Fatigue resistance of monolithic and multilayer zirconia crowns using veneer layering or CAD-on technique.

This study aims to evaluate the fatigue resistance of monolithic zirconia (Yz) and multilayer ceramic structures using the CAD-on technique in different thicknesses. Fifty (N=50) standardized single crowns preparations were made in fiberglass-reinforced epoxy resin (NEMA grade G10), digitalized, and restorations were machined in CAD-CAM, composing 5 groups (n= 10): Control: 1.5 mm (milled zirconia framework + manual layered porcelain); Yz monolithic 1.5 mm; Yz monolithic 1.0 mm; CAD-on 1.5 mm; and CAD-on 1.0 mm (milled zirconia framework 0.5 mm thickness bonded by a low fuse ceramic to a milled lithium disilicate layer of 1.0 mm or 0.5 mm, respectively). The G10 bases were conditioned with 10% hydrofluoric acid; the crowns were air abraded with 110 µm alumina particles; and then luted onto each other with self-adhesive resin cement. A cyclic fatigue test was performed (initial load: 400N for 10,000 cycles, frequency of 20 Hz, step size of 200N) until failure, and the data was submitted to a survival statistical analysis. No failures were observed at Yz monolithic 1.5 mm. High and similar performance was observed for Cad-On groups and Yz monolithic 1.0 mm. The control group depicted the worst behavior. The Weibull modulus of CAD-on 1.5 mm was higher than the control while being similar to the other conditions. Both the monolithic systems and the CAD-on technique showed high and similar fatigue fracture behavior and survival rates, which were also higher than the control bilayer system. Both systems reduced the occurrence of delamination failures, making them suitable for clinical use.

Effect of preheating and ultrasound application of resin-based luting agents on the failure load of a lithium disilicate glass-ceramic.

PURPOSE: To assess the effect of preheating resin-based materials and ultrasound application on the failure load of a lithium disilicate glass-ceramic. MATERIALS AND METHODS: Ninety ceramic specimens were produced (14×12×1.0 mm) and divided into 9 groups (n = 10) to be bonded to a dentin analog (Nema G10) with light-cured luting agent (LC), flowable resin composite (FL), and supra-nano filled resin composite (SN), as follows: LC/R - LC at room temperature; LC/P - preheated LC; LC/P/U - preheated LC and Ultrasound; FL/R - FL at room temperature; FL/P - preheated FL; FL/P/U - preheated FL and Ultrasound; SN/R - SN at room temperature; SN/P - preheated SN; SN/P/U - preheated SN and Ultrasound. The failure load test was performed in a universal testing machine with the aid of acoustic detection. The data was analyzed with two-way ANOVA (for failure load) and Weibull statistics (Weibull modulus - m and characteristic strength, based on 95% confidence intervals - CI). RESULTS: The analyses of failure load revealed no statistically significant difference among groups considering the type of luting agent (P = 0.075; F = 2,673), the application method (P = 0.772; F = 2,259), and the interaction between them (P = 0.297; F = 1,248). The characteristic strength did not show differences among groups (95% CI). The m, which indicates structural reliability, showed lower values for SN/P/U and SN/P, with a difference from other selected groups (95% CI). CONCLUSION: Preheating of resin-based materials and ultrasound application did not affect the failure load of lithium disilicate glass-ceramic. Lower reliability was observed with supra-nano filled resin composite.

Fatigue resistance of monolithic and multilayer zirconia crowns using veneer layering or CAD-on technique

Abstract This study aims to evaluate the fatigue resistance of monolithic zirconia (Yz) and multilayer ceramic structures using the CAD-on technique in different thicknesses. Fifty (N=50) standardized single crowns preparations were made in fiberglass-reinforced epoxy resin (NEMA grade G10), digitalized, and restorations were machined in CAD-CAM, composing 5 groups (n= 10): Control: 1.5 mm (milled zirconia framework + manual layered porcelain); Yz monolithic 1.5 mm; Yz monolithic 1.0 mm; CAD-on 1.5 mm; and CAD-on 1.0 mm (milled zirconia framework 0.5 mm thickness bonded by a low fuse ceramic to a milled lithium disilicate layer of 1.0 mm or 0.5 mm, respectively). The G10 bases were conditioned with 10% hydrofluoric acid; the crowns were air abraded with 110 μm alumina particles; and then luted onto each other with self-adhesive resin cement. A cyclic fatigue test was performed (initial load: 400N for 10,000 cycles, frequency of 20 Hz, step size of 200N) until failure, and the data was submitted to a survival statistical analysis. No failures were observed at Yz monolithic 1.5 mm. High and similar performance was observed for Cad-On groups and Yz monolithic 1.0 mm. The control group depicted the worst behavior. The Weibull modulus of CAD-on 1.5 mm was higher than the control while being similar to the other conditions. Both the monolithic systems and the CAD-on technique showed high and similar fatigue fracture behavior and survival rates, which were also higher than the control bilayer system. Both systems reduced the occurrence of delamination failures, making them suitable for clinical use.

Resumo Este estudo teve como objetivo avaliar o comportamento à fadiga de estruturas cerâmicas monolíticas de zircônia (Yz) e multicamadas utilizando a técnica CAD-on em diferentes espessuras. Cinquenta (N=50) preparos unitários padronizados foram confeccionados em resina epóxi reforçada com fibra de vidro (NEMA grau G10), digitalizados e as restaurações usinadas em CAD-CAM, compondo 5 grupos (n= 10): Controle: 1,5 mm (estrutura de zircônia fresada + porcelana estratificada manualmente); Yz monolítica 1,5 mm; Yz monolítica 1,0 mm; CAD-on em 1,5 mm; e CAD-on 1,0 mm (estrutura de zircônia fresada com 0,5 mm de espessura ligada por uma cerâmica de baixa fusão a uma camada de dissilicato de lítio fresado de 1,0 mm ou 0,5 mm, respectivamente). As bases do G10 foram condicionadas com ácido fluorídrico a 10%; as coroas foram jateadas com partículas de alumina de 110 μm; e então cimentadas uma sobre a outra com cimento resinoso autoadesivo. Foi realizado um teste de fadiga cíclica (carga inicial: 400N para 10.000 ciclos, frequência de 20 Hz, step de 200N) até a falha, e os dados foram submetidos a uma análise estatística de sobrevivência. Nenhuma falha foi observada para Yz monolítica de 1,5 mm. Desempenho alto e semelhante foi observado para os grupos Cad-On e Yz monolítica 1,0 mm. O grupo controle apresentou o pior comportamento. O módulo de Weibull do CAD-on 1,5 mm foi maior que o grupo controle, sendo semelhante às outras condições. Tanto os sistemas monolíticos quanto a técnica CAD-on apresentaram alto e semelhante desempenho mecânico e taxas de sobrevivência, que também foram superiores ao sistema bicamada de controle. Ambos os sistemas reduziram a ocorrência de falhas de delaminação, tornando-os adequados para uso clínico.

Do preheated composite resin or adhesive resin layer strengthen the feldspar ceramic?

STATEMENT OF PROBLEM: Preheated composite resin and adhesive coating have been recommended as luting agents for ceramic veneers; however, information about the mechanical behavior of feldspathic porcelain veneers after using these methods is still limited. PURPOSE: The purpose of this in vitro study was to evaluate the influence of the use of preheated composite resin or an adhesive resin layer on the strengthening of a feldspathic porcelain. MATERIAL AND METHODS: Feldspathic porcelain disks were fabricated (N=210), etched (10% hydrofluoric acid for 90 seconds), and bonded according to resin-based luting agents (30 per group) for the biaxial flexural strength tests: photopolymerized resin cement, flowable composite resin, preheated composite resin, with or without previous adhesive coating. Characteristic strength and Weibull modulus were calculated. The viscosity of the luting agents was measured by using isothermal analyses. Finite element analysis simulated the flexural test. Fractographic and bonded interfaces were observed. RESULTS: The use of preheated composite resin led to the lowest stress levels in the feldspathic porcelain veneers. However, it did not increase the ceramic strengthening compared with other luting agents, as higher values were observed with flowable composite resin (P<.05). The use of an adhesive resin layer had no significant effect on ceramic strengthening when associated with preheated composite resin or resin cement (P>.05). Preheated composite resin presented the highest viscosity and led to incomplete filling of the porcelain surface irregularities. Failures originated on the ceramic surface subjected to tensile stress and were typically associated with pores at the ceramic-luting agent interface. CONCLUSIONS: The use of preheated composite resin or an adhesive resin layer did not have a positive effect on strengthening feldspathic porcelain.

Obtaining optimal esthetics with veneered zirconia and lithium disilicate frameworks on substrates of different colors.

OBJECTIVE: This study sought to describe the clinical and laboratory procedures and to discuss aspects involved in obtaining satisfactory esthetics on substrates presenting different colors. CLINICAL CONSIDERATIONS: This case report describes the clinical and laboratory procedures for obtaining an optimal esthetic result using different ceramic framework materials veneered with feldspathic ceramic over substrates of different colors. Zirconia frameworks were used for darkened substrates and were reinforced with lithium disilicate for substrates with minimal discoloration. The same feldspathic veneering ceramic was applied to provide similar translucency and color for favorable esthetics. CONCLUSIONS: The materials explored in the present case report presented favorable aesthetic results in masking darkened substrates. CLINICAL SIGNIFICANCE: Clinicians should consider the condition and color of the substrate when selecting the restorative material for masking such a condition.

Cyclic contact fatigue resistance of ceramics for monolithic and multilayer dental restorations.

OBJECTIVE: To evaluate the cyclic contact fatigue resistance and failure mode of ceramics for monolithic and multilayer restorations. METHODS: Ceramic structures (10 mm × 1.8 mm) were fabricated as follows (n = 28): (1) CAD-on- trilayer structure composed of Y-TZP (yttria stabilized tetragonal zirconia polycrystal- IPS e.max ZirCAD) infrastructure, fusion glass-ceramic (IPS e.max CAD Crystall/Connect) and lithium disilicate-based glass-ceramic (IPS e.max CAD); (2) ZFC- bilayer structure composed of Y-TZP infrastructure veneered by a fluorapatite glass-ceramic (IPS e.max Ceram); (3) LDC- monolithic lithium-disilicate glass-ceramic (IPS e.max CAD); and (4) YZW- monolithic Y-TZP (Zenostar Zr Translucent). All ceramics structures were bonded to a dentin analog substrate (G10). Specimens were submitted to cyclic contact fatigue test in a pneumatic cycling machine with 80 N load and 2 Hz frequency in distilled water at 37 °C. Test was interrupted after 104, 105, 5 × 105 and 106 cycles and the presence or absence of failure was recorded. Fatigue data were analyzed using Kaplan-Meier (log rank) and Holm-Sidak tests (α = 0.05). The relationship between the type of crack leading to failure and the experimental group was analyzed using chi-square test (α = 0.05). RESULTS: There was no statistical difference between CAD-on and YZW groups (p = 0.516), which presented the highest survival rates after cyclic loading, followed by ZFC and LDC groups (p < 0.01). There was a significant relationship between type of crack and experimental group (p < 0.001). LDC specimens showed the greatest frequency of radial cracks, while cone cracks were more prevalent for ZFC and CAD-on specimens. SIGNIFICANCE: Monolithic Y-TZP (YZW) showed similar fatigue resistance to CAD-on multilayer specimens, but different failure mode. Monolithic lithium disilicate glass-ceramic (LDC) and Y-TZP conventionally veneered by glass-ceramic (ZFC) showed lower survival time under fatigue.

Fracture Load and Failure Mode of CAD-on Ceramic Structures.

This study evaluated the fracture load (Lf) and the failure mode of CAD-on (Ivoclar Vivadent) ceramic structures, testing the hypotheses that Lf of multilayer structures is governed by the veneering ceramic strength and that chipping is more frequent in multilayer than monolithic structures. Disc-shaped specimens were fabricated as follows: CAD-on- trilayer structure composed of Y-TZP (yttria stabilized tetragonal zirconia polycrystal- IPS e.max ZirCAD) infrastructure, fusion glass-ceramic (IPS e.max CAD Crystall/Connect) and lithium disilicate-based glass-ceramic (IPS e.max CAD); YLD- bilayer structure composed of Y-TZP infrastructure and fluorapatite layering ceramic (IPS e.max Ceram); LDC- monolithic lithium-disilicate glass-ceramic (IPS e.max CAD); and YZW- monolithic Y-TZP (Zenostar Zr Translucent). The specimens were loaded in compression until failure and fracture surfaces were evaluated using fractographic principles. Lf values were statistically analyzed using the Weibull statistics, Kruskal-Wallis and Dunn tests (a= 0.05). YZW (1329 N) and CAD-on (1085 N) showed the greatest Lf median values, followed by YLD (832 N) and LDC (421 N). All monolithic structures (LDC and YZW) fractured catastrophically and all YLD structures failed by chipping. The CAD-on technique seems to be a very promising fabrication process because it showed high Lf, similar to monolithic zirconia, and small chipping rate.

Substrate masking ability of bilayer and monolithic ceramics used for complete crowns and the effect of association with an opaque resin-based luting agent.

PURPOSE: To evaluate the substrate masking ability of different ceramic systems used for complete crowns and assess the influence of their association with an opaque resin-based luting agent (OLA). METHODS: Eleven ceramic groups were tested (n=10). Bilayer groups were: ZrPc - zirconia+porcelain; CAD-onHT - zirconia+high translucent lithium disilitace; CAD-onLT - zirconia+low translucent lithium disilicate; LDPc - high opaque lithium disilicate+porcelain. Monolithic groups were: TZ - high translucent zirconia; TLS - translucent, zirconia-reinforced lithium silicate; HTLS - high translucent, zirconia-reinforced lithium silicate; LTLD - low translucent lithium disilicate; HTLD - high translucent lithium disilitace; LGC - leucite-reinforced glass ceramic; FC - feldsphatic ceramic. The substrates adopted were resin composites shaded A1 (control), A3.5 and C4; coppery and silvery metals. Color differences (ΔE00) and translucency parameter (TP00) were assessed with the CIEDE2000 formula. ΔE00 was obtained assessing the ceramic influence only and in association with OLA. RESULTS: Zirconia groups presented lower ΔE00 and TP00. CAD-on structures associated to OLA led to the lower ΔE00 when tested over metals. ΔE00 for LDPc were similar to zirconia when associated to OLA. Monolithic groups presented significant higher ΔE00 and TP00 compared to bilayers, with ΔE00 below the acceptability threshold only when associated to OLA over substrate shade A3.5. CONCLUSIONS: Ceramic type and the white-opaque resin-based luting agent presented a significant effect on the substrate masking ability. All the discolored substrates tested are adequately masked with veneered zirconia or with LDPc (preferably associated to OLA). The CAD-on technique associated with OLA improved the masking ability over metallic substrates.

Effect of Surface Coating on Bond Strength between Etched Feldspar Ceramic and Resin-Based Luting Agents.

This study evaluated adhesive protocols (silane, silane and unfilled resin, and universal adhesive) of bond strength between feldspar ceramic and resin-based luting agents (RBLAs). Thirty ceramic disks were embedded into acrylic resin, polished, etched, and randomly divided into 6 groups: S-RC: silane (S) and light-cured resin cement (RC) (RelyX Veneer; 3M ESPE); SB-RC: S followed by bond (B) (Clearfil SE Bond, Kuraray) and RC; UA-RC: universal adhesive (UA) (Single Bond Universal; 3M ESPE) and RC; flowable composite resin (F) was used on groups S-F, SB-F, and UA-F, and luting agent cylinders were built. The response variables (n=20) were microshear bond strength (MPa), characteristic strength (σ0 , MPa), and Weibull modulus (m). The RC groups presented similar bond strengths regardless of whether or not bond was used. The S-F group with only silane application showed the highest bond strength, while the universal adhesive showed the lowest bond strength. The reliability was only affected in the UA-RC group, which was lower than the S-F group. Silane application is fundamental since the universal adhesive only decreased the bond strength between the feldspar ceramic and the RBLAs. Overall, the use of unfilled resin did not positively influence bond strength.

Feldspar Ceramic Strength and The Reinforcing Effect by Adhesive Cementation Under Accelerated Aging.

This study evaluated the effect of the accelerated artificial aging (AAA) on feldspar ceramic strength and the reinforcing effect promoted by adhesive cementation with resin luting agent. One hundred twenty feldspar ceramic disks were obtained. Sixty disks were acid-etched, silanized, and coated with an experimental resin luting agent simulating the adhesive luting procedures. Four groups were created (n=30): uncoated ceramic (control group), uncoated ceramic submitted to AAA, ceramic coated with resin luting agent, and coated ceramic submitted to AAA. Biaxial flexural testing with ball-on-ring setup was carried out. Biaxial flexural strength (s bf , MPa), characteristic strength (s 0 , MPa), and Weibull modulus (m) were calculated for axial positions z=0 (ceramic surface) and z=-t2 (luting agent surface). Data of s bf at positions z=0 and z=-t2 were separately submitted to statistical analyses (a=0.05). The uncoated ceramic submitted to AAA had no significant difference in s bf and s 0 compared with the control group. Resin coating of the ceramic increased s bf and s 0 at z=0. The AAA increased the s bf and s 0 for the resin-coated ceramic specimens at z=0 and also the s 0 at axial position z=-t2. The structural reliability at z=0 and z=-t2 was not influenced by the variables tested. In conclusion, resin coating improved the mechanical strength of the feldspar ceramic. The AAA procedure was not effective in aging the uncoated or resin-coated feldspar ceramic specimens.

Ceramic strengthening by tuning the elastic moduli of resin-based luting agents.

OBJECTIVE: Resin-based luting agents (RBLAs) with tuned elastic moduli (E) were prepared and their influence on the strengthening, reliability, and mode of failure of luted feldspar ceramic was investigated. METHODS: RBLAs with low E (2.6GPa), intermediate E (6.6GPa), and high E (13.3GPa) were prepared and used to coat acid-etched ceramic disks. Positive (untreated ceramic) and negative (acid-etched ceramic) control groups were tested. The response variables (n=30) were biaxial flexural strength (σbf, MPa), characteristic strength (σ0, MPa), and Weibull modulus at the ceramic surface (z=0) and luting agent surface (z=-t2). A 3D finite element analysis simulated the biaxial flexural test. Fractographic analysis and morphology of the bonded interfaces were analyzed using scanning electron microscopy. RESULTS: The RBLAs improved σbf and σ0 at z=0, particularly those with intermediate and high E, whereas the mechanical reliability was only affected in the negative control. At z=-t2, differences between all RBLAs were observed but the structural reliability was independent of the RBLA tested. Increasing E of the RBLA was associated with increased stress concentration at the RBLA and reduced stresses reaching the ceramic. Failures originated on the ceramic surface at the ceramic-cement interface. In the high E group, failure sometimes originated from the RBLA free surface. All RBLAs completely filled the ceramic irregularities. SIGNIFICANCE: Increased E of the RBLA reduced the variability of strength, the stress reaching the ceramic structure, and sometimes altered the origin of failure. The use of high E RBLAs seems beneficial for luting feldspar ceramics.

Reabilitação oral ­ parte 1: prótese total implantossuportada na mandíbula associada a próteses cerâmicas na maxila / Oral rehabilitation ­ part 1: mandibular implant-supported denture associated to maxillary ceramic dental prostheses

A presente coluna teve como objetivo apresentar um relato de caso clínico de reabilitação oral envolvendo diferentes possibilidades em prótese dentária: uma prótese total fixa implantossuportada (PTF) na mandíbula; e restaurações cerâmicas com infraestruturas de dissilicato de lítio sobre os dentes remanescentes e infraestruturas de zircônia sobre os implantes. O tratamento foi desenvolvido em quatro etapas: i) restabelecimento da dimensão vertical de oclusão (DVO); ii) PTF na mandíbula; iii) reabilitação temporária superior; e iv) próteses cerâmicas superiores. A coluna foi dividida em duas partes: 1) etapas i, ii e iii; e 2) etapa iv. Após o acompanhamento clínico de quatro anos da PTF na mandíbula e seis meses das próteses cerâmicas superiores, a reabilitação apresentou-se satisfatória do ponto de vista estético e funcional.

The purpose of this column was to present a clinical case report of oral rehabilitation involving different possibilities in dental prosthesis: a fixed implant-supported denture (FD) on the jaw; and ceramic restorations with lithium disilicate frameworks on the remaining teeth and zirconia frameworks on the implants. The treatment was developed in four steps: i) reestablishment of the vertical occlusion dimension (OVD); ii) FD on the jaw; (iii) maxil-lary temporary rehabilitation; and iv) ceramic prostheses on the maxillary. The column was divided into two parts: 1) steps i, ii and iii; and 2) step iv. After the four-year of FD clinical follow-up and six months of the superior ceramic prostheses, the rehabilitation was considered aesthetic and functional satisfactory.

Reliability and mode of failure of bonded monolithic and multilayer ceramics.

OBJECTIVES: To evaluate the reliability of monolithic and multilayer ceramic structures used in the CAD-on technique (Ivoclar), and the mode of failure produced in ceramic structures bonded to a dentin analog material (NEMA-G10). METHODS: Ceramic specimens were fabricated as follows (n=30): CAD-on- trilayer structure (IPS e.max ZirCAD/IPS e.max Crystall./Connect/IPS e.max CAD); YLD- bilayer structure (IPS e.max ZirCAD/IPS e.max Ceram); LDC- monolithic structure (IPS e.max CAD); and YZW- monolithic structure (Zenostar Zr Translucent). All ceramic specimens were bonded to G10 and subjected to compressive load in 37°C distilled water until the sound of the first crack, monitored acoustically. Failure load (Lf) values were recorded (N) and statistically analyzed using Weibull distribution, Kruskal-Wallis test, and Student-Newman-Keuls test (α=0.05). RESULTS: Lf values of CAD-on and YZW structures were statistically similar (p=0.917), but higher than YLD and LDC (p<0.01). Weibull modulus (m) values were statistically similar for all experimental groups. Monolithic structures (LDC and YZW) failed from radial cracks. Failures in the CAD-on and YLD groups showed, predominantly, both radial and cone cracks. SIGNIFICANCE: Monolithic zirconia (YZW) and CAD-on structures showed similar failure resistance and reliability, but a different fracture behavior.

Tightening techniques for the retaining screws of universal abutment / Técnicas de aperto para parafusos de retenção do pilar universal

Purpose: This study evaluated the torque maintenance of universal abutment retaining screws using different tightening techniques, and coated or uncoated screws. Material and method: The screws were tightened to implants as following: Control - 32 Ncm torque; H20 - holding 32 Ncm torque for 20 s; R - 32 Ncm torque, repeated after 10 min (retorque); and H20+R - combining the two tightening techniques. Titanium and coated screws were also evaluated. Result: Statistical analysis showed higher maintained torque for titanium screws (p< 0.001). The H20+R technique showed the highest maintained torque (p=0.003), but the H20 technique's maintained torque was similar. Conclusion Titanium screws associating the two tightening techniques can improve maintained torque.

Objetivo: Este estudo avaliou a manutenção do torque de parafusos de retenção do pilar universal utilizando diferentes técnicas de aperto e parafusos com ou sem revestimento. Material e método: Os parafusos foram apertados nos implantes da seguinte forma: Controle - 32 Ncm de torque; H20 - segurando os 32 Ncm de torque por 20 s; R - 32 Ncm de torque, repetido após 10 min (retorque); e H20+R - combinando as duas técnicas de aperto. Foram também avaliados parafusos de titânio com e sem revestimento da rosca. Resultado: A análise estatística mostrou maior manutenção do torque de parafusos de titânio (p< 0,001). A técnica H20+R apresentou a maior manutenção do torque (p=0,003), semelhante a manutenção do torque da técnica H20. Conclusão: Parafusos de titânio combinando as duas técnicas de aperto pode melhorar a manutenção do torque.

Visual and instrumental shade matching using CIELAB and CIEDE2000 color difference formulas.

OBJECTIVES: To compare visual and instrumental shade matching performances using two shade guides and three color difference formulas. METHODS: One hundred dental students (DS) volunteers (35 males and 65 females) with normal color vision participated in the study. The spectral reflectance of 4 extracted human upper central incisors (UCI) and shade tabs from Vita Classical (VC) and Vita Toothguide 3D-Master (3D) shade guides were measured using a spectroradiometer (SP) under D65 illuminant (diffuse/0° geometry) inside a viewing booth with a gray background. Color coordinates (CIE L*, a*, b*, C* and h°) were calculated according to CIE D65 illuminant and CIE 2° Standard Observer. Color coordinates of UCI were also evaluated using a dental spectrophotometer (EA - Easyshade Advance). DS used VC and 3D to visually select the best shade match for each UCI, under same experimental conditions used for the SP evaluation. Three color difference metrics (CIELAB, CIEDE2000(1:1:1) and CIEDE2000(2:1:1)) were used to calculate the best instrumental shade matching based on minimum color difference. RESULTS: The agreement between visual and instrumental shade matching was greater using SP (25-75%) than EA (0-25%). The percentage of best match for the visual assessment was more consistent using VC (23-55%) than 3D (19-34%). Considering the best performance (using SP and VC), the CIEDE2000(2:1:1) color difference formula showed the best estimate to the visual perception from DS. SIGNIFICANCE: Within the limitations of this study, combining the use of SP, CIEDE2000(2:1:1) and Vita Classical shade guide most closely represented the visual perception of DS. Instrumental shade determination should be accompanied by experienced human visual assessment.

Pilar de zircônia personalizado com base metálica para prótese unitária sobre implante / Zirconia customized abutment with metallic base for implant crown

Durante muitos anos pilares metálicos pré-fabricados têm sido utilizados em reabilitações implantossuportadas. Porém, eles não correspondem à necessidade ideal em algumas situações clínicas, mesmo apresentando diversas dimensões. Com o avanço dos materiais e das técnicas de fabricação, a utilização de cerâmicas odontológicas para pilares têm ganhando notoriedade. Desse modo, a utilização de pilares de zircônia, produzidos em CAD-CAM, tem possibilitado um melhor manejo de casos específicos, onde a personalização destes pilares resulta em um suporte mais favorável do tecido gengival peri-implantar e proporciona uma linha de cimentação mais próxima da margem gengival, aumentando previsibilidade do resultado final. Esta coluna tem como objetivo apresentar um caso clínico de reabilitação do primeiro molar inferior esquerdo (36) com implante, para tal foi utilizado um pilar de zircônia personalizado com base metálica e coroa de dissilicato de lítio.

For many years prefabricated metal abutments have been used in implant-supported rehabilitations. however inn some clinical situations they do not match the ideal needs even when presenting several options. With the development of new materials and manufactu-re techniques, dental ceramics used as abutments gained notoriety. Therefore, the use of zirconia abutments, manufactured in CAD-CAM, has enabled a better handling of specific cases, where the customization of these abutments results on better support of gingival peri-implant tissue and to provide a cementation line closer to the gingival margin, increasing the predictability of treatment results. This column has as purpose to present a clinical case of rehabilitation of the mandibular left first molar (36) with implant, using a customized zirconia abutment with metallic base and crown of lithium disilicate.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating.

PURPOSE: The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. MATERIALS AND METHODS: Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at 10(6) cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukey's test (5%). RESULTS: The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). CONCLUSION: The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws.

Zirconia as a Dental Biomaterial.

Ceramics are very important in the science of dental biomaterials. Among all dental ceramics, zirconia is in evidence as a dental biomaterial and it is the material of choice in contemporary restorative dentistry. Zirconia has been applied as structural material for dental bridges, crowns, inserts, and implants, mostly because of its biocompatibility, high fracture toughness, and radiopacity. However, the clinical success of restorative dentistry has to consider the adhesion to different substrates, which has offered a great challenge to dental zirconia research and development. This study characterizes zirconia as a dental biomaterial, presenting the current consensus and challenges to its dental applications.

Efeito do lubrificante no torque de afrouxamento de parafusos protéticos sob dois níveis de adaptação de próteses implantossuportadas / Lubrication effect on loosening torque of prosthetic screw under two levels of implant-supported prostheses fit

A literatura sugere que a utilização de lubrificante poderia aumentar a estabilidade das conexões parafusadas. Este estudo avaliou a influência do uso de lubrificante líquido no torque de afrouxamento de parafusos protéticos em próteses mandibulares implantossuportadas sob diferentes níveis de adaptação. Foram criadas duas condições de adaptação (adaptação passiva e desajuste), confeccionando 2 modelos de gesso a partir de cada prótese. Foram utilizados 20 conjuntos de parafusos protéticos de titânio (5 parafusos cada conjunto) divididos aleatoriamente em 4 grupos: 1) sem lubrificante + adaptação passiva (grupo controle); 2) sem lubrificante + esajuste; 3) com lubrificante + adaptação passiva e 4) com lubrificante + desajuste. O torque de afrouxamento dos parafusos foi mensurado 10 minutos após aplicação do torque de aperto (10 Ncm), utilizando torquímetro digital. Os resultados foram submetidos à ANOVA (2 fatores) e teste de Tukey (a=0,05). Os valores médios (desvio padrão) de torque de afrouxamento (Ncm) foram: G1 = 7,6 (0,4); G2 = 6,6 (0,3); G3 = 7,5 (0,2) e G4 = 6,9 (0,8). O fator ‘adaptação’ apresentou diferença estatisticamente significante (p=0,003). Porém, o fator ‘lubrificante’ e a interação entre os fatores não foram significantes (p=0,537 e p=0,311, respectivamente). O desajuste diminuiu o torque de afrouxamento dos parafusos protéticos, enquanto que o lubrificante líquido não apresentou efeito considerável.

The literature suggests that the use of lubricant may increase the screw joint stability. This study has evaluated the influence of the use of liquid lubricant on loosening torque of prosthetic screws in implant-supported mandibular dentures under different fit levels. Two conditions were created (passive fit and misfit) making 2 cast models from each denture. Twenty set of titanium prosthetic screws (5 screws each set) were randomly divided in 4 groups: 1) without lubricant + passive fit (control group); 2) without lubricant + misfit; 3) with lubricant + passive fit; and 4) with lubricant + misfit. The loosening torque of the screws was measured 10 minutes after applied torque (10 Ncm) using digital torque meter. The data were submitted to the ANOVA (two-way) and Tukey’s test (a;=0.05). The mean values (standard deviation) of loosening torque (Ncm) were: G1 = 7.6 (0.4); G2 = 6.6 (0.3); G3 = 7.5 (0.2); and G4 = 6.9 (0.8). The factor ‘fit’ presented significant statistically difference (p=0.003). However, the factor ‘lubricant’ and the factors interaction were not significant (p=0.537 and p=0.311, respectively). The misfit decreased the loosening torque of the prosthetic screws, whereas the liquid lubricant did not present considerable effect