Comparison of marginal and internal fit of three-unit implant-supported fixed prosthetic substructures fabricated using CAD/CAM systems.

OBJECTIVE: This study compared the marginal and internal fit of implant-supported fixed dentures fabricated using CAD/CAM systems. MATERIALS AND METHODS: A lower jaw model representing partial edentulism was produced. Two dental implants were inserted in the area of teeth 35 and 37, onto which cemented abutments were screwed. The model was scanned using a laboratory scanner and transferred to a design software program for substructure fabrication. Sixty substructures were fabricated out of each group for six substructure types (n = 10), cast Co-Cr (control), milling Co-Cr, laser sintering Co-Cr, titanium (Ti), zirconium, and polyetheretherketone (PEEK) substructures. The marginal and internal fit was evaluated using a silicone replica viewed under a stereomicroscope. The data were analyzed using the statistical package program for social sciences (SPSS, Chicago, IL, USA, v. 17) at a significance level of 0.05. Marginal and internal gaps were compared using the one-way ANOVA test and Tukey's post hoc test. The differences between abutment teeth were determined using the independent sample t-test. RESULTS: There was a significant difference in the marginal gap between PEEK and Ti groups (p < 0.05) but no difference between other groups (p > 0.05). There was a significant difference in the internal gap between PEEK, laser sintering Co-Cr, and milling Co-Cr groups (p < 0.05) but no difference between other groups (p > 0.05). The PEEK group had a higher marginal gap than the Ti group and a higher internal gap than the DMLS Co-Cr group (p < 0.05). CONCLUSION: All substructures have a marginal and internal fit within acceptable clinical limits. CLINICAL RELEVANCE: This in vitro study suggests that materials and techniques used in CAD/CAM systems improve the fitting accuracy of implant-supported fixed restorations.

Artifact expression of polyetheretherketone in cone beam computed tomography: An in vitro study.

STATEMENT OF PROBLEM: Dental prosthetic materials can cause artifacts in cone beam computed tomography (CBCT) images, adversely affecting diagnostic quality, although the problem may be less with polyetheretherketone (PEEK). Studies evaluating the artifacts caused by frequently used prosthetic materials are lacking. PURPOSE: The purpose of this in vitro study was to compare the artifacts in CBCT images caused by PEEK, zirconia, cobalt-chromium (Co-Cr) alloy, and titanium (Ti). MATERIAL AND METHODS: A polymethylmethacrylate phantom (Ø4.0×4.0 cm) with a central cylindrical aperture (Ø0.5×0.5 cm) was produced. Co-Cr, Ti, zirconia, and PEEK cylinders (0.5×0.5 cm) were manufactured, and CBCT images of the empty phantom (control group) with the test cylinders inside were made 3 times. In all images, the axial sections passing through the middle of the materials were evaluated. Eight regions of interest (ROI) area were determined around the materials (0.5×0.5 cm). The presence of artifacts was evaluated by making gray value standard deviation (SD) calculations in these ROI areas. The average SD values of 8 ROI fields from the 3 CBCT scans were made, and the materials were compared with each other in terms of the presence of artifacts by using 1-way analysis of variance (α=.05). RESULTS: The difference between the SD values of the control and the PEEK cylinder was not statistically significant (P>.05). The SD values of both the control and PEEK groups were significantly lower than those of the zirconia, Co-Cr, and Ti groups (P<.05). CONCLUSIONS: Zirconia, Ti, and Co-Cr caused artifacts in CBCT images, but the artifacts with PEEK were similar to those in the control group, suggesting it was the optimal choice in terms of achieving diagnostic quality.

An In Vitro Evaluation of the Effect of Various Adhesives and Surface Treatments on Bond Strength of Resin Cement to Polyetheretherketone.

PURPOSE: To investigate the effect of various surface pretreatments and adhesive systems on bond strength of resin cement to polyetheretherketone (PEEK). MATERIALS AND METHODS: 360 PEEK specimens were divided into 4 groups to receive the following pretreatments (n = 90): no pretreatment, sandblasting, silica coating and Er:YAG laser. Surface roughness (SR) and scanning electron microscopy (SEM) evaluations were conducted after mechanical pretreatments for topographical surface evaluations. After the pretreatments, each group was divided into 3 subgroups (n = 30) according to the adhesive system used: no adhesive system, Visio.link, and Signum PEEK Bond. Resin cement was applied, and specimens underwent 5000 thermocycles (5-55°C) before shear bond strength (SBS) test. One-way ANOVA and Tukey test were used to analyze the SR data; 2-way ANOVA and Fisher's LSD test were used to analyze the SBS data at the confidence interval of 95% (α = 0.05). RESULTS: The sandblasting group demonstrated the highest SR values (p < 0.05). No significant differences in SR values were identified among silica coating, laser, and control groups (p ˃ 0.05). Conditioning with Visio.link after sandblasting group exhibited the highest SBS values (p < 0.05). No significant differences in SBS values were found between laser and control group (p ˃ 0.05). Conditioned groups presented higher SBS values than unconditioned groups (p < 0.05). Between the two adhesive systems, Visio.link demonstrated statistically significant higher SBS values than Signum PEEK Bond (p < 0.05). CONCLUSION: Silica coating and sandblasting were shown to provide superior pretreatment of PEEK surface. Laser pretreatments showed no effectiveness on bond strength of resin cement to PEEK. Adhesive systems improved the resin bonding to PEEK.

The effect of various polishing systems on surface roughness and phase transformation of monolithic zirconia.

PURPOSE: The purpose of this study was to evaluate and compare three polishing systems on the surface roughness and phase transformation of monolithic zirconia. MATERIALS AND METHODS: 100 disk shaped specimens (10 mm diameter, 3 mm thickness) were fabricated from monolithic zirconia blocks. 20 specimens were left as a control group and remaining specimens were grinded by diamond bur to simulate the occlusal adjustments. Grinded specimens were randomly divided into 4 groups: group G (no polishing), group M (Meisinger, zirconia polishing kit), group E (EVE Diacera, zirconia polishing kit), and group P (EVE Diapol, porcelain polishing kit). Surface roughness was measured with profilometer and surface topography was observed with SEM. XRD analysis was performed to investigate the phase transformation. Statistical analysis was performed with one-way ANOVA and Tukey's post hoc tests at a significance level of P=.05. RESULTS: All polishing groups showed a smoother surface than group G. Among 3 polishing systems, group M and group E exhibited a smoother surface than the group P. However, no significant differences were observed between group M and group E (P>.05). Grinding and polishing did not cause phase transformations in zirconia specimens. CONCLUSION: Zirconia polishing systems created a smoother surface on zirconia than the porcelain polishing system. Phase transformation did not occur during the polishing procedure.

The effect of ultrafast fiber laser application on the bond strength of resin cement to titanium.

The purpose of this study was to investigate the effect of ultrafast fiber laser treatment on the bond strength between titanium and resin cement. A total of 60 pure titanium discs (15 mm × 2 mm) were divided into six test groups (n = 10) according to the surface treatment used: group (1) control, machining; group (2) grinding with a diamond bur; group (3) ultrafast fiber laser application; group (4) resorbable blast media (RBM) application; group (5) electro-erosion with copper; and group (6) sandblasting. After surface treatments, resin cements were applied to the treated titanium surfaces. Shear bond strength testing of the samples was performed with a universal testing machine after storing in distilled water at 37 °C for 24 h. One-way ANOVA and Tukey's HSD post hoc test were used to analyse the data (P < 0.05). The highest bond strength values were observed in the laser application group, while the lowest values were observed in the grinding group. Sandblasting and laser application resulted in significantly higher bond strengths than control treatment (P < 0.05). Ultrafast fiber laser treatment and sandblasting may improve the bond strength between resin cement and titanium.

The effect of veneering on the marginal fit of CAD/CAM-generated, copy-milled, and cast metal copings.

OBJECTIVE: This in vitro study investigated the marginal fit of metal and zirconia copings before and after veneering on dies with shoulder/chamfer (s/c) finish lines. MATERIALS AND METHODS: Using CAD/CAM, ten (n = 10) each s/c zirconia (NZ) copings and ten (n = 10) each s/c metal (MM) copings were generated. As controls, ten (n = 10) each s/c zirconia copings were copy-milled (ZZ) and ten (n = 10) each s/c metal copings were cast (CC). The vertical marginal discrepancy of the copings was measured at 20 predefined spots of the circular shoulder and chamfer finish lines in microns (µm) before and after a first and a second veneering firing using a stereomicroscope at ×40 magnification. Data were statistically analyzed, and the comparisons of CAD/CAM-milled (NZ, MM), copy-milled (ZZ), and cast (CC) copings before and after veneering were made at a significance level of p < 0.05. RESULTS: Gap width at s/c finish lines of ZZ was (91 ± 11/100 ± 28) and increased significantly (109 ± 21/141 ± 18) after the first firing (ZZ1). NZ showed significantly smaller gaps than ZZ (36 ± 6/46 ± 12) and (NZ1) after the first firing (61 ± 16/71 ± 29). Gap widths of CC groups (36 ± 8/25 ± 4) were not significantly different from NZ but were significantly lower after the (CC1) first veneering firing (40 ± 8/42 ± 7). MM copings showed gap values similar to NZ. Second firings did not significantly increase gaps in all groups except ZZ2 of chamfer finish line. CONCLUSION: Veneering increased the marginal gap width of copings. CLINICAL RELEVANCE: Within the limits of this in vitro study, aesthetic ceramic veneering of CAD/CAM-generated copings caused a statistically significant but tolerable loss of marginal fit precision.

Influence of Tooth Preparation Design on Fitting Accuracy of CAD-CAM Based Restorations.

OBJECTIVE: The purpose of this study was to evaluate the marginal fit of different zirconia and metal frameworks and compare them with each other on different finish line configurations. MATERIALS AND METHODS: 20 stainless steel dies 10 with shoulder and 10 with chamfer finish line including 6 mm preparation height and 3 degree axial angle simulating a 6 degree total occlusal covergence of the prepared tooth were produced. After embedding the each group of die into the arch-shaped acrylic resin blocks, impressions were made using silicone based impression material and 120 casts were prepared subsequently. The dies were divided into six groups each having 20 specimens (10 with shoulder, 10 with chamfer finish line). Group CM consisted of Co-Cr produced by conventional casting procedure, group MM of Co-Cr prepared by metal milling, group LM of Co-Cr prepared by direct laser metal sinterization (DLMS), group ZZ of Zirkonzahn (Zirkonzahn GmbH, Gais, Italy), group LZ of Lava Zirconia (3 M ESPE Dental AG, Seefeld, Germany) and group DZ of DC-Zirkon (DCS Dental AG, Allschwil, Switzerland). Stereomicroscope were used to evaluate the marginal fit of frameworks and marginal gap values obtained from the images were analyzed using Mann-Whitney U Test and Kruskal-Wallis H Test with Bonferroni correction. RESULTS: The lowest value of marginal gap was identified in the samples from the LZ group and the highest value was identified in those from ZZ in both finish lines. The effect of finish lines was not significant for most groups but CM frameworks with chamfer finish lines and the DZ frameworks with shoulder finish lines showed significantly lower marginal gap values. CONCLUSION: The marginal gaps of the various tested zirconia and metal framework were within the range of clinical acceptability (120 µm). CLINICAL SIGNIFICANCE: The results of this in vitro study suggest that margin preparation design and type of zirconia and metal framework materials for various CAD-CAM systems have a significant effect on marginal fit of the resulting restorations. (J Esthet Restor Dent 28:238-246, 2016).

Evaluation of the bond strength of different adhesive agents to a resin-modified calcium silicate material (TheraCal LC).

This study evaluated the bond strength of different adhesive agents to TheraCal LC and mineral trioxide aggregate (MTA) and examined the morphologic changes of these materials with different surface treatments. A total of 120 specimens, 60 of MTA Angelus (AMTA), and 60 of TheraCal LC, were prepared and divided into six subgroups according to the adhesive agent used; these agents included Scotchbond Multipurpose, Clearfil SE Bond, Clearfil Protect Bond, Clearfil S3 Bond, OptiBond All-in-One, and G-aenial Bond. After application of adhesive agents, Filtek Z250 composite resin was placed onto the specimens. Shear bond strengths were measured using a universal testing machine, followed by examination of the fractured surfaces. The surface changes of the specimens were observed using scanning electron microscopy. Data were compared by two-way analysis of variance. Although no significant differences were found among the bond strengths of different adhesives to AMTA (p = 0.69), a significant difference was found in terms of bond strengths of different adhesives to the TheraCal LC surface (p < 0.001). The total-etch adhesive system more strongly bonded to TheraCal LC compared to the bond with other adhesives. TheraCal LC bonded significantly more strongly than AMTA regardless of the adhesive agents tested. Resin-modified calcium silicate showed higher bond strength than AMTA in terms of the composite bond to these materials with different bonding systems. On the other hand, the highest shear bond-strength values were found for composite bonds with the combination of TheraCal LC and the total-etch adhesive system. SCANNING 38:403-411, 2016. © 2015 Wiley Periodicals, Inc.

Effect of surface treatments on the bond strength of veneering ceramic to zirconia.

AIM: The purpose of this study was to evaluate the effect of different surface treatments on the bond strength of veneering ceramic to zirconia. METHODS: Square (15 mm x 10 mm x 2 mm) zirconia specimens (n=18) received one of the following surface treatments: Group 1, sandblasting; Group 2, Clearfil ceramic primer application; Group 3, grinding; Group 4, alloy primer application; and Group 5, RelyX ceramic primer application. The zirconia core specimens were layered with a veneering porcelain (5 mm x 3 mm x 3 mm). Mean shear bond strength values (MPa) were calculated. Data were analyzed with one-way ANOVA and Tukey's post hoc pairwise comparisons (α=0.05). Fractured surfaces of the specimens were examined with scanning electron microscope (SEM). RESULTS: This study showed that bond strengths of the metal primer-treated zirconia specimens (Group 4) were significantly higher than those of the other paired groups. The application of metal primer affected the specimens' failure mode. SEM analysis demonstrated that Group 4 had mainly cohesive fractures, while the other groups showed approximately equal levels of adhesive and mixed fracture types. The mean and SD values for shear bond strengths ranged from 8.90 ± 3.42 MPa (Group 2) to 19.74 ± 4.96 MPa (Group 4). CONCLUSIONS: In conclusion, the application of a metal primer to a zirconia core increased the bond strength of veneering ceramics. The use of chemical agents to improve the strength of the zirconia core's bond to veneering ceramic may have more benefits than the use of mechanical pretreatments.

Peel strength of denture liner to PMMA and polyamide: laser versus air-abrasion.

PURPOSE: This study investigated the effect of laser parameters and air-abrasion on the peel strength of silicon-based soft denture liner to different denture resins. MATERIALS AND METHODS: Specimens (N=180) were prepared out of three different denture base resins (Rodex, cross-linked denture base acrylic resin; Paladent, heat-cured acrylic resin; Deflex, Polyamide resin) (75 mm × 25 mm × 3 mm). A silicon-based soft denture liner (Molloplast B) was applied to the denture resins after the following conditioning methods: a) Air-abrasion (50 µm), b) Er,Cr:YSGG laser (Waterlase MD Turbo, Biolase Technology) at 2 W-20 Hz, c) Er,Cr:YSGG laser at 2 W-30 Hz, d) Er,Cr:YSGG laser at 3 W-20 Hz, e) Er,Cr:YSGG laser at 3 W-30 Hz. Non-conditioned group acted as the control group. Peel test was performed in a universal testing machine. Failure modes were evaluated visually. Data were analyzed using two-way ANOVA and Tukey's test (α=.05). RESULTS: Denture liner tested showed increased peel strength after laser treatment with different parameters (3.9±0.4 - 5.58±0.6 MPa) compared to the control (3.64±0.5 - 4.58±0.5 MPa) and air-abraded groups (3.1±0.6 - 4.46±0.3 MPa), but the results were not statistically significant except for Paladent, with the pretreatment of Er,Cr:YSGG laser at 3 W-20 Hz. Polyamide resin after air-abrasion showed significantly lower peel strength than those of other groups (3.1±0.6 MPa). CONCLUSION: Heat-cured acrylic resin, PMMA, may benefit from Er,Cr:YSGG laser treatment at 3 W-20 Hz irradiation. Air-abrasion of polyamide resins should be avoided not to impair their peel bond strengths to silicon-based soft denture liners.

Rehabilitation of an extracted anterior tooth space using fiber-reinforced composite and the natural tooth.

Conservative solutions for the restoration of a single edentulous space in the anterior maxilla present an esthetic challenge to the clinician. A 45-year-old male patient whose right upper central tooth was planned to be extracted was referred to our clinic for a conservative, rapid, and economic treatment. After radiographic and clinical examinations, it was decided that the tooth which was to be extracted should be used for the restoration of its own extracted area. The extracted tooth was splinted to adjacent teeth with the aid of the grooves and fiber-reinforced composite (everStick, StickTech Ltd., Turku, Finland). Following an early and unexpected failure of the restoration, the fiber layer was thickened twice with a flowable composite resin (Stick Flow, Stick Tech Ltd.) which fit better to the grooves. The restoration satisfied the patient with a good mechanical behavior, esthetics, and long-term durability after 12 months while. Restoring the missing tooth area with the patient's own tooth is advantageous when combined with modern adhesive techniques. The clinician must pay attention to the mechanical adaptation of the restoration and the technique sensitivity of the applied adhesive system.