The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth.

INTRODUCTION: Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS: Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS: Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION: No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

Precision layering techniques: Integrating digital tools for accurate color matching and realistic try-ins in anterior composite restorations.

OBJECTIVE: This article aims to demonstrate the clinical application of a comprehensive workflow that integrates digital tools for accurate color matching, and its immediate implementation in the restoration of anterior teeth. CLINICAL CONSIDERATIONS: Two patients demonstrating dissatisfaction regarding a maxillary central incisor had an old restoration replaced resorting to a digital workflow to enhance the predictability of the new direct restoration. OptiShade allowed the precise assessment of tooth color and the CompoShade application provided precise color and material selection, as well as the determination of a layering strategy. Precision and accuracy of the colorimeter and the composite layering application were demonstrated clinically in vivo. CONCLUSIONS: Implementing a digital workflow with the integration of OptiShade measurements and the CompoShade layering recipe calculation, as well as the respective realistic try-in, enables the achievement of precise color matching for anterior composite restorations. CLINICAL SIGNIFICANCE: The employment of a digital colorimeter and layering recipes simplify shade matching, and optimizes composite resin clinical use and success. The implementation of a realistic try-in, previous to the definitive restoration, allows the clinician to perform any adjustments if needed.

Accuracy of digital impressions of multiple dental implants: an in vitro study.

INTRODUCTION: Studies demonstrated that the accuracy of intra-oral scanners can be compared with conventional impressions for most indications. However, little is known about their applicability to take impressions of multiple implants. AIM: The aim of this study was to evaluate the accuracy of four intra-oral scanners when applied for implant impressions in the edentulous jaw. MATERIAL AND METHODS: An acrylic mandibular cast containing six external connection implants (region 36, 34, 32, 42, 44 and 46) with PEEK scanbodies was scanned using four intra-oral scanners: the Lava C.O.S. and the 3M True Definition, Cerec Omnicam and 3Shape Trios. Each model was scanned 10 times with every intra-oral scanner. As a reference, a highly accurate laboratory scanner (104i, Imetric, Courgenay, Switzerland) was used. The scans were imported into metrology software (Geomagic Qualify 12) for analyses. Accuracy was measured in terms of trueness (comparing test and reference) and precision (determining the deviation between different test scans). Mann-Whitney U-test and Wilcoxon signed rank test were used to detect statistically significant differences in trueness and precision respectively. RESULTS: The mean trueness was 0.112 mm for Lava COS, 0.035 mm for 3M TrueDef, 0.028 mm for Trios and 0.061 mm for Cerec Omnicam. There was no statistically significant difference between 3M TrueDef and Trios (P = 0.262). Cerec Omnicam was less accurate than 3M TrueDef (P = 0.013) and Trios (P = 0.005), but more accurate compared to Lava COS (P = 0.007). Lava COS was also less accurate compared to 3M TrueDef (P = 0.005) and Trios (P = 0.005). The mean precision was 0.066 mm for Lava COS, 0.030 mm for 3M TrueDef, 0.033 mm for Trios and 0.059 mm for Cerec Omnicam. There was no statistically significant difference between 3M TrueDef and Trios (P = 0.119). Cerec Omnicam was less accurate compared to 3M TrueDef (P < 0.001) and Trios (P < 0.001), but no difference was found with Lava COS (P = 0.169). Lava COS was also less accurate compared to 3M TrueDef (P < 0.001) and Trios (P < 0.001). CONCLUSIONS: Based on the findings of this in vitro study, the 3M True Definition and Trios scanner demonstrated the highest accuracy. The Lava COS was found not suitable for taking implant impressions for a cross-arch bridge in the edentulous jaw.

Fracture resistance of hybrid ceramic abutments with different restoration lengths: A pilot study.

AIM: In this pilot study, the fracture resistance of hybrid abutments with different restoration lengths was investigated. MATERIALS AND METHODS: Sixteen monolithic zirconia restorations of an upper right incisor were designed to fit a titanium base abutment. Eight central incisors had a crown length of 8 mm (T1) and the other half a length of 12 mm (T2). All crowns were cemented on the titanium base using a resin cement. After cementation, the samples were placed in a thermocycler for 5000 cycles. Fracture strength was measured using a universal test machine. Deformations and fractures of the samples were investigated. RESULTS: The mean fracture resistance of T1 was 515 N (SD 96 N, 339-650) and 305 N (SD 57 N, 234-408) for T2 (p < 0.001). Both groups showed deformation of the titanium base, with no significant difference between both groups (p = 0.200). A difference in fracture type (p = 0.013) was observed, with significantly more screw fractures occurring in group T1 (p = 0.026). CONCLUSION: Within the limitations of this study, hybrid restorations with standard titanium base abutments can withstand forces that have been associated with chewing, irrespective of the crown length. However, the shorter crowns demonstrated more fatal fractures.

A Completely Digital Workflow for Nanoceramic Endocrowns: A 5-Year Prospective Study.

PURPOSE: To evaluate the success of monolithic endocrowns fabricated using a digital workflow. MATERIALS AND METHODS: Twenty-three patients requiring restoration of devitalized molars or premolars were included in the study. The preparation was scanned using an intraoral scanner (Cerec Bluecam, Dentsply Sirona), and a monolithic restoration was made from a nanoparticle resin-based hybrid composite (#10 Cerasmart [CS]; #10 Lava Ultimate [LU], 3M Espe) or a polymer-infiltrated ceramic (#10 Vita Enamic [VE]). At the time of placement and after 6 months, 1 year, and 5 years of function, radiographs were taken to evaluate the marginal integrity of the restorations, and clinical pictures were taken to assess the quality of the restoration using the USPHS criteria. RESULTS: After 5 years, the restorative success rate was 70.8%, the restorative survival rate was 87.5%, and the tooth survival was 91.6%. Four chippings (two LU, two CS), three fractures (three LU), and two debonding of the restorations (two CS) occurred. Also, two teeth were extracted after 5 years of follow-up (two VE) because of secondary caries and a root fracture. The USPHS ratings were high, except for color match, which was rated the lowest at all time intervals. CONCLUSION: Nanoceramic endocrowns made using a completely digital workflow have an acceptable survival rate after 5 years. However, the complication rate was high.

Clinical Evaluation of Resin Composite CAD/CAM Restorations Placed by Undergraduate Students.

To evaluate the clinical outcomes of resin composite CAD/CAM restorations in a prospective cohort study, and to assess patient and operator satisfaction after restoration placement, 59 indirect resin composite were placed by supervised undergraduate students, of which 43 restorations were followed over a mean period of 28 months (14-44 months) and evaluated using USPHS criteria. Patient and operator satisfaction levels were assessed using a visual analogue scale (VAS) after restoration placement. A total of 37 patients and 47 restorations were included for further study. Four teeth were extracted-three due to extensive drug-induced secondary caries in the same patient, and one tooth due to large periapical periodontitis after 44 months of service. The overall survival rate was 91.4%, and success rate was 87.2%. Differences between baseline and endpoint scores were significant for marginal discoloration (p < 0.05) and adaptation (p < 0.001). Color match (p < 0.05) and surface texture (p < 0.001) differed significantly, affecting all restoration types. VAS scores for patient and operator satisfaction showed a significant rank correlation (p < 0.01), and pairwise comparison showed significant differences for mean overall patient and operator VAS scores (p < 0.001). Lava Ultimate CAD/CAM may be considered a suitable material for overlays and endocrown restorations when combined with IDS, air abrasion, and MDP-containing adhesive systems. Marginal disintegration may present in inlays and onlays over time.

Immediate Implant Placement and Loading of Single Implants in the Esthetic Zone: Clinical Outcome and Esthetic Evaluation in a Japanese Population.

This study evaluated the clinical outcomes of immediately loaded maxillary anterior single implants placed in fresh extraction sockets. A patient cohort that was treated 1.5 years earlier was recalled, and 18 patients (6 men, 12 women) with 21 implants were included. Clinical photographs and periapical radiographs were taken at follow-up and baseline to determine the bone loss and change in esthetics. No marginal bone loss was detected at follow-up (mean bone level ± standard deviation = 0.32 ± 0.82 mm). Immediate implant placement and loading resulted in predictable clinical and esthetic outcomes, with soft and hard tissue levels remaining stable over time.

Accuracy of optical dental digitizers: an in vitro study.

The aim of this study was to evaluate the accuracy, in terms of trueness and precision, of optical dental scanners. An experimental acrylic resin cast was created and digitized using a microcomputed tomography (microCT) scanner, which served as the reference model. Five polyether impressions were made of the acrylic resin cast to create five stone casts. Each dental digitizer (Imetric, Lava ST, Smart Optics, KaVo Everest) made five scans of the acrylic resin cast and one scan of every stone cast. The scans were superimposed and compared using metrology software. Deviations were calculated between the datasets obtained from the dental digitizers and the microCT scanner (= trueness) and between datasets from the same dental digitizer (= precision). With exception of the Smart Optics scanner, there were no significant differences in trueness for the acrylic resin cast. For the stone casts, however, the Lava ST performed better than Imetric, which did better than the KaVo scanner. The Smart Optics scanner demonstrated the highest deviation. All digitizers demonstrated a significantly higher trueness for the acrylic resin cast compared to the plaster cast, except the Lava ST. The Lava ST was significantly more precise compared to the other scanners. Imetric and Smart Optics also demonstrated a higher level of precision compared to the KaVo scanner. All digitizers demonstrated some degree of error. Stone cast copies are less accurate because of difficulties with scanning the rougher surface or dimensional deformations caused during the production process. For complex, large-span reconstructions, a highly accurate scanner should be selected.