of different CAD-CAM materials: an in vitro study.

BACKGROUND: Occlusal veneer had been evaluated for mechanical properties using lithium disillicate. However, studies evaluating the mechanical properties of occlusal veneer with different preparation designs and ceramic materials are lacking. So, this in vitro study aimed to evaluate the fracture resistance of occlusal veneers with two designs fabricated from two different ceramic materials. MATERIAL AND METHODS: Fourty mandibular third molars were distributed to 2 groups (n = 20) according to preparation design: group (O) anatomical occlusal reduction and group (OA) anatomical occlusal and 1 mm axial reduction. Each group was additionally subdivided into two subgroups (n = 10) according to ceramic materials; in subgroup X, lithium disilicate (e.max CAD, Ivoclar AG, Schaan, Liechtenstein) was used, and in subgroup S, zirconia-reinforced lithium silicate (ZLS) (Vita Suprinity, VitaZahnfabrik, Bad Säckingen, Germany) was used. All specimens were cemented with a light-cure resin cement (Choice 2, Bisco, Schaumburg, USA). 5000 thermocycles were applied to all specimens with both temperatures of 5 °C and 55 °C in two water baths; the dwell time was 30s at each bath, and the transfer time was 10s. Then all specimens were subjected to a fatigue simulation under dynamic loading of 200 N for 250,000 cycles. A universal testing machine (5500R/1123, Instron, Norwood, USA) was used to evaluate the fracture strength with a crosshead speed of 1 mm/min. All data were analyzed statistically by using a two-way ANOVA, and for some violations of assumptions, these results were compared with those obtained by the nonparametric test (Scheirer Ray Hare) (α = 0.05). RESULTS: A statistically significantly higher fracture resistance in the 'OA' (3389 N) compared to the 'O' (2787 N) group regardless of the ceramic material (P < .001) and a statistically significantly higher fracture resistance in the 'X' (3295 N) compared to the 'S' (2881 N) regardless of the preparation design (P = .015). CONCLUSIONS: For occlusal veneers, all preparation designs and materials (such as Vita Suprinity and e.max CAD) had clinically acceptable fracture resistance values that were greater than the maximal biting forces. On the other hand, the e.max CAD with occlusal veneer, including axial reduction design, demonstrated the maximum fracture resistance value. Finally, no relationship between fracture strength and mode of failure was found.

Surface roughness associated with bacterial adhesion on dental resin-based materials.

This study investigates the surface quality and bacterial adhesion properties of various dental materials, including indirect composites, veneering composites, direct composites, polyether ether ketone (PEEK), and two millable polymethyl methacrylate (PMMA). Material specimens were processed following manufacturer instructions, initially evaluated for surface roughness and Streptococcus sanguinis (S. sanguinis) adhesion. Subsequently, toothbrushing simulation was employed to simulate aging, and changes in material surfaces were assessed via roughness measurements and bacterial adhesion testing. Prior to simulated aging, direct and indirect composites exhibited the lowest roughness values. However, after the simulated toothbrushing, veneering composites displayed the highest roughness levels. Both PMMA materials demonstrated the highest S. sanguinis adhesion levels, both before and after artificial aging. Interestingly, the indirect composite material showed a reduction in bacterial adhesion following toothbrushing simulation. Surprisingly, this study did not reveal a clear correlation between roughness and bacterial adhesion.

Fracture resistance and fractographic analysis of pressable glass-ceramics with different partial coverage designs for maxillary premolars.

BACKGROUND: Partial coverage concepts have met the main goal of conservative dentistry. Vonlays, which combine features of veneers and onlays, are a recent alternative to full coverage designs and overlay partial coverage restorations. This in vitro study was conducted to compare the fracture resistance of the newly introduced pressable zirconia-reinforced lithium silicate with pressable lithium disilicate ceramic and to determine the optimal preparation design for partial coverage on upper premolars. METHODS: Fifty-two duplicated epoxy resin dies were prepared following vonlay and overlay preparation guidelines. For each preparation (n = 26), the specimens were divided into two subgroups to be restored with lithium disilicate (IPS e.max Press) or zirconia-reinforced lithium silicate (Vita Ambria) (n = 13 each). Ceramic vonlays and overlays were bonded using dual cure resin cement, subjected to thermomechanical fatigue, and the load to fracture was tested by using a universal testing machine. The specimens were fractographically analyzed via scanning electron microscopy (SEM). The normality of the fracture resistance data was checked using the Shapiro‒Wilk test and Q‒Q plots, and two-way ANOVA was used to assess the effect of the type of preparation and ceramic material on the fracture resistance. RESULTS: The group of overlays restored with zirconia-reinforced lithium silicate showed the highest mean fracture load (1218.69 N), while the group of vonlays restored with lithium disilicate had the lowest mean fracture resistance (967.15 N). The effect of preparation design and material type on fracture resistance was significant for both factors, p = 0.003 and p < 0.0001, respectively. Different features of the fracture surfaces, such as arrest lines, hackles, and directions of crack propagation, were observed. CONCLUSIONS: Zirconia-reinforced lithium silicate exhibited greater resistance to fracture compared to lithium disilicate, making it a potential substitute for partial coverage restorations. Additionally, the overlay showed superior fracture resistance when compared to the vonlay preparation design.

Effects of Artificial Aging of Direct Resin Nano-Hybrid Composite on Mean Bond Strength Values for Veneer Ceramic Samples.

BACKGROUND This study investigates the effect of artificial aging of direct resin nanohybrid composites on mean bond strength values for veneer ceramic samples. MATERIAL AND METHODS Ninety direct nanohybrid composite resin (Tetric N-Ceram) cylindrical discs were divided into 5 groups (n=18 each) based on aging cycles (thermocycling), as follows: TC=no aging (control), T1=850, T3=2500, T6=5000, and T12=10000 cycles, representing 1, 3, 6, and 12 months of clinical usage, respectively. Lithium disilicate glass ceramic (IPS e.max Press) cylindrical discs were cemented to resin discs using resin cement (Variolink N) after surface treatments (ceramic etching, silaning, composite abrasion). Differences in means between subgroups were calculated using one-way ANOVA, followed by the Tukey honestly significant differences post hoc test. Differences were considered statistically significant with a P value ≤0.05. RESULTS The highest SBS between ceramic and aged composite was observed at 1 month (m=20.35) but did not differ significantly from the control group (m=20.97). For all other subgroups (3, 6, 12 months) SBS was significantly less than that of the control (P≤0.05). At 1 and 3 months, cohesive failures were more common, whereas adhesive failures were more common in 6- and 12-month-old composites. CONCLUSIONS SBS of aged composites was less than that of non-aged composites, with SBS decreasing proportionally as the resin aged. When cementing a ceramic restoration over existing composite restorations, those older than 1 month should be removed and replaced with new ones.

No-prep dentistry using the Simple Orthodontic Extrusion (SOE) technique to create occlusal space. Illustration in tooth wear and resin-bonded bridges

In restorative dentistry, the lack of occlusal space may lead to the mutilation of healthy tissue in order to provide sufficient space for the restorative material. Noprep dentistry can be achieved by placing high-bite restorations, followed by Simple Orthodontic Extrusion (SOE) of other teeth to close the created open bite. This rapid, partial orthodontic treatment is well accepted by patients as it can be easily performed using simple buttons, and it takes only a few weeks to reestablish occlusal contacts. The SOE technique is a further development of the Dahl concept. It has the advantages without the disadvantages. Two applications of this technique are presented in this article: the treatment of the severe wear of anterior teeth with no-prep palatal veneers made of Polymer-infiltrated Ceramic Network (PICN, 'hybrid ceramic') material and the realization of no-prep zirconia resin-bonded bridges (RBBs) to replace missing lateral incisors. An original 3D-printed resin guide for correctly positioning RBBs and facilitating the removal of excess composite cement is also presented. This work highlights the considerable advantages of multidisciplinary collaboration in the field of minimally invasive dentistry.

Spot-etch technique and other adhesive strategies for provisional veneers.

AIM: The objective of the present study was to evaluate the influence of different adhesive strategies regarding shear bond strength (SBS) of provisional resin--based materials bonded to the enamel surface as well as on the enamel surface roughness. MATERIALS AND METHODS: Bovine incisors were randomly divided into six groups (n = 10) according to the adhesive strategy used: BRControl (bis-acrylic resin); Spot-etch+BR (spot-etch + bis-acrylic resin); Spot--etchSB2+BR (spot-etch + adhesive + bis-acrylic resin); Spot-etchZ350Flow+BR (spot-etch + flowable composite resin + bis-acrylic resin); SBU+BR (universal adhesive + bis-acrylic resin); Spot-etchSBMP+Z350 (spot-etch + adhesive + composite resin). The enamel surface roughness was determined by a surface profil-ometer. An SBS test was performed in a universal testing machine, and failure modes were classified under magnification. The SBS data were analyzed by one-way analysis of variance (ANOVA). A paired t test was used for enamel surface roughness intragroup comparisons, and the Friedman one-way repeated meas-ures analysis of variance by ranks was used for differences in enamel surface roughness between groups, with the Tukey post hoc test (a = 0.05). RESULTS: BRControl had the lowest SBS values (MPa), with a significant difference (P ≤ 0.001) from the other groups. Spot-etch+BR had the highest SBS values but with no significant differences from the other groups in which the spot-etch technique was also used. Adhesive failure mode was predominant for all groups. BRControl had the lowest surface roughness difference, significantly different (P = 0.001) from all the other groups. CONCLUSIONS: Spot-etch and other adhesive strategies could be applied to increase the SBS values of provisional restorations to enamel compared with no surface pretreatment. However, the adhesive strategy may change the enamel surface roughness, revealing the importance of cleaning the tooth surface.

Evaluation of vertical marginal discrepancy and load-to-failure of monolithic zirconia and lithium disilicate laminate veneers manufactured in different thicknesses.

OBJECTIVES: This study aimed to evaluate the feasibility of monolithic zirconia laminate veneers (MZLV) compared to lithium disilicate laminate veneers (LDLV). MATERIALS AND METHODS: Sixty resin replicas, each prepared with depths of 0.5 mm, 0.7 mm, and 1 mm, were produced using a 3D printer from acrylic teeth. Laminate veneers of these thicknesses were milled from pre-sintered monolithic zirconia (3rd generation) and lithium disilicate blocks. The intaglio surface of MZLV was treated with air abrasion using 110 µm diameter silica-modified aluminium oxide particles and ceramic primer, while LDLV was etched with etchant gel and treated with the ceramic primer before cementation with resin cement. Vertical marginal discrepancy (VMD) was assessed using a stereomicroscope, and a load-to-failure test was conducted using a universal testing machine. Failure modes were evaluated macroscopically on fractured surfaces. Data were analysed statistically using Two-way ANOVA and Bonferroni correction (α = 0.05). RESULTS: LDLV samples exhibited significantly larger VMD compared to MZLV samples across all thicknesses, especially in cervical, palatal, and mean data. Within the LDLV group, load-to-fracture values for 0.7 mm and 1.0 mm thicknesses were similar, whereas for 0.5 mm thickness, it was significantly lower. In the MZLV group, load-to-fracture values were lower for 0.7 mm and 1.0 mm thicknesses compared to LDLV, but higher for 0.5 mm thickness. CONCLUSIONS: Material choice and restoration thickness significantly influence laminate veneer restorations' success. MZLV generally exhibits superior vertical marginal fit compared to LDLV, with varying load-to-failure values across different thicknesses. Clinical management of debonding in MZLV is simpler compared to restoration fracture in LDLV. CLINICAL RELEVANCE: Considering clinical factors, MZLV may be a preferable option to LDLV for this restoration with the thickness of 0.5 mm.

Microhardness, diametral tensile strength and color stability of heated resin composites used for luting ceramic veneers.

PURPOSE: To evaluate color change in ceramic veneers luted to enamel with light-cured, dual-cured resin luting agents, or heated resin composites, as well as to evaluate microhardness and diametral tensile strength of these luting agents. METHODS: For color analysis, 0.5 mm-thick leucite-reinforced glass ceramic veneers (IPS Empress CAD) were cemented onto 40 bovine dental blocks (n= 10) using RelyX Ultimate (RU) or RelyX Veneer (RV) resin-based luting agents, or Gradia Direct (GD) and Palfique Lx5 (P) heated resin composites. After luting, the specimens were subjected to thermocycling (10,000 cycles). Color analysis was performed before and after thermocycling (L*, a*, b*, ΔEab, ΔE00). For the microhardness (Knoop) and diametral tensile strength tests, specimens (Ø 6 x 2 mm) were made (RU, RV, GD, and P). The specimens were subdivided into eight groups (n=10) and light-cured through different ceramic sheets (thicknesses of 0.5 mm or 1.5 mm). Knoop microhardness was performed on the top surface in a microhardness tester, and diametral tensile strength on a universal testing machine. Data were submitted to statistical analysis, using two-way ANOVA, Tukey, and Kruskal-Wallis tests (α= 0.05). RESULTS: For the general color alteration, there was no statistically significant difference between the luting materials (ΔEab, P= 0.57; ΔE00, P= 0.50). There was no interaction between luting agent and thermocycling, for L* (P= 0.87), a* (P= 0.97) and b* (P= 0.95) values. Thermocycling significantly affected only the L* values (P= 0.047), which increased after the cycles. For microhardness, there was a statistically significant difference considering luting agents and ceramic thickness (P< 0.001). GD heated resin composite presented significantly lower microhardness values than all other materials, at both ceramic thicknesses. At a thickness of 1.5 mm, RU cement had higher microhardness values than RV and P materials. Diametral tensile strength was significantly influenced by luting agent (P= 0.01), but not by ceramic thickness (P= 0.55). Diametral tensile strength of GD resin composite was higher than that of the RU, but neither of these two materials differed from RV and P. CLINICAL SIGNIFICANCE: Heated resin composite, used as luting agents, showed similar color stability to light-cured and dual-cure resin cements, however its microhardness was affected by ceramic thickness.

Abordagem estética e conservadora para fechamento de múltiplos diastemas: relato de caso / Aesthetic and conservative approach to multiple diastema closure: case report / Enfoque estético y conservador para el cierre de múltiples diastemas: relato de caso

Introdução:Na odontologia moderna, a estética vem ocupando um espaço cada vez mais expressivo, e o desejo por dentes mais brancos, a insatisfação com o alinhamento dos dentes e com a anatomia dentária, têm sido os motivos mais relevantes de procura dos pacientes nos consultórios odontológicos.Objetivo:O presente artigo tem como objetivo descrever, através de relato de caso clínico, uma abordagem terapêutica estética e conservadora para fechamento de múltiplos diastemas anterossuperiores com a utilização de facetas de resina composta.Relato de caso:Paciente do sexo masculino, 21 anos de idade, procurou atendimento queixando-se de insatisfação estética pelos diastemas apresentados. Por meio de um planejamento digital das facetas em resina, com mockup e modelo impresso em 3D, as restaurações foram feitas respeitando anatomia, forma, opacidade e cores dos dentes naturais do paciente. O resultado dos procedimentos adotados foi satisfatório, demonstrando que a técnica empregada foi eficaz, sendo capaz de devolver um sorriso estético e biológico ao paciente. A odontologia contemporânea tem ofertado cada vez mais materiais com capacidade de devolver estética e função em dentes de forma minimamente invasivas, além de passar total confiabilidade em tratamentos a longo prazo, agradando o paciente desde a apresentação digital do planejamento traçado pelo cirurgião dentista com previsibilidade dos resultados, até o momento final do tratamento.Conclusões:O recontorno estético com resina composta representa uma opção funcional e de baixo custo para o tratamento de pacientes que apresentam diastemas múltiplos, principalmente em pacientes jovens pela preservação daestrutura dentária e possibilidade de reparo, sendo considerado um procedimento reversível, rápido e de baixo custo (AU).

Introduction:Aesthetics have been occupying an increasingly significant role in modern dentistry, and the desire for whiter teeth, dissatisfaction with tooth alignment, and dental anatomy concerns have been the most relevant reasons for patients seeking dental care. Objective:This article aims to describe an aesthetic and conservative therapeutic approach for closing multiple anterior upper diastemas using composite resin veneers in a clinical case report. Case report:A 21-year-old male patient sought treatment, expressing dissatisfaction with the diastemas he had. The restorations were performed using digital planning of the resin veneers with a mockup and a 3D-printed model, while respecting the patient's natural tooth anatomy, shape, opacity, and colors. The results of the adopted procedures were satisfactory, demonstrating effectiveness of the employed technique in restoring an aesthetic and biologically harmonious smile to the patient. Contemporary dentistry has been offering increasingly more materials capable of providing aesthetics and function to teeth through minimally invasive approaches. This not only ensures long-term treatment reliability, but also pleases the patient with a digital presentation of the treatment plan outlined by the dentist, predicting the results up to the final stages of the treatment. Conclusions:Aesthetic contouring using composite resin presents a functional and cost-effective option for treating patients with multiple diastemas, especially among young patients due to its preservation of dental structure, repair potential, and being considered a reversible, fast, and low-cost procedure (AU).

Introducción: En la odontología moderna, la estética viene ocupando un espacio cada vez más destacado, y las ganas de tener dientes más blancos, la insatisfacción con el alineamiento de los dientes, y la anatomía dental son las razonesmás relevantes por las cuales los pacientes acuden a las consultas odontológicas. Objetivo:El presente artículo tiene como objetivo describir, a través de un relato de caso clínico, un abordaje terapéutico estético y conservador para el cierre de múltiples diastemas anterosuperiores mediante el uso de carillas de resina compuesta. Informe de caso:Paciente del sexo masculino, 21 años de edad, buscó atendimiento quejándose de insatisfacción estética debido a los diastemas presentados. A través de una planificación digital de las carillas en resina, con un mockup y un modelo impreso en 3D, las restauraciones fueron ejecutadas, respetándose la anatomía, forma, opacidad y colores de los dientes naturales del paciente. El resultado de los procedimientos adoptados fue satisfactorio y demostró que la técnica utilizada fue eficaz, siendo capaz de restituir una sonrisa estética y funcional al paciente. La odontología contemporánea viene ofreciendo cada vez más materiales con la capacidad de devolver estética y función a los dientes de maneras mínimamente invasivas, además de brindar total confiabilidad en tratamientos a largo plazo, satisfaciendo al paciente desde la presentación digital del plan trazado por el cirujano dentista con la previsibilidad de los resultados, hasta el momento final del tratamiento. Conclusiones:El recontorneado estético con resina compuesta representa una opción funcional y de bajo costo para el tratamiento de pacientes con múltiples diastemas, especialmente en pacientes jóvenes, debido a la preservación de la estructura dental y la posibilidad de reparación. Se considera, de este modo, que se trata de un procedimiento reversible, rápido y económico (AU).

Effect of Different Adhesive Resin and Composite Veneering Materials on Adhesion to Polyetheretherketone.

OBJECTIVE: To evaluate the effect of different adhesives and veneering resins on the shear bond strength (SBS) of polyetheretherketone (PEEK). METHODS: A total of 138 PEEK specimens were randomly divided into 6 groups according to adhesive material application: Control (C, no application), Adhese Universal (A) (Ivoclar Vivadent, Schaan, Liechtenstein), Gluma Bond Universal (G) (Heraeus Kulzer, South Bend, IN, USA), G-PremioBOND (P) (GC Corporation, Tokyo, Japan), Single Bond Universal (S) (3M, Saint Paul, MN, USA) and visio.link (V) (Bredent, Senden, Germany). Each adhesive group was divided into two subgroups according to the type of veneering material: Estenia direct composite (D) and Gradia Plus indirect composite (IN) (both GC Corporation). After the veneering process, the specimens were aged by thermal cycling. Kruskal-Wallis and Mann-Whitney U tests were used for SBS analysis (P < 0.05). RESULTS: The highest SBS results were obtained in the VIN group, followed by the VD, PD, GIN, AIN, AD, SIN, SD, PIN, GD, CIN and CD groups, respectively (P = 0.001). There were no significant differences in terms of the type of veneering composite when the same adhesive was applied (P > 0.05), except for Gluma Bond Universal (P = 0.009). All the adhesives tested showed clinically acceptable SBS results. CONCLUSION: Visio.link offered the highest adhesion to PEEK, whereas the tested universal adhesives may be used as an alternative to visio.link in clinical settings. It was determined that changing the veneer type has no statistical difference when the same adhesive material is used.

Effect of 3D printing technology and print orientation on the trueness of additively manufactured definitive casts with different tooth preparations.

OBJECTIVES: To evaluate the fabrication trueness of additively manufactured maxillary definitive casts with various tooth preparations fabricated with different 3-dimensional (3D) printers and print orientations. METHODS: A maxillary typodont with tooth preparations for a posterior 3-unit fixed partial denture, lateral incisor crown, central incisor and canine veneers, first premolar and second molar inlays, and a first molar crown was digitized with an industrial scanner. This scan file was used to fabricate definitive casts with a digital light processing (DLP) or stereolithography (SLA) 3D printer in different orientations (0-degree, 30-degree, 45-degree, and 90-degree) (n = 7). All casts were digitized with the same scanner, and the deviations within each preparation site were evaluated. Generalized linear model analysis was used for statistical analysis (α = 0.05). RESULTS: The interaction between the 3D printer and the print orientation affected measured deviations within all preparations (P ≤ 0.001) except for the lateral incisor crown and canine veneer (P ≥ 0.094), which were affected only by the main factors (P < 0.001). DLP-90 mostly led to the highest and DLP-0 mostly resulted in the lowest deviations within posterior tooth preparations (P ≤ 0.014). DLP-30 led to the lowest deviations within the first premolar inlay and DLP-45 led to the lowest deviations within the central incisor veneer preparation (P ≤ 0.045). CONCLUSIONS: Posterior preparations of tested casts had the highest trueness with DLP-0 or DLP-30, while central incisor veneer preparations had the highest trueness with DLP-45. DLP-90 led to the lowest trueness for most of the tooth preparations. CLINICAL SIGNIFICANCE: Definitive casts with tooth preparations fabricated with the tested DLP 3D printer and the print orientation adjusted on tooth preparation may enable well-fitting restorations. However, 90-degree print orientation should be avoided with this 3D printer, as it led to the lowest fabrication trueness.

Influence of gingival color on the color differences of dental laminate veneers.

STATEMENT OF PROBLEM: The effect of various gingival colors on the color differences of laminate veneers is unclear and comparative evaluations should be documented. PURPOSE: The purpose of this in vitro study was to investigate the influence of different gingival colors on the color differences of laminate veneers. MATERIAL AND METHODS: Five maxillary typodonts were used to obtain study models using 5 different gingival colors: light pink (LP), dark pink (DP), orange (Or), brown (Br), and violet (V). A total of 45 laminate veneers were milled using A1-shaded lithium disilicate ceramic and cemented on natural tooth-colored substrates. Color parameters were assessed using a spectroradiometer at 3 measurement areas (cervical third, mid-third, and incisal third) along the midline of laminate veneer with a focus measuring diameter of 1 mm. Color differences (∆E*ab and ∆E00) were calculated and compared with perceptibility (PT: ∆E*ab=1.22, ΔE00=0.81) and acceptability (AT: ∆E*ab=2.66, ΔE00=1.77) visual thresholds. Color variation data were statistically analyzed using 2-way ANOVA and Tukey HSD tests (α=.05). RESULTS: Two-way ANOVA results of the ∆E*ab values revealed significant interaction between the gingival color and the measurement area (P=.002). The ∆E*ab and ΔE00 values of laminate veneers were significantly higher in the LP-V group that presented values above AT (P<.001). Measurement area significantly influenced ∆E values of laminate veneers (P<.001). Greater ∆E values were registered at the measurement area of the cervical third in the groups of LP-DP, LP-Br, LP-V, and Or-V. Regardless of the measurement area, ∆E00 values below AT were obtained for the gingival color groups of LP-Or, DP-Or, DP-Br, and DP-V. CONCLUSIONS: Gingival color influenced the color differences of laminate veneers. When the gingival color was a darker gingival color, rather than light pink, the color difference increased, especially at the measurement area of the cervical third.

Composition control of additively manufactured color-graded temporary veneer.

OBJECTIVE: The aim of this study was to design and assess composite resin composition for patient-specific esthetic color-graded temporary veneer. METHODS: Various compositions of composite structures (assorted by Ba2SiO4 filler, TiO2 pigment, and photoinitiator) were prepared via additive manufacturing with 3 s UV exposure (405 nm, 10 W/cm2) per 50 µm thick layer followed by 20 min post-curing treatment after fabrication. The effect of each component on the generated color shades was observed and compared to the commonly used VITA shade guide. The coloration was explored by staining aging treatment under dry, wet, artificial saliva environments, coffee, and cola. The mechanical properties were also evaluated. Color measurement and comparison were done using a colorimeter (lightness (L*), green-red color (a*), and blue-yellow color (b*)), and the changes were calculated by CIEDE2000 (ΔE00), translucency parameter (TP) and whiteness index (WID). The composition color analysis results were then applied to produce a color-graded temporary veneer for mimicking a natural look. RESULT: Mechanically, all composition result in adequate bending strength with maximum achievable strength of 111.64 MPa. At the same time, the composite color was affected by each constituent differently. The L* value, which indicates the color lightness of the composite, was considerably tuned by the TiO2 pigment, whereas Ba2SiO4 filler only triggered minor changes. Photoinitiator concentration significantly affected the yellowness, indicated by the increased b* value. Similar tendency also observed toward the calculated TP and WID as well. Based on these evaluations, color-graded temporary veneer successfully generated, matching the VITA A3, A2, and B1 shades gradation. However, the stability of the composite color decreased at high amounts of Ba2SiO4 and photoinitiator. SIGNIFICANCE: The study presents a composition guide for fabricating temporary patient-specific color-graded veneer. It provides insights on the effect of the constituent material on dental esthetics.

Load-bearing capacity, internal accuracy and time-efficiency of heat-pressed, milled and 3D-printed lithium disilicate ultra-thin occlusal veneers.

OBJECTIVES: The primary aim of this in vitro study was to compare the load-bearing capacity of lithium disilicate occlusal veneers, fabricated via different manufacturing processes. Secondary objectives included assessing internal accuracy and production time-efficiency. METHODS: Four fabrication methods for ultra-thin lithium disilicate occlusal veneers on extracted human molars with simulated erosive defects were compared (n = 20/group): CAM: milled lithium disilicate (IPS e.max CAD); HPR: heat-pressed lithium disilicate (IPS e.max Press) out of a milled PMMA template (Ddpmma CAST); 3DP: 3D-printed lithium disilicate (experimental lithium disilicate); PTE: heat-pressed lithium disilicate (IPS e.max Press) out of a 3D-printed template (SilaPrint cast). Internal accuracy was measured prior to thermo-mechanical aging, followed by static loading to measure the load-bearing capacity (Fmax). Fabrication time (time-efficiency) was also recorded. Statistical analysis was performed using the Kruskal-Wallis (KW) test. RESULTS: No statistically significant differences were found in median load-bearing capacities (Fmax) between the groups (KW p = 0.5902): CAM 1821 N, HPR 1896 N, 3DP 2003 N, PTE 1687 N. Significant differences were found in internal accuracy between the groups that employed printing processes (3DP, PTE) and all other groups in margins (p < 0.001), cusps (p < 0.0018), and fossae (p < 0.0346). The time-efficiency measurements indicated an increase in fabrication time, starting from CAM 67.2 ± 5.8 min, followed by HPR 200.8 ± 33.0 min, PTE 289.2 ± 38.7 min, and peaking with the highest duration observed for 3DP 701.6 ± 8.1 min. SIGNIFICANCE: The fabrication method of ultra-thin lithium disilicate occlusal veneers does not significantly impact their load-bearing capacity, but affects the clinical fit and adaptation of the veneers.

[Types and colors of 1 374 chair-side CAD/CAM all-ceramic restorations].

PURPOSE: To analyse the types of chairside CAD/CAM all-ceramic restorations and the color range of all-ceramic materials used so as to provide reference for the application of clinical chairside all-ceramic restoration and the color selection of all-ceramic materials. METHODS: IPS e.max CAD prostheses and related data were collected from January 2021 to December 2021 from the Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The number and type of restorations and the color of materials were investigated and analyzed by descriptive statistics. RESULTS: A total of 1 374 restorations were included, of which 624 were crown restorations, accounting for 45.41% of the total restorations. 516 cases were veneer, accounting for 37.55%; 219 were inlays, accounting for 15.94%; fixed bridges were all adhesive bridges, with the least number with only 15 cases, accounting for 1.09%. In terms of the selection of restoration materials, the use rate of low-transparent(LT) ceramic blocks was significantly higher than that of other transparent ceramic blocks. A was the most frequently used ceramic color. The most frequently used porcelain blocks for veneers were LTA2 and LTA1; for inlay were LTA3; for crowns were LTA2 and LTA3. The blocks used in the fixed bridges were all LT, and A3 color was the majority. CONCLUSIONS: Chairside CAD/CAM all-ceramic prostheses made of IPS e.max CAD materials have been widely used in clinical practice. The types of prostheses include veneer, inset, crown and fixed bridge. The most commonly used IPS e.max CAD blocks are LTA2, LTA3 and LTA1. These findings have certain guiding significance for the clinical restoration decision and the reserve of porcelain blocks in primary hospitals.

A comparative evaluation of marginal fit and microleakage of computer-aided design/computer-aided manufacturing-milled zirconia and prefabricated posterior occlusal veneers: An in vitrostudy.

AIMS: The aim of this study was to compare the marginal fit of prefabricated occlusal veneers with computer-aided design/computer-aided manufacturing (CAD-CAM)-milled zirconia occlusal veneers in the posterior teeth. SETTINGS AND DESIGN: Forty extracted human maxillary premolars were divided into two groups of 20 each. Group 1 was prepared to receive prefabricated occlusal veneers, and Group 2 was prepared to receive CAD-CAM-milled zirconia occlusal veneers. MATERIALS AND METHODS: Prefabricated samples (Edelweiss) were selected for Group 1, whereas for Group 2, the tooth preparations were scanned, and occlusal veneers were fabricated using Exocad designing software and milling machine. After luting, both the groups were submerged in dye, sectioned, and evaluated for marginal fit and microleakage under a stereomicroscope using the microscope imaging software and its measurement tool. STATISTICAL ANALYSIS USED: Data collected were subjected to statistical analysis using SPSS 27.0. Intragroup and intergroup comparison was done using the Mann-Whitney U test. The Chi-square test was applied to check the depth of penetration of dye based on percentages. RESULTS: The marginal gap of zirconia occlusal veneers fabricated with CAD-CAM is higher compared to that of prefabricated occlusal veneers. Similarly, the depth of penetration of dye is higher in CAD-CAM-milled zirconia occlusal veneers than prefabricated occlusal veneers. CONCLUSION: The marginal fit of prefabricated occlusal veneer is better than the marginal fit of zirconia occlusal veneers fabricated with CAD-CAM. Similarly, it can also be concluded that the microleakage of prefabricated occlusal veneer is less compared to the CAD-CAM-milled zirconia occlusal veneers.

Resistance of CAD/CAM composite resin and ceramic occlusal veneers to fatigue and fracture in worn posterior teeth: A systematic review.

Severe tooth wear is related to substantial loss of tooth structure, with dentin exposure and significant loss (≥1/3) of the clinical crown. The objective of this systematic review was to summarize and analyze the scientific evidence regarding the mechanical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin and CAD/CAM lithium disilicate ceramic occlusal veneers, in terms of fatigue and fracture resistance, on severely worn posterior teeth. Currently, occlusal veneers are an alternative for treating worn posterior teeth. Although scientific evidence demonstrates the good performance of lithium disilicate occlusal veneers, there are less brittle materials with a modulus of elasticity more similar to dentin than ceramics, such as resin CAD/CAM blocks. Therefore, it is important to identify which type of material is best for restoring teeth with occlusal wear defects and which material can provide better clinical performance. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the PubMed, Embase, Web of Science, Scopus, Cochrane, OpenGrey, Redalyc, DSpace, and Grey Literature Report databases was conducted and supplemented by a manual search, with no time or language limitations, until January 2022. We aimed to identify studies evaluating the fatigue and fracture resistance of CAD/CAM composite resin and ceramic occlusal veneers. The quality of the full-text articles was evaluated according to the modified Consolidated Standards of Reporting Trials (CONSORT) criteria for in vitro studies, and 400 articles were initially identified. After removing duplicates and applying the selection criteria, 6 studies were included in the review. The results demonstrated that the mechanical performance of CAD/CAM composite resin occlusal veneers is comparable to that of CAD/CAM lithium disilicate occlusal veneers in terms of fatigue and fracture resistance.

Influence of sandblasting and bonding on the shear bond strength between differently pigmented polyetheretherketone (PEEK) and veneering composite after artificial aging.

OBJECTIVE: Achieving a strong bond between Polyetheretherketone (PEEK) and veneering composites is challenging due to PEEKs low surface energy. This study examined the effects of sandblasting and bonding on the shear bond strength (SBS) between veneering composite and pigmented PEEK, considering artificial aging. METHODS: Of three pigmented PEEK compounds (DC4420R, DC4450R, DC4470R; Evonic Operations GmbH, Marl, Germany), 40 specimens each were milled and polished up to 2500 grit. Prior to veneering, specimens were divided into 4 subgroups: Subgroup 1: Polishing; 2: Polishing + bonding; 3: Sandblasting; 4: Sandblasting + bonding. Sandblasting was performed using Al2O3. Adhesive was an agent containing MMA (Signum Universal Bond, Kulzer GmbH, Hanau, Germany). After veneering (Composite, Kulzer GmbH) the subgroups were divided into 2 subgroups. One subgroup was immersed in 37 °C warm distilled water for 24 h. The second subgroup was artificially aged by thermocycling (TCL) with 5000 cycles in distilled water (5 °C / 55 °C; 30 s). Surface roughness, water contact angles and failure modes were recorded. SBS was measured using a universal testing machine. RESULTS: Results demonstrated that the combination of sandblasting and bonding significantly improved the SBS compared to polishing alone. PEEK color did not significantly influence the SBS. Aging by TCL had a negative effect on the SBS. SIGNIFICANCE: Sandblasting and the use of an adhesive containing MMA were found to be effective in achieving satisfactory SBS between veneering composite and pigmented PEEK surfaces. These pretreatment methods demonstrate their potential for establishing durable and reliable bonding in clinical applications.

The effects of monomer type, filler size, and filler content of three resin cements on the color stability of laminate veneers exposed to accelerated aging.

STATEMENT OF PROBLEM: Commercially available resin cements consist of various filler sizes, filler content and monomers, and it is unclear which of these factors have the greatest effect on the color stability of laminate veneers. OBJECTIVES: To evaluate the color stability of lithium disilicate-reinforced laminate veneers inserted with three commercial resin cements with various filler sizes/contents and monomers upon accelerated aging. METHODS: Veneers were fabricated and cemented on resin abutments using three commercially available resin cements comprised of two different monomers and varying filler sizes/contents: 1) triethylene glycol dimethacrylate, TEGDMA (RelyX™ Veneer = 0.6 µm/66 %, Calibra® Esthetic Light Cure =1.2 µm/65 %); and 2) urethane dimethacrylate, UDMA (Variolink Esthetic LC = 0.1 µm/38 %). A total of 60 specimens were fabricated (n = 20 for each cement). The relative number of particles (N) and relative surface area (A) were calculated for each filler size/content. Color coordinates (L*, a*, b*) were measured, and color change (ΔE00) was calculated after cementation and following aging at 150, 300, 450, and 600 h using xenon light. Differences in color coordinates and color change were determined using repeated measures ANOVA followed by Tukey's post hoc test (α = .05). A post-hoc power analysis was performed to confirm reliability of the results. RESULTS: Based on a post-hoc power analysis of a repeated measures ANOVA with two between-factors and 1 within-factor, we had 89 % power to detect a difference of effect by cement type, 10 % power to detect a difference by shade, and 100 % power to detect a difference of effect by aging. The UDMA-based cement (0.1 µm/38 %) was least affected by aging, despite having the largest number of particles (N = 1010) and largest particle surface area (A = 7.02). The TEGDMA-based cements exhibited a significant color change, with 0.6 µm/66 % (A = 2.03, N = 8.12) producing a larger ΔE00 than 1.2 µm/65 % (A = 1.00, N = 1.00). CONCLUSIONS: Among the commercial cements tested, UDMA-based resin (0.1 µm/38 %) provided better color stability than TEGDMA-based resin cements. The color change after aging was affected by the relative surface area and relative number of particles for the TEGDMA-based resin cement (0.6 µm/66 % and 1.2 µm/65 %), with a larger surface area and a higher relative number of particles, accelerated color change with aging. The present study demonstrates a novel approach to determine color stability for any resin cement with particulate filler. CLINICAL IMPLICATIONS: The dental practitioner should be selective in choosing a commercial light cure cementation product for laminate veneers, as UDMA containing resin cement is more resistant to color changes over time than TEGDMA, regardless of the filler size/content.