Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

OBJECTIVES: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

The effect of restorative material selection and cementation procedures on the durability of endocrowns in the anterior teeth: an in-vitro study.

OBJECTIVE: To investigate the fracture resistance and failure modalities of anterior endocrown restorations fabricated employing diverse ceramic materials, and bonded using various cementation methodologies. MATERIALS AND METHODS: Forty maxillary central incisors were divided into two main groups based on the ceramic materials used; GroupI (Zir): zirconia endocrwons (Zolid HT+, Ceramill, Amanngirrbach) and GroupII (E-Max): e-max endocrowns (IPS e.max CAD, Ivoclar Vivadent). Both groups were further split into two subgroups depending on the cementation protocols; subgroup IA "ZirMDP": endocowns cemented with MDP primer + MDP resin cement, subgroup IB (ZirNon-MDP): cemented with MDP primer + non-MDP resin cement, subgroup IIA (E-maxMDP): cemented with MDP primer + MDP resin cement, subgroup IIB (E-maxNon-MDP): cemented with MDP primer + non-MDP resin cement. (n = 10/subgroup). Endocrowns were manufactured using CAD/ CAM. Teeth were subjected to 10,000 thermal cycles. The fracture test was performed at 45o with a palatal force direction until the fracture occurred. Test results were recorded in Newton. The failure mode was examined using a stereomicroscope. A One-way ANOVA test was utilized to compare different groups regarding fracture strength values. Tukey`s Post Hoc was utilized for multiple comparisons. RESULTS: The comparative analysis of fracture strength across the diverse groups yielded non-significant differences, as indicated by a p-value exceeding 0.05. Nonetheless, an observable trend emerged regarding the mode of failure. Specifically, a statistically significant prevalence was noted in fractures localized within the endocrown/tooth complex below the cementoenamel junction (CEJ) across all groups, except for Group IIB, "E-max Non-MDP," where fractures within the endocrown/tooth complex occurred above the CEJ. CONCLUSIONS: Combining an MDP-based primer with an MDP-based resin cement did not result in a significant effect on the anterior endocrown fracture strength. CLINICAL RELEVANCE: Regardless of the presence of the MDP monomer in its composition, adhesive resin cement achieved highly successful fracture strength when used with MDP-based ceramic primers. Additionally, ceramic materials exhibiting elastic moduli surpassing those of dentin are discouraged due to their propensity to induce catastrophic fractures within the tooth structure.

Effect of multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness.

OBJECTIVES: To investigate the effect of multiple firings on color, translucency, and biaxial flexure strength of Virgilite-containing (Li0.5Al0.5Si2.5O6) lithium disilicate glass ceramics of varying thickness. MATERIALS AND METHODS: Sixty discs were prepared from Virgilite-containing lithium disilicate blocks. Discs were divided according to thickness (n = 30) into T0.5 (0.5 mm) and T1.0 (1.0 mm). Each thickness was divided according to the number of firing cycles (n = 10); F1 (Control group): 1 firing cycle; F3: 3 firing cycles, and F5: 5 firing cycles. The discs were tested for color change (ΔE00) and translucency (TP00) using a spectrophotometer. Then, all samples were subjected to biaxial flexure strength testing using a universal testing machine. Data were collected and statistically analyzed (α = 0.5). For chemical analysis, six additional T0.5 discs (2 for each firing cycle) were prepared; for each firing cycle one disc was subjected to X-ray diffraction analysis (XRD) and another disc was subjected to Energy dispersive X-ray spectroscopy (EDX) and Scanning electron microscope (SEM). RESULTS: Repeated firing significantly reduced the translucency of F3 and F5 compared to F1 in T0.5 (p < 0.001), while for T1.0 only F5 showed a significant decrease in TP00 (p < 0.001). For ΔE00, a significant increase was recorded with repeated firings (p < 0.05) while a significant decrease resulted in the biaxial flexure strength regardless of thickness. CONCLUSIONS: Repeated firings had a negative effect on both the optical and mechanical properties of the Virgilite-containing lithium disilicate glass ceramics. CLINICAL RELEVANCE: Repeated firings should be avoided with Virgilite-containing lithium disilicate ceramics to decrease fracture liability and preserve restoration esthetics.

Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns.

OBJECTIVES: The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments. METHODS: A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 µm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05). RESULTS: Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials. CONCLUSIONS: The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials. CLINICAL RELEVANCE: Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.

Quantitative examination of factors influencing the colour reproduction ability of lithium disilicate glass-ceramics.

BACKGROUND: Effects of ceramic translucency, layer thickness, and substrate colour on the shade of lithium disilicate glass-ceramic restorations proved to be significant in several studies, however, quantitative, numerical results on the relationship between the colour difference and these parameters are still lacking. The purpose of this in vitro study was to quantitatively determine how the colour reproduction ability of a lithium disilicate glass-ceramic is affected by its translucency, layer thickness, and substrate colour. METHODS: Ceramic samples were prepared from A2 shade IPS e.max CAD blocks with high and low translucencies (HT and LT) in a thickness range of 0.5-2.5 mm (+/- 0.05 mm). Layered samples were acquired utilizing composite substrates in 9 shades; transparent try-in paste was used. The spectral reflectance of the specimens was assessed under D65 standard illumination with a Konica Minolta CM-3720d spectrophotometer. The CIEDE2000 colour difference (ΔE00) between two samples was analysed using perceptibility and acceptability thresholds set at 50:50%. Statistical analysis involved linear regression analysis and the Kruskal-Wallis test. RESULTS: An increase in the thickness of 0.5 mm reduced the ΔE00 of the HT samples to 72.8%, and that of the T samples to 71.1% (p < 0.0001). 7 substrates with HT and LT specimens had significantly different results from the mean (p < 0.05). A thickness of 0.5 mm is not sufficient to achieve an acceptable result at any level of translucency, while the low translucency ceramic at a thickness of 1.5 mm gave acceptable results, except for severely discoloured substrates (ND8 and ND9). CONCLUSIONS: The colour reproduction ability of lithium disilicate glass-ceramics is significantly affected by their translucency, layer thickness, and 7 substrates out of 9 substrates examined.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study.

BACKGROUND: An optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars. METHODS: Thirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test. RESULTS: Marginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%). CONCLUSIONS: Direct restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn't significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations. CLINICAL SIGNIFICANCE: Indirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

A randomized controlled clinical trial on press and block lithium disilicate partial crowns: A 4-year recall.

PURPOSE: To evaluate clinical performances of two lithium disilicate systems (Initial LiSi press vs Initial LiSi Block, GC Co.) using modified United States Public Health Service (USPHS) evaluation criteria and survival rates after 4 years of clinical service. METHODS: Partial adhesive crowns on natural abutment posterior teeth were made on 60 subjects who were randomly divided into two groups: Group 1: Initial LiSi press and Group 2: Initial LiSi Block. Fabrication of partial crowns was made with full analog and digital procedure in Groups 1 and 2 respectively. The restorations were followed-up for 1 and 4 years, and the modified USPHS evaluation was performed at baseline and each recall together with periodontal evaluation. Contingency tables to assess for significant differences of success over time in each group and time-dependent Cox regression to test for differences between the two groups were used and the level of significance was set at P< 0.05. RESULTS: Regarding modified USPHS scores, all evaluated parameters showed Alpha or Bravo and no Charlie was recorded. No statistically significant difference emerged between the two groups in any of the assessed variables (P> 0.05). No statistically significant difference between scores recorded at the baseline and each recall. All modified USPHS scores were compatible with the outcome of clinical success and no one restoration was replaced or repaired, and the survival rate was 100% after 4 years of clinical service. No difference was found between traditional and digital procedure to fabricate the crowns. The two lithium disilicate materials showed similar results after 4 years of clinical service. CLINICAL SIGNIFICANCE: The crowns made with the two tested lithium disilicate materials with analog and digital procedures showed 100% survival after 4 years of clinical service with no statistically significant difference using the modified USPHS scores.

Advances in ceramics for tooth repair: From bench to chairside.

OBJECTIVES: To give a comprehensive review of advancement in dental ceramics, fabrication methods, and the challenges associated with clinical application. DATA, SOURCES AND STUDY SELECTION: Researches on chemical composition, biomechanical behaviors, optical properties, bonding strategies and fabrication methods were included. The search of articles was independently conducted by two authors in the PubMed, Scopus, Medline and Web of Science. CONCLUSIONS: Dental ceramics have shown significant advancements in terms of esthetics and function. However, improving fracture toughness without compromising optical properties remains a challenge. Repairing fractured zirconia or glass-matrix ceramic prostheses with the same material is difficult due to the sintering process. Developing innovative bonding techniques that provide strong and long-lasting bonding strength between ceramics and tooth structures poses a recurring obstacle. CLINICAL SIGNIFICANCE: Despite the emergence of dental ceramics and fabrication techniques, certain limitations such as susceptibility to brittleness and fracture still exist. Therefore, the current review provided valuable information around the advanced dental ceramics in tooth repair. The laboratory test data and the clinical outcome are also presented in details, aiming to guide clinicians in making informed decisions regarding ceramic restorations.

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial.

OBJECTIVES: The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla. MATERIALS AND METHODS: Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12). RESULTS: No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups. CONCLUSION: Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters. CLINICAL RELEVANCE: There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

Laser debonding of ultrathin occlusal veneers fabricated from different CAD/CAM ceramic materials.

BACKGROUND: Erbium lasers safely offer the possibility of reuse for debonded restorations. Since these lasers have a high affinity for water molecules, they are absorbed by resin cement causing explosive ablation of the cement and thus, the restoration debonds. The efficiency of this process depends on many factors, including the ceramic type, its chemical composition and thickness. Therefore, this study was designed to test the time taken to debond ultrathin occlusal veneers made of three types of milled ceramic materials and evaluate the integrity of these restorations after debonding. METHODS: Three ceramic types were evaluated in this study: lithium disilicate (IPS Emax CAD), highly condensed lithium disilicate (GC initial®LiSi), and translucent zirconia (Katana zirconia STML). Each group consisted of 8 occlusal veneers of 0.5 mm thickness. The samples were cemented to the occlusal surfaces of the upper molar teeth. An Er; Cr: YSGG laser was applied to the occlusal veneers using the scanning method, and time until debonding was calculated. The debonded samples were then inspected under a stereomicroscope for possible damage. Numerical data are presented as the mean with 95% confidence interval (CI), standard deviation (SD), minimum (min.) and maximum (max.) values. Normality and variance homogeneity assumptions were confirmed using Shapiro-Wilk's and Levene's tests, respectively. Data were normally distributed and were analyzed using one-way ANOVA followed by Tukey's post hoc test. The significance level was set at p < 0.05 for all tests. Statistical analysis was performed with R statistical analysis software version 4.3.2 for Windows (R Core Team (2023). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/). RESULTS: There was no significant difference in debonding time between the different materials (p = 0.995). The longest debonding time was found for Katana STML (87.52 ± 20.45) (seconds), followed by Emax (86.94 ± 20.63) (seconds), while the lowest value was found for LiSi initial (86.14 ± 25.16) (seconds). In terms of damage to the debonded veneers, The Emax and zirconia samples showed no damage. However, 40% of the LiSi samples fractured during debonding, and 20% exhibited cracks. Only 40% of the LiSi samples were sound after debonding. CONCLUSION: Er; Cr: YSGG laser can be used efficiently to remove ceramic occlusal veneers. However, its effect on LiSi restorations needs further research.

The fracture resistance of pulpotomized primary molars restored with zirconia crowns, lithium disilicate or resin based ceramic endocrowns.

BACKGROUND: Endocrown in pediatric dentistry was rooted in the fundamental principles of preserving healthy dental tissues, leveraging contemporary adhesive methodologies. AIM: This research aimed on assessing and comparing the fracture resistance of pulpotomized primary molars when rehabilitated with zirconia crowns and two distinct types of endocrowns, namely E-Max and Brilliant Crios. METHODS: The study involved thirty, anonymized, freshly extracted second primary molars that underwent pulpotomy. These teeth were then evenly divided into three groups, each consisting of ten specimens: the zirconia crown, the E-Max endocrown, and the Brilliant Crios endocrown groups. Post-pulpotomy, the teeth were prepared for their respective restorations. Subsequent to this preparation, the zirconia crowns, E-Max endocrowns, and Brilliant Crios endocrowns were secured. To evaluate the fracture resistance using a computer-controlled testing machine (Instron), a progressively increasing load was applied to each group until fracture occurred. The gathered data were then analyzed for outliers and subjected to normality testing using the Shapiro-Wilk and/or Kolmogorov-Smirnov tests, with a significance threshold set at 0.05. RESULTS: There was no statistically significant difference in fracture resistance of pulpotomized primary molars among lithium disilicate (E-Max) group (mean=1367.59N), Brilliant Crios group (mean=1349.73N) and zirconia group (mean=1240.82N). CONCLUSION: Endocrowns can be considered a promising restoration for pulpotomized primary molars.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Static and dynamic stress analysis of different crown materials on a titanium base abutment in an implant-supported single crown: a 3D finite element analysis.

BACKGROUND: This Finite Element Analysis was conducted to analyze the biomechanical behaviors of titanium base abutments and several crown materials with respect to fatigue lifetime and stress distribution in implants and prosthetic components. METHODS: Five distinct designs of implant-supported single crowns were modeled, including a polyetheretherketone (PEEK), polymer-infiltrated ceramic network, monolithic lithium disilicate, and precrystallized and crystallized zirconia-reinforced lithium silicates supported by a titanium base abutment. For the static load, a 100 N oblique load was applied to the buccal incline of the palatal cusp of the maxillary right first premolar. The dynamic load was applied in the same way as in static loading with a frequency of 1 Hz. The principal stresses in the peripheral bone as well as the von Mises stresses and fatigue strength of the implants, abutments, prosthetic screws, and crowns were assessed. RESULTS: All of the models had comparable von Mises stress values from the implants and abutments, as well as comparable maximum and minimum principal stress values from the cortical and trabecular bones. The PEEK crown showed the lowest stress (46.89 MPa) in the cervical region. The prosthetic screws and implants exhibited the highest von Mises stress among the models. The lithium disilicate crown model had approximately 9.5 times more cycles to fatique values for implants and 1.7 times more cycles to fatique values for abutments than for the lowest ones. CONCLUSIONS: With the promise of at least ten years of clinical success and favorable stress distributions in implants and prosthetic components, clinicians can suggest using an implant-supported lithium disilicate crown with a titanium base abutment.

Adhesive Cementation of CAD/CAM Silica-based Ceramics: Effect of Adhesive Type and Long-term Aging on the Bond Strength to Composite Cement.

PURPOSE: To investigate the effect of adhesive type and long-term aging on the shear bond strength (SBS) between silica-based ceramics and composite cement (CC). MATERIALS AND METHODS: Lithium-silicate (LS), feldspathic (FD) and polymer-infiltrated ceramic (PIC) blocks were sectioned (10 x 12 x 2 mm) and divided into 24 groups considering the factors: "ceramics" (LS, FD, and PIC), "adhesive" (Ctrl: without adhesive; 2SC: 2-step conventional; 3SC: 3-step conventional; 1SU: 1-step universal), and "aging" (non-aged or aged [A]). After the surface treatments, CC cylinders (n = 15, Ø = 2 mm; height = 2 mm) were made and half of the samples were subjected to thermocycling (10,000) and stored in water at 37°C for 18 months. The samples were submitted to SBS testing (100 kgf, 1 mm/min) and failure analysis. Extra samples were prepared for microscopic analysis of the adhesive interface. SBS (MPa) data was analyzed by 3-way ANOVA and Tukey's test (5%). Weibull analysis was performed on the SBS data. RESULTS: All factors and interactions were significant for SBS (p<0.05). Before aging, there was no significant difference between the tested groups and the respective control groups. After aging, the LS_1SU (22.18 ± 7.74) and LS_2SC (17.32 ± 5.86) groups exhibited significantly lower SBS than did the LS_Ctrl (30.30 ± 6.11). Only the LS_1SU group showed a significant decrease in SBS after aging vs without aging. The LS_1SU (12.20) group showed the highest Weibull modulus, which was significantly higher than LS_2SC_A (2.82) and LS_1SU_A (3.15) groups. CONCLUSION: No type of adhesive applied after silane benefitted the long-term adhesion of silica-based ceramics to CC in comparison to the groups without adhesive.

Bonding of Composite Cements Containing 10-MDP to Zirconia Ceramics Without Dedicated Ceramic Primer.

PURPOSE: To measure zirconia-to-zirconia microtensile bond strength (µTBS) using composite cements with and without primer. MATERIALS AND METHODS: Two Initial Zirconia UHT (GC) sticks (1.8x1.8x5.0 mm) were bonded using four cements with and without their respective manufacturer's primer/adhesive (G-CEM ONE [GOne] and G-Multi Primer, GC; Panavia V5 [Pv5]), and Panavia SA Cement Universal [PSAu], and Clearfil Ceramic Plus, Kuraray Noritake; RelyX Universal (RXu) and Scotchbond Universal Plus [SBUp], 3M Oral Care). Specimens were trimmed to an hour-glass shaped specimen whose isthmus is circular in cross-section. After 1-week water storage, the specimens were either tested immediately (1-week µTBS) or first subjected to 50,000 thermocycles (50kTC-aged µTBS). The fracture mode was categorized as either adhesive interfacial failure, cohesive failure in composite cement, or mixed failure, followed by SEM fracture analysis of selected specimens. Data were analyzed using linear mixed-effects statistics (α = 0.05; variables: composite cement, primer/adhesive application, aging). RESULTS: The statistical analysis revealed no significant differences with aging (p = 0.3662). No significant difference in µTBS with/without primer and aging was recorded for GOne and PSAu. A significantly higher µTBS was recorded for Pv5 and RXu when applied with their respective primer/adhesive. Comparing the four composite cements when they were applied in the manner that resulted in their best performance, a significant difference in 50kTC-aged µTBS was found for PSAu compared to Pv5 and RXu. A significant decrease in µTBS upon 50kTC aging was only recorded for RXu in combination with SBUp. CONCLUSION: Adequate bonding to zirconia requires the functional monomer 10-MDP either contained in the composite cement, in which case a separate 10-MDP primer is no longer needed, or in the separately applied primer/adhesive.

Replacement of unsatisfactory ceramic veneers with the aid of a digital workflow.

This case report focuses on the replacement of ceramic laminate veneers with suboptimal marginal fit and design, employing a digital workflow and CAD-CAM technology. The patient, a woman in her 30s, expressed concerns about the appearance and hygiene challenges of her existing veneers. A comprehensive assessment, including clinical examination, facial photographs and intraoral scanning, was conducted. Utilising CAD software, facial photographs and 3D models merged to create a digital wax-up, crucial in designing suitable veneers and addressing issues like overcontouring and a poor emergence profile. Following the removal of old veneers, a mock-up was performed and approved. Preparations ensured space for restorations with well-defined margins. The final restorations, milled with Leucite-reinforced vitreous ceramic, were cemented. At the 1 year follow-up, improved aesthetics, gingival health and functional restorations were observed. This report highlights the efficacy of digital workflows in achieving consistent and aesthetically pleasing outcomes in ceramic laminate veneer replacement.

Full-ceramic resin-bonded fixed dental prostheses: A systematic review.

Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs) are more appropriate. This study's objective was to analyze the available research on full-ceramic RBFDPs. In this study, Web of Science, MEDLINE/PubMed, Scopus, Embase, Cochrane Library, and Google Scholar databases were searched for articles published in English between 2010 and 2020. A total of 14 studies were reviewed based on the eligibility criteria. The results showed that using a cantilever design with one abutment had an advantage over two abutments. Additionally, it was proposed that preparations designed with retentive aids, such as a proximal box, groove, and pinhole, could improve RBFDP survival rates. IPS e.max ZirCAD, In-Ceram alumina, and zirconia CAD/CAM were the most commonly used framework materials. Most studies used air abrasion, salinization, or hydrofluoric acid for surface treatment. Adhesive resin cements were the most frequently used type of cement. The survival rate of In-Ceram ceramics (85.3%-94.8%) was lower than that of In-Ceram zirconia and IPS e.max ZirCAD. Debonding, followed by framework fracture, was the leading cause of failure. Following 3-10 years follow-up, the survival percentage of all-ceramic RBFDPs ranged from 76% to 100%. Although RBFDPs have demonstrated satisfactory success as a conservative treatment, long-term follow-ups and higher sample sizes in clinical research are required to gain more reliable outcomes on the clinical success rate of various RBFDP designs.

Laboratory study of fracture resistance and failure mode of porcelain laminate veneers with different preparation depths in endodontically treated teeth.

PURPOSE: To compare the fracture resistance and failure mode of porcelain laminate veneers with different preparation depths in endodontically treated teeth. METHODS: Root canal treatment was performed for 40 maxillary central incisors, and then the teeth were divided into four groups (n= 10). The preparation depths were as follows: Group A: 0.9 mm, Group B: 0.6 mm, Group C: 0.3 mm, and in all three groups, 2 mm butt joint incisal reductions were performed; Group D was a control group with no preparation. Then 30 lithium disilicate porcelain veneers were milled by CAD- CAM method and cemented. After that, all specimens were subjected to cyclic loading and thermal cycling and finally were tested by a universal testing machine until failure occurred. RESULTS: The mean failure loads (N) after exposure to continuous load were as follows: Group A: 625.70 (401.45-1037.77), Group B: 780.32 (222.93-1391.82), Group C: 748.81 (239.68-1241.87) and Group D (control) : 509.88 (84.42-1025.85) and P= 0.216. Analysis of failure mode in four groups showed that P= 0.469. There was no significant difference between the control and the other groups. In this study, 0.3, 0.6 and 0.9 mm depths of preparation for porcelain laminate veneers for endodontically treated teeth had no significant difference in fracture resistance and failure mode with non-prepared teeth. CLINICAL SIGNIFICANCE: Reasonable consideration might be given to porcelain laminate veneer treatment for teeth that have become discolored and resistant to bleaching (such as instances where discoloration is severe following root canal treatment). This approach is considered to be on the conservative side, and has demonstrated that a labial preparation depth reduction of up to 0.9 mm does not have any impact on the failure mode or fracture resistance of endodontically-treated teeth.

Effect of surface treatment and resin cement type on the bond strength of polyetheretherketone to lithium disilicate ceramic.

BACKGROUND: This study aims to evaluate the effect of surface treatment and resin cement on the shear bond strength (SBS) and mode of failure of polyetheretherketone (PEEK) to lithium disilicate ceramic (LDC). This is suggested to study alternative veneering of PEEK frameworks with a ceramic material. METHODS: eighty discs were prepared from PEEK blank and from lithium disilicate ceramic. Samples were divided into four groups according to surface treatment: Group (A) air abraded with 110 µm Al2O3, Group (AP) air abrasion and primer application, Group (S) 98% sulfuric acid etching for 60 s, Group (SP) Sulfuric acid and primer. Each group was subdivided into two subgroups based on resin cement type used for bonding LDC:1) subgroup (L) self- adhesive resin cement and 2) subgroup (B) conventional resin cement (n = 10). Thermocycling was done for all samples. The bond strength was assessed using the shear bond strength test (SBS). Failure mode analysis was done at 50X magnification with a stereomicroscope. Samples were chosen from each group for scanning electron microscope (SEM). The three-way nested ANOVA followed by Tukey's post hoc test were used for statistical analysis of results. Comparisons of effects were done utilizing one way ANOVA and (p < 0.05). RESULTS: The highest mean of shear bond strength values was demonstrated in Group of air abrasion with primer application using conventional resin cement (APB) (12.21 ± 2.14 MPa). Sulfuric acid groups showed lower shear bond strength values and the majority failed in thermocycling especially when no primer was applied. The failure mode analysis showed that the predominant failure type was adhesive failure between cement and PEEK, while the remaining was mixed failure between cement and PEEK. CONCLUSION: The air abrasion followed by primer application and conventional resin cement used for bonding Lithium Disilicate to PEEK achieved the best bond strength. Primer application did not have an effect when self-adhesive resin cement was used in air-abraded groups. Priming step is mandatory whenever sulfuric acid etching surface treatment is utilized for PEEK.

Fabrication trueness and internal fit of different lithium disilicate ceramics according to post-milling firing and material type.

OBJECTIVES: To evaluate whether post-milling firing and material type affect the fabrication trueness and internal fit of lithium disilicate crowns. METHODS: A prefabricated cobalt chromium abutment was digitized to design a mandibular right first molar crown. This design file was used to fabricate crowns from different lithium disilicate ceramics (nano-lithium disilicate (AM), fully crystallized lithium disilicate (IN), advanced lithium disilicate (TS), and lithium disilicate (EX)) (n = 10). Crowns, the abutment, and the crowns when seated on the abutment were digitized by using an intraoral scanner. Fabrication trueness was assessed by using the root mean square method, while the internal fit was evaluated according to the triple scan method. These processes were repeated after the post-milling firing of AM, TS, and EX. Paired samples t-tests were used to analyze the effect of post-milling firing within AM, TS, and EX, while all materials were compared with 1-way analysis of variance and Tukey HSD tests (α = 0.05). RESULTS: Post-milling firing reduced the surface deviations and internal gap of AM and EX (P ≤ 0.014). AM mostly had higher deviations and internal gaps than other materials (P ≤ 0.030). CONCLUSIONS: Post-milling firing increased the trueness and internal fit of tested nano-lithium disilicate and lithium disilicate ceramics. Nano-lithium disilicate mostly had lower trueness and higher internal gap; however, the maximum meaningful differences among tested materials were small. Therefore, the adjustment duration and clinical fit of tested crowns may be similar. CLINICAL SIGNIFICANCE: Tested lithium disilicate ceramics may be suitable alternatives to one another in terms of fabrication trueness and internal fit, considering the small differences in measured deviations and internal gaps.