Influence of different cutting instruments and rotational speeds on heat generation and cutting efficiency when sectioning different types of zirconia.

PURPOSE: The purpose of this study was to evaluate the temperature generated on the intaglio surface and efficiency when cutting different types of zirconia with different rotary instruments and rotational speeds. METHODS: A conventional diamond rotary instrument (Brasseler, grit size 107 µm) and special diamond rotary instrument marketed to cut zirconia (4 ZR, Brasseler, grit size 126 µm) were tested on 3Y-TZP and 4Y-TZP zirconia with a rotation speed of 100,000 rpm and 200,000 rpm. Zirconia specimens were cut under water cooling (110 mL/min) in a custom-made holder attached to a universal testing machine. The temperature was recorded with infrared sensors pointing at the intaglio surface of the zirconia specimens. RESULTS: A rotation speed of 200,000 rpm resulted in significantly shorter cutting times, but also in significantly higher temperatures at the intaglio surface of the zirconia specimens compared with a rotation speed of 100,000 rpm. Significantly shorter cutting times were observed for the conventional diamond rotary instrument than for the special rotary instrument marketed to cut zirconia. Using the special rotary instrument, significantly longer cutting times were recorded for 3Y-TZP than for 4Y-TZP. CONCLUSIONS: A conventional diamond rotary instrument was more efficient than a special rotary instrument. However, to avoid high temperatures when cutting zirconia clinically, a rotation speed of 100,000 rpm is recommended.

The physical-mechanical properties of 3D-printed versus conventional milled zirconia for dental clinical applications: A systematic review with meta-analysis.

AIM OF STUDY: This systematic review aimed to compare the physical-mechanical properties of 3D-printed (additively manufactured (AM)) zirconia compared to conventionally milled (subtractive manufactured: SM) zirconia specimens. MATERIALS AND METHODS: A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies that evaluated AM zirconia specimens and restorations regarding the physical-mechanical properties and mechanical behavior of zirconia. The main topic focused on 3Y-TZP. However, records of 4YSZ and 5YSZ were also included to gather more comprehensive evidence on additively manufactured zirconia ceramic. The quality of studies was assessed using the ROB2 tool, Newcastle Ottawa scale, and the Modified Consort Statement. Of 1736 records, 57 were assessed for eligibility, and 38 records were included in this review, only two clinical trials meet the inclusion criteria and 36 records were laboratory studies. There were no signs of mechanical complications and wear to antagonists with short-term clinical observation. SM thin specimens ≤1.5 mm showed statistically significant higher flexural strength than AM zirconia (p ≤ 0.01), while thicker specimens showed comparable outcomes (p > 0.5). The fracture resistance of dental restorations was dependent on the aging protocol, restoration type, and thickness. The bond strength of veneering ceramic to zirconia core was comparable. CONCLUSIONS: The results pooled from two short-term clinical trials showed no signs of mechanical or biological complications of additively manufactured 3Y-TZP zirconia crowns. The flexural strength might depend on the specimens' thickness, but it showed promising results to be used in clinical applications, taking into account the printing technique and orientation, material composition (yttria content), solid loading, and sintering parameters. 3D-printed restorations fracture resistance improved when adhered to human teeth. The veneering ceramic bond was comparable to milled zirconia specimens. Long-term RCTs are recommended to confirm the mechanical behavior of 3D-printed restorations.

Investigation of Mechanical Properties of Polymer-Infiltrated Tetrapodal Zinc Oxide in Different Variants.

The aim of this study was to evaluate the influence of weight ratio, the shape of the precursor particles, and the application of a phosphate-monomer-containing primer on the mechanical properties of polymer infiltrated ceramic networks (PICNs) using zinc oxide. Two different types of zinc oxide particles were used as precursors to produce zinc oxide networks by sintering, each with two different densities resulting in two different weight ratios of the PICNs. For each of these different networks, two subgroups were built: one involving the application of a phosphate-monomer-containing primer prior to the infiltration of Bis-GMA/TEGDMA and one without. Elastic modulus and flexural strength were determined by using the three-point bending test. Vertical substance loss determined by the chewing simulation was evaluated with a laser scanning microscope. There was a statistically significant influence of the type of precursor particles on the flexural strength and in some cases on the elastic modulus. The application of a primer lead to a significant increase in the flexural strength and in most cases also in the elastic modulus. A higher weight ratio of zinc oxide led to a significantly higher elastic modulus. Few statistically significant differences were found for the vertical substance loss. By varying the shape of the particles and the weight fraction of zinc oxide, the mechanical properties of the investigated PICN can be controlled. The use of a phosphate-monomer-containing primer strengthens the bond between the infiltrated polymer and the zinc oxide, thus increasing the strength of the composite.

The Influence of Contamination and Different Cleaning Methods and the Effect of Plasma Treatment of CoCr Alloy on Tensile Bond Strength to Composite Resin.

PURPOSE: To investigate the influence of contamination and different cleaning methods on resin bonding to cobalt-chro- mium (CoCr) alloy disks. MATERIALS AND METHODS: A total of 160 CoCr disks were divided into 3 groups. The first group (N = 64) was air abraded with alumina particles and contaminated with a silicone disclosing agent and saliva; the second group (N = 64) was air abraded but not contaminated; the third group (N = 32) was neither air abraded nor contaminated. The first two groups were di- vided into 4 subgroups (N = 16) according to the cleaning method: ultrasonic bath in 99% isopropanol, use of a cleaning suspension of zirconium oxide particles, use of a cleaning suspension based on 10-MDP salt, and treatment with atmo- spheric plasma. The third group was divided into 2 subgroups (N = 16): treatment with atmospheric plasma and no treat- ment. All CoCr specimens were bonded to plexiglas tubes filled with a bonding resin that contained phosphate monomer. Tensile bond strength (TBS) was examined by tensile testing after 3 and 150 days of water storage plus 37,500 thermal cy- cles (N = 8). RESULTS: After contamination, TBS was significantly reduced after 150 days of water storage. Groups without air abrasion showed initially low TBS and debonded spontaneously after 150 days of water storage. CONCLUSION: None of the cleaning methods was able to remove saliva and silicone disclosing agent on CoCr-alloy sur- faces. Surface activation by plasma treatment has no long-term effect on the bond strength.

3D-printed versus conventionally milled zirconia for dental clinical applications: Trueness, precision, accuracy, biological and esthetic aspects.

OBJECTIVES: This systematic review aimed to compare the clinical outcome, internal gap, trueness, precision, and biocompatibility of 3D-printed (AM) compared to milled (SM) zirconia restorations. DATA SOURCE: A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies compared AM zirconia to SM zirconia restorations regarding clinical outcome, fit, trueness, precision, and biocompatibility. STUDY SELECTION: Of 1736 records, only 59 were screened for eligibility, and 22 records were included in this review. The quality of studies was assessed using the revised Cochrane risk-of-bias tool (ROB2), and the Modified Consort Statement. One clinical study exhibited a low risk of bias. All laboratory studies revealed some bias concerns. Short-term observation showed 100 % survival with no signs of periodontal complications. 3D-printed zirconia crowns showed statistically significant lower ΔE and a better match to adjacent teeth (p ≤ 0.5). The fit, trueness, and precision vary with the printing technique and the tooth surface. CONCLUSIONS: 3D-printed zirconia crowns provide better aesthetic color and contour match to adjacent natural teeth than milled crowns. Both 3D printing and milling result in crowns within the clinically acceptable internal and marginal fit. Except for nanoparticle jetting, the marginal gap of SM crowns was smaller than AM crowns, however, both were clinically acceptable. Laminate veneers might be more accurately produced by 3D printing. 3D-printed axial surface trueness was better than milled axial surfaces. Long-term RCTs are recommended to confirm the clinical applicability of 3D-printed restorations. CLINICAL SIGNIFICANCE: Internal fit and gap, precision, and trueness are fundamental requirements for successful dental restorations. Both techniques produce restorations with clinically acceptable marginal and internal fit. Axial surfaces and narrow or constricted areas favored 3D-printed than conventionally milled zirconia.

Influence of post material and ferrule thickness on the fracture resistance of endodontically treated premolars: A laboratory study.

STATEMENT OF PROBLEM: The influence of the ferrule thickness and post materials on the fracture resistance of endodontically treated teeth remains unclear. PURPOSE: The purpose of this laboratory study was to evaluate the influence of post material and ferrule thickness on the fracture resistance of endodontically treated mandibular premolars. MATERIAL AND METHODS: Sixty-four extracted and endodontically treated mandibular first premolars were used and divided into 4 test groups (n=16) depending on the ferrule thickness: F-0: without a ferrule, F-0.5: with a 0.5-mm ferrule thickness, F-1: with a 1-mm ferrule thickness, and F-1.5: with a 1.5-mm ferrule thickness. In groups with ferrules, the height ranged from 2 mm buccally/lingually to 1 mm proximally. Teeth in subgroups (n=8) were restored with either prefabricated glass fiber (FF) or titanium posts (FT) (ISO size 70 and length of 7.5 mm) and then adhesively restored with composite resin foundation materials. After foundation procedures, each specimen was restored with a cobalt chromium crown which was cemented with glass-ionomer cement. All specimens were subjected to dynamic loading in a masticatory simulator for 1 200 000 loading cycles with a nominal load of 5 Kg at 1.2 Hz and simultaneous thermocycling (5 to 55 °C). Specimens were then quasistatically loaded at 30 degrees in a universal testing machine until fracture. Fracture loads were analyzed by using 2-way ANOVA followed by the Tukey honestly significant difference test (α=.05). RESULTS: Fracture loads ranged from 610 ±45 N (no ferrule - glass fiber post) to 1216 ±169 N (1.5 mm ferrule thickness - glass fiber post). A statistically significant increase in fracture resistance was observed with increasing ferrule thickness (P<.001). However, post materials did not show a statistically significant influence (P=.977). CONCLUSIONS: Under the conditions of this laboratory study, increasing the ferrule thickness had a significant effect on the fracture resistance of endodontically treated teeth after thermomechanical fatigue, irrespective of post materials.

Durability of Resin Bonding to Dental 3Y-TZP Zirconia Using Different Adhesive Systems.

This laboratory study was conducted to evaluate and compare the resin bond strength of different adhesive resin systems in different combinations and the durability of their bonds with zirconia ceramic. MATERIALS AND METHODS: One hundred and twenty-eight specimens were milled from 3Y-TZP zirconia ceramic. The bonding surfaces of all disks were wet polished, steam cleaned, airborne-particle abraded and ultrasonically cleaned in 99% isopropanol. The specimens were randomly divided into four main groups according to the applied resin system; two conventional and two self-adhesive systems were used. Each group was further subdivided into two subgroups; the first was conditioned with the specified primer for conventional luting resins or not conditioned for the self-adhesive systems, whereas the second subgroup of each was conditioned with the same phosphate monomer-containing primer (Alloy Primer). The zirconia specimens were adhesively bonded, using the allocated luting resin, to plexiglass tubes filled with self-curing composite resin (Clearfil FII). Half of the specimens of each subgroup were stored in distilled water at 37 °C for 3 days, whereas the other half were subjected to artificial aging, 150 days of storage and additional thermal cycling. Thereafter, all specimens were subjected to TBS testing using a universal testing machine. Statistical analysis was conducted using two-way ANOVA followed by separate one-way ANOVAs. The Games-Howell post-hoc test was applied for pairwise comparisons. RESULTS: All specimens survived storage with thermal cycling. The mean TBS values ranged from a minimum of 43.4 ± 5.0 MPa to a maximum of 66.4 ± 3.5 after 3 days and from a minimum of 13.6 ± 2.5 MPa to a maximum of 50.1 ± 9.4 MPa after 150 days. CONCLUSIONS: Artificial aging had a significantly negative effect on all test groups. The chosen adhesive-resin system had a significant effect on the resulting TBS values. The highest TBS values were achieved for the self-adhesive luting resin G-Cem One but were statistically comparable to the results obtained for the dual-cure luting resin G-Cem LinkForce.

Effect of Thermomechanical Dynamic Loading on the Retention of Metallic and Nonmetallic Telescopic Mandibular Overdentures.

PURPOSE: To evaluate the effect of thermomechanical dynamic loading on the retention of telescopic mandibular overdentures with different metallic and nonmetallic material combinations. MATERIALS AND METHODS: Four groups were tested: (1) ZP (zirconia abutments/PEEK framework); (2) PP (PEEK abutments/PEEK framework); (3) TP (titanium abutments/PEEK framework); and (4) TG (titanium abutments/gold copings/cobalt-chromium framework). Each specimen contained four implants positioned over a polyvinylchloride-cylindrical base. After 10,000 removal/insertion cycles, the specimens were subjected to thermomechanical dynamic load in a chewing simulator for 1,200,000 loading cycles, corresponding to 5-year clinical fatigue. A screw was used to receive the chewing load, and 0.5 mm was permitted between the screw and the metal top fixed into the base to simulate the resilience of the posterior residual ridge tissues. Vertical chewing loads of 60 N were applied at a speed of 30 mm/second. Thermocycling was applied with a temperature ranging between 5°C and 55°C. The retentive force was measured using a universal testing machine 10 times before and after the thermomechanical dynamic loading test with a speed of 8 mm/second. RESULTS: The mean retentive force increased significantly from 13.2 (± 4.6) N to 16.4 (± 6.1) N in group ZP (P = .002), while in group TP, it decreased significantly from 4.9 (± 2.1) N to 3.3 (± 1.7) N (P = .046). There was no statistically significant change in the retentive force for groups PP and TG. CONCLUSIONS: The investigated metallic and nonmetallic combinations of double-crown-retained mandibular overdentures maintained acceptable levels of retention after thermomechanical dynamic loading. Further laboratory and clinical studies are needed before their routine clinical use can be recommended.

Influence of shading on zirconia's phase transformation and flexural strength after artificial aging.

OBJECTIVES: The aim of this study was to determine the phase transformation and the influence of aging on the flexural strength of different colored zirconia. The effect of hydrothermal aging in an autoclave was compared with the effect of mechanical stress by simulating chewing. METHODS: High-strength zirconia (3Y-TZP) was investigated in three different colors: uncolored, A3, and D3. Disc-shaped specimens (N = 3) were analyzed by X-ray diffraction (XRD), and flexural strength was determined on bar-shaped specimens (N = 15) in a 4-point bending test before and after performing two different aging protocols: aging in an autoclave (134 °C, 70 h) and aging in a chewing simulator (5 kg load, 1.2 million cycles). During autoclave aging, the fraction of monoclinic phase on the surface was determined every 5 h. Once this exceeded 25 vol%, aging of the bar specimens was stopped. RESULTS: While in the unstained group the mean value of the proportion of monoclinic phase already exceeded 25 vol% after 30 h in the autoclave, this was the case in both stained groups only after 70 h. No measurable phase transformation could be detected after chewing simulation. Only color A3 showed a statistically significant (p ≤ 0.05) decrease in flexural strength after aging in the chewing simulator. SIGNIFICANCE: The colored zirconia showed a higher resistance to phase transformation through hydrothermal aging. The metal oxides in the staining solutions are assumed to hinder the phase transformation in the zirconia. Therefore, the significant reduction in the stained zirconia after chewing simulation is particularly interesting.

Comparison of properties and cost efficiency of zirconia processed by DIW printing, casting and CAD/CAM-milling.

OBJECTIVES: The aim of this study was to evaluate the mechanical properties and cost efficiency of direct ink writing (DIW) printing of two different zirconia inks compared to casting and subtractive manufacturing. METHODS: Zirconia disks were manufactured by DIW printing and the casting process and divided into six subgroups (n = 20) according to sintering temperatures (1350 °C, 1450 °C and 1550 °C) and two different ink compositions (Ink 1, Ink 2). A CAD/CAM-milled high strength zirconia (3Y-TZP) was added as reference group. The biaxial flexural strength (BFS) was measured using the piston-on-three-balls test. X-ray-diffraction (XRD) was used for microstructural analysis. The cost efficiency was compared for DIW printing and subtractive manufacturing by calculation of the manufacturing costs of one dental crown. RESULTS: Using XRD, monoclinic and tetragonal phases were detected for Ink 1, for all other groups no monoclinic phase was detected. The CAD/CAM-milled ceramic showed a significantly higher BFS than all other groups. The BFS of Ink 2 was significantly higher than the BFS of Ink 1. At a sintering temperature of 1550 °C the mean BFS of the printed Ink 2 was 822 ± 174 MPa. The BFS of the cast materials did not show a significantly higher BFS than the corresponding printed group for any tested parameter-set. The manufacturing costs of DIW printed crowns are lower than the manufacturing costs of CAD/CAM-milled crowns. CONCLUSION: DIW has a high potential to replace subtractive processes for dental applications, as it shows promising mechanical properties for appropriate ink compositions and facilitates a highly cost effective production.

Survival and debonding resistance of posterior cantilever resin-bonded fixed dental prostheses for moderately and severely worn dentition during thermomechanical loading.

OBJECTIVES: The purpose of this study was to investigate the survival rate, the debonding resistance, and the failure modes of different occlusal veneer designs when used as a retainer for posterior cantilever, resin-bonded fixed dental prostheses (RBFDPs) at two tooth wear levels. METHODS: Four test groups were assigned: two groups with occlusal-proximal preparation (PT1 and PT2 for grade 2 and 3 wear), and two groups for occlusal-proximal and lingual preparation (PLT1 and PLT2 for grade 2 and 3 wear) Monolithic zirconia ceramic (3Y-TZP) RBFDPs were luted with an adhesive bonding system (Panavia V5). The specimens underwent a chewing simulation for 1.200.000 cycles with a load of 5 kg and thermocycling for 7500 cycles between 5 °C and 55 °C. The surviving restorations were debonded under quasi-static conditions. The results were analyzed with ANOVA. RESULTS: The specimens exhibited a 100 % survival rate after thermomechanical fatigue loading. The debonding resistance was statistically significant higher for group PLT1 than for group PT1 (P = 0.004), and higher for group PT2 than group PT1 (P ≤ 0.001). However, the debonding resistance showed no statistically significant difference between groups PT2 and PLT2 (P = 0.343), and groups PLT1 and PLT2 (P = 0.222). Groups PT1 and PT2 showed favorable failure modes in 62.5 % and 0.00 % of the specimens, respectively. While groups PLT1 and PLT2 presented 25 % favorable failure modes. SIGNIFICANCE: Occlusal veneers showed promising results as a retainer for cantilever RBFDPs. The lingual extension might increase debonding resistance. Nevertheless, conservative designs with lingual and proximal bevels are to be recommended, irrespective of the level of tooth wear.

Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE). DATA SOURCES: A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies. STUDY SELECTION/RESULTS: The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE. CONCLUSIONS: Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins. CLINICAL SIGNIFICANCE: The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence.

The Correlation of Surface Roughness Parameters of Zirconia and Lithium Disilicate with Steatite Wear.

PURPOSE: Various surface roughness parameters are utilized to describe the surface in the tooth to ceramics abrasion and to assess the resulting wear. The use of three-dimensional parameters may offer a better estimation for wear and an improved deduced clinical surface treatment. The aim of this study was to determine the influence of various surface roughness parameters of zirconia and lithium disilicate ceramics on the wear of steatite antagonists. MATERIAL AND METHODS: Forty zirconia specimens with a diameter of 7 mm and a thickness of 3 mm and 40 lithium disilicate specimens with the dimensions 10×10×4 mm were each divided into five subgroups. Two subgroups were treated with different clinically established diamond burs; a third subgroup was treated with a silicone polishing set. Two additional subgroups were produced by glazing the surfaces after treatment. Surface roughness parameters were determined by laser scanning microscopy. All specimens underwent 1.2 million loading cycles using steatite antagonists. After regular intervals of cycles, precision impressions were made to assess the wear. The correlation between wear and different roughness parameters was evaluated using the Spearman correlation test. RESULTS: For the glazed zirconia, unglazed zirconia, and glazed lithium disilicate specimens no significant correlations (p > 0.05) between the investigated roughness parameters and antagonist wear could be found. In the unglazed lithium disilicate groups, significant (p ≤ 0.05) correlations with steatite substance loss could be found for several roughness parameters after 1.2 million cycles. CONCLUSIONS: For lithium disilicate, it seems not sufficient to use only one roughness parameter to indicate the wear behavior of the surface. There was no correlation between wear and the tested roughness parameters of zirconia surfaces.

Accuracy and dimension stability of scannable versus conventional interocclusal registration materials: An in vitro study.

STATEMENT OF PROBLEM: Scientific data to support scannable and computer-aided design and computer-aided manufacturing (CAD-CAM)-compatible interocclusal registration materials are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the ability of different registration materials (conventional versus scannable) to record maxillary-mandibular relationships and compare the dimensional stability of these records after storage times of 1 hour and 48 hours. MATERIAL AND METHODS: Six groups of interocclusal registration materials were tested: 3 conventional (Registrado X-tra, Futar D Fast, and O-Bite) and 3 scannable (Registrado Scan, Futar Cut & Trim Fast, and O-Bite Scan). Eight registrations were made for each group by using a custom-made device with a dial gauge to measure vertical discrepancies. Records were stored at room temperature, and discrepancies measured after 1 hour and 48 hours. The data were statistically analyzed with the Wilcoxon test with respect to time and the Kruskal-Wallis test with respect to materials, followed by the Mann-Whitney test with the Bonferroni-Holm correction (α=.05). RESULTS: The median vertical discrepancies ranged from -2 µm (FS) to 11 µm (O-Bite) after 1 hour and from 3 µm (Futar Cut & Trim Fast) to 13 µm (Registrado X-tra and O-Bite) after 48 hours. A statistically significant difference (P<.001) was found between the results after 1 hour and 48 hours for all materials. All scannable interocclusal registration materials showed significantly lower vertical discrepancies than the corresponding conventional materials after 1 hour and 48 hours (P<.05). CONCLUSIONS: All registration materials showed vertical discrepancies that might be clinically acceptable. Vertical discrepancies increased after 48 hours of storage for all materials but were still clinically acceptable.

Clinical outcomes and influence of material parameters on the behavior and survival rate of thin and ultrathin occlusal veneers: A systematic review.

PURPOSE: Various oral rehabilitation approaches are available for severely worn dentition. However, evidence-based guidelines for permanent treatment are limited. This review aims to investigate clinical observational findings and compare in-vitro outcomes of thin and ultrathin occlusal veneers using different materials and approaches. METHODS: An electronic search of online databases, such as PubMed (MEDLINE), BioMed Central (BMC), Cochrane, and Scopus, was performed for the 2009 - Jun 2021 period, following the PRISMA 2020 criteria. The reports sought for retrieval were all the articles evaluating the clinical outcomes of permanent full-mouth rehabilitation, and all in-vitro records that investigated and compared fracture strength, survival rate, and modes of failure of ultrathin (0.3 - 0.6 mm), thin (0.5 - 0.8 mm), and thick (0.8-1.5 mm) occlusal veneer restorations, with regard to the available indirect restorative materials. The Newcastle Ottawa risk of bias criteria was used to judge the clinical studies and a modified consort statement was used for the evaluation of in-vitro studies. The data of the included studies were extracted and grouped based on the similarity of the outcomes and study protocols. Data heterogeneity determined the qualitative and quantitative grouping of the results. RESULTS: Two clinical and 17 in-vitro studies were included. Data exhibited heterogeneity within the materials, variables, testing protocols and observation periods. Therefore, only qualitative synthesis of the results was feasible. Clinically used 1 mm lithium disilicate overlays and ultrathin one-step no-prep polymer infiltrated ceramic network (PICN) occlusal veneers exhibited very high success and survival rates. The analysis of in-vitro studies exhibited variable survival rates and fracture load values, based on materials, thickness, and restorative approaches used. CONCLUSIONS: Within the limitations of this systematic review, it can be concluded that the clinical outcomes of thin and ultrathin occlusal veneers/overlays are auspicious. In-vitro experimental results support the usage of the thin and ultrathin occlusal veneers.

Effect of thermo-mechanical dynamic loading on the retention of metallic and non-metallic telescopic mandibular overdentures.

PURPOSE: To evaluate the effect of thermomechanical dynamic loading on the retention of telescopic mandibular overdentures with different metallic and nonmetallic material combinations. MATERIALS AND METHODS: Four groups were tested: (1) ZP (zirconia abutments/PEEK framework); (2) PP (PEEK abutments/PEEK framework); (3) TP (titanium abutments/PEEK framework); and (4) TG (titanium abutments/gold copings/cobalt-chromium framework). Each specimen contained four implants positioned over a polyvinylchloride-cylindrical base. After 10,000 removal/insertion cycles, the specimens were subjected to thermomechanical dynamic load in a chewing simulator for 1,200,000 loading cycles, corresponding to 5-year clinical fatigue. A screw was used to receive the chewing load, and 0.5 mm was permitted between the screw and the metal top fixed into the base to simulate the resilience of the posterior residual ridge tissues. Vertical chewing loads of 60 N were applied at a speed of 30 mm/second. Thermocycling was applied with a temperature ranging between 5°C and 55°C. The retentive force was measured using a universal testing machine 10 times before and after the thermomechanical dynamic loading test with a speed of 8 mm/second. RESULTS: The mean retentive force increased significantly from 13.2 (± 4.6) N to 16.4 (± 6.1) N in group ZP (P = .002), while in group TP, it decreased significantly from 4.9 (± 2.1) N to 3.3 (± 1.7) N (P = .046). There was no statistically significant change in the retentive force for groups PP and TG. CONCLUSIONS: The investigated metallic and nonmetallic combinations of double-crown-retained mandibular overdentures maintained acceptable levels of retention after thermomechanical dynamic loading. Further laboratory and clinical studies are needed before their routine clinical use can be recommended.

Influence of Aging and Surface Treatment on the Composite Bond Strength to Translucent 3Y-TZP Zirconia.

PURPOSE: The purpose of this study was to assess the effect of aging and alumina-particle air abrasion at different pressures on the bond strength of two luting composites to a translucent 3Y-TZP zirconia. MATERIALS AND METHODS: Half of the 192 disk-shaped zirconia specimens were aged in an autoclave (group A) for 20 h (134°C, 2 bar), and the other half was not aged (group N). For each group, a different surface treatment was applied: as-sintered (group SIN), alumina-particle air abrasion either at 1 bar (group 1B) or at 2.5 bar (group 2.5B). Disks were bonded to Plexiglas tubes filled with composite resin using a phosphate monomer-based luting composite (group SA) or with a separate phosphate monomer containing primer before using a phosphate-monomer-free luting composite (group V5). All specimens were subjected to tensile bond strength testing (TBS) before and after thermocycling. RESULTS: There were no statistically significant differences caused by autoclave aging for the test groups before thermocycling, except for the A-SIN-SA group, where the TBS decreased significantly. The variation of the aluminaparticle air abrasion pressure showed no statistically significant effect, except in the N-1B-V5 group, where TBS was significantly lower than N-2.5B-V5. After thermocycling, the TBS of most groups decreased significantly. Specimens of the primer group, which were abraded at 1 bar, showed a significant decrease in TBS in comparison with alumina-particle air abrasion at 2.5 bar. CONCLUSION: Twenty hours of autoclave aging had almost no influence on the bond strength of the test groups. For the primer/resin bonding system, higher pressure during alumina-particle air abrasion might help obtain a higher and more durable bond strength to zirconia.

Retention durability of one-retainer versus two-retainer posterior RBFDPs after chewing simulation.

The clinical use of one-retainer RBFDPs in the anterior region has shown higher survival rates compared to conventional two-retainer RBFDPs. The motivation for this study was to assess the validity of this observation when extended to the posterior region. The aim was thus to evaluate different preparation and framework designs for replacing premolars, particularly one-retainer versus two-retainer designs, on the retention of monolithic zirconia posterior RBFDPs. Extracted caries-free human premolars and third molars were embedded in auto-curing resin to create models with an edentulous space of premolar width. Abutment teeth were prepared according to these six designs (n = 8 each): one or two upper retainers with narrow rests, one or two upper retainers with wide rests, and one or two-retainers with wide rests. RBFDPs were milled from monolithic zirconia (KATANA Zirconia HT), and were adhesively bonded using Panavia V5 with corresponding primers. After thermodynamic loading, the quasi-static tensile force required for failure was determined. Failure modes were evaluated using a microscope. Survival rates after thermodynamic loading were 75% for one group (one upper-molar retainer with narrow rest), 100% for the other groups. The debonding forces ranged from 310 ± 224 N (group one upper-molar retainer with narrow rest) to 927 ± 292 N (group two upper retainers with narrow rests). Two-retainer designs failed at significantly higher tensile forces than designs with one retainer (p ≤ 0.05). There were no significant differences between upper and lower designs, or rest widths. Although RBFDPs with two retainers withstood higher debonding forces, RBFDPs with one retainer and wide rest still have a high potential for clinical treatment because of the high forces required for their debonding.

Comparison of Testing Designs for Flexural Strength of 3Y-TZP and 5Y-PSZ Considering Different Surface Treatment.

The aim of this study was to analyze the influence of different surface treatments and the corresponding surface roughness on the ball-on-three-balls test and piston-on-three-balls test for measuring flexural strength 3Y-TZP and 5Y-PSZ. Additionally, the influence of cutting the material into the specimens when pre-sintered or fully sintered was analyzed. A total of 120 specimens for each material group, 3Y-TZP zirconia (Katana HT, Kuraray) and the 4 different layers of multilayered 5Y-PSZ zirconia (Katana UTML, Kuraray), were produced. The used material was cut into half of the specimens in a fully sintered stage, the other half was cut when pre-sintered. Each subgroup was divided into 3 different surface treatment groups being air abraded with 50 µm alumina particles at 1 bar pressure, ground with 600 SiC paper or polished up to 1 µm with a polycristalline diamond suspension. These were then analyzed by X-ray diffraction (XRD) (N = 3) and tested for flexural strength using the ball-on-three-balls test (N = 10) or piston-on-three-balls test (N = 10). For 3Y-TZP groups different surface roughness did not result in statistically significant differences in flexural strength but cutting the specimens in fully sintered state significantly reduced flexural strength of 1133 ± 109 to 741 ± 81 MPa. For 5Y-PSZ groups air abrasion of the specimens with alumina particles significantly reduced the flexural strength of 562 ± 68 MPa to 358 ± 58 MPa. Cutting and surface treatment in pre-sintered or fully sintered state had no significant influence. Flexural strength testing with the ball-on-three-balls test resulted in about 20% higher strengths compared to the piston-on-three-balls test. Results of both tests showed the same tendencies when compared.

Cellular properties of human gingival fibroblasts on novel and conventional implant-abutment materials.

OBJECTIVES: To characterize human-gingival-fibroblast-(HGFs) viability, proliferation and adhesion on polymer-infiltrated-ceramic-network-(PICN), polyetheretherketone-(PEEK), hydroxyapatite-reinforced-polyetheretherketone-(HA-PEEK), polyetherketoneketone-(PEKK), as well as conventional titanium-(Ti) and zirconia ceramic-(Zr) implant materials in-vitro. METHODS: Six materials (n = 40/group, 240 specimens) were standardized for surface roughness, assessed employing water contact angle measurements (WCA) and loaded with HGFs. HGF viability and proliferation were assessed at 24 and 72 h. Cell adhesion strength was evaluated after 24 h exposure to lateral shear forces using a shaking-device at 320 and 560-rpm.and qualitatively tested by scanning-electron-microscopy-(SEM) at 3, 24 and 72 h. RESULTS: PICN demonstrated the lowest mean WCA (48.2 ± 6.3º), followed by Zr (73.8 ± 5.1º), while HA-PEEK showed the highest WCA (87.2 ± 1.5º; p ≤ 0.05). After 24 h, Zr showed the highest mean HGFs-viability rate (88 ± 14%), while PEKK showed the lowest one (78 ± 7%). At 72 h, Zr continued to show the highest HGF-viability (80 ± 6%) compared to PEKK (67.5 ± 6%) and PEEK (67%±5). SEM did not reveal differences between different materials with respect to cell attachment at 3, 24 or 72 h. At 320 rpm shaking, HGFs showed to be best attached to PICN (mean%-of-detached-cells ± SD; 26 ± 11%) and worst to PEEK (54 ± 18%). At 560 rpm shaking, Zr showed the least detached cells (32 ± 4%), while HA-PEEK revealed the highest number of detached cells (58 ± 3%; ANOVA/Tukey-post-hoc-test, differences not statistically significant). SIGNIFICANCE: Dental implant abutment materials and their wettability strongly affect HGF proliferation and adhesion properties. Although, PICN showed the best wettability properties, Zr exhibited the strongest adhesion strength at high shaking. Within the current study's limitations, Zr remains the most biocompatible abutment material.