Potential complications of CAD/CAM-produced resin composite crowns on molars: A retrospective cohort study over four years.

PURPOSE: Evaluation of the clinical performance of computer-aided design/computer-aided manufacturing-produced resin composite crowns (CAD/CAM composite crowns) on molars with a particular focus on placement location. METHODS: A retrospective cohort study was performed based on the clinical records of patients with CAD/CAM composite crowns on molars (June 2016 to March 2021). The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated based the Cox proportional hazard model to evaluate the effect of tooth location on complication type and occurrence. Covariates included crown location (maxilla/mandible, distalmost tooth/not distalmost tooth, and first molar/second or third molar) and endodontically treated (nonvital) or untreated (vital) tooth. RESULTS: Overall, 362 crowns were evaluated (mean follow-up: 378 days, median: 286 days), and 106 crowns (29.3%) showed complications, most frequently crown debonding. The cumulative success and survival rates were 70.9% and 93.7%, respectively, after 1 year and 49.5% and 86.5%, respectively, after 3 years. There was no significant difference in the HRs and log-rank tests in the Kaplan-Meier curves based on crown location parameters (P > 0.05). However, placement on vital teeth was associated with higher risks than on nonvital teeth (HR, 1.55; 95% CI, 1.03-2.23). In addition, the cement as a covariate yielded a high HR. CONCLUSIONS: The location of CAD/CAM composite molar crowns is unlikely a risk factor for complications; therefore, these crowns can be clinically applied to all molars. However, the application of such molar crowns to vital teeth and the use of a cement other than adhesive resin cement present risks.

Impact of adhesive primer and light-curing on polymerization kinetics of self-adhesive resin cement in association with free radical reaction.

This study analyzed the impact of adhesive primer and light-curing on the polymerization kinetics of urethane dimethacrylate-based self-adhesive resin cement combined with free radical reaction. Specimens were prepared by mixing the cement paste with or without adhesive primer. Subsequently, specimens were light-cured or set without light-curing. The degree of conversion (DC), Vickers hardness (Hv), and free radical concentrations were repeatedly measured up to 168 h after the curing initiation. Irrespective of the curing procedures, DC, Hv, and free radical concentration rapidly increased during the initial 30 min of curing. The specimens cured with adhesive primer and/or light-curing generally showed higher values of DC, Hv, and radical concentration than those set by chemical curing alone, especially during the initial polymerization phase. Kinetic analysis using a linear mixed model revealed that the adhesive primer had a higher coefficient estimate than light-curing, indicating that the former had a higher impact on the polymerization. Additionally, the adhesive primer alleviated the Hv reduction caused by water and air during the initial polymerization phase, although light-curing hardly prevented the polymerization inhibition. Therefore, we suggest that application of adhesive primer is beneficial to achieve higher degree of conversion and better mechanical properties of self-adhesive resin cements by enhancing free radical reactions.

Clinical evaluation of monolithic zirconia crowns: a failure analysis of clinically obtained cases from a 3.5-year study.

PURPOSE: The primary purpose of this study was to examine the clinical performance of monolithic zirconia single crowns in terms of short-term failure or complications. The secondary purpose was to detect the originating flaws of clinically failed monolithic zirconia crowns to find the causes of failure. METHODS: A short-term prospective cohort study based on record evaluation and clinical examination of patients treated with tooth-supported monolithic zirconia crowns was performed in the Department of Fixed Prosthodontics, Tohoku University Hospital, Japan. The crowns were prepared during the follow-up period from April 2014 to July 2018. The 3.5-year cumulative success and survival rates were set as primary endpoints. Fractures of the crown or fragments were inspected under a scanning electron microscope for descriptive fractography. RESULTS: During the study period, 40 monolithic zirconia crowns were placed. Four crowns experienced clinical complications, including: 1) fracture of the crown (two crowns), 2) abrasion of the crown (one crown), and 3) fracture of the antagonist tooth (one crown). The estimated Kaplan-Meier 3.5-year success and survival rates were 90.5% (95% confi dence interval [CI]: 73.1-97.1) and 92.8% (95% CI: 74.1-98.3), respectively. Fractography revealed that all fractures were initiated from the wear phase on the occlusal surface. CONCLUSIONS: The results of this study suggest that the molar application of monolithic zirconia crowns requires detailed attention to interocclusal clearance and the restoration of the antagonist tooth.

A possible risk of CAD/CAM-produced composite resin premolar crowns on a removable partial denture abutment tooth: a 3-year retrospective cohort study.

PURPOSE: To evaluate the early performance of computer-aided design/computer-aided manufacturing (CAD/CAM)-produced composite resin crown (CAD/CAM composite crown) treatment on premolars, specifically, placement on a removable partial denture (RPD) abutment tooth, and the distalmost tooth in the dental arch, as possible clinical risk factors. METHODS: A retrospective cohort study (April 2014 to July 2017) was performed utilizing the clinical records of patients who received a premolar CAD/CAM composite crown treatment. The variables of time of treatment for (1) successful crowns (complication event-free) and (2) surviving crowns (clinically functional including re-luted) were estimated using Kaplan-Meier analysis. Survival distributions regarding "RPD abutment tooth" and "distalmost tooth" were analyzed with the log-rank test. Multilevel survival analyses were used to identify hazard ratios and associated risk factors. RESULTS: Five hundred and forty-seven crowns were evaluated (mean follow-up time 1.3±0.9years) in 327 patients. A total of 87 crowns had at least one complication, with loss of crown retention being the most common (70 crowns). Estimated success and survival rates at 3 years were 71.7% and 96.4%, respectively. The risk of complications was significantly higher for an RPD abutment tooth than for a non-RPD abutment tooth. There was no significant difference between the distalmost tooth and non-distalmost tooth in the dental arch. CONCLUSIONS: The demonstrated complication rate for CAD/CAM composite crowns placed on premolars was 15.9% over a period of up to 3 years. There was a substantial risk of complications with placement of such a crown on an RPD abutment tooth.

Influence of microscale expansion and contraction caused by thermal and mechanical fatigue on retentive strength of CAD/CAM-generated resin-based composite crowns.

CAD/CAM-generated resin-based composite crowns have been proposed as an inexpensive alternative to conventional crowns. However, concerns have been raised about crown loosening in clinical use. Therefore, the present in vitro study aimed to evaluate the influence of thermal and mechanical cycling (TC and MC) on retentive strength of CAD/CAM resin-based crowns in relation to microscale expansion and contraction caused by fatigue. Eighty standardized dies were produced using a resin-based composite material. Crowns were milled from resin-based composite (n = 40) and glass-ceramic blocks (n = 40; control) using a dental CAD/CAM system. The crowns bonded to the dies were subjected to TC (temperature: 5 and 55 °C, cycles: 50,000) and MC (load: 200 N, cycles: 1.2 million). After fatigue treatment, retentive strength of the crowns was evaluated by a crown pull-off test at a crosshead speed of 1 mm/min. Coefficient of thermal expansion (CTE) and modulus of elasticity (E-modulus) of each material were also analyzed to estimate the microscale expansion and contraction during TC and MC. TC and MC significantly reduced the retentive strength of the CAD/CAM resin-based crowns whereas that of the CAD/CAM ceramic crowns was only affected by TC. In addition, the resin-based crowns showed a higher number of crown loosening during TC than the ceramic crowns. Analyses of CTE and E-modulus indicated that the resin-based crowns would be more deformed during TC and MC than the ceramic crowns. The present study demonstrated that the resistance of crowns to microscale expansion and contraction caused by thermal and mechanical fatigue would play an important role in maintaining retentive strength.

Cytoprotective effects of grape seed extract on human gingival fibroblasts in relation to its antioxidant potential.

Cytoprotective effects of short-term treatment with grape seed extract (GSE) upon human gingival fibroblasts (hGFs) were evaluated in relation to its antioxidant properties and compared with those of a water-soluble analog of vitamin E: trolox (Tx). GSE and Tx showed comparable antioxidant potential in vitro against di(phenyl)-(2,4,6-trinitrophenyl)iminoazanium (DPPH; a stable radical), hydroxyl radical (•OH), singlet oxygen (1O2), and hydrogen peroxide (H2O2). Pretreatment or concomitant treatment with GSE for 1 min protected hGFs from oxidative stressors, including H2O2, acid-electrolyzed water (AEW), and 1O2, and attenuated the intracellular formation of reactive oxygen species induced by H2O2 and AEW. Tx also reduced the H2O2- and AEW-induced intracellular formation of reactive oxygen species, but showed no cytoprotective effects on hGFs exposed to H2O2, AEW, or 1O2. These results suggest that the cytoprotective effects of GSE are likely exerted independently of its antioxidant potential.

Cutting efficiency of diamond burs operated with electric high-speed dental handpiece on zirconia.

Zirconia-based dental restorations are becoming used more commonly. However, limited attention has been given to the difficulties experienced, concerning cutting, in removing the restorations when needed. The aim of the present study was to compare the cutting efficiency of diamond burs, operated using an electric high-speed dental handpiece, on zirconia (Zir) with those on lithium disilicate glass-ceramic (LD) and leucite glass-ceramic (L). In addition, evaluation of the cutting efficiency of diamond burs on Zir of different thicknesses was performed. Specimens of Zir were prepared with thicknesses of 0.5, 1.0, 2.0, and 4.0 mm, and specimens of LD and L were prepared with a thickness of 1.0 mm. Cutting tests were performed using diamond burs with super coarse (SC) and coarse (C) grains. The handpiece was operated at 150,000 rpm with a cutting force of 0.9 N. The results demonstrated that cutting of Zir took about 1.5- and 7-fold longer than cutting of LD and L, respectively. The SC grains showed significantly higher cutting efficiency on Zir than the C grains. However, when the thickness of Zir increased, the cutting depth was significantly decreased. As it is suggested that cutting of zirconia is time consuming, this should be taken into consideration in advance when working with zirconia restorations.

Synergistic interaction between wavelength of light and concentration of H2O2 in bactericidal activity of photolysis of H2O2.

The present study aimed to evaluate the interaction between wavelength of light in the range of ultra violet A-visible and concentration of H2O2 in the reaction of photolysis of H2O2 from the point of view of hydroxyl radical (·OH) generation and the bactericidal activity. Light emitting diodes (LEDs) emitting the light at wavelengths of 365, 385, 400 and 465 nm were used at an irradiance of 1000 mW/cm(2). H2O2 was used at the final concentrations of 0, 250, 500, and 1000 mM. Quantitative analysis of ·OH generated by the LED irradiation of H2O2 were performed using an electron spin resonance-spin trapping technique. In a bactericidal assay, a bacterial suspension of Staphylococcus aureus prepared in sterile physiological saline was irradiated with the LEDs. The bactericidal activity of each test condition was evaluated by viable counts. When H2O2 was irradiated with the LEDs, ·OH was generated and bacteria were killed dependently on the concentration of H2O2 and the wavelength of LED. The two-way analysis of variance revealed that the wavelength, the H2O2 concentration and their interaction significantly affected the yield of ·OH and the bactericidal activity of the photolysis of H2O2. Therefore, it is suggested that bactericidal activity of photolysis of H2O2 could be enhanced by controlling the wavelength and the concentration of H2O2, which may contributes to shortening the treatment time and/or to reducing the concentration of H2O2.