Effects of New Generation All-Ceramic and Provisional Materials on Fibroblast Cells.

PURPOSE: The purpose of this in vitro study was to evaluate the cytotoxic and apoptotic effects of seven new-generation all-ceramic materials for CAD/CAM (Lava Ultimate [LU], VITA Mark II [VM], InCoris TZI [IC], IPS e.max CAD [EM], VITA Suprinity [VS], Cerasmart [CS], IPS Empress CAD [EC]) and six provisional materials (Protemp 4 [PT], Telio CAD [TC], CAD-Temp [CT], Telio Lab [TL], Temdent Classic [TD], Telio CS C&B [TS]) on L929 mouse fibroblast cells. MATERIALS AND METHODS: 24 disc-shaped specimens (∅ = 5 mm, h = 2 mm) were prepared from each test material. Medium extracts were collected at the 1st, 3rd, and 7th days for each group and tested using the L929 cell line. Cytotoxicity was evaluated using XTT assay, and apoptosis was determined by Annexin-V/PI staining. Data were analyzed using one-way ANOVA, Tukey's multiple comparison tests at a significance level of p < 0.05. RESULTS: The cell viability results among all-ceramic material groups after the 1st and 7th days of incubation periods showed statistically significant differences (p < 0.05). There were significant differences within the ceramic groups in different incubation periods regarding apoptosis rate (p < 0.05). Throughout the entire test period, LU and VM from the CAD/CAM all-ceramic materials and PT and TC from the provisional restoration materials showed cell viability higher than 90%. EC and TD showed the lowest cell viability and highest apoptosis rates in their own groups. For the provisional materials, there were significant differences in cell viability and apoptosis rate in all the incubation periods for each material (p < 0.05). CONCLUSIONS: Although some new-generation CAD/CAM and provisional restoration materials display slight cytotoxicity values, the results are still within the reliable range, and they can safely be used in clinical conditions.

Effect of Hydrothermal Aging and Beverages on Color Stability of Lithium Disilicate and Zirconia Based Ceramics.

Background and Objectives: All-ceramic prosthesis is widely used in modern dental practice because of its improved physico-mechanical and optical properties. These restorations are exposed to coloring agents from various nutrition and beverages in the oral cavity. Long-term color stability is critical for the success of these restorative materials. The purpose of this in vitro study was to assess the effect of common beverages and mouthwash on the color stability of lithium disilicate (LD), monolithic zirconia (MZ) and bilayer zirconia (BZ) surfaces. Materials and Method: Thirty disc-shaped specimens from each material were fabricated; each group was subdivided (n = 10) according to coffee, green tea and chlorhexidine immersion solutions. The baseline color of ceramic discs was recorded according to the CIE L*a*b* system with a portable spectrophotometer. The second measurement was recorded after 3000 thermocycling and immersion in coloring agents for 7 days. The mean color difference was calculated and data were compared with Kruskal-Wallis and Mann-Whitney post hoc tests (0.05). Results: ΔE values for LD with the immersion of coffee, tea, and Chlorhexidine gluconate (CHG) were 1.78, 2.241 and 1.58, respectively. Corresponding ΔE values for MZ were 5.60, 5.19, and 4.86; marginally higher than the clinically acceptable level of 3.5. Meanwhile, BZ showed better color stability compared to MZ with ΔE values of 4.22, 2.11 and 1.43. Conclusions: Among the ceramics evaluated, LD ceramic was found to be more color stable, while MZ ceramics displayed a higher susceptibility to discoloration. MZ and BZ ceramic colors were significantly altered with coffee immersion, while LD ceramics were more affected by green tea.

Influence of misfit on the occurrence of veneering porcelain fractures (chipping) in implant-supported metal-ceramic fixed dental prostheses: an in vitro pilot trial.

OBJECTIVE: Technical complications such as veneer fractures are more common in implant-supported than tooth-supported restorations. The underlying causes have not been fully identified. The aim of this study was to evaluate whether misfit between the restoration and the implant may affect the risk of veneer fractures. MATERIALS AND METHODS: Twenty standardized five-unit implant-supported metal-ceramic fixed dental prostheses (FDP)s were manufactured and fixed in acrylic blocks. The test group consisted of ten FDPs fixed with a 150-µm misfit at the distal abutment. The remaining ten FDPs were fixed without misfit and acted as a control group. All FDPS underwent cyclic loading for a total of 100,000 cycles at 30-300 N. The FDPs were checked for cracks or chip-off fractures regularly. After cyclic load, the retorque value of all abutment screws was checked. RESULTS: Cracks within the veneering porcelain were noted in nine FDPs in the test group and one FDP in the control group. This difference was statistically significant (P < 0.001). Fractures of the veneering porcelain occurred in three FDPs in the test group. No fractures occurred in the control group. This difference was not statistically significant. There were no significant differences in retorque values neither between the groups nor between different abutment positions in the FDPs. CONCLUSIONS: Within the limitations of this in vitro pilot trial, it is suggested that misfit between a restoration and the supporting implant may increase the risk of cracking and/or chipping of the veneering porcelain for metal-ceramic FDPs.

Enamel wear by antagonistic restorative materials under erosive conditions.

OBJECTIVES: This study aimed to analyse loss of enamel worn against composite, leucite glass ceramic or enamel antagonists under non-erosive and alternating or simultanuous erosive-attritive conditions. MATERIALS AND METHODS: Flat human enamel specimens were loaded (1 Hz, 300 g loading weight, each subgroup n = 12) with antagonists made from a hybrid-composite (Z250, 3 M Espe), a nano-composite (Filtek Supreme XTE, 3 M Espe), leucite glass ceramic (IPS Empress CAD LT, Ivoclar Vivadent) or enamel. Specimens were either submitted to mechanical loading in mineral solution (60 s) or to loading under alternating or simultaneous erosive conditions. For alternating erosion-attrition, specimens were eroded by citric acid (pH 2.6, 60 s) and then loaded with the respective antagonist for 60s. For simultaneous erosion-attrition, specimens were loaded with the respective antagonist while being immersed in citric acid (pH 2.6, 60 s). After each cycle, specimens were stored in water for 1 h. After 18 cycles, enamel loss was calculated profilometrically and statistically analysed by two-way ANOVA and Tukey's post-hoc tests (p < 0.05). RESULTS: Enamel loss (µm, mean ± standard deviation) was significantly highest for simultaneous erosion-attrition (ceramic 9.4 ± 1.1, hybrid-composite 8.3 ± 0.7, nano-composite 7.8 ± 1.2, enamel 7.4 ± 0.8) followed by alternating erosion-attrition (ceramic 3.5 ± 0.5, hybrid-composite 2.1 ± 0.8, nano-composite 1.0 ± 0.2, enamel 2.5 ± 0.7) and attrition in mineral solution (ceramic 0.5 ± 0.3, hybrid composite 0.3 ± 0.1, nano composite 0.1 ± 0.2, enamel 0.1 ± 0.1). Ceramic antagonists resulted in significantly higher loss than the remaining antagonistic materials when alternating or simultaneous erosion-attrition was performed. CONCLUSION: Erosive conditions had a massive impact on enamel worn against different antagonistic materials, with simultaneous erosive-attritive conditions being more detrimental than alternating erosive-attritive conditions. CLINICAL RELEVANCE: Enamel wear by antagonistic restorative materials is significantly influenced by erosive conditions.

Comparison of fracture strength and failure mode of different ceramic implant abutments.

STATEMENT OF PROBLEM: The whitish color of zirconia (ZrO2) abutments offers favorable esthetics compared with the grayish color of titanium (Ti) abutments. Nonetheless, ZrO2 has greater opacity, making it difficult to achieve natural tooth color. Therefore, lithium disilicate (LaT) abutments have been suggested to replace metal abutments. PURPOSE: The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth implant restorations using ZrO2 and LaT abutments, and to compare them with titanium (Ti) abutments. MATERIAL AND METHODS: Five different types of abutments, Ti; ZrO2 with no metal base; ZrO2 with a metal base (ZrT); LaT; and LaT combination abutment and crown (LcT) were assembled on 40 Ti implants and restored with LaT crowns. Specimens were subjected to quasistatic loading using a universal testing machine, until the implant-abutment connection failed. As bending of the metal would be considered a clinical failure, the values of force (N) at which the plastic deformation of the metal occurred were calculated, and the rate of deformation was analyzed. Statistical analysis was done using the Mann-Whitney U test (α=.05). RESULTS: Group ZrO2 revealed the lowest resistance to failure with a mean of 202 ±33 N. Groups ZrT, LaT, and LaC withstood higher forces without fracture or debonding of the ceramic suprastructure, and failure was due to deformation of metal bases, with no statistically significant differences between these groups regarding the bending behavior. CONCLUSIONS: Within the limitations of this in vitro study, it was concluded that LaT abutments have the potential to withstand the physiological occlusal forces that occur in the anterior region and that ZrO2 abutments combined with Ti inserts have much higher fracture strength than pure ZrO2 abutments.

A practice-based clinical evaluation of the survival and success of metal-ceramic and zirconia molar crowns: 5-year results.

This practice-based study evaluates the survival and success of conventionally luted metal-ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty-three patients were treated from 07/2008 to 07/2009 with either metal-ceramic crowns (MCC) or zirconia crowns (ZC). Forty-five patients (26 female) with 91 restorations (obser-vational period: 64.0 ± 4.8 months) participated in a clinical follow-up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan-Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0.05). Five complete failures (MCC: 2, ZC: 3) were recorded (5-year ECSv: MCC: 97.6%, (95% confidence interval (95%-CI): [93%; 100%]/ZC: 94.0%, (95%-CI): [87%; 100%]). Of the MCCs (n = 41), 85.0%, [95%-CI: (77%; 96%)] remained event-free, whereas the ECSc for the ZCs (n = 50) was 74.3% (95%-CI): [61%; 87%]. No significant differences in ECSv (P = 0.51), ECSc (P = 0.43) and ECVCSc (P = 0.36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0.035), (5-year VCF-rate: 14.8%) than crowns placed on tooth-neighboured abutments (n = 47), (5-year VCF-rate: 4.3%). In the present study, zirconia molar crowns demonstrated a 5-year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.

Clinical study to evaluate the wear of natural enamel antagonist to zirconia and metal ceramic crowns.

STATEMENT OF PROBLEM: Tooth wear is a complex process, which, if not prevented, may adversely affect the integrity of the stomatognathic system. Different restorative dental materials may affect the amount of wear on natural enamel antagonists. PURPOSE: The purpose of this in vivo study was to evaluate and compare the wear of enamel opposing natural enamel, zirconia, and metal ceramic crowns after 1 year. MATERIAL AND METHODS: Ten participants between 18 and 35 years of age requiring 2 complete crowns, 1 on either side of maxillary or mandibular molar region, and having healthy natural teeth in the opposing arch were selected. For each participant, 1 monolithic polished zirconia crown and 1 glazed metal ceramic crown were fabricated and cemented. To evaluate the wear of the antagonistic natural enamel (premolar and molar), polyvinyl siloxane impressions were made immediately (baseline) and at 1 year after cementation. The wear of natural enamel against natural enamel was evaluated as the control. The resulting casts were scanned (using a 3D white light scanner), and 3D software was used to calculate the maximum amount of linear wear. RESULTS: One-way repeated measures ANOVA was conducted to analyze data. Mean ±SD occlusal wear of the antagonistic enamel 1 year after the cementation of metal ceramic crowns was 69.20 ±4.10 µm for premolar teeth and 179.70 ±8.09 µm for molar teeth, whereas for zirconia crowns, it was 42.10 ±4.30 µm for premolar teeth and 127.00 ±5.03 µm for molar teeth. Occlusal wear of natural enamel opposing natural enamel was 17.30 ±1.88 µm in the premolar region and 35.10 ±2.60 µm in the molar region. The Bonferroni post hoc test revealed that the occlusal wear of antagonistic enamel 1 year after the cementation of a metal ceramic crown was significantly higher (P<.001) than that of an opposing zirconia crown or natural enamel. CONCLUSIONS: Zirconia crowns led to less wear of antagonist enamel than metal ceramic crowns, but more than natural enamel.

Antagonist enamel tooth wear produced by different dental ceramic systems: A systematic review and network meta-analysis of controlled clinical trials.

OBJECTIVES: The aim of this study was to evaluate the amount of enamel tooth wear induced by different antagonistic ceramic crown materials in the posterior area within a follow-up period up to 24 months in function. A network meta-analysis was performed to assess the effect of the materials on the mean vertical loss (MVL) of the antagonist enamel tooth surface. DATA: Main search terms used in combination: ceramic, dental materials, metal ceramic, tooth wear and dental enamel. SOURCES: An electronic search was conducted in PubMed/Medline, Embase, and Cochrane CENTRAL plus hand-searching. STUDY SELECTION: Eligibility criteria included clinical studies reporting on MVL on antagonist's tooth up to 24 months following the permanent crown placement. From a total of 5697 articles, 7 studies reporting on 261 crowns for 177 subjects with 3 ceramic materials (Lithium disilicate, metal-ceramic, monolithic zirconia) were included. Among all, metal-ceramic and zirconia caused significantly higher enamel tooth wear on antagonist teeth, representing 82.5 µm [54.4; 110.6]) and 40.1 µm [22.2; 58.0]) more MVL than natural teeth group. In contrast, lithium disilicate showed only 5.0 µm [-48.2; 58.1]) more MVL than occurs on opposing natural teeth. CONCLUSIONS: This systematic review demonstrated that prosthodontic ceramic materials produced significantly more antagonist enamel tooth wear than opposing natural enamel tooth wear, and ceramic material type was correlated to the degree of enamel tooth wear. Additional well-conducted, randomized controlled trials with homogeneous specimens are required due to inadequate sample size and number of the clinical studies included in the analyses. CLINICAL SIGNIFICANCE: The amount of wear caused by different restorative materials has a high influence on the antagonistic natural teeth and should therefore be evaluated intensively by the dentist.

Practice-based clinical evaluation of metal-ceramic and zirconia molar crowns: 3-year results.

This practice-based study evaluates the clinical performance of conventionally luted metal-ceramic and zirconia molar crowns fabricated with pronounced anatomical core design and a prolonged cooling period of the veneering porcelain. Fifty-three patients were treated from 07/2008 until 07/2009 with either metal-ceramic crowns (MCC) (high-noble alloy + low-fusing porcelain) or zirconia crowns (Cercon System, DeguDent, Germany). Forty-nine patients (30 women/19 men) with 100 restorations (metal-ceramic: 48/zirconia: 52, mean observational period: 36·5 ± 6 months) participated in a clinical follow-up examination and were included in the study. Time-dependent survival (in situ criteria), success (event-free restorations) and chipping rates (defects of the veneering ceramics) were calculated according to the Kaplan-Meier method and analysed in relation to the crown fabrication technique, using a Cox regression model (P < 0·05). Three complete failures (metal-ceramic: 1, zirconia: 2) were recorded (survival rate after 3 years: metal-ceramic: 97·6%, zirconia: 95·2%). Of the metal-ceramic restorations, 90·9% remained event-free (two ceramic fractures, one endodontic treatment), whereas the success rate for the zirconia was 86·8% (two ceramic fractures, one endodontic treatment, one secondary caries). No significant differences in survival (P = 0·53), success (P = 0·49) and ceramic fracture rates (P = 0·57) were detected. The combination of a pronounced anatomical core design and a modified firing of the veneering porcelain for the fabrication of zirconia molar crowns resulted in a 3-year survival, success and chipping rate comparable to MCC.

Marginal bone loss of two implant systems with three different superstructure materials: a randomised clinical trial.

Marginal bone level is a criterion for implant success. The aetiological factors of bone loss have not been clarified. The aim of this study was to evaluate the influence of implant systems and prosthetic materials on the marginal bone loss. Twenty-three patients participated; two implant systems and three superstructure materials were used in this study. Twenty-two of the implants were restored with porcelain fused to base metal alloy (BMA), 25 with porcelain fused to noble metal alloy (NMA) and 20 with zirconium oxide-based ceramics. Radiographs were taken at baseline and 3, 6 and 12 months after loading. Crestal bone-level changes were assessed with digital subtraction radiographs. The effects of superstructure materials and implants were evaluated with one-way anova and independent samples t-test, respectively (α = 0·05). The mean crestal bone loss was found 0·483 mm in 3 months, 0·622 mm in 6 months and 0·816 mm in 12 months. Prosthetic materials were found to have greater effect (ß = 0·575, P = 0·015) on crestal bone loss than implant systems (P > 0·05). The porcelain fused to BMA restorations showed higher crestal bone loss than NMA-based restorations (P = 0·003) at 3 months, (P = 0·038), at 6 months and (P = 0·00) at 12 months; however, crestal bone loss differences between NMA and zirconia were not significant (P = 0·629) at 3 months, (P = 0·974) at 6 months and (P = 1) at 12 months. Within the limitations of this study, our results revealed that rather than the implant systems, prosthetic materials seemed to have an effective role on crestal bone.

One-piece zirconia oral implants: one-year results from a prospective cohort study. 1. Single tooth replacement.

AIM: To investigate the clinical and radiographic outcome of a one-piece zirconia oral implant for single tooth replacement after 1 year. MATERIALS AND METHODS: A total of 65 patients received a one-stage implant surgery with immediate temporization. Standardized radiographs were taken at implant insertion and after 1 year to monitor peri-implant bone loss. A univariate analysis of the influence of different baseline parameters on marginal bone loss from implant insertion to 12 months was performed. Soft tissue parameters were evaluated at prosthesis insertion and at the 1-year follow-up. RESULTS: After 1 year, three implants were lost, giving a cumulative survival rate of 95.4%. The marginal bone loss after 1 year was 1.31 mm. Thirty-four per cent of the implants lost at least 2 mm bone, and 14% more than 3 mm. The univariate analysis could not depict any parameter influencing marginal bone loss. Probing depth, Clinical Attachment Level, Bleeding and Plaque Index decreased over 1 year. CONCLUSIONS: The cumulative survival rate of the presented ceramic implant was comparable to the reported survival rate of titanium implants when immediately restored. However, the frequency of increased radiographic bone loss (>2 mm) after 1 year was considerably higher as compared to conventional two-piece titanium implants. The presented zirconia implant can therefore not be recommended for clinical usage.

The effect of dental restoration type and material on periodontal health.

PURPOSE: To investigate the relationship between the type and material of dental restorations and periodontal health in a sample of Jordanians. MATERIALS AND METHODS: Patients attending the Dental Teaching Clinics of Jordan University of Science and Technology with restored teeth were examined. For every patient, the plaque index, gingival index, probing depth and clinical attachment level were recorded on restored and non-restored tooth surfaces. The restoration types were Classes II, III and V, in addition to crowns and bridge abutments. The restorative materials included amalgam, tooth-coloured materials (resin composite and glass ionomer), non-precious alloys, porcelain and acrylic. RESULTS: Class III restorations were associated with the lowest plaque index (0.62), gingival index (1.13), probing depth (1.62 mm) and clinical attachment level (0.31 mm). Class II restorations had the highest plaque index (0.99) and probing depth values (2.27 mm). Crowns and bridge abutments had the highest gingival index (1.65 and 1.61, respectively), high probing depth (2.01 and 2.15 mm), but a low plaque index (0.69 and 0.66). Class V restorations demonstrated the highest attachment loss (0.92 mm). Resin composite and glass ionomer restorative materials demonstrated the lowest gingival index (1.21) and probing depth (1.75 mm), whereas porcelain demonstrated the lowest plaque index (0.51) and clinical attachment level (0.14 mm). Amalgam was associated with the highest plaque index (1.01) and probing depth (2.29 mm). Non-precious alloys and acrylic covered castings demonstrated the highest gingival index (1.73 and 1.72, respectively) and clinical attachment level (1.00 and 0.88 mm). CONCLUSIONS: Crowns, bridge abutments (especially acrylic and non-precious metals) and Class II amalgam restorations appear to be associated with periodontal breakdown.

[Development of modified zirconia based dental material].

Ceramic materials are increasingly used in dentistry, because of their excellent biocompatibility. Zirconia based ceramic is unique among others due to its high flexural strength. This study examined physical and mechanical properties, as well as toxic and sanitary-chemical characteristics of zirconia based ceramics to select optimum compositions, in comply with the relevant requirements for medical consumables, particularly with materials for all-ceramic frameworks. The initial powders were synthesized in the systems ZrO2-Y2O3 (I), ZrO2-Yb2O3 (II), ZrO2-Y2O3-Yb2O3 (III). Four different zirconia based ceramics were investigated. We studied specific surface of powders, phase composition of the samples, relative density and porosity, flexural strength, fracture toughness, microstructure at x10 000 magnification. Toxicological and sanitary-chemical tests were conducted in accordance with ISO10993, GOST 52770-2007, GOST R 51148-98, GN 2.3.3.972-00 etc.

The influence of antagonistic surface roughness on the wear of human enamel and nanofilled composite resin artificial teeth.

STATEMENT OF PROBLEM: Depending on the applied finishing technique, ceramics may have different values of surface roughness; therefore, their abrasive effect on antagonists may vary. However, different materials may be affected differently by the surface roughness of ceramics. PURPOSE: The purpose of the present study was to evaluate and correlate the wear of human enamel and nanofilled composite resin teeth with the surface roughness of the antagonistic ceramic after simulated mastication. MATERIAL AND METHODS: Three groups of 8 human teeth and 3 groups of 8 nanofilled composite resin teeth were tested against 3 sets of 16 zirconia ceramic balls with different average surface roughness values. Each group was loaded for 300,000 cycles in a mastication simulator. Wear resistance was analyzed by measuring volume and vertical substance lost, determined with a laser scanner. Data were statistically analyzed using 2-way ANOVA. The Pearson correlation test was used to determine whether there was a relationship between the antagonistic surface roughness and the degree to which the materials had worn. RESULTS: An increase in the antagonistic surface roughness significantly increased the wear of composite resin and human enamel. The effect of the antagonistic surface roughness on the wear was significant (P<.001). The correlation between the volume loss and antagonistic surface roughness was significant (r=0.667, P<.001). CONCLUSIONS: Nanofilled composite resin and human enamel exhibited different amounts of wear. In general, human enamel showed less wear than nanofilled composite resin. Surface roughness of the antagonistic ceramic influenced the wear of human enamel more than it affected the wear of composite resin.

Initial enamel wear of glazed and polished leucite-based porcelains with different fusing temperatures.

This study used the radiotracer method to measure the initial enamel wear caused by low- and high-fusing porcelains after glazing or polishing. It also tested the correlation between enamel wear and porcelain surface roughness (Ra). Surface morphology was assessed by optical microscopy. Cylindrical specimens of three porcelains (two high-fusing, one low-fusing) were either autoglazed or polished. Flattened enamel specimens were irradiated with neutrons and submitted to the wear assay for 2,500 cycles in distilled water using a 285 g load; the released beta 32P particles were measured for 10 minutes. For all samples, Ra was recorded with a profilometer before and after testing. Enamel wear was not significantly different for porcelain or finishing method but there was a trend of interaction between the two variables (p = 0.08). A positive correlation was found between enamel wear and the initial Ra of porcelain (r = 0.71). The glazed surfaces of high-fusing porcelains were wavy and had a greater Ra, while the polished surfaces had grooves and pores prior to wear testing. The low-fusing porcelain demonstrated lower Ra and a more homogeneous surface. All abraded surfaces had similar morphology after the wear assay.

In vitro investigation of human enamel wear by dental porcelain.

BACKGROUND: Ceramic crown that fires the layering porcelain on zirconia corping is starting to be used due to aesthetic requirements. However, many ceramics are used, but wear characteristics are often unknown. OBJECTIVE: This study was performed to investigate the wear of human enamel by porcelains, and to determine the influence of porcelain hardness, surface roughness and crystal of porcelain on the enamel wear. METHODS: Enamel specimens were prepared from extracted human molar teeth. Porcelain specimens were prepared from Deguceram Gold, Vita Omega 900, and Cercon Ceram Kiss. Enamel wear volume was calculated and the porcelain wear depth, surface roughness and Vickers hardness was measured. Moreover, the observation of a crystal by scanning electron microscope and the crystal by X-ray diffraction were identified. RESULTS: Omega 900 showed the smallest enamel wear volume and porcelain wear depth. The Vickers hardnesses of Omega 900 and Cercon Ceram Kiss were almost identical. Leucite was detected from Deguceram Gold and Omega 900, and Silica and Silicon Nitride were detected from Cercon Ceram Kiss. CONCLUSIONS: The enamel wear is influenced not by the hardness of the porcelain but by the surface roughness, the size and shape of the crystal.

Wear of ceramic and antagonist--a systematic evaluation of influencing factors in vitro.

OBJECTIVE: (1) To systematically review the existing literature on in vitro assessments of antagonist wear of ceramic materials; (2) To systematically evaluate possible influencing factors on material and antagonist wear of ceramic specimens. METHODS: The database MEDLINE was searched with the terms "enamel," "wear" and "antagonist." The selected studies were analyzed with regard to wear parameters, type of antagonist and outcome. In the laboratory study, three ceramic materials were selected with different compositions and physical properties: IPS d.SIGN low-fusing metal ceramic, IPS Empress leucite ceramic, e.max Press lithium disilicate ceramic. These materials were subjected to the Ivoclar wear method (Willytec chewing simulator, 120,000cycles, 5kg weight) by systematically modifying the following variables which resulted in 36 tests with 8 specimens in each group: (1) configuration (flat, crown specimen), (2) surface treatment (polish, glaze), (3) type of antagonist (ceramic, two types of enamel stylus). Furthermore, the enamel styluses were cut to measure the enamel thickness and cusp width. Wear of both the material and the antagonist was quantified by scanning plaster replicas of the specimens with a laser scanner (etkon es1) and matching baseline and follow-up data with the Match 3D software (Willytec). The data were log-transformed to stabilize the variance and achieve near normality. To test the influence of specific test parameters, a four-way ANOVA with post hoc tests and Bonferroni correction was applied. RESULTS: The systematic review revealed 20 in vitro studies in which a material and the antagonist wear of the same material was examined. However, the results were inconsistent mainly due to the fact that the test parameters differed widely. Most studies used prepared enamel from extracted molars as the antagonist and flat polished ceramic specimens. The test chamber was filled with water and some sort of sliding movement was integrated in the wear generating process. However, there was a huge variation in relation to the applied force, the used force actuator, the number of cycles, and the frequency of cycles per time as well as the number of specimens. The results of the systematic laboratory tests revealed that the following factors strongly influence the wear: configuration (more material wear of flat versus crown specimens), surface treatment (more antagonist wear of glazed versus polished specimens), the antagonist system (more material wear and less antagonist wear for ceramic stylus versus enamel stylus), and enamel thickness (less wear for thicker enamel). Material wear was not very much different between the materials. However, e.max Press generally caused more antagonist wear than the other two materials, which were quite similar. However, the main influencing factors did not yield consistent results for all the subgroups and there was a huge variability of results within the subgroups especially in those groups that used enamel as antagonist. SIGNIFICANCE: As far as consistency and correlation with clinical studies is concerned, the set-up that consists of unprepared enamel of molar cusps against glazed crowns seems to be the most appropriate method to evaluate a ceramic material with regard to antagonist wear. However, due to the high variability of results large sample sizes are necessary to differentiate between materials, which calls the whole in vitro approach into question.

Influence of ceramic inlays and composite fillings on fracture resistance of premolars in vitro.

OBJECTIVE: The aim of this study was to assess the resistance of fracture of mesio-occlusal-distal (MOD) ceramic inlays and composite fillings in premolars and to compare fracture modes between the groups. MATERIAL AND METHODS: Twenty seven extracted intact human premolars were selected and divided into three groups: I - intact teeth (control group), II - MOD cavities restored with indirect ceramic inlays (Finesse, Dentsply Ceramco, USA), III - MOD cavities restored with direct composite fillings (Filtek P60, 3M ESPE, USA). The fracture resistance (N) was assessed under axial compressive loading with a metal cylinder 3.2 mm in diameter at a cross-head speed of 0.5 mm/min in a universal testing machine. The data were analyzed with ANOVA and t-test (pd< or =0.05). Fracture modes were recorded based on the degree of tooth structure and restoration damage. RESULTS: The mean force applied to cause failure for group I was 1.218 kN +/-0.223, for group II - 1.407 kN +/-0.374 and for group III - 0.941 kN +/-0.258. T-test showed significant difference between groups I and III (p=0.027), and groups II and III (p=0.008). The fracture modes observed in all groups tended to involve restoration's and cusp's fracture. CONCLUSION: It was observed that ceramic inlays in premolars have higher load to fracture value than composite fillings and similar to intact teeth. Both restorations, ceramic and composite in the premolars, tended to fracture together with palatal cusp of tooth.

Randomized clinical study of wear of enamel antagonists against polished monolithic zirconia crowns.

OBJECTIVES: To test the hypothesis that there is no difference in the in vivo maximum wear of enamel opposing monolithic zirconia crowns, enamel opposing porcelain fused to metal crowns and enamel opposing enamel. METHODS: Thirty patients needing single crowns were randomized to receive either a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned for baseline data. Polyvinylsiloxane impressions were obtained and poured in white stone. Patients were recalled at six-months and one-year for re-impression. Stone models were scanned using a tabletop laserscanner to determine maximum wear. Statistical analysis was performed using Mann-Whitney U to determine any significant differences between the wear of enamel against zirconia and metal-ceramic crowns. RESULTS: Sixteen zirconia and 14 metal-ceramic crowns were delivered. There were no statistical differences in mean wear of crown types (p=0.165); enamel antagonists (p=0.235) and enamel controls (p=0.843) after one year. CONCLUSION: Monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel after one year. SIGNIFICANCE: This study is clinically significant because the use of polished monolithic zirconia demonstrated comparable wear of opposing enamel to metal-ceramic and enamel antagonists.