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.

Effect of finish line location and saliva contamination on the accuracy of crown finish line scanning.

PURPOSE: Intraoral scanners are used widely as an alternative to conventional impressions, but studies on the influence of finish line location and saliva contamination on scanning trueness are lacking. The purpose of this in vitro study was to evaluate the influence of finish line location and saliva contamination on the scanning trueness of crown finish lines. MATERIALS AND METHODS: Three ivorine teeth were prepared for all-ceramic crowns with finish lines placed equigingivally, 0.5 mm subgingivally, and 1.0 mm subgingivally. A single-cord technique was used for gingival retraction, and a total of 180 intraoral scans were made using two intraoral scanners (Emerald; Planmeca USA Inc., Hoffman Estates, IL, USA & Trios 3; 3Shape A/S, Copenhagen, Denmark). The prepared teeth were separated from the dentoform and scanned using the same intraoral scanners to create reference scans. All scans were imported to the design software (Dental System 2019; 3Shape A/S, Copenhagen, Denmark). After marking the finish lines of prepared teeth, intraoral scans were aligned to the reference scans for comparisons. Vertical and horizontal marginal discrepancies were measured at four different measuring points (buccal, lingual, mesial, and distal) and analyzed. Two-way ANOVA and Tukey HSD tests were used for statistical analysis (α = 0.05). RESULTS: The average vertical and horizontal discrepancies from various groups ranged from -33 to 440 µm. For both intraoral scanners, subgingival finish line groups showed greater vertical and horizontal discrepancies compared with equigingival finish line groups. Saliva contamination significantly increased both vertical and horizontal discrepancies for all finish line locations. The discrepancy increases due to saliva contamination were greater for the subgingival groups. CONCLUSIONS: Subgingival finish lines were not accurately captured using the intraoral scanners. The presence of saliva significantly reduced scanning trueness, and this was amplified when the finish lines were located subgingivally.

Trueness of 3-dimensionally printed complete arch implant analog casts.

STATEMENT OF PROBLEM: Although a completely digital workflow has numerous advantages, a physical definitive cast may be especially helpful for the accurate assembly of components of complex complete arch-fixed prostheses, the evaluation of esthetic and occlusion features, or prosthesis fabrication. Research on the accuracy of additive complete arch casts with implants positioned with a large anterior-posterior (A-P) spread is sparse. PURPOSE: The purpose of this in vitro study was to evaluate the trueness of complete arch 4-implant analog casts with a large A-P distribution fabricated with different 3-dimensional (3D) printers. MATERIAL AND METHODS: Ten systems were evaluated representing currently available printing technologies and materials for the additive fabrication of complete arch 4-implant analog casts and compared for deviations in the X-, Y-, and Z-axes from the master model scan (MMS), recorded in standard tessellation language (STL). The MMS was provided to the laboratory selected by the manufacturer, permitting them to create their specific cast with computer-aided design and computer-aided manufacture specific to a particular system, including analog receptacle offset settings. Laboratories fabricated N=10 casts and affixed analogs. A conventional splinted impression and stone cast (CON) was fabricated as a control. The casts were scanned with a precision laboratory scanner (D2000; 3Shape A/S), and files were imported into the Convince metrology software program (3Shape A/S) for comparison with the MMS for mean deviations in the X-, Y-, and Z- axes. A 2-way ANOVA and the Tukey HSD comparison tests were performed between system groups and the 4 implant locations (α=.05). Comparative color maps were used to determine dimensional changes of the edentulous ridges. RESULTS: For 2-dimensional deviations from the MMS in each of the 3 axes, the printer type, implant location, and interaction between those 2 variables were found to be statistically significant (P<.05). Comparisons among printers showed the smallest deviations for Asiga Pro 4K (ASG) and Stratasys Origin One (ORI) printers in both the X- and Y-axes and for CON in the Z-axis. For 3D deviations, comparison among printers indicated that ORI, SprintRay Pro55 S (SPR), and Ackuretta SOL (ACK) had the largest deviations, whereas CON and ASG showed the smallest deviations. Comparison color mapping demonstrates a disparity between printed model dimensional changes and implant analog positioning since the color maps of the casts' ridge crests were not in concordance with the results of the implant analog deviations. CONCLUSIONS: ASG, 3D Systems ProJet MJP 2500 Plus (MJP), 3D Systems NextDent 5100 (NEX), Stratasys J5 DentaJet (PJ5), Ivoclar PrograPrint PR5 (PR5), and Prodways ProMaker LD20 (PWY) were similar in terms of 3D deviations to the conventional stone cast control. Comparative color mapping showed the direction and quantity of the dimensional changes of the ridge crest frequently did not correlate with the 3D deviations of implant analog positioning. Implant analog insertion errors were predominantly responsible for analog position 3D deviations rather than the polymerization shrinkage of additive photopolymers.

Comparison of strength of milled and conventionally processed PMMA complete-arch implant-supported immediate interim fixed dental prostheses.

STATEMENT OF PROBLEM: A typical conversion process of a complete-arch immediate loading protocol entails preparing holes in a complete denture for connection to interim copings, which reduces the strength of the prosthesis. The excellent mechanical properties of milled polymethyl methacrylate (PMMA) disks may provide interim prostheses with improved strength. PURPOSE: The purpose of this in vitro study was to measure the flexural strength and failure load of simulated acrylic resin immediate implant-supported interim prostheses fabricated by conventional processing and computer-aided manufacturing. MATERIAL AND METHODS: A master patient model was created with an acrylic resin base and 2 BioHorizons Internal 4.5-mm-diameter implants placed with a 21.5-mm span and multiunit abutments (MUA) tightened to place. Two groups with different prosthodontic designs were used: one represented the standard fixed prosthesis with support at each end (noncantilever, NC), and the other group represented the cantilever portion of the prosthesis (cantilever, C). Two connection designs of prosthesis blocks to MUA abutments were evaluated: one with typical holes in the prosthesis for capturing interim copings and one with a low-profile coping. For the heat-processed PMMA groups (HP/NC and HP/C), wax patterns were milled, and heat-polymerized denture base PMMA prostheses were processed. The milled PMMA groups (M/NC and M/C) were milled from a tooth-shaded PMMA disk for the prosthesis blocks. The milled low-profile groups (Mlp/NC and Mlp/C) had identical dimensions except that connection to the low-profile coping was designed with a cement space and a narrow diameter screw access hole and was milled from a PMMA disk. The failure load (N) of the cantilever prostheses was recorded, and for NC groups, the 3-point flexural strength formula (MPa) was calculated. The Weibull modulus, characteristic strength, and summary statistics were computed, and the groups were statistically analyzed with ANOVA and the post hoc Tukey test (α=.05). RESULTS: The mean flexural strengths (MPa) were HP/NC=91.35 ±18.92; M/NC=143.94 ±36.79; Mlp/NC=117.06 ±13.86. Significant differences were found among groups (P<.001). Mean failure loads (N) and Weibull modulus (WM) of cantilever prosthesis strengths were for HP/C=512.66, WM=5.597; M/C=695.06, WM=4.875; Mlp/C=254.97, WM=1.797 (P<.001). CONCLUSIONS: Implant fixed interim structures milled from high-density PMMA blanks had a 35% higher flexural strength for both the standard prostheses and the cantilever prostheses than heat-processed denture base PMMA. The low-profile coping design was stronger than the heat-processed material, and the failure point was relocated from the lateral walls to the cervical margin area.

Challenges of Using Resonance Frequency Analysis to Identify Stability of a Dental Implant Placed in the Mandible.

PURPOSE: This numerical study examined the efficacy and challenges of using resonance frequency analysis to identify the stability of implants placed in mandibles. The study also examined the feasibility of using angular stiffness as an alternative index to quantify dental implant stability in mandibles. MATERIALS AND METHODS: A finite element model consisting of a mandible, an implant, an abutment, and a bonding layer (between the implant and the mandible) was created in commercially available software ANSYS. The level of osseointegration was modeled by varying the stiffness of the bonding layer. Three sets of boundary conditions were imposed on the mandible: fixed, rotationally free, and rotationally restrained. Three implant locations were studied: central, premolar, and molar positions. An alternative abutment mimicking SmartPeg and eight different implant lengths were also included. A modal analysis and a static analysis were conducted to calculate resonance frequencies and angular stiffness, respectively. RESULTS: Two types of vibration modes were found. One was jawbone modes, for which the mandible deformed significantly but not the bonding layer. Resonance frequencies of the jawbone modes were not sensitive to the level of osseointegration. The other was implant modes, for which the bonding layer deformed significantly but not the mandible. Among multiple implant modes obtained, only one was trackable as the level of osseointegration increased. The resonance frequency of the trackable implant mode was very sensitive to the implant location as well as boundary conditions, but not as much to the level of osseointegration. In contrast, angular stiffness was sensitive to the level of osseointegration but not as much to boundary conditions. CONCLUSION: The efficacy of using resonance frequency analysis to quantify the stability of a dental implant is questionable. Its high sensitivity to implant locations and boundary conditions as well as its low sensitivity to the level of osseointegration cause huge uncertainties in correlating measured resonance frequencies to implant stability. Angular stiffness is a much more reliable indicator because of its high sensitivity to the level of osseointegration and low sensitivity to boundary conditions.

Effect of fluorescent and nonfluorescent glaze pastes on lithium disilicate pressed ceramic color at different thicknesses.

STATEMENT OF PROBLEM: Materials possessing fluorescent properties are assumed to emit sufficient visible light to change tooth color under daylight illumination. Fluorescent and nonfluorescent glaze pastes are available to finish the surface of a pressed lithium disilicate restoration. However, the effect of a fluorescent-glaze layer on the final color of the restoration remains unclear. PURPOSE: The purpose of this in vitro study was to measure the color dimensions of lithium disilicate glass-ceramic with different thicknesses and different surface treatments under daylight (D65) illumination conditions. MATERIAL AND METHODS: A total of 120 pressed lithium disilicate glass-ceramic disks were fabricated with 4 different thicknesses: 0.7, 1.2, 1.7, and 2.2 mm. In each thickness, 3 different subgroups were created based on the surface treatment performed (n=10): polished (NG), clear glaze (CG), and fluorescent glaze (FG). For the NG group, disks were polished with 180-, 320-, 600-, 800-, and 1400-grit SiC papers and a polishing machine. For the glazed groups, the CG and FG groups, the specimens were polished with 180-grit SiC papers and the same polishing machine. After the polishing sequence, the final thickness was verified in all groups by using digital calipers (0.5, 1.0, 1.5, and 2.0 mm). Additionally, 20 µL of clear glaze or fluorescent glaze was applied on the CG and FL groups by using an electronic positive displacement repeating pipette. The glaze layer was crystallized in a furnace according to the manufacturer recommendations. Color measurements in the CIELab coordinates were made with a spectrometer coupled to an integrating sphere and a standardized photography gray card as a background. Color difference (ΔE) values were calculated by using the CIE76 and CIEDE2000 formulas. The Shapiro-Wilk test revealed that the data were normally distributed. Two-way ANOVA and the Bonferroni test for multiple comparisons were used to analyze the data (α=.05). RESULTS: Statistically significant differences were found among the groups for the L∗, a∗, and b∗ values for the different ceramic thicknesses and surface finishing treatments evaluated (P<.001), except for the b∗ value between the FG and CG groups (P=.988). The L∗ value on the polished group was significantly higher than that on the glazed specimens, followed by the fluorescent-glazed and then by the clear-glazed specimens (P<.001). The ΔE values using the CIE76 formula varied from 0.87 to 2.76 among specimen groups and from 0.32 to 2.34 using the CIEDE2000 among the tested groups. CONCLUSIONS: Ceramic thickness and surface finishing treatment affected all color dimensions (L∗, a∗, and b∗ values) of lithium disilicate ceramic under daylight conditions. These differences resulted in a perceptible but acceptable color mismatch. The value (L∗ color dimension) of the lithium disilicate ceramic was higher on fluorescent-glazed than on not-fluorescent-glazed specimens.

A Critique of Resonance Frequency Analysis and a Novel Method for Quantifying Dental Implant Stability in Vitro.

PURPOSE: This study assessed the ability of resonance frequency measurements to differentiate the stability of implants with different lengths and diameters, and in different densities of bone. Another objective was to identify an alternative parameter capable of quantifying dental implant stability, thus facilitating greater sensitivity for efficacious detection of compromised or failing implants. MATERIALS AND METHODS: Implants of two different diameters (4 and 5 mm) and six different lengths were individually placed in synthetic bone blocks of three different densities (15, 40/20, and 40 pounds per cubic foot) in combination with two different abutments (short and tall) to evaluate their stability. Resonance frequency measurements were obtained via Osstell ISQ and experimental modal analysis (EMA). The resonance frequency measurements were further confirmed via finite element analysis (FEA) using commercially available software ANSYS. RESULTS: Resonance frequencies measured via Osstell ISQ and EMA did not change with respect to the length of the implants. The FEA also confirmed the measured results. FEA simulations further indicated that angular stiffness at the neck of the implant (ie, the base of the abutment) varied considerably with respect to the implant length and diameter. Moreover, the calculated angular stiffness was independent of the type of abutment used. CONCLUSION: The results obtained from resonance frequency analyses did not accurately represent dental implant stability. Changes to implant length and diameter did not affect resonance frequencies. In contrast, angular stiffness at the neck of the implant represented a superior index for quantifying dental implant stability. It not only successfully differentiated stability of implants of both varying lengths and diameters, but also produced quantitative data that was independent of the type of abutments used.

Accuracy of 3-dimensional computer-aided manufactured single-tooth implant definitive casts.

STATEMENT OF PROBLEM: The integration of the digital workflow into routine prosthodontic practice for single-tooth implant surgery and fixed prosthesis fabrication has occurred at a remarkable pace in the last 5 years. With the greater demands of esthetics and precision, the definitive implant analog cast must ensure accurate implant positioning as well as an accurate relationship to adjacent teeth. PURPOSE: The purpose of this in vitro study was to evaluate the accuracy of the 3-dimensional (3D) implant position of definitive casts produced by 3D printing and analog technology. MATERIAL AND METHODS: A master patient model was created from a dentate typodont. The maxillary left central incisor was removed, and a Straumann RC implant was positioned for a screw-retained prosthesis. A laboratory scanner with an accuracy of 5 µm was used for all scanning. A scanbody was connected to the master model implant and scanned to create a master patient file, which served as the control master patient for all comparisons. The two 3D printing systems used for this study were the Statasys Objet500 (group OBJ), an industrial Polyjet production system, and the Formlabs Formlab 2 (group FORM), a budget SLA Vat system. In addition, a conventional gypsum cast (group GYP) with an implant analog was made with elastomeric impression material. With a sample size of 10 per group, each gypsum cast and 2 printed group casts were scanned with the D2000 laboratory scanner 5 times per cast. Convince software (3Shape) was used for 3D analysis to calculate accuracy. The following variables were measured: implant analog vertical displacement, horizontal displacement of implant platform and apex, degree of tilting in the vertical axis, and rotational position change around the vertical axis. Means and standard deviations were calculated for trueness. One-way ANOVA and the post hoc t test with Bonferroni correction were used to investigate any significant differences among the experimental groups (α=.05). RESULTS: For vertical displacement of the implant body, group OBJ had the lowest value of -30 ±24 µm. The values obtained for OBJ and FORM were significantly different from that obtained for GYP (P<.05). For horizontal displacement of the implant shoulder, Group OBJ had the lowest value, 85 ±12 µm, and the difference among these groups was significantly different (P<.05). The value for horizontal displacement of the implant apex was 123 ±25 µm for group OBJ and not significantly different from that obtained for group GYP (136 ±40 µm) but significantly different from that obtained for group FORM (326 ±54 µm). Also, the analysis of implant body tilting in the vertical axis showed significant differences between the values obtained for groups GYP and OBJ and between the values obtained for groups OBJ and FORM. With regard to implant rotational position change around the vertical axis, the values obtained for the gypsum cast and group FORM were not statistically different from those obtained for the master patient control model (P>.05). However, the implant orientation of group OBJ was significantly different from the orientation of groups GYP and FORM (P<.05). The actual clinical relevance of these printing system discrepancies is yet to be determined because the level of clinical acceptable discrepancy in the x, y, and z vectors is still undefined. CONCLUSIONS: This study showed statistically significant differences in accuracy among the implant analog cast fabrication systems; however; the level of clinical acceptable discrepancy is still undefined. Although further research is needed, this study supports the conclusion that the Polyjet industrial printing system was more accurate than the conventional implant analog gypsum cast.

Effect of simulated intraoral variables on the accuracy of a photogrammetric imaging technique for complete-arch implant prostheses.

STATEMENT OF PROBLEM: Conventional impression techniques to obtain a definitive cast for a complete-arch implant-supported prosthesis are technique-sensitive and time-consuming. Direct optical recording with a camera could offer an alternative to conventional impression making. PURPOSE: The purpose of this in vitro study was to test a novel intraoral image capture protocol to obtain 3-dimensional (3D) implant spatial measurement data under simulated oral conditions of vertical opening and lip retraction. MATERIAL AND METHODS: A mannequin was assembled simulating the intraoral conditions of a patient having an edentulous mandible with 5 interforaminal implants. Simulated mouth openings with 2 interincisal openings (35 mm and 55 mm) and 3 lip retractions (55 mm, 75 mm, and 85 mm) were evaluated to record the implant positions. The 3D spatial orientations of implant replicas embedded in the reference model were measured using a coordinate measuring machine (CMM) (control). Five definitive casts were made with a splinted conventional impression technique of the reference model. The positions of the implant replicas for each of the 5 casts were measured with a Nobel Procera Scanner (conventional digital method). For the prototype, optical targets were secured to the implant replicas, and 3 sets of 12 images each were recorded for the photogrammetric process of 6 groups of retractions and openings using a digital camera and a standardized image capture protocol. Dimensional data were imported into photogrammetry software (photogrammetry method). The calculated and/or measured precision and accuracy of the implant positions in 3D space for the 6 groups were compared with 1-way ANOVA with an F-test (α=.05). RESULTS: The precision (standard error [SE] of measurement) for CMM was 3.9 µm (95% confidence interval [CI] 2.7 to 7.1 µm). For the conventional impression method, the SE of measurement was 17.2 µm (95% CI 10.3 to 49.4 µm). For photogrammetry, a grand mean was calculated for groups MinR-AvgO, MinR-MaxO, AvgR-AvgO, and MaxR-AvgO obtaining a value of 26.8 µm (95% CI 18.1 to 51.4 µm). The overall linear measurement error for accurately locating the top center points (TCP) followed a similar pattern as for precision. CMM (coordinate measurement machine) measurement represents the nonclinical gold standard, with an average error TCP distance of 4.6 µm (95% CI 3.5 to 6 µm). All photogrammetry groups presented an accuracy that ranged from 63 µm (SD 17.6) to 47 µm (SD 9.2). The grand mean of accuracy was calculated as 55.2 µm (95% CI 8.8 to 130.8 µm). CONCLUSIONS: The CMM group (control) demonstrated the highest levels of accuracy and precision. Most of the groups with the photogrammetric method were statistically similar to the conventional group except for groups AvgR-MaxO and MaxR-MaxO, which represented maximum opening with average retraction and maximum opening with maximum retraction.

The Evolution and Revolution in Prosthodontics Continues.

The rate of innovations in prosthodontics has been picking up considerable momentum and products have emerged, demonstrating superb strength and high esthetics. Trends indicate a preference for metal-free restorations, as the offerings of zirconia products have become more nuanced. Also, innovative scanning systems provide dental teams a greater flexibility and enhanced productivity.

Modern Management Principles Come to the Dental School.

The University of Washington School of Dentistry may be the first dental school in the nation to apply lean process management principles as a primary tool to re-engineer its operations and curriculum to produce the dentist of the future. The efficiencies realized through re-engineering will better enable the school to remain competitive and viable as a national leader of dental education. Several task forces conducted rigorous value stream analyses in a highly collaborative environment led by the dean of the school. The four areas undergoing evaluation and re-engineering were organizational infrastructure, organizational processes, curriculum, and clinic operations. The new educational model was derived by thoroughly analyzing the current state of dental education in order to design and achieve the closest possible ideal state. As well, the school's goal was to create a lean, sustainable operational model. This model aims to ensure continued excellence in restorative dental instruction and to serve as a blueprint for other public dental schools seeking financial stability in this era of shrinking state support and rising costs.

Reconstruction of esthetics with a digital approach.

Anterior restorations represent a great challenge for both the clinician and dental technician. Long-term provisional restorations can be used to test a new restorative design and to improve the predictability of the definitive restoration with regard to shape, shade, occlusion, and soft tissue interface. To improve the clinical outcome and reduce costs, a new treatment strategy was developed. Teeth were restored with long-term provisional crowns fabricated from a polymer material using a computer-aided design/computer-assisted manufacture (CAD/CAM) system. Definitive all-ceramic restorations fabricated by the same CAD/CAM system were cemented as duplicates of the individualized provisional crowns after 3 months.

Marginal and internal fit of zirconia based fixed dental prostheses fabricated with different concepts.

The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks, fabricated with two different fabrication concepts. Three-unit, posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the laboratory Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM) system Cercon® Brain (Brain) and the centralized CAD/CAM system Compartis Integrated Systems (Compartis). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance (ANOVA) was used to compare data (α = 0.05). Mean gap dimensions at the marginal opening for Brain and Compartis were 56.0 (±34.5) µm and 51.7 (±45.2) µm, respectively. Mean internal gap dimensions of 62.8 (±37.5) µm to 164.6 (±33.4) µm were measured depending on the measurement location and the fabrication concept. Mean marginal openings and internal adaptations were not significantly different for both systems. Three out of four measurement locations showed significantly different cement gaps. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use. The laboratory fabrication exhibited similar accuracy as the centralized manufacturing.

Three-year clinical prospective evaluation of zirconia-based posterior fixed dental prostheses (FDPs).

This clinical study evaluated posterior three-unit fixed dental prostheses (FDPs) made of zirconia substructures veneered with pressable glass-ceramic. Nineteen patients received 21 FDPs replacing either the second premolar, first molar, or second molar. The FDPs were cemented with glass ionomer. Recall examinations were performed every 12 months. The mean service time of the FDP was 40 months. At 30 months, one maxillary FDP exhibited zirconia framework fracture at a thinned occlusal area of the abutment. Loss of retention led to the removal of one FDP after 38 months. The Kaplan-Meier survival probability was 90.5% after 40 months for all types of failures and 95.2% concerning framework fractures. The overpressing technique appears to be reliable in terms of the veneering material. However, one framework fracture was observed in this study.

Precision of fit: zirconia three-unit fixed dental prostheses.

The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks fabricated with two different computer-assisted design (CAD)/computer-assisted manufacturing (CAM) systems. Three-unit posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the Lava CAD/CAM system (Lava) and the Procera-bridge-zirconia CAD/CAM system (Procera). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance was used to compare data (alpha = 0.05). Mean gap dimensions at the marginal opening for Lava and Procera were 15 (+/-7) microm and 9 (+/-5) microm, respectively. Mean marginal openings (P = 0.012) and internal adaptation at two out of three measurement locations were significantly different. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use.

Load-bearing capacity of all-ceramic three-unit fixed partial dentures with different computer-aided design (CAD)/computer-aided manufacturing (CAM) fabricated framework materials.

The purpose of this in vitro study was to compare the load-bearing capacity of posterior three-unit fixed dental prostheses (FDP) produced with three different all-ceramic framework materials: glass-infiltrated alumina (ICA), glass-infiltrated alumina strengthened with zirconia (ICZ), and yttria-stabilized polycrystalline zirconia (YZ). Additionally, the influence on aging of mechanical cyclic fatigue loading and thermal cycling in water were evaluated. A total of 20 frameworks each were fabricated from ICA, ICZ, and YZ by a computer-aided design (CAD)/computer-aided manufacturing (CAM) system. The framework designs were identical for all specimens. All frameworks were veneered with porcelain and cemented with glass-ionomer. Prior to fracture testing, 10 FDP of each experimental group were subjected to thermal and mechanical cycling. Additionally, fractographic analysis was performed. Statistical analysis showed that FDP made from YZ had significantly higher load to failure, whereas no difference was found between the other two materials. Aging did not have a significant effect on the fracture load.

In vitro safety evaluation of a new ultrasound power toothbrush.

OBJECTIVE: To evaluate the safety of a novel ultrasound power toothbrush using a series of laboratory tests simulating extended brushing on the natural tooth surface, dental restorations, crowns, and orthodontic brackets. METHODS: To evaluate safety on the natural tooth and restored surfaces, human molars (n = 60) were prepared with restorations centered on the facial cementoenamel junction. The specimens received restorations of either 1) amalgam, 2) nanofilled composite resin, 3) glass ionomer, 4) cast gold-cemented with glass ionomer, or 5) pressed ceramic adhesively cemented with a composite resin cement. Orthodontic specimens (n = 33) were created by cementing brackets onto the buccal surfaces of extracted teeth. Crown specimens (n = 32) were created by cementing cast metal crowns onto identical pre-molar metal dies using zinc phosphate. All specimens were exposed to extended brushing in an environment controlled for time, brush head force, and dentifrice slurry. Treatment was assigned randomly to the specimens, and brushing was done with either the ultrasound toothbrush (Ultreo), or one of two positive controls: a manual toothbrush (Oral-B 35) and an oscillating-rotating power toothbrush (Oral-B Triumph). Negative control specimens remained unbrushed. Qualitative analysis via scanning electron microscopy was utilized to evaluate the tooth surface and restoration integrity. Shear and tensile testing was used to evaluate orthodontic bracket and crown retention, respectively. RESULTS: Exposure of the teeth and restored surface to the manual toothbrush resulted in some bristle furrows on cementum/dentin root surfaces, especially at the heights of contour and light grooves on the composite resin surfaces. The two power toothbrushes had no signs of root surface wear. None of the toothbrushes demonstrated breakdown of the restorative margins, any loss of cement, or any effect on the enamel. No significant treatment effect on the orthodontic bracket or crown retention force was found (ANOVA, p > 0.05). CONCLUSION: The new Ultrasound toothbrush was found to be safe on natural tooth surfaces and restorative materials, as established in comparison to positive and negative controls. Furthermore, no safety concerns related to orthodontic bracket or dental crown retention were identified with any treatment.

Relationship between mercury accumulation in young-of-the-year yellow perch and water-level fluctuations.

A three-year (2001-2003) monitoring effort of 14 northeastern Minnesota lakes was conducted to document relationships between water-level fluctuations and mercury bioaccumulation in young-of-the-year (YOY) yellow perch (Perca flavescens) collected in the fall of each year at fixed locations. Six of those lakes are located within or adjacent to Voyageurs National Park and are influenced by dams on the outlets of Rainy and Namakan lakes. One site on Sand Point Lake coincides with a location that has nine years of previous monitoring suitable for addressing the same issue over a longer time frame. Mean mercury concentrations in YOY yellow perch at each sampling location varied significantly from year to year. For the 12-year monitoring site on Sand Point Lake, values ranged from 38 ng gww(-1) in 1998 to 200 ng gww(-1) in 2001. For the 14-lake study, annual mean concentrations ranged by nearly a factor of 2, on average, for each lake over the three years of record. One likely factor responsible for these wide variations is that annual water-level fluctuations are strongly correlated with mercury levels in YOY perch for both data sets.

The shear bond strength between luting cements and zirconia ceramics after two pre-treatments.

This study evaluated the shear-bond strength of 11 luting cements from different material classes to manufactured pre-treated zirconia ceramics (Lava: 97% ZrO2, stabilized with 3% Y2O3). In addition, the influence of the curing method on shear-bond strength was investigated. The cements examined were one zinc-phosphate cement (Fleck's zinc cement), two standard glass-ionomer cements (Fuji I, Ketac-Cem), three resin-modified glass-ionomer cements (Fuji Plus, Fuji Cem, RelyX Luting), four standard resin cements (RelyX ARC, Panavia F, Variolink II, Compolute) and one self-adhesive universal resin cement (RelyX Unicem). The ceramic surface was sand-blasted with 100-microm alumina or tribochemically coated with silica. After bonding procedure, one group was tested after 30 minutes (Time I), the other group was stored in distilled water at 37 degrees C for 14 days and subsequently thermocycled 1000 times (Time II). Statistical analysis was performed by multifactorial ANOVA models with interactions. For multiple pairwise comparisons, the Tukey method was used. After sandblasting, the highest shear-bond strength was obtained for the self-adhesive universal resin cement at 9.7 MPa (Time I) and 12.7 MPa (Time II), respectively. When using the Rocatec system, the highest values were found for one of the resin cements at 15.0 MPa (Time I) and for the self-adhesive universal resin cement at 19.9 MPa (Time II).