In vitro inhibition of demineralization from bioglass-containing adhesive and composite.

PURPOSE: To measure and compare the area of inhibition around a bioglass-containing adhesive and resin-based composite following an in vitro artificial caries model in human extracted teeth. METHODS: Preparations were made at the CEJ of extracted human molars (40, n=10/material) and restored with combinations of a bioglass-containing adhesive (BA, Regen), a reference adhesive which served as a negative control (RA), a bioglass-containing composite (BC, Regen), and a reference composite which served as a negative control (RC): BABC, RABC, BARC, RARC. All materials were light-cured and then finished with a polishing disc. Teeth were incubated (37°C) for 24 hours in water. A demineralization solution composed of 0.1 M lactic acid, 3 mM Ca3(PO4)2, 0.1% thymol, and NaOH (to adjust pH= 4.5) and a remineralization solution composed of 1.5 mM Ca, 0.9 mM P, and 20 mM Tris(hydroxymethil)-aminomethane (pH= 7.0) were prepared. Specimens were placed in the demineralization solution for 4 hours followed by a remineralization solution for 20 hours and cycled daily for 30 days. The specimens were embedded, sectioned into 100 µm sections, and the interface between the adhesive/composite and root dentin margin was viewed with polarized light. A line was drawn parallel with the zone of demineralization for each tooth. The area of "inhibition" (defined as the area external to the line) or "wall lesion" (defined as the area internal to the line) was traced with internal image evaluation software and measured. Areas of inhibition were measured as positive values and areas of wall lesions were measured as negative values. RESULTS: A one-way ANOVA found significant differences between materials for "inhibition/wall lesion" areas in root dentin (P< 0.001). Tukey post-hoc analysis ranked materials (µm2, mean± SD): BABC (3590± 2847)a RABC (1903± 1025)a, BARC (-792± 850)b, RARC (-2544± 1760)b. CLINICAL SIGNIFICANCE: The use of bioglass-containing resin-based composite with or without a bioglass-containing adhesive demonstrated inhibition of demineralization at the restoration margin.

Effect of Surface Treatment and Cement on Fracture Load of Traditional Zirconia (3Y), Translucent Zirconia (5Y), and Lithium Disilicate Crowns.

PURPOSE: To determine if surface treatment and cement selection for traditional 3 mol% yttria partially stabilized zirconia (3Y-PSZ), "translucent" 5 mol% yttria-stabilized zirconia (5Y-Z), or lithium disilicate crowns affected their fracture load. MATERIALS AND METHODS: Crowns with 0.8 mm uniform thickness (96, n = 8/group) were milled of 3Y-PSZ (Lava Plus), 5Y-Z (Lava Esthetic), or lithium disilicate (e.max CAD) and sintered/crystallized. Half the crowns were either particle-abraded with 30 µm alumina (zirconias) or etched with 5% hydrofluoric acid (lithium disilicate), and the other half received no surface treatment. Half the crowns from each group were luted with resin-modified glass ionomer (RMGI, RelyX Luting Plus) and half were luted with a resin cement (RelyX Unicem 2) to resin composite dies. Crowns were load cycled (100,000 cycles, 100 N force, 24°C water) and then loaded with a steel indenter until failure. A three-way ANOVA examined the effects of material, cement, and surface treatment on fracture load. Post-hoc comparisons were performed with the Tukey-Krammer method. RESULTS: Fracture load was signficiantly different for materials and cements (p < 0.0001) but not surface treatments (p = 0.77). All lithium disilicate crowns luted with RMGI failed in fatigue loading cycling; 3Y-PSZ and 5Y-Z crowns luted with resin showed a higher fracture load compared with RMGI (p < 0.001). With resin cement, there was no signficant difference in fracture load between 5Y-Z and lithium disiliciate (p = 1) whereas 3Y-PSZ had a higher fracture load (p < 0.0001). CONCLUSIONS: Cement type affected fracture load of crowns but surface treatment did not. The 0.8 mm uniform thick crowns tested benefited from using resin cement regardless of type of ceramic material. Crowns fabricated from 5Y-Z may be particle-abraded if luted with resin cement.

Comparison of the mechanical properties of translucent zirconia and lithium disilicate.

STATEMENT OF PROBLEM: Three mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) possesses excellent mechanical properties but is relatively opaque. Five mol% yttria-stabilized zirconia polycrystal (5Y-ZP) offers improved translucency, but many of its clinical properties have not been compared with those of 3Y-TZP and lithium disilicate. PURPOSE: The purpose of this in vitro study was to compare the flexural strength, translucency parameter, bond strength, and enamel and material wear of 5Y-ZP (Katana UTML) with 3Y-TZP (Katana HT) and lithium disilicate (e.max CAD). MATERIAL AND METHODS: Flexural strength bars were sectioned (n=10, 25×4×2 mm), sintered or crystallized, polished, and fractured at 1 mm/min. Translucency specimens (1 mm thick) were fabricated (n=10). Their L*a*b* values were measured against a black-and-white background with a spectrophotometer, and ΔE00 was calculated. Zirconia bond strength specimens were airborne-particle abraded with 50 µm alumina followed by the application of a 10-methacryloxydecyl dihydrogen phosphate-containing primer (Clearfil Ceramic Primer). Lithium disilicate bond strength specimens were etched with 5% hydrofluoric acid followed by application of a silane-containing primer (Clearfil Ceramic Primer). A Tygon tube filled with resin cement (Panavia SA) was fixed to the surface of the ceramics and light-polymerized. After 1 day or 150 days of water storage, the resin cement was debonded in a macroshear test (n=10). The cusps of extracted human molars were isolated and mounted into the University of Alabama at Birmingham wear-testing device. Wear testing was performed with a 20-N load for 300000 cycles in 33% glycerin. The volumetric wear of polished zirconia, lithium disilicate, and enamel were measured along with the wear of the opposing enamel cusps using a noncontact profilometer (n=8). The data were compared by ANOVA and Tukey-Kramer analysis (α=.05). RESULTS: No statistical difference was seen between the bond strengths (P=.155) or the opposing enamel wear (P=.533) of different ceramics. A statistically significant difference was seen between the flexural strength (P<.001), translucency parameter (P<.001), and wear (P<.001) of the materials. The flexural strength values (MPa) were 1194 ±111 (Katana HT), 688 ±159 (Katana UTML), and 450 ±53 (e.max LT). The translucency parameter values were 6.96 ±0.53 (Katana HT), 8.30 ±0.24 (Katana UTML), 9.28 ±0.36 (e.max LT), and 12.64 ±0.48 (e.max HT). Bond strength values (MPa) at 1 and 150 days were 34.22 ±5.14 and 28.37 ±6.03 (Katana HT), 35.04 ±5.69 and 25.03 ±6.44 (Katana UTML), and 35.50 ±3.45 and 22.32 ±3.45 (e.max LT). Material and enamel wear (mm3) were 0 and 0.24 ±0.19 (Katana HT), 0 and 0.23 ±0.09 (Katana UTML), 0.28 ±0.13 and 0.31 ±0.10 (e.max CAD), and 0.09 ±0.03 and 0.31 ±0.14 (enamel). CONCLUSIONS: 5Y-TZP has a flexural strength and translucency parameter between those of 3Y-TZP and lithium disilicate. Both the short-term and long-term bond strength of 5Y-ZP and 3Y-TZP was shown to be similar to lithium disilicate. 5Y-ZP demonstrated no measurable material wear and opposing enamel wear similar to that of all the other materials tested.

Microleakage around Class V Composite Restorations after Ultrasonic Scaling and Sonic Toothbrushing around their Margin.

OBJECTIVES: To measure microleakage around class V composite restorations after piezoelectric ultrasonic scaling and sonic toothbrushing. METHODS: 3 mm × 2 mm × 1.5 mm boxes were prepared on buccal and lingual surfaces of extracted molars centered on the cementum-enamel junction. Half the preparations were beveled (0.5 mm). Preparations were restored with composite and polished. Restorations on one side of the teeth were either traced with an ultrasonic scaler (60 seconds, n = 16) or brushed in a sonic toothbrushing machine (2 hours, n = 16). After thermocycling (10,000 cycles/5-55°C), specimens were immersed in 5 wt% Fuchsine solution (24 hours). Samples were sectioned and evaluated for percentage of dye penetration. Data were analyzed with an exact Wilcoxon rank-sum test and exact Wilcoxon signed-rank test (alpha = 0.05). RESULTS: Microleakage was observed at the cementum-composite interface but not the enamel-composite interface. There was not a statistically significant effect of the bevel for ultrasonic scaling or for sonic toothbrushing. Data obtained with and without a bevel were combined and a statistically significant difference in microleakage between the treatment and control sides of the tooth were found for ultrasonic scaling (32.5%±44.9%, n = 16; p = 0.016) but not sonic toothbrushing (2.5% ± 41.2%, n = 16; p = 1.0). CONCLUSIONS: Piezoelectric ultrasonic scaling increased microleakage at cementum-composite interface and there was no difference in microleakage with the use of a bevel. CLINICAL SIGNIFICANCE: Piezoelectric sonic scaling around Class V composite restorations with margins in cementum should be avoided. Beveled margins will not reduce the incidence of microleakge resulting from ultrasonic scaling in Class V restorations. Placing the apical margin of the restoration in enamel should be attempted whenever possible to prevent future microleakage. (J Esthet Restor Dent 29:41-48, 2017).

Light-transmitting fiber optic posts: An in vitro evaluation.

STATEMENT OF PROBLEM: The clinical challenge of adhering cement to intracanal dentin is transmitting light to the most apical parts of root canals to allow more efficient polymerization of the cement. PURPOSE: The purpose of this in vitro study was to compare the cement-polymerizing ability, microstructure, and radiopacity of a new fiber optic post (iLumi fiber optic Post) with a clinically successful fiber post (DT Light Post). MATERIAL AND METHODS: Polymerizing ability was compared using a modified depth-of-polymerization protocol. A split aluminum mold with a 12-mm cylindrical hole (diameter=4.7 mm) was filled with light-polymerized resin cement (Variolink Esthetic LC). Each fiber post (n=12) was positioned and light-polymerized on the coronal end for 60 seconds with a light-emitting diode polymerization light. Unpolymerized resin was dissolved with an organic solvent, and the weight and length of the polymerized resin cement were measured. Scanning electron microscopy was used to examine vertical and horizontal cross-sections. The radiopacity values of both the posts and 5 additional reference posts were evaluated using an aluminum step wedge. RESULTS: The weight and length of the polymerized resin cement were significantly greater (P<.05) with the fiber optic post, which scanning electron microscopy showed to have a higher density of parallel fibers. The iLumi post demonstrated greater radiopacity among the tested fiber posts and a titanium alloy post. CONCLUSIONS: The iLumi fiber optic posts have a unique structural fiber composition and excellent radiopacity and light-transmitting ability that produce more complete polymerization of the resin cement than the DT Light posts.

Gloss and Stain Resistance of Ceramic-Polymer CAD/CAM Restorative Blocks.

OBJECTIVE: To evaluate the gloss and stain resistance of several new ceramic-polymer CAD/CAM blocks MATERIALS AND METHODS: Specimens (4 mm) were sectioned from: Enamic (polymer-infused ceramic), LAVA Ultimate (nano-ceramic reinforced polymer), e.max (lithium disilicate), Paradigm C (porcelain), and Paradigm MZ100 (composite). Specimens were wet polished on a polishing wheel to either 320 grit silicon paper (un-polished, N = 8) or 2000 grit silicon carbide papers followed by a 0.05 µm alumina slurry (polished, N = 8). Initial gloss and color (L*a*b*) values were measured. Specimens were stored in a staining solution at 37°C in darkness for 12 days (simulating 1 year). After storage, L*a*b* values re-measured. Change in color was reported as ΔE00 based on the CIEDE2000 formula. Gloss and ΔE00 were analyzed by two-way analysis of variance (ANOVA) (alpha = .05). Separate one-way ANOVA and Tukey post-hoc analyses were performed for both polish conditions and all materials. RESULTS: Two-way ANOVA showed that factors material, polish and their interaction were significant for both gloss and ΔE00 (p < .01). Post-hoc analysis reveals that polished specimens had significantly less color change than un-polished specimens for Paradigm C and LAVA Ultimate. E.max had significantly higher gloss and less color change than all other materials. CONCLUSION: The composition and polish of CAD/CAM materials affects gloss and stain resistance. CLINICAL SIGNIFICANCE: Ceramic-polymer hybrid materials can achieve the high gloss required for esthetic restorations. These materials should be polished in order to minimize staining. If polished, all of the tested materials exhibited clinically acceptable color changes at 1 year of simulated staining. (J Esthet Restor Dent 28:S40-S45, 2016).

Factors influencing the progression of noncarious cervical lesions: A 5-year prospective clinical evaluation.

STATEMENT OF PROBLEM: The etiology (chemical, friction, abfraction) of noncarious cervical lesion (NCCL) progression is poorly understood. PURPOSE: The purpose of this 5-year prospective clinical trial was to measure the relationship between NCCLs and various etiologic factors. MATERIAL AND METHODS: After review board approval, 29 participants with NCCLs were enrolled. Polyvinyl siloxane impressions were made of each NCCL, and casts were poured at baseline, 1, 2, and 5 years. The casts were scanned with a noncontact profilometer, and 1-, 2-, and 5-year scans were superimposed over baseline scans to measure volumetric change in NCCLs. T-scan and Fujifilm Prescale films were used to record relative and absolute occlusal forces on teeth with NCCLs at the 5-year recall. Participant diet, medical condition, toothbrushing, and adverse oral habit questionnaires were given at the 5-year recall. Occlusal analysis was completed on mounted casts to determine the presence of wear facets and group function. Volumetric lesion progression from 1 to 5 years was correlated to absolute and relative occlusal force using mixed model analysis. The Kruskall-Wallis and Mann-Whitney analyses compared lesion progression with diet, medical condition, toothbrushing, adverse oral habits, wear facets, and group function. RESULTS: The NCCL progression rate over 5 years was 1.50 ±0.92 mm(3)/yr. The rate of progression of NCCLs was related to mean occlusal stress (P=.011) and relative occlusal force (P=.032) in maximum intercuspation position. No difference was seen in NCCL progression between participants with any other factors. CONCLUSION: Heavy occlusal forces play a significant role in the progression of NCCLs.

Cleaning Methods for Zirconia Following Salivary Contamination.

PURPOSE: To determine the best method of cleaning saliva-contaminated zirconia in preparation for resin bonding. MATERIAL AND METHODS: Flat blocks of zirconia were particle abraded with aluminum oxide and divided into eight groups (n = 10). Groups 1 to 4 were first treated with one coat of an MDP primer (Z-prime Plus) and groups 5 to 8 were left untreated. A thin coat of fresh whole saliva was painted on all specimens (except the control, group 1) and left in contact for 3 minutes. The specimens were then cleaned by rinsing with water for 20 seconds (groups 2 and 5), or cleaned with 35% phosphoric acid for 20 seconds and rinsed (groups 3 and 6), or cleaned with a zirconia cleaning solution (Ivoclean) for 20 seconds and rinsed (groups 4 and 7), or abraded with aluminum oxide particles and rinsed (group 5). Following the cleaning procedure, groups 5 to 8 were treated with one coat of Z-prime Plus. A 2.5 mm diameter tube was filled with composite (Z100), affixed to the zirconia surface, and light-cured. Specimens were stored in water (37°C for 24 hours) followed by thermocycling (5°C to 55°C for 10,000 cycles). Shear bond strength testing was performed at a crosshead speed of 1 mm/min. Bond strength values were compared to the control using a Dunnett's test (alpha = 0.05). Contact angles of the zirconia specimens with and without Z-prime Plus were measured with water using a goniometer. RESULTS: Groups 2, 5, and 8 were not significantly different from the control. Application of Z-prime made the zirconia surface more hydrophobic. CONCLUSIONS: If salivary contamination occurs after MDP application, rinsing off the saliva with water will preserve bond strength. If salivary contamination occurs prior to MDP application, particle abrasion or cleaning with Ivoclean will preserve bond strength.

Depth of cure of bulk fill composites with monowave and polywave curing lights.

PURPOSE: To measure and compare the depth of cure (DOC) of two bulk fill resin composites using a monowave and polywave light curing unit (LCU) according to ISO 4049 and using custom tooth molds. METHODS: The DOC of Tetric Evoceram Bulk Fill and Filtek Bulk Fill Posterior were measured using a monowave LED LCU (Elipar S10) and a polywave LED LCU (Bluephase G2). Metal molds were used to fabricate 10 mm long DOC specimens (n = 10) according to ISO 4049. Uncured composite material was scraped away with a plastic instrument and half the length of remaining composite was measured as the DOC. Custom tooth molds were fabricated by preparing > 10 mm long square- shaped (4 x 4 mm) holes into the mesial/distal surfaces of extracted human molars. Resin composite was placed into one end of the prepared tooth and light polymerized. Uncured resin composite was removed from the opposite side from which the tooth was irradiated and the tooth was sectioned mesio-distally. Half the length of remaining cured composite was measured as the DOC. Data were analyzed by three-way ANOVA (α = 0.05) for factors material, LCU, and mold. RESULTS: The main effect LCU was not significant (P = 0.58). The interaction effect between material x mold was significant (P = 0.0001). The DOC of the composites differed significantly only with the stainless steel mold in which Tetric Evoceram Bulk Fill showed a deeper DOC than Filtek Bulk Fill Posterior (4.03 ± 0.14 vs 3.56 ± 0.38 mm, P < 0.0001).

Color and Gloss of Nano-Filled Resin-Modified Glass Ionomers and Resin Composites.

OBJECTIVE: The study aims to compare in vitro stain resistance, color stability, gloss, and gloss retention of a nano-filled resin-modified glass ionomers (RMGIs) to a traditional RMGI and resin-based composites (RBCs). MATERIALS AND METHODS: Specimens (N = 20) were fabricated from a nano-filled RBC (Filtek Supreme Plus, 3M ESPE, St. Paul, MN, USA), a nanohybrid RBC (Clearfil Majesty Esthetic, Kuraray; Tokyo, Japan), a nano-filled RMGI (Ketac Nano, 3M ESPE), and traditional RMGI (Fuji II LC, GC America, Chicago, IL, USA). L*a*b* values were recorded with a spectrophotometer, and gloss was measured with a glossmeter. For each material, 10 specimens were stored in distilled water in darkness for 1 week and 10 specimens were placed in a staining solution for 1 week. After storage, specimens were cleaned and L*a*b* and gloss measurements were remeasured. RESULTS: Data were analyzed by analysis of variance (ANOVA) and Tukey analyses. Regarding color change, materials ranked: Ketac = Fuji > Filtek > Clearfil in water, and Ketac > Fuji > Filtek > Clearfil in staining solution. Prior to storage, the initial gloss of the materials ranked: Filtek ≥ Clearfil ≥ Ketac > Fuji. After storage, the materials ranked: Filtek = Clearfil > Ketac > Fuji in water, and Filtek > Clearfil > Ketac > Fuji in staining solution. Gloss retention was similar for all materials in water and gloss retention ranked: Filtek = Clearfil > Ketac = Fuji in staining solution. CONCLUSIONS: The nano-RMGI showed less stain resistance but higher gloss than the traditional RMGI. Both RMGIs had more color change, less stain resistance, lower gloss and less gloss retention than the RBCs. CLINICAL SIGNIFICANCE: The clinician should be aware that the use of a nano-RMGI may improve the gloss of an RMGI restoration; however, color change will likely occur, particularly if the patient consumes a staining diet.

Fracture load of ceramic restorations after fatigue loading.

STATEMENT OF PROBLEM: A clinician must decide what ceramic coping and veneer material to prescribe based on the amount of tooth reduction possible and the desired esthetic outcome of the restoration. PURPOSE: The purpose of this in vitro study was to compare the fracture strength of monolithic and bilayered lithium disilicate (IPS e.max) and zirconia (LAVA) crowns at clinically relevant thicknesses after load cycling. MATERIAL AND METHODS: Crowns (n=8) were fabricated from 6 groups: 1.2-mm monolithic lithium disilicate, 1.5-mm monolithic lithium disilicate, 1.5-mm bilayered lithium disilicate with hand-layered veneer, 0.6 mm monolithic zirconia, 1.2-mm bilayered zirconia with hand-layered veneer, and 1.2-mm bilayered zirconia with milled veneer (dimension represents thickness at the occlusal pit). Crowns were cemented to identical milled resin dies with resin-modified glass ionomer cement. Cemented crowns were stored at 37°C for 24 hours and load cycled for 200,000 cycles at 25 N at a rate of 40 cycles/minute. The ultimate fracture load for each specimen was measured in a universal testing machine. Data were analyzed with a 1-way ANOVA and Tukey honest significant difference post hoc analysis (α=.05). RESULTS: Mean ±SD fracture load values were 1465 ±330 N for monolithic lithium disilicate (1.2-mm thickness) and 2027 ±365 N (1.5-mm thickness) and 1732 ±315 N for bilayered hand-veneered lithium disilicate (1.5-mm thickness). Fracture loads were 1669 ±311 N for monolithic zirconia crowns (0.6mm thickness), 2625 ±300 N for zirconia milled-veneered (1.2-mm thickness), and 2655 ±590N for zirconia hand-veneered crowns (1.2mm thickness). One-way ANOVA showed a statistically significant difference among the groups (P<.01). Veneered zirconia crowns showed the highest fracture strength, 1.2-mm hand veneered zirconia was similar to that of 1.5-mm monolithic zirconia, and all other groups were not statistically different. CONCLUSIONS: Crowns of 1.2-mm bilayered zirconia had higher fracture loads than 0.6-mm zirconia or 1.2-mm lithium disilicate monolithic crowns.

Contact angle of unset elastomeric impression materials.

STATEMENT OF PROBLEM: Some elastomeric impression materials are hydrophobic, and it is often necessary to take definitive impressions of teeth coated with some saliva. New hydrophilic materials have been developed. PURPOSE: The purpose of this in vitro study was to compare contact angles of water and saliva on 7 unset elastomeric impression materials at 5 time points from the start of mixing. MATERIAL AND METHODS: Two traditional polyvinyl siloxane (PVS) (Aquasil, Take 1), 2 modified PVS (Imprint 4, Panasil), a polyether (Impregum), and 2 hybrid (Identium, EXA'lence) materials were compared. Each material was flattened to 2 mm and a 5 µL drop of distilled water or saliva was dropped on the surface at 25 seconds (t0) after the start of mix. Contact angle measurements were made with a digital microscope at initial contact (t0), t1=2 seconds, t2=5 seconds, t3=50% working time, and t4=95% working time. Data were analyzed with a generalized linear mixed model analysis, and individual 1-way ANOVA and Tukey HSD post hoc tests (α=.05). RESULTS: For water, materials grouped into 3 categories at all time-points: the modified PVS and one hybrid material (Identium) produced the lowest contact angles, the polyether material was intermediate, and the traditional PVS materials and the other hybrid (EXA'lence) produced the highest contact angles. For saliva, Identium, Impregum, and Imprint 4 were in the group with the lowest contact angle at most time points. CONCLUSION: Modified PVS materials and one of the hybrid materials are more hydrophilic than traditional PVS materials when measured with water. Saliva behaves differently than water in contact angle measurement on unset impression material and produces a lower contact angle on polyether based materials.

Influence of particle abrasion or hydrofluoric acid etching on lithium disilicate flexural strength.

STATEMENT OF PROBLEM: Lithium disilicate is a translucent, glass-containing material used for ceramic restorations. Clinicians frequently use alumina abrading or hydrofluoric acid etching to create micromechanical retention in the intaglio surface before bonding a lithium disilicate restoration to the tooth. Few studies have investigated how the etching or abrasion processes affect the flexural strength of lithium disilicate ceramics. PURPOSE: The purpose of this study was to measure and compare the flexural strength of e.max CAD after alumina abrasion at differing pressures and acid etching at differing concentrations and times. MATERIAL AND METHODS: Bars of e.max CAD (9 groups of 10; 22×2.5×2.5 mm) were prepared, polished sequentially with 180, 320, and 600 abrasive paper, and sintered according to the manufacturer's instructions. Four groups were particle abraded (30-µm alumina particles from 10 mm at 55, 100, 200, or 300 kPa for 10 seconds). Four groups were etched with either 5% hydrofluoric acid (20 seconds or 120 seconds) or 9.5% hydrofluoric acid (20 seconds or 120 seconds). The control was polished and fired only (no treatment). Specimens were placed onto an Instron (1 mm/min crosshead speed) and loaded to failure in a 3-point flexural test. One-way ANOVA and the Dunnett t test determined intergroup differences (α=.05). RESULTS: Compared with the control, the 100, 200, and 300 kPa alumina abraded groups produced significantly lower flexural strengths (P<.001); however, the flexural strength of the 55 kPa abraded group was not statistically different from the control (P=.080). The flexural strength of the 5% and the 9.5% hydrofluoric acid-etched groups also were not significantly different from the control (P>.050); however, the 9.5% hydrofluoric acid at 20 seconds group was nearly statistically significant (P=.051). CONCLUSION: Alumina particle abrasion at pressures of 100 kPa and higher significantly reduced flexural strength by creating stress risers in e.max CAD and should not be used. Hydrofluoric acid etching should be used to increase micromechanical retention and clean the intaglio surface of the restoration before bonding.

Influence of surface treatment of yttrium-stabilized tetragonal zirconium oxides and cement type on crown retention after artificial aging.

STATEMENT OF PROBLEM: Information about the influence of zirconia crown surface treatment and cement type on the retention of zirconia crowns is limited. It is unclear whether zirconia crowns require surface treatment to enhance their retention. PURPOSE: The purpose of this in vitro study was to evaluate the effect of surface treatment on the retention of zirconia crowns cemented with 3 different adhesive resin cements after artificial aging. MATERIAL AND METHODS: Ninety extracted human molars were prepared for ceramic crowns (approximately 20-degree taper, approximately 4-mm axial length) and were divided into 3 groups (n=30). Computer-aided design and computer-aided manufacturing zirconia copings were fabricated. Three surface treatments were applied to the intaglio surface of the copings. The control group received no treatment, the second group was airborne-particle abraded with 50 µm Al2O3, and the third group was treated with 30 µm silica-modified Al2O3, The copings were luted with a self-etch (RelyX Unicem 2), a total-etch (Duo-Link), or a self-etch primer (Panavia F 2.0) adhesive cement. They were stored for 24 hours at 37°C before being artificially aged with 5000 (5°C-55°C) thermal cycles and 100,000 cycles of 70 N dynamic loading. Retention was measured on a universal testing machine under tension, with a crosshead speed of 0.5 mm/min. Statistical analysis was performed with 1-way and 2-way ANOVA. RESULTS: Mean retention values ranged from 0.72 to 3.7 MPa. Surface treatment increased crown retention, but the difference was not statistically significant (P>.05), except for the Duo-Link cement group (P<.05). Analysis of the adhesives revealed that the Duo-Link cement resulted in significantly lower crown retention (P<.05) than the other 2 cements. CONCLUSION: For zirconia crowns, retention seems to be dependent on cement type rather than surface treatment.

A Novel Concept for Developing a Precise and Predictable Post and Core Complex Using the Injectable Resin Technique.

Post systems have long been used in the roots of teeth to retain dental restorations. The primary objectives of current post and core systems are to replace missing coronal tooth structure, retain the core, and provide sufficient retention and resistance form to the final restoration to restore original form and function. Many varieties of user-friendly post and core systems are available today for different endodontic, restorative, and esthetic requirements. The present article provides a history of post and core usage in dentistry, describes various systems and materials for this purpose, and discusses empirical data regarding fiber-reinforced post systems.

A Novel Concept for Developing a Precise and Predictable Post and Core Complex Using the Injectable Resin Technique (Part 2).

Post and core systems have long been used in dentistry for the purposes of replacing missing coronal tooth structure, retaining the core, and providing sufficient retention and resistance form to the final restoration to re-establish original form and function. While Part 1 of this two-part article provided a history of post and core systems and materials and discussed empirical data regarding fiber-reinforced post systems, this second part of the article focuses on an alternative approach for developing a fiber-reinforced post and core system using a monoblock system via the injectable resin technique and a recently developed fiber-optic post. The present article explains the concept of a ferrule effect and demonstrates the novel restorative procedure.

Strength comparison of four techniques to secure implant attachment housings to complete dentures.

STATEMENT OF PROBLEM: Implant overdentures become thinner and weaker after direct transfer of implant attachment housings. While much has been published on denture repair, these data do not directly apply to implant overdentures because the introduction of a metal housing changes the character of the repair. It is desirable to make a strong repair to avoid prosthesis fracture. PURPOSE: The purpose of this study was to compare the flexural strengths of 4 different methods for chairside direct transfer of implant attachment housings. MATERIAL AND METHODS: Eighty 11.5 × 9.1 × 39 mm heat-polymerized acrylic resin blocks were processed, assessed for porosities, and polished. An 8.5 mm diameter hole was drilled to a depth of 5 mm in the center of each block. Attachment housings were set into the bases with 4 different repair materials: autopolymerized acrylic resin (APAR), light-polymerized acrylic resin (LPAR), autopolymerized acrylic resin with silanated attachment housings (APSAH), and light-polymerized acrylic resin with silanated attachment housings (LPSAH). Blocks were immersed in water for 30 days in an incubator. A 3-point bend test was done in a universal testing machine, and load to fracture was recorded (MPa). Results were compared with 2-way ANOVA (α=.05). RESULTS: APSAH had the highest mean flexural strength at fracture (863.1 ±87 MPa) as compared to APAR (678.4 ±72.4 MPa), LPAR (550.9 ±119.3 MPa), and LPSAH (543.2 ±100.8 MPa). A comparison among the 4 groups showed that there were significant differences in maximum flexural strength (P<.001). The mean maximum strength of autopolymerized acrylic resin groups was significantly higher than light-polymerized acrylic resin groups. Silanation increased strength significantly compared to nonsilanated groups. CONCLUSIONS: The flexural strength of autopolymerized acrylic resin with silanated attachment housings was significantly higher than autopolymerized acrylic resin alone, light-polymerized acrylic resin alone, or light-polymerized acrylic resin with silanated attachment housings. Autopolymerized acrylic resin produced stronger constructs than light-polymerized materials.

The wear of polished and glazed zirconia against enamel.

STATEMENT OF PROBLEM: The wear of tooth structure opposing anatomically contoured zirconia crowns requires further investigation. PURPOSE: The purpose of this in vitro study was to measure the roughness and wear of polished, glazed, and polished then reglazed zirconia against human enamel antagonists and compare the measurements to those of veneering porcelain and natural enamel. MATERIAL AND METHODS: Zirconia specimens were divided into polished, glazed, and polished then reglazed groups (n=8). A veneering porcelain (Ceramco3) and enamel were used as controls. The surface roughness of all pretest specimens was measured. Wear testing was performed in the newly designed Alabama wear testing device. The mesiobuccal cusps of extracted molars were standardized and used as antagonists. Three-dimensional (3D) scans of the specimens and antagonists were obtained at baseline and after 200 000 and 400 000 cycles with a profilometer. The baseline scans were superimposed on the posttesting scans to determine volumetric wear. Data were analyzed with a 1-way ANOVA and Tukey Honestly Significant Difference (HSD) post hoc tests (α=.05) RESULTS: Surface roughness ranked in order of least rough to roughest was: polished zirconia, glazed zirconia, polished then reglazed zirconia, veneering porcelain, and enamel. For ceramic, there was no measureable loss on polished zirconia, moderate loss on the surface of enamel, and significant loss on glazed and polished then reglazed zirconia. The highest ceramic wear was exhibited by the veneering ceramic. For enamel antagonists, polished zirconia caused the least wear, and enamel caused moderate wear. Glazed and polished then reglazed zirconia showed significant opposing enamel wear, and veneering porcelain demonstrated the most. CONCLUSIONS: Within the limitations of the study, polished zirconia is wear-friendly to the opposing tooth. Glazed zirconia causes more material and antagonist wear than polished zirconia. The surface roughness of the zirconia aided in predicting the wear of the opposing dentition.

Flow profile of regular and fast-setting elastomeric impression materials using a shark fin testing device.

STATEMENT OF THE PROBLEM: Light-bodied impression materials with high flow over time are needed to capture preparation margins, particularly with impressions of multiple preparations. PURPOSE: The flow of five different impression materials (three vinyl polysiloxane, one polyether, and one hybrid) of two setting times (fast and regular) was compared over 30-second intervals. MATERIALS AND METHODS: Flow was measured using a shark fin testing apparatus (3M ESPE, Seefeld, Germany). A weighted metal caste was suspended above a cup of impression material. The caste was dropped into the impression material, which displaced the material and caused it to flow into a triangular notch within the caste, creating a "shark fin." The test was repeated for each specimen at 30-second increments. These shark fin molds were kept in an incubator to allow setting of the impression materials. After complete setting, the height of the "shark fin" was measured. The data were analyzed using separate two-way analysis of variance and Tukey's HSD post hoc analyses to determine significant intergroup differences (p = 0.05). RESULTS: Shark fin values differed significantly among materials and at each time interval (p = 0.05). Polyether impression materials produced the greatest flow when compared with the vinyl polysiloxane and hybrid materials. CONCLUSION: Based on the limitations of this study and the materials used, polyether impression material had a better flow profile compared with the vinyl polysiloxane and hybrid materials. CLINICAL SIGNIFICANCE: An impression material must be selected based on the consistency and flow properties of the material, its setting time, anatomic aspects of the preparation, and speed of the operator. Impressions with deep subgingival margins and/or multiple preparations may be better captured with a polyether impression material.