Biaxial Flexural Strength of Printed Splint Materials.

One therapeutical alternative in the treatment of functional disorders is the use of printed oral splints. The mechanical properties of these materials are highly essential to their clinical effectiveness, and their performance may vary depending on factors such as cleaning, post-polymerization, or their orientation during construction. The objective of this in vitro investigation is to evaluate the effectiveness of the selected materials in terms of their biaxial flexural strength in relation to the criteria listed above. Splint materials were used in the printing of 720 discs. The printing process was carried out in different orientations in relation to the building platform. Either an automatic or manual cleaning process was performed on the samples. For post-polymerization, either an LED or Xenon light was utilized. A piston-on-three-ball test was used to measure the biaxial flexural strength (BFS) of the materials after they were stored in water for either 24 h or 60 days. The homogeneity of the data was controlled by employing the Levene method, and the differences between the groups were analyzed using the ANOVA and Bonferroni methods. After being stored for twenty-four hours, the mean BFS ranged anywhere from 79 MPa to 157 MPa. Following a period of sixty hours, the BFS exhibited a substantial drop and revealed values that ranged from 72 to 127 MPa. There was no significant difference that could be identified between the materials or between the various cleaning processes. The results of post-polymerization showed that the LED light produced higher means than the Xenon light did. In terms of position, the mean values varied greatly, with 0°'s mean value being 101 MPa, 45°'s mean value being 102 MPa, and 90°'s mean value being 115 MPa. The use of a build orientation of 90° and post-polymerization with LED light resulted in significantly increased biaxial flexural strength. According to this study, this design should be implemented in order to ensure that splint materials have the highest possible strength.

Effects of storage and toothbrush simulation on Martens hardness of CAD/CAM, hand-cast, thermoforming, and 3D-printed splint materials.

OBJECTIVES: To investigate Martens hardness parameters of splint materials after storage in liquids and toothbrush simulation. MATERIALS AND METHODS: Ten specimens per material and group were fabricated (hand-cast CAST, thermoformed TF, CAD/CAM-milled CAM, 3D-printed PS, PL, PK, PV), stored in air, water, coffee, red wine, and cleaning tablets and investigated after fabrication, 24 h, 2- and 4-week storage or toothbrushing. Martens hardness (HM), indentation hardness (HIT), indentation modulus (EIT), the elastic part of indentation work (ηIT), and indentation creep (CIT) were calculated (ISO 14577-1). STATISTICS: ANOVA, Bonferroni post hoc test, between-subjects effects, Pearson correlation (α = 0.05). RESULTS: HM varied between 30.8 N/mm2 for PS (water 4 weeks) and 164.0 N/mm2 for CAM (toothbrush). HIT values between 34.9 N/mm2 for PS (water 4 weeks) and 238.9 N/mm2 for CAM (toothbrush) were found. EIT varied between 4.3 kN/mm2 for CAM (toothbrush) and 1.8 kN/mm2 for PK (water 2 weeks). ηIT was found to vary between 16.9% for PS (water 4 weeks) and 42.8% for PL (toothbrush). CIT varied between 2.5% for PL (toothbrush) and 11.4% for PS (water 4 weeks). The highest impact was identified for the material (p ≤ 0.001). CONCLUSIONS: Storage and toothbrushing influenced Martens parameters. The properties of splints can be influenced by the choice of materials, based on different elastic and viscoelastic parameters. High HM and EIT and low CIT might be beneficial for splint applications. CLINICAL RELEVANCE: Martens parameters HM, EIT, and CIT might help to evaluate clinically relevant splint properties such as hardness, elasticity, and creep.

Influence of fabrication settings on the in-vitro performance of subtractively manufactured resin-based molar crowns.

PURPOSE: To investigate the influence of milling parameters on the durability during in-vitro aging-simulation, and fracture force of resin-based composite crowns. MATERIALS AND METHODS: Identical molar crowns (n=8 per group) were milled from resin-based composite crowns (Grandio, VOCO, Germany) with different processing speed (soft, normal, fast) or level of details (very high, high, low) form 98mm discs. To investigate the influence of cooling, one group was milled wet. The influence of polishing was tested in two groups. All crowns were adhesively bonded on standardized resin-based composite molars. Aging was performed with thermal cycling and mechanical loading (2x3000x5°C/55°C, 2min, H20 dist., 1.2x106 force 50N). Fracture forces were determined (v=1mm/min, Z010, Zwick, Germany). STATISTICS: Pearson-correlation, one-way ANOVA, Bonferroni post-hoc-tests (α=0.05). RESULTS: All crowns survived TCML without any failures. The fracture values varied between 1237.3 ± 326.7N and 3308.6 ± 655.8N. Significant (p<0.001) differences between the individual manufacturing approaches were detected. Failure was categorized as a fracture of the crown and partial loosening of the crown. No different failure pattern was observed between the tested systems. CONCLUSION: A medium level of detail seems to be ideal to achieve highest fracture forces. No relationship existed between machining speed and fracture force. Fracture force was not affected by wet grinding. In individual cases, polishing reduced crown fracture values, due to reduced wall thickness.

Attachment of Respiratory Pathogens and Candida to Denture Base Materials-A Pilot Study.

Denture prostheses are an ideal and extensive reservoir for microorganisms to attach to their surfaces. The aim of the study was to elucidate interactions between materials for the fabrication of denture bases and the attachment of microorganisms, focusing on respiratory pathogens and Candida species. Specimens (6 mm × 1 mm) with a standardized surface roughness (Sa = 0.1 µm) were prepared from heat-pressed polymethyl methacrylate (PMMA), CAD/CAM-processed PMMA, and CAD/CAM-processed polyether ether ketone (PEEK). The specimens were randomly placed in the vestibular areas of complete upper dentures in seven patients and were removed either after 24 h without any oral hygiene measures or after a period of four weeks. The microorganisms adherent to the surface of the specimens were cultivated and subsequently analyzed using mass spectrometry (MALDI-TOF). The means and standard deviations were calculated, and the data were analyzed using a two-way analysis of variance (ANOVA) and Tukey post-hoc test where appropriate (α = 0.05). There was a significant increase (p ≤ 0.004) in the total bacterial counts (CFU/mL) between the first (24 h) and the second (four weeks) measurements. Regarding quantitative microbiological analyses, no significant differences between the various materials were identified. Respiratory microorganisms were detected in all samples at both measurement time points, with a large variance between different patients. Only after four weeks, Candida species were identified on all materials but not in all participants. Candida species and respiratory microorganisms accumulate on various denture base resins. While no significant differences were identified between the materials, there was a tendency towards a more pronounced accumulation of microorganisms on conventionally processed PMMA.

Aging and Fracture Resistance of Implant-Supported Molar Crowns with a CAD/CAM Resin Composite Veneer Structure.

Chipping of implant-supported molar crowns (iSCs) is a frequently reported complication. This study aimed to investigate the in-vitro aging and fracture resistance of iSCs with a CAD/CAM resin composite veneer structure fabricated with the Rapid Layer Technology (RLT) approach. Eight iSCs per group were fabricated by using two different CAD/CAM resin composites (Shofu Block HC: SH; Grandio blocs: GB) for veneer structures, and zirconia (ZrO2), polyetheretherketone (PEEK), and cobalt-chromium (CoCr; control) as framework materials. The surfaces to be bonded were sandblasted, cleaned in an ultrasonic bath, and a coupling agent was applied. A self-adhesive resin luting composite was used to adhesively lute the veneer structures to the frameworks. The crowns were semi-permanently cemented to the abutments. After storage in deionized water, iSCs were loaded in a chewing simulator (TCML, 10,000 thermal cycles 5 °C to 55 °C for 20 s, 1.2 million, loading force 50 N). Four ZrO2 and one CoCr crown did not survive the TCML. The fracture force was determined after 24 h storage in deionized water and yielded values of ≥974 N. Lowest fracture forces were yielded in the PEEK-SH group in comparison to CoCr or ZrO2 groups (p ≤ 0.031). For identical framework materials, no significant influence of the veneering material was observed. All PEEK-GB frameworks fractured, and chipping occurred for ZrO2-SH and all CoCr frameworks. PEEK-SH and ZrO2-GB presented both chipping and framework fractures. Within the limitations of this in-vitro study, the RLT with a CAD/CAM resin composite veneer structure might be a promising approach to veneer iSCs. Yet, the choice of the CAD/CAM resin composite and of the framework material determine the fracture resistance.

Stability and wear of zirconia crowns with micro-layering.

OBJECTIVES: To investigate stability and wear of tooth-supported zirconia single crowns with micro-layering in-vitro. MATERIALS AND METHODS: Molar crowns and specimens were fabricated from 5Y-TZP zirconia (Gen-X, Amann-Girrbach). Three groups were investigated: ML I: 0.1 mm cutback/painted/glazed (MiYO, Jensen); ML II: occlusal 0.3 mm cutback/painted/veneered/glazed (MiYO), and a monolithic control group (polished). After thermal cycling and mechanical loading (TCML), crowns were loaded to failure in a universal testing machine. Two-body wear test was performed. Wear (mean, maximum, antagonist) and roughness (Ra, Rz) were determined with a 3D laser-scanning-microscope. RESULTS: All crowns survived TCML. In the control (2501.5 N) and ML II group (1775.3 N) significantly lower fracture forces were observed than in ML I (3636.4 N) (p ≤ 0.003). Significant wear differences were found (p ≤ 0.001) but not for antagonist wear (p ≥ 0.202). Lowest wear was observed in the control group 10.2 ± 1.5 µm/28.8 ± 6.4 µm, ML I 112.8 ± 37.3 µm/152.9 ± 42.8 µm, and ML II 192.4 ± 49.1 µm/340.7 ± 54.2 µm. Roughness was characterized by a Ra from 1.6 µm (control) to 3.0 µm (ML II), and a Rz from 11.8 µm (Control) to 24.0 µm (ML II). Roughness significantly differed between control group and ML I (p = 0.002) as well as ML I and ML II (p = 0.020). CONCLUSIONS: Good in-vitro performance and fracture stability without chipping or fracture were found for all systems. Wear and roughness were comparable to conventional ceramic veneering systems. CLINICAL RELEVANCE: The micro-layering of zirconia restorations can be recommended, yet the micro-layering could be worn during clinical application.

Digital Workflow in Oral Splint Manufacturing.

AIM: The digital workflow used to manufacture an adjusted oral splint will be demonstrated in a patient case. MATERIALS AND METHODS: A 25-year-old female patient presented for management of her bruxism. Therefore, an adjusted oral splint was manufactured. A computer-aided motion analysis of the patient was conducted (JMA Optic, Amann Girrbach) and full-arch scans of the maxilla and mandible, a biocopy of the maxilla with bite fork as well as buccal scans of the centric jaw relation (Primescan, Dentsply Sirona). The jaw relation was determined beforehand by ballistic closing on a chairside fabricated anterior jig. The digital construction of a Michigan splint took place in the laboratory. The design was nested and milled from a polymethyl methacrylate (PMMA)-containing blank (CLEARsplint Disc, Astron Dental Corporation). RESULT: The oral splint was inserted into the patient's mouth and checked to ensure a tensionfree fit. The static and dynamic contact relationship was checked. During the follow-up visit, the patient reported an improvement in tension in the masticatory muscles. CONCLUSION: The procedure described allows for an adjusted oral splint to be manufactured in a purely digital workflow.

Aging and fracture resistance of screw-retained implant-supported molar crowns fabricated from lithium disilicate containing virgilite.

Purpose To investigate aging and fracture resistance of screw-retained implant-supported single crowns (iSCs) fabricated from lithium disilicate containing virgilite (VLD). Materials and Methods iSCs were fabricated from VLD (CEREC Tessera, Dentsply Sirona) and lithium disilicate (control; n=8, e.max CAD, Ivoclar) and bonded to a Ti-base abutment. VLD crowns were luted either with (VLDc, n=8) or without (VLDw, n=8) a coupling agent. iSCs were cleaned, sterilized, and screw-retained on implants. Fracture force was determined after thermal cycling and mechanical loading (TCML). Results All crowns survived TCML. No significant differences in mean fracture forces were identified between VLDc 1583 N, VLDw 1694 N, and control 1797 N (P=0.639 ANOVA, P=1.000 Bonferroni). Conclusion Screw-retained iSCs fabricated from VLD provide acceptable stability, which is independent on the usage of a coupling agent for bonding to Ti-base abutments and sterilization. Int J Prosthodont 2023. doi: 10.11607/ijp.8369.

In vitro fatigue and fracture testing of temporary materials from different manufacturing processes in implant-supported anterior crowns.

OBJECTIVES: The aim of this study was to investigate the in vitro fatigue and fracture force of temporary implant-supported anterior crowns made of different materials with different abutment total occlusal convergence (TOC), with/without a screw channel, and with different types of fabrication. MATERIALS AND METHODS: One hundred ninety-two implant-supported crowns were manufactured (4° or 8° TOC; with/without screw channel) form 6 materials (n = 8; 2 × additive, 3 × subtractive, 1 × automix; reference). Crowns were temporarily cemented, screw channels were closed (polytetrafluoroethylene, resin composite), and crowns were stored in water (37 °C; 10 days) before thermal cycling and mechanical loading (TCML). Fracture force was determined. STATISTICS: Kolmogorov-Smirnov, ANOVA; Bonferroni; Kaplan-Meier; log-rank; α = 0.05. RESULTS: Failure during TCML varied between 0 failures and total failure. Mean survival was between 1.8 × 105 and 4.8 × 105 cycles. The highest impact on survival presented the material (η2 = 0.072, p < .001). Fracture forces varied between 265.7 and 628.6 N. The highest impact on force was found for the material (η2 = 0.084, p < .001). CONCLUSION: Additively and subtractively manufactured crowns provided similar or higher survival rates and fracture forces compared to automix crowns. The choice of material is decisive for the survival and fracture force. The fabrication is not crucial. A smaller TOC led to higher fracture force. Manually inserted screw channels had negative effects on fatigue testing. CLINICAL RELEVANCE: The highest stability has been shown for crowns with a low TOC, which are manufactured additively and subtractively. In automix-fabricated crowns, manually inserted screw channels have negative effects.

Long-term survival of monolithic tooth-supported lithium disilicate crowns fabricated using a chairside approach: 15-year results.

OBJECTIVES: To investigate the clinical performance of chairside fabricated tooth-supported posterior single crowns from lithium disilicate ceramic. MATERIALS AND METHODS: Thirty-four crowns (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein) were inserted between 2006 and 2007 and again evaluated after 15 years. Survival and success rates were calculated according to Kaplan-Meier, and the quality of the crowns was evaluated by using modified United States Public Health (USPHS) criteria. RESULTS: Twenty-two crowns were available for recall; six patients were defined as dropouts. The mean observation period was 15.2 years (± 0.2). Six failures occurred (1 technical/5 biological) resulting in a survival rate of 80.1%. The success rate was 64.2%. The roughness of the crowns increased (p = 0.021) and the majority of adhesive gaps were discolored (p = 0.001) in comparison to baseline. The color, tooth, and crown integrity remained stable over the follow-up period (p ≥ 0.317). CONCLUSION: The fabrication of tooth-supported lithium disilicate crowns using a chairside approach yielded acceptable long-term survival and success rates. Due to discoloration, the long-term use of dual-cure self-adhesive resin cements might result in unpleasing esthetic results. CLINICAL RELEVANCE: The performance of posterior lithium disilicate single crowns revealed excellent to good clinical quality and an acceptable number of events after 15 years of clinical service.

Influence of the Application Time of Silane for the Bonding Performance between Feldspar or Lithium Disilicate Ceramics and Luting Resin Composites.

A correct silanization time is essential for successful surface functionalization and sufficient bonding to dental ceramics. The shear bond strength (SBS) of lithium disilicate (LDS) and feldspar (FSC) ceramics and luting resin composite was investigated with respect to different silanization times, taking into account the physical properties of the individual surfaces. The SBS test was performed with a universal testing machine, and the fracture surfaces were evaluated by stereomicroscopy. The surface roughness of the prepared specimens was analyzed after etching. Changes in surface properties due to surface functionalization were evaluated by surface free energy (SFE) via contact angle measurement. Fourier transform infrared spectroscopy (FTIR) was used to determine the chemical binding. The roughness and SBS of the control group (no silane, etched) were higher for FSC than for LDS. Regarding the SFE, the dispersive fraction increased and the polar fraction decreased after silanization. FTIR confirmed the presence of silane on the surfaces. The SBS of LDS showed a significant increase from 5 to 15 s, depending on the silane and luting resin composite. For FSC, cohesive failure was observed for all samples. For LDS specimens, a silane application time of 15 to 60 s is recommended. Based on clinical conditions, no difference between the silanization times was observed for FSC specimens, indicating that etching alone produces sufficient bonding.

In-vitro performance of subtractively and additively manufactured resin-based molar crowns.

PURPOSE: To compare the in-vitro performance and wear behavior of additively or subtractively fabricated resin-based composite molar crowns for temporary and permanent application. MATERIALS AND METHODS: Identical molar crowns (n = 8 per group) were manufactured from materials for temporary or permanent application (3x temporary additive fabrication, 3x additive permanent fabrication, 1x temporary subtractive fabrication, 1x permanent subtractive fabrication). All crowns were adhesively bonded (Calibra Universal, Dentsply Sirona, USA) on standardized resin-based composite molars (FDI 46, P Pro temporary Crown & Bridge). Thermal cycling and mechanical loading (2 × 3000 × 5°C/55 °C, 2min, H20 dist., 1.2 × 106 force 50N) were performed and fracture force was determined (v = 1 mm/min, Z010, Zwick, Germany). Mean wear, maximum wear, and roughness were investigated on polished (P1200) specimens (n = 8 per group, d = 8 mm) in a pin-on-block test (50N; 120000 cycles; 1.6Hz; H2O). Statistics were performed by using one-way ANOVA, Bonferroni post-hoc-tests, and Pearson-correlation (α = 0.05). RESULTS: All crowns survived TCML without failures. Fracture forces ranged from 1362.4 ± 182.4N to 2354.1 ± 373.3N for the additive temporary crowns, from 1680.4.4 ± 525.1N to 2601.6 ± 403.7N for the additive permanent crowns, and reached values of 2988.5 ± 604.7N for subtractive temporary crowns and 3092.0 ± 307.6 N for subtractive permanent crowns. Significant (p < 0.001) differences were identified between the various additively manufactured systems, but not for the subtractively fabricated systems (p = 0.673). Mean wear of the additive temporary crowns ranged between 114.5 ± 25.8 µm and 163.8 ± 21.4 µm without significant differences (p = 0.061). Mean wear of the additive permanent crowns ranged between 120.0 ± 27.5 µm and 171.3 ± 31.8 µm with significant differences (p = 0.004). No statistically significant differences were identified between temporary and permanent subtractively manufactured specimens, with mean wear ranging between 140.5 ± 51.1 µm and 176.6 ± 26.8 µm (p = 0.673). Maximum wear of additive temporary specimens ranged between 221.4.5 ± 53.3 µm and 322.1 ± 50.6 µm; significant differences were identified between the groups (p = 0.016). Maximum wear of additive permanent specimens ranged between 246.3 ± 47.3 µm and 337.4 ± 61.4 µm, and significant differences were identified between the groups (p = 0.006). Mean wear of the subtractive group (permanent and temporary) showed no differences in maximum wear from 277.9 ± 79.7.1 µm to 316.4 ± 58.1 µm (p = 0.288). Ra roughness ranged from 0.7 ± 0.2 µm to 3.6 ± 1.3 µm with significant differences (p < 0.001) and Rz reference between 65.9 ± 26.2 µm and 16.8 ± 6.3 µm. CONCLUSION: Temporary and permanent molar crowns provided at least acceptable in-vitro performance and fracture force for clinical mid-term application. Laboratory wear stability of the resin-based materials appeared sufficient, but should be verified under clinical conditions.

Prevalence of temporomandibular disorders and bruxism in seniors.

BACKGROUND: Information on the prevalence of temporomandibular disorders (TMD) or possible/probable bruxism in seniors is heterogeneous and sparse. OBJECTIVES: To elucidate the prevalence of TMD and possible/probable bruxism in German adults aged 60 years and older. METHODS: Participants of the Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE) born between 1950-1952 (C1) and 1930-1932 (C2) were examined in 2014-2016 (fourth wave). The participants were surveyed and clinically examined by one calibrated examiner. Two questions of the Patient Health Questionnaire (PHQ) were utilised to evaluate self-reported bruxism. The clinical examination included signs of probable bruxism and the RDC/TMD examination protocol. RESULTS: Data from 191 participants were available. No RDC/TMD diagnosis was made in 83.2%. Of the participants, 15.2% received a single diagnosis and 1.6% multiple diagnoses that included disc displacements (9.4%) and degenerative joint diseases (8.9%). A total of 24.7% reported bruxism that included self-reported awake bruxism in 11.9% and sleep bruxism in 16.2%. Wear was clinically identified in 27.2% of the participants. No sex-related differences were observed. Significant differences were detected for probable bruxism between C1 (14.1%) and C2 (54.3%). CONCLUSION: In the German population aged 60 years and older, the prevalence of TMD is 16.8%. TMD is characterised by temporomandibular joint disorders, including disc displacements and degenerative joint disorders. Bruxism was observed in a quarter of the old population.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH.

BACKGROUND: When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets. AIM: Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA). METHODS: This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns. RESULTS: Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated. CONCLUSIONS: Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

Impact of the occlusal contact pattern and occlusal adjustment on the wear and stability of crowns.

OBJECTIVES: To investigate the impact of the occlusal contact situation and occlusal adjustment on wear, roughness, and fracture force of molar crowns. MATERIALS AND METHODS: CAD/CAM crowns (lower right first molar, n = 64; 4 groups à 8, 3Y-TZP zirconia and resin composite) and corresponding antagonists (upper right first molar; 3Y-TZP zirconia) were manufactured. Crowns were constructed according to two principles of occlusion (group "T": Peter K. Thomas' "point-centric" cusp-to-fossa tripodization concept, with 15 contact points; group "RA" Sigurd P. Ramfjord and Major M. Ash, "freedom in centric" concept with four contacts). On one half of the crowns, occlusal adjustment was performed (groups "T adjusted" and "RA adjusted"). All crowns underwent combined thermal cycling (TC) and mechanical loading (ML) (ML: 1.2 × 106 cycles, 50 N, 2 Hz, mouth opening 1 mm; TC: 2 × 3000 cycles, 5/55°C). Wear area and depth of each contact point on the occlusal surfaces of crowns and antagonists were determined using a digital microscope. Surface roughness (Ra, Rz) was measured in and besides (reference) the worn area (3D laser-scanning microscope). Fracture force of the crowns was determined (statistics: Levene-test, one-way-ANOVA; Bonferroni-post-hoc-test; between-subjects effects, Pearson correlation, α=0.05). RESULTS: The resin composite crowns yielded significantly higher mean values for wear area and depth (p < 0.001) and lower fracture forces (p < 0.001). Resin composite surfaces showed increased roughness after TCML while zirconia exhibited smoothened surfaces. The occlusal design significantly impacted wear depth (p = 0.012) and fracture force (p < 0.001). Resin composite crowns with fewer contact points (group RA) showed more wear and lower fracture force. Adjusted resin composite crowns showed increased wear areas and depths (p = 0.009-0.013). For zirconia crowns, the adjustment impacted wear area (p = 0.013), wear depth (p = 0.008), and fracture force (p = 0.006), with adjusted zirconia crowns exhibiting more wear and lower maximum forces until fracture. Zirconia wear depth was also impacted by the occlusal design (p = 0.012). Antagonistic wear was influenced by the restorative material, the occlusal contact pattern, and the adjustment. CONCLUSIONS: The investigated materials show strongly varying performances with zirconia being significantly influenced by the adjustment, while for resin composites, contact design and adjustment had a major impact. CLINICAL RELEVANCE: The results show the necessity of adapting occlusal design and adjustment in order to improve roughness, wear, and stability of zirconia and resin composite crowns.

Intraoral Repair of Chipping Due to Cohesive Failure-Results of a Nationwide Survey Among Dentists in Germany.

PURPOSE: To survey the materials favored by dentists for intraoral repair of cohesive chipping. MATERIALS AND METHODS: From August 2019 to February 2020, dentists were surveyed to determine the frequency of cohesive chipping experienced within the last 3 months and to identify their preferred approaches for intraoral repair. RESULTS: Of the participants, 42.5% observed chipping (n = 506). Participants favored the application of roughening devices, silane, and composite resins. Self-etching glass-ceramic primers or hydrofluoric acid were used for ceramic etching. CONCLUSION: Dentists apply a variety of materials for intraoral repair of chipping, including materials that are not approved for intraoral use. Int J Prosthodont 2023;36:216-218. doi: 10.11607/ijp.7098.

Defective claudin-10 causes a novel variation of HELIX syndrome through compromised tight junction strand assembly.

Formation of claudin-10 based tight junctions (TJs) is paramount to paracellular Na+ transport in multiple epithelia. Sequence variants in CLDN10 have been linked to HELIX syndrome, a salt-losing tubulopathy with altered handling of divalent cations accompanied by dysfunctional salivary, sweat, and lacrimal glands. Here, we investigate molecular basis and phenotypic consequences of a newly identified homozygous CLDN10 variant that translates into a single amino acid substitution within the fourth transmembrane helix of claudin-10. In addition to hypohidrosis (H), electrolyte (E) imbalance with impaired urine concentrating ability, and hypolacrimia (L), phenotypic findings include altered salivary electrolyte composition and amelogenesis imperfecta but neither ichthyosis (I) nor xerostomia (X). Employing cellular TJ reconstitution assays, we demonstrate perturbation of cis- and trans-interactions between mutant claudin-10 proteins. Ultrastructures of reconstituted TJ strands show disturbed continuity and reduced abundance in the mutant case. Throughout, both major isoforms, claudin-10a and claudin-10b, are differentially affected with claudin-10b showing more severe molecular alterations. However, expression of the mutant in renal epithelial cells with endogenous TJs results in wild-type-like ion selectivity and conductivity, indicating that aberrant claudin-10 is generally capable of forming functional paracellular channels. Thus, mutant proteins prove pathogenic by compromising claudin-10 TJ strand assembly. Additional ex vivo investigations indicate their insertion into TJs to occur in a tissue-specific manner.

Acid Resistance of CAD/CAM Resin Composites.

Acid resistance of CAD/CAM resin composites. Erosion-related tooth surface loss is closely related to acid exposure, such as contact with acidic beverages or disease-related reflux. As a result, dental restorations in affected patients are also exposed to acids, which indicates that the performance and longevity of a dental restoration is impacted by the acid resistance of the individually employed restorative materials. However, unlike for ceramic materials, the acid resistance of CAD/CAM resin composites is not commonly evaluated by the manufacturers, and no standardised test methods have yet been established. Against this background, the present in vitro study aimed to examine the long-term resistance of CAD/CAM resin composites (Brilliant Crios, Cerasmart, Grandio blocs, Lava Ultimate, Shofu Block HC) against three acidic media (tonic water, acetic acid, hydrochloric acid) as well as demineralized water and to investigate potential damage mechanisms. Changes in surface roughness (Sa) were detected by confocal laser scanning microscopy (CLSM), and changes in surface hardness were measured using Vickers hardness (HV). The damage mechanisms were analysed by scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) and micro X-ray computer tomography (µXCT). For each material, few changes in either Sa or HV were identified for at least one of the different media; for Cerasmart, the sharpest deterioration in surface properties was observed. SEM-EDS revealed leaching of barium, aluminium, and titanium from fillers in a 2 µm zone on the rough but not on the polished surface of the specimen. Within the limitations of the current study, it can be concluded that polished CAD/CAM resin composites can be recommended for clinical use in patients with erosive conditions.

Acid resistance of self-adhesive resin luting cements - changes in surface texture parameters and microhardness.

OBJECTIVES: When consumed in excess, acidic foods and beverages can cause dental erosions leading to irreversible loss of tooth substance. In many cases, prosthetic rehabilitation of the damaged teeth is mandatory. The aim of this in vitro study was to investigate, for the first time on this scale, the resistance of various commonly used self-adhesive resin luting cements (Bifix SE, VOCO; G-Cem LinkAce, GC; RelyX Unicem, 3 M Oral Care; SpeedCEM Plus, Ivoclar ) against acidic media, and to find out whether they can withstand long-term exposure. These results were compared with an adhesive resin luting cement (Panavia V5, Kuraray) that functioned as reference gold standard. Furthermore we applied area roughness parameters for surface texture analysis in the present investigation, to highlight their advantages for investigations on the surface quality of resin luting cements. METHODS: Six specimens with identical diameter (10 mm) and thickness (3 mm) were prepared from each self-adhesive and adhesive resin luting cement and forwarded to an incubation in various acidic media for a period of 232 h. Conductivity and pH-values of each acidic medium was analyzed for each material group prior (t 0) and after exposure (t 1). The specimens were examined for Vickers microhardness and surface quality. For the evaluation of surface roughness, the parameters Sa, Sdr, Spc Spk, Sk, and Svk were investigated by using different filtered surfaces (S-L; S-F) according to ISO 25 178. Statistical analysis was conducted at a significance level of α = 0.050. RESULTS: For the evaluation of the acid resistance of self-adhesive resin luting cements investigations on conductivity and pH-value assessment of storage solution appear unsuitable, while the assessment of microhardness and surface analysis revealed valid data. It could be shown that changes in surface texture of the resin luting cements can be determinend in qualitative and quantitative manner. While the microhardness and surface quality of some resin luting cements hardly changed, others showed significantly reduced values in microhardness and changes in their surface quality (p < 0.001). SIGNIFICANCE: The data of the current study emphasize the relevance of interactions between resin luting cements and acids and suggest further laboratory and clinical studies to elucidate its impact on the clinical performance of the materials investigated.

Pull-off Force of Four Different Implant Cements Between Zirconia Crowns and Titanium Implant Abutments in Two Different Abutment Heights.

This study evaluated the pull-off force between titanium abutments and zirconia crowns that were bonded using four different cements and two abutment heights (AHs). In total, 24 titanium abutments (3-mm AH: n = 12; 5-mm AH: n = 12; taper: 7.5 degrees) and 24 zirconia crowns were designed, manufactured, cemented with one of four dental cements (one temporary, two semi-permanent, one permanent), stored in water for 24 hours, and thermocycled (37,500 cycles, equal to ~4 years in vivo). The pull-off force needed to separate the abutment and crown in each combination was determined eight times per combination of cement type and abutment height. Statistical analysis was conducted at a significance level of P < .05. The permanent self-adhesive composite cement showed a high pull-off force with a risk for crown fracture (mean: 381 N for 3-mm AH; 617 N for 5-mm AH). In contrast, the temporary zinc-oxide cement showed frequent premature decementation after thermocycling (mean: 14 N with 3-mm AH; 28 N with 5-mm AH). Both semi-permanent methacrylate-based cements ranked between the other cements (mean: 31 N/37 N for 3-mm AH; 120 N/72 N for 5-mm AH). Statistically significant differences were found between all cements (ANOVA P < .001). The abutment heights differed significantly for all cements (P < .005) except for the temporary zinc-oxide cement. Methacrylate-based cements were the most reliable cements for semi-permanent mounting of zirconia crowns on titanium abutments. They provide sufficient retention to avoid unintended loosening and are weak enough to remove the crown without causing damage.