Preparation Ferrule Design Effect on Endocrown Failure Resistance.

PURPOSE: To evaluate the effect of preparation ferrule inclusion with fracture resistance of mandibular molar endocrowns. MATERIALS AND METHODS: Recently extracted mandibular third molars were randomly divided into 3 groups (n = 12) with the coronal tooth structure removed perpendicular to the root long axis approximately 2 mm above the cemento-enamel junction with a slow-speed diamond saw. The pulp chamber was exposed using a diamond bur in a high-speed handpiece with pulpal remnants removed and canals instrumented using endodontic hand instruments. The chamber floor was restored using a resin core material with a two-step, self-etch adhesive and photopolymerized with a visible light-curing unit to create a 2 mm endocrown preparation pulp chamber extension. One and two millimeter ferrule height groups were prepared using a diamond bur in a high-speed handpiece following CAD/CAM guidelines. Completed preparation surface area was determined using a digital measuring microscope. Scanned preparations were restored with lithium disilicate restorations with a self-adhesive resin luting agent. All manufacturer recommendations were followed. Specimens were stored at 37°C/98% humidity and tested to failure after 24 hours at a 45° angle to the tooth long axis using a universal testing machine. Failure load was converted to MPa using the available bonding surface area with mean data analyzed using Kruskal-Wallis/Dunn (p = 0.05). RESULTS: Calculated failure stress found no difference in failure resistance among the three groups; however, failure load results identified that the endocrown preparations without ferrule had significantly lower fracture load resistance. Failure mode analysis identified that all preparations demonstrated a high number of catastrophic failures. CONCLUSIONS: Under the conditions of this study, ferrule-containing endocrown preparations demonstrated significantly greater failure loads than standard endocrown restorations; however, calculated failure stress based on available surface area for adhesive bonding found no difference between the groups. Lower instances of catastrophic failure were observed with the endocrown preparations containing 1 mm of preparation ferrule design; however, regardless of the presence of ferrule, this study found that all endocrown restorations suffered a high proportion of catastrophic failures but at loads greater than reported under normal masticatory function.

Effect of Premolar Axial Wall Height on Computer-Aided Design/Computer-Assisted Manufacture Crown Retention.

PURPOSE: To evaluate the effect of premolar axial wall height on the retention of adhesive, full-coverage, computer-aided design/computer-assisted manufacture (CAD/CAM) restorations. MATERIALS AND METHODS: A total of 48 premolar teeth randomized into four groups (n = 12 per group) received all-ceramic CAD/CAM restorations with axial wall heights (AWH) of 3, 2, 1, and 0 mm and 16-degree total occlusal convergence (TOC). Specimens were restored with lithium disilicate material and cemented with self-adhesive resin cement. Specimens were loaded to failure after 24 hours. RESULTS: The 3- and 2-mm AWH specimens demonstrated significantly greater failure load. Failure analysis suggests a 2-mm minimum AWH for premolars with a TOC of 16 degrees. CONCLUSION: Adhesive technology may compensate for compromised AWH.

Bicuspid Axial Wall Height Effect on CAD/CAM Crown Fracture Mode on Preparations Containing Advanced Total Occlusal Convergence.

PURPOSE: To evaluate bicuspid axial wall height effect on the fracture mode of adhesively luted, all-ceramic CAD/CAM crowns with a 20° total occlusal convergence (TOC). MATERIALS AND METHODS: Recently extracted premolars were randomly divided into 4 groups (n = 12) with all-ceramic crown preparations accomplished using a high-speed handpiece inserted into a milling device. Specimens were prepared containing occlusogingival axial wall heights of 3, 2, and 1 mm as well as a group containing a flat preparation surface with no axial wall height. All preparations contained a 20° TOC. Completed preparation surface area was determined, and preparation features confirmed using a digital measuring microscope. Scanned preparations (CEREC) were fitted with milled and crystallized lithium disilicate full coverage restorations and luted with a self-etching adhesive resin cement after hydrofluoric acid etching and silanation. All manufacturer recommendations were followed. Specimens were stored at 37°C/98% humidity for 24 hours. Specimens were tested to failure at a 45° angle to the long axis of the tooth root on a universal testing machine. Failure load was converted to MPa using the available bonding surface area with mean data analyzed using Kruskal-Wallis/Dunn's (p = 0.05) RESULTS: The 3 mm preparation height specimens were similar to the 2 mm specimens, and both demonstrated significantly stronger failure load than the 1 mm axial wall height and flat preparation specimens. The flat preparation and 1 mm axial wall height specimens all failed adhesively, while the 2 mm and 3 mm specimens failed largely due to tooth fracture. CONCLUSIONS: Further evidence is provided that CAD/CAM adhesive techniques may compensate for less than ideal preparation features. Under the conditions of this study, bicuspid preparations with a 20° TOC restored with adhesively luted, CAD/CAM e.max CAD crowns require at least 2 mm of axial wall height, but further planned fatigue studies are necessary before definitive recommendations can be made.

Failure load effect of molar axial wall height with CAD/CAM ceramic crowns with moderate occlusal convergence.

OBJECTIVES: To evaluate the significance of axial wall height (AWH) in molar fracture resistance involving CAD/CAM adhesively bonded, all-ceramic full coverage restorations on preparations with moderate total occlusal convergence (TOC) (16°). MATERIALS AND METHODS: 60 newly extracted maxillary third molars were divided into 5 groups (n = 12). Specimens were prepared for full-coverage, all ceramic restorations with occlusal cervical AWHs of 4, 3, 2, 1 as well as a flat preparation (0 mm AWH) with all preparations with AWH containing a moderate 16° TOC. Scanned preparations were fitted with a lithium disilicate restoration with a self-adhesive resin luting agent after intaglio surface preparation with hydrofluoric acid and silanation. Specimens were stored at 37°C/98% humidity for 24 hours and tested to failure at a 45° angle applied to the palatal cusp on a universal testing machine. Mean results were analyzed using ANOVA/Tukey's (P = .05). RESULTS: Preparations containing 2, 3, and 4 millimeters of AWH demonstrated similar and higher resistance to fracture than the 1 and zero millimeter AWH groups. CONCLUSIONS: Under the conditions of this study, results suggest that adhesive CAD/CAM technology may compensate for reduced axial wall height. However, more definitive results depend on fatigue testing. CLINICAL SIGNIFICANCE: These in vitro results suggest that adhesive CAD/CAM technology may compensate for less than optimal AWH.

Selected physical properties of new resin-modified glass ionomer luting cements.

STATEMENT OF PROBLEM: Two resin-modified glass ionomer (RMGI)-based luting agents have been recently marketed without independent reports of their physical properties. PURPOSE: The purpose of this in vitro study was to evaluate selected physical properties of 2 newly marketed RMGI luting agents and compare the findings with traditional materials. MATERIAL AND METHODS: Specimens (N=12) of Nexus RMGI, UltraCem, GC Fuji Cem 2, and RelyX Luting Plus were fabricated using standardized molds for flexural strength and fracture toughness according to manufacturer recommendations and stored in physiologic phosphate-buffered saline solution at 37°C until testing. Specimens were tested at 1 and 24 hours, 1 week, and 1 month. Mean values for flexural strength, flexural modulus, flexural toughness, and fracture toughness were determined. Additionally, film thickness (N=12) for each material was determined following Amerian National Standards Association/American Dental Association (ANSI/ADA) specifications. Mean results were analyzed with Kruskal-Wallis and Mann-Whitney U tests (α=.05). RESULTS: All luting agents exhibited a similar film thickness that met ANSI/ADA requirements for aqueous-based luting agents. Nexus RMGI surprisingly demonstrated significantly greater flexural strength and fracture toughness at 1 hour, which decreased significantly at 24 hours, making it similar to the other materials evaluated. All materials had similar flexural strength values at 7 days. CONCLUSIONS: Physical property performance was material dependent. Nexus RMGI demonstrated greater early physical properties that were significantly less at 24 hours. UltraCem, GC Fuji Cem 2, and RelyX Luting Plus demonstrated the increasing physical property development that is normally associated with polyalkenoate-based systems.

Effects of preheating on the properties of silorane- and methacrylate-based composites.

This study evaluated how preheating affected the properties of a silorane-based composite restorative material and 4 methacrylate-based composites. Viscosity, compressive strength, depth of cure, and polymerization shrinkage were examined. Data were analyzed with a 2-way ANOVA per physical property and composite type. With the exception of the flowable composite, significant reductions in viscosity were found between all preheated and room temperature composites, with no significant difference in other properties. In general, preheating the restorative composites decreased viscosity, but did not affect compressive strength, depth of cure, or shrinkage per composite type.

Shear bond strength of new self-adhesive flowable composite resins.

Recently, new self-adhesive flowable composite resin systems have been introduced to the market. These new composite resin systems reportedly bond to dentin and enamel without the application of an adhesive bonding agent. The purpose of this study was to evaluate the shear bond strength to enamel of two new self-adhesive flowable composites with and without the use of an etch-and-rinse bonding agent. The new self-adhesive flowable composites had significantly lower bond strengths to enamel compared to a traditional adhesively bonded flowable composite. Both self-adhesive flowable composites had a significant increase in bond strength to enamel with the use of a phosphoric acid-etch and adhesive bonding agent.