Repair of monolithic zirconia restorations with different direct resin composites: effect on the fatigue bonding and mechanical performance.

OBJECTIVE: The study aims to evaluate the shear bond and flexural strength fatigue behavior of yttrium-stabilized zirconia (4YSZ) repaired using different resin composites. MATERIALS AND METHODS: Cylindric specimens of 4YSZ were obtained for the bond strength (Ø = 6 mm, 1.5 mm of thickness) and biaxial flexural strength (Ø = 15 mm, 1 mm of thickness) fatigue tests and divided into 3 groups according to the repair resin composite: EVO (nanohybrid), BULK (bulk-fill), and FLOW (flowable). The zirconia surface was air-abraded with alumina particles, a 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer was applied, and the resin composite was build-up over the zirconia. Fatigue shear bond strength and flexural fatigue strength tests were performed (n = 15). One-way ANOVA and Tukey post hoc tests were carried out for both outcomes, besides scanning electron microscopy and finite element analysis. RESULTS: The repair material affected the fatigue shear bond strength of zirconia ceramic. The BULK group (18.9 MPa) depicted higher bond strength values than FLOW (14.8 MPa) (p = 0.04), while EVO (18.0 MPa) showed similar results to both groups. No effect was observed for the mechanical behavior (p = 0.53). The stress distribution was similar for all groups. CONCLUSION: The repair of yttrium-stabilized zirconia (4YSZ) ceramics with bulk-fill resin composites was the best option for high fatigue bond strength. However, the fatigue mechanical performance was similar regardless of the applied repair material. CLINICAL RELEVANCE: The repair of yttrium-stabilized zirconia (4YSZ) monolithic restorations may be performed with nanohybrid and bulk-fill resin composites in order to promote longevity in the treatment.

Effects of occlusal splint therapy on opposing tooth tissues, filling materials and restorations.

BACKGROUND: Little is known about the effect of the type of splint material, heat-cured PMMA (HC) or chemical-cured PMMA (CC) on the wear of opposing tooth surfaces. OBJECTIVE: The aim of this in vitro study was to evaluate two-body wear of dentin, enamel, glass-ceramic or one of four resin composites when opposing splint materials, namely ProBase HC and CC. METHODS: The two-body wear of bovine dentine, bovine enamel, glass-ceramic IPS e.max CAD (EMAX) and four composites (Filtek Z250 [Z250], Clearfil AP-X [AP-X], Clearfil Majesty Posterior [CMP], Filtek Supreme XTE [FSE]) opposing three antagonists (HC and CC and stainless steel as control) were evaluated in the ACTA wear machine. In addition, all the surfaces were evaluated with scanning electron microscopy. RESULTS: The highest average wear was observed in the case of dentin. The lowest average wear was found EMAX. In every case-except for EMAX-the wear rate was higher with HC than with CC (all differences being statistically significant). CONCLUSIONS: The level of wear of enamel, dentin and various resin composites was higher in contact with HC than in CC, the wear of dentin being the highest. In the case of a patient with no or little tooth wear or whose teeth are restored with composite material or glass-ceramic, the splint HC might be preferred because of its better durability. However, when the splint is in contact with opposing dentin preservation of the dentin, CC might be the best choice.

Effect of surface treatment and glaze application on shade characterized resin-modified ceramic after toothbrushing.

STATEMENT OF PROBLEM: The extrinsic characterization with pigments and glaze application on the surface of ceramic restorations promotes individualization and esthetics. However, whether this characterization is resistant to toothbrushing abrasive wear is unclear. PURPOSE: The purpose of this in vitro study was to investigate the abrasive wear resistance of characterized and glazed resin-modified ceramic with different surface treatments before characterization. MATERIAL AND METHODS: Eighty rectangular specimens (10×8×6 mm) were precision cut from Vita Enamic and randomly divided in 4 groups as per the surface treatment before the characterization technique. These groups included the following: no additional treatment or polishing only, acid etching, airborne-particle abrasion, and self-etching silanization. For each surface treatment, 2 subgroups were created considering the presence or absence of the glaze layer after shade characterization, totaling 8 groups (n=10). The specimens were submitted to toothbrushing simulation (150 000 cycles, 2.45-N, 180 strokes per minute) with a soft and straight toothbrush and a solution of toothpaste and distilled water (250 g/L). After each 50 000 cycles, the wear of the characterized surface was measured by using a contact profilometer in µm which was equivalent to 5, 10, and 15 years of simulated toothbrushing. The rates were analyzed by using 3-way ANOVA and the post hoc Tukey test (α=.05). Scanning electron microscopy analysis was performed to access the surface profile between the evaluated periods. RESULTS: The mean wear rate (Rz) of the characterized surface was affected by the isolated factors, including surface treatment, glaze, and time (P<.001), with no interactive effects noted. A higher mean value of Rz was observed for polishing only (12.9 ±4.4 µm), followed by airborne-particle abrasion (10.2 ±4.5 µm), acid etching (9.4 ±2.4 µm), and then self-etching silanization (7.6 ±2.9 µm). Mean wear rate was also increased by the glaze (11.1 ±4.7 µm) compared with its absence (9 ±3.2 µm) and by the length of time, with 15 years (11.3 ±4.5 µm) followed by 10 years (9.8 ±4.0 µm) and 5 years (9 ±3.6 µm). The scanning electron microscopy images showed similar worn surfaces for each subgroup, glaze removal after 150 000 cycles, and surface homogeneity in function of time. CONCLUSIONS: Self-etching silanization was found to be the treatment suitable for reducing the wear of characterized resin-modified ceramic during prolonged brushing of more than 5 years. Glaze application did not protect the characterization from surface wear, regardless of the ceramic surface treatment performed on the specimens.

Wear of direct resin composites and teeth: considerations for oral rehabilitation.

Little is known about the wear rate of enamel and dentin opposing resin composite following restoration of the occlusal surface in patients with tooth wear. Hence, the aim of this in vitro study was to evaluate the wear of enamel and dentin surfaces when opposing each of three resin composites in a two-body and three-body wear test. The two-body and three-body wear of dentin, enamel, and three resin composites (Clearfil AP-X, Filtek Z250, and Filtek Supreme) opposing four antagonists (stainless steel and three resin composites) were evaluated using the ACTA wear machine. In addition, all the surfaces were evaluated with scanning electron microscopy. The results showed the lowest wear rate in enamel and the highest in dentine, with the composite showing intermediate wear rates. The three-body wear results were not affected by the antagonist and showed pure wear caused by the abrasive food medium. The in vitro enamel/composite wear ratio was 2.5. The results show that tooth wear accelerates as soon as enamel disappears and dentin is exposed to composite resin. Therefore, it is important to protect dentin with a restorative material.

Morphogenesis of aligned collagen fibers in the annulus fibrosus: Mammals versus avians.

The mammalian intervertebral disc (IVD) consists of a gel-like, disordered nucleus pulposus (NP) surrounded by a highly ordered collagen structure, the annulus fibrosus (AF). While this concentric array of lamellae has been amply studied, its physical origin is poorly understood. The notochord is a rod-like organ located in the mid-line of the growing embryo and plays an essential role in IVD development. The aim of this study was to elucidate the effect of notochord development on the collagen fiber arrangement evolution in the AF. To that end, we studied IVD development in mouse embryos and compared these observations to those from chicken embryos, which do not form the typical laminar structure around the NP. In mouse, cross-aligned collagen arrangement of the AF forms from the sclerotome upon bulging of the notochord to become NP. By contrast, the notochord in the chicken embryo swells substantially without the physical restrictions of the future vertebrae and thus do not bulge. From these observations, we conclude that physical and geometrical constrictions are essential for the formation of the highly structured AF.

Wear resistance and abrasiveness of CAD-CAM monolithic materials.

STATEMENT OF PROBLEM: Computer-aided design and computer-aided manufacturing (CAD-CAM) restorations are in contact with the antagonist tooth, either a natural tooth or a restoration. Therefore, clinicians should be aware of the wear resistance of CAD-CAM materials and the wear behavior of the antagonist. PURPOSE: The purpose of this in vitro study was to evaluate the wear resistance and abrasiveness of CAD-CAM materials. MATERIAL AND METHODS: In a 2-body wear test, the materials IPS e.max CAD (Ivoclar Vivadent AG), Vita Suprinity (Vita Zahnfabrik), Lava Ultimate (3M ESPE), Vita Enamic (Vita Zahnfabrik), and Lava Plus (3M ESPE) acted as abraders and, together with bovine enamel, also as antagonists. Each antagonist wheel ran against each abrader wheel for 200000 cycles, with a spring force of 15 N, and at a rotational speed of 1 Hz in distilled water. The wear rate was determined with a surface profilometer. The surfaces were observed with scanning electron microscopy, and their hardness, coefficient of friction, and roughness were evaluated. RESULTS: Lava Plus and IPS e.max CAD exhibited the highest potential for wear of Lava Ultimate. These 2 materials, together with Vita Suprinity, provided the highest wear of enamel and Vita Enamic. Vita Suprinity and IPS e.max CAD had higher wear than Lava Plus, and the inverse was also true. Vita Enamic and Lava Ultimate were among the materials that caused the lowest wear of enamel and all other evaluated materials. Scanning electron microscopy images revealed that except for Lava Ultimate, all other materials damaged enamel, in which Vita Suprinity and IPS e.max CAD were more aggressive when sliding against the materials. Lava Plus had the greatest hardness, followed by Vita Suprinity and IPS e.max CAD, Vita Enamic, and then Lava Ultimate. The coefficient of friction varied from 0.42 to 0.53. The Vita Enamic and Lava Ultimate showed the highest surface roughness. CONCLUSIONS: The nanofilled composite resin and polymer-infiltrated ceramic were more antagonist-friendly (whether enamel or CAD-CAM material) than glass-ceramics and zirconia. Care should be taken when selecting the material that will contact mainly with glass-ceramics. Hardness should also be considered when selecting a material.

Toward a new generation of pelvic floor implants with electrospun nanofibrous matrices: A feasibility study.

OBJECTIVE: The use of knitted, polypropylene meshes for the surgical treatment of pelvic organ prolapse (POP) is frequently accompanied by severe complications. Looking for alternatives, we studied the potential of three different electrospun matrices in supporting the adhesion, proliferation, and matrix deposition of POP and non-POP fibroblasts, the most important cells to produce extracellular matrix (ECM), in vitro. STUDY DESIGN: We electrospun three commonly used medical materials: nylon; poly (lactide-co-glycolide) blended with poly-caprolactone (PLGA/PCL); and poly-caprolactone blended with gelatin (PCL/Gelatin). The matrices were characterized for their microstructure, hydrophilicity, and mechanical properties. We seeded POP and non-POP fibroblasts from patients with POP and we determined cellular responses and ECM deposition. RESULTS: All matrices had >65% porosity, homogenous microstructures, and close to sufficient tensile strength for pelvic floor repair: 15.4 ± 3.3 MPa for Nylon; 12.4 ± 1.6 MPa for PLGA/PCL; and 3.5 ± 0.9 MPa for PCL/Gelatin. Both the POP and non-POP cells adhered to the electrospun matrices; they proliferated well and produced ample ECM. Overall, the best in vitro performance appeared to be on nylon, presumably because this was the most hydrophilic material with the thinnest fibers. CONCLUSION: Electrospun nanofibrous matrices show feasible mechanical strength and great biocompatibility for POP and non-POP fibroblasts to produce their ECM in vitro and, thus, may be candidates for a new generation of implants for pelvic floor repair. Further studies on electrospun nanofibrous matrices should focus on mechanical and immunological conditions that would be presented in vivo. Neurourol. Urodynam. 36:565-573, 2017. © 2016 Wiley Periodicals, Inc.

Carbon dots combined with phytosphingosine inhibit acid-induced demineralization of hydroxyapatite in vitro.

OBJECTIVES: To study the effects of carbon dots (CDs), in combination with phytosphingosine (PHS), against acid-induced demineralization of hydroxyapatite in vitro. METHODS: CDs were generated from citric acid and urea by microwave heating. Transmission electron microscope (TEM), FT-IR, and fluorescence intensity were used to characterize the CDs. A hydroxyapatite (HAp) model was used to investigate the protective effects of CDs, PHS, and their combinations with and without a salivary pellicle against acid-induced demineralization in vitro. Ca2+ release as a parameter to evaluate the inhibition of demineralization was measured by capillary electrophoresis. The interactions between CDs, PHS, and HAp discs were investigated using a fluorescence detector. RESULTS: Uniform-sized CDs were synthesized, showing typical optical characteristics. CDs exhibited no inhibition of acid-induced demineralization in vitro, in contrast to PHS. Notably, a pre-coating of CDs increased the protective effects of PHS against acid-induced demineralization, which was not disturbed by the presence of a salivary pellicle and Tween 20. Scanning electron microscope (SEM) confirmed the binding and layers formed of both CDs and PHS to the HAp surfaces. Based on fluorescence spectra CDs binding to HAp seemed to be dependent on Ca2+ and PO43- interactions. CONCLUSIONS: CDs combined with PHS showed protective effects against acid-induced demineralization of HAp discs in vitro.

Porphyromonas gingivalis interaction with Candida albicans allows for aerobic escape, virulence and adherence.

In the oral cavity Candida albicans interacts with many oral bacteria, including Porphyromonas gingivalis, both physically and metabolically. The aim of this in vitro study was to characterize these interactions and study their effects on the survival of P. gingivalis. First, metabolic interactions were evaluated by counting the colony forming units (CFU) after co-culturing. The results indicated that the anaerobic bacterium P. gingivalis survives under aerobic conditions when co-cultured with C. albicans. This is due to the oxygen consumption by C. albicans as determined by a reduction in survival upon the addition of Antimycin A. By measuring the protease activity, it was found that the presence of C. albicans induced gingipain activity by P. gingivalis, which is an important virulence factor. Adherence of P. gingivalis to hyphae of C. albicans was observed with a dynamic flow system. Using various C. albicans mutants, it was shown that the mechanism of adhesion was mediated by the cell wall adhesins, members of the agglutinin-like sequence (Als) family: Als3 and Als1. Furthermore, the two microorganisms could be co-cultured into forming a biofilm in which P. gingivalis can survive under aerobic culturing conditions, which was imaged using scanning electron microscopy. This study has further elucidated mechanisms of interaction, virulence acquisition and survival of P. gingivalis when co-cultured with C. albicans. Such survival could be essential for the pathogenicity of P. gingivalis in the oxygen-rich niches of the oral cavity. This study has emphasized the importance of interaction between different microbes in promoting survival, virulence and attachment of pathogens, which could be essential in facilitating penetration into the environment of the host.

Effect of printing layer orientation and polishing on the fatigue strength of 3D-printed dental zirconia.

OBJECTIVE: The aim of the study was to evaluate the influence of surface polishing and printing layer orientation on the fatigue behaviour of 3 mol% yttria-stabilized zirconia (3Y-TZP) by stereolithography (SLA) in comparison with subtractive manufacturing. MATERIALS AND METHODS: 60 experimental zirconia bar-shaped specimens were 3D-printed (P) via SLA, and 30 specimens were milled (M) from commercial zirconia block (Lava™ Frame, 3 M ESPE AG). All specimens had the same dimensions (1 mm × 1 mm x 12 mm) after sintering. The 3D-printed specimens were randomly divided according to printing orientations: parallel or perpendicular to the tensile surface in the fatigue test. The specimens were subsequently submitted to two surface finishing protocols (n = 15/gr): unpolished or polished. Their phase compositions were analysed by X-ray diffraction. The fatigue behaviour was evaluated by a stepwise approach. RESULTS: The milled and both 3D-printed groups showed similar phase compositions for the as-sintered condition. Considerable amounts of rhombohedral phase were detected after polishing. Milled unpolished samples presented significantly higher fatigue strength than 3D-printed unpolished samples. Polishing did not improve the fatigue strength for milled zirconia but was advantageous for the 3D-printed specimens. 3D-printed specimens with parallel printing-layer orientation were significantly stronger than specimens with perpendicular layers regardless of surface finishing. CONCLUSION: The manufacturing techniques had a significant influence on the fatigue strength of 3Y-TZP, but not on the phase compositions of the surface. The polishing protocol showed different effects on 3Y-TZP fatigue strength and induced phase transition of the 3Y-TZP from Tetragonal to Rhombohedral. The best fatigue strength was achieved through milling using an unpolished surface and SLA-printed layers that were parallel to the tensile surface, followed by polishing.

Failed Dental Implant: When Titanium Fractures.

Despite the widespread use of titanium implants in orthopedic and dental surgeries, concerns have recently emerged regarding potential deformations and fractures after osseointegration. In a recent clinical case, a titanium implant fractured after successful osseointegration. This fracture occurred despite the absence of any significant trauma or excessive external force applied to the area. The fracture was attributed to a combination of factors, including abutment design flaws, material fatigue, and biomechanical stress imposed on the implant during functional loading. This raises concerns about the long-term durability and reliability of titanium implants, particularly in high-stress areas such as the posterior region or weight-bearing bones. An image was made with scanning electron microscopy showing the fracture region near the prosthetic platform and highlighting the knowledge that despite their ductility, titanium implants can fracture.

Biomimetic calcium phosphate coating on medical grade stainless steel improves surface properties and serves as a drug carrier for orthodontic applications.

OBJECTIVE: Recently, stainless steel (SSL) miniscrew implants have been used in orthodontic clinics as temporary anchorage devices. Although they have excellent physical properties, their biocompatibility is relatively poor. Previously, our group developed a two-phase biomimetic calcium phosphate (BioCaP) coating that can significantly improve the biocompatibility of medical devices. This study aimed to improve the biocompatibility of SSL by coating SSL surface with the BioCaP coating. METHODS: Titanium (Ti) discs and SSL discs (diameter: 5 mm, thickness: 1 mm) were used in this study. To form an amorphous layer, the Ti discs were immersed in a biomimetic modified Tyrode solution (BMT) for 24 h. The SSL discs were immersed in the same solution for 0 h, 12 h, 24 h, 36 h and 48 h. To form a crystalline layer, the discs were then immersed in a supersaturated calcium phosphate solution (CPS) for 48 h. The surface properties of the BioCaP coatings were analysed. In addition, bovine serum albumin (BSA) was incorporated into the crystalline layer during biomimetic mineralisation as a model protein. RESULTS: The morphology, chemical composition and drug loading capacity of the BioCaP coating on smooth SSL were confirmed. This coating improved roughness and wettability of SSL surface. In vitro, with the extension of BMT coating period, the cell seeding efficiency, cell spreading area and cell proliferation on the BioCaP coating were increased. SIGNIFICANCE: These in vitro results show that the BioCaP coating can improve surface properties of smooth medical grade SSL and serve as a carrier system for bioactive agents.

The influence of pre-heating the restoration and luting agent on the flexural strength of indirect ceramic and composite restorations.

Background: This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites. Materials and Methods: 400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated. Results: There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations. Conclusion: Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations.

Different luting procedures significantly impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations, with light-curing cement demonstrating superior performance for specific thicknesses.Pre-heated resin composites, either with or without pre-heated restorations, offer a viable alternative to conventional dual-curing cement for bonding indirect restorations, presenting potential clinical advantages.Restoration thickness plays a crucial role in the mechanical response of restorations, with thinner resin composite restorations benefiting from dual- or light-curing, while thicker ones are less sensitive to luting procedure variations.

Coating glass-ionomer cements with a nanofilled resin.

OBJECTIVES: The objective of this study was to investigate the effect of a nanofilled resin coat on the flexural strength (FS) and the early wear (after 50,000 and 200,000 cycles) of the glass-ionomer cements Fuji IX GP Extra (FIXE) and Ketac Molar Aplicap (KM). MATERIALS AND METHODS: Specimens were prepared and half of them were coated with G-Coat plus. The uncoated specimens were used as controls. Flexural strength (n = 10) was evaluated after 24 h using a 3-point bending test on a universal testing machine (ISO 9917-2). Wear (n = 20) was evaluated after 50,000 and 200,000 cycles using the ACTA wear machine. One-way, two-way ANOVA and Tukey post-hoc tests were used to analyze differences in FS and wear. RESULTS: For FIXE the coat significantly increased the FS and the wear along the two time spans. KM did not show a significant difference in FS with the coat. Improvements in wear were observed only after 50,000 cycles. CONCLUSION: Based on these laboratory results, it is concluded that G-coat Plus is indicated in association with GP IX Extra with the aim to improve the mechanical properties of the former. However, this study is limited to a short-term observation.

Wear of bulk-fill resin composites.

OBJECTIVE: Bulk-fill resin composites are a special group of restorative materials designed to reduce chair time needed to insert a direct composite restoration. However, other factors determine the clinical success of a restorative material. Clinically the major reasons for failure of direct restorations are secondary caries and fracture of the restoration or the tooth itself. In the long-term composite resin restorations in posterior teeth may be prone to wear. As bulk-fill materials have their own composition that will determine their mechanical properties, the wear resistance may be affected as well. The aim of this in vitro study was to evaluate the wear of bulk-fill composites in comparison with a conventional hybrid composite. The null hypothesis was that there are no differences between the four bulk-fill materials and one traditional highly filled nanohybrid composite for posterior use when subjected to a two-body wear rate test and hardness measurement. METHODS: Four bulk-fill composites SDR Smart Dentin Replacement (SDR), X-tra base (XBA), FiltekBulk Fill (FUP), Dual-Curing Bulk Composite (FBFL) and conventional nanohybrid resin composite Grandio (GDO) subjected to a two-body wear test against a stainless steel (SS) antagonist wheel. Scanning Electron Microscopy analysis was performed to detect the surface alterations. Microhardness of all samples was tested (n = 5) with a Vickers diamond indenter (5 indentations in each specimen). One-way ANOVA and Tukey's post hoc test (P < 0.01) were used to analyze differences in wear values. The hardness data were submitted to one-way ANOVA test, followed by the Tukey post hoc test (α = 0.05). T-test was applied to compare wear rate in time interval between one day and one month. RESULTS: The highest wear rate values were recorded for SDR and the lowest wear rate values were for GDO. Hardness was the highest for GDO and the lowest for FBFL. SIGNIFICANCE: The bulk-fill composites have a higher wear rate and lower hardness than the conventional nanohybrid composite, making them less suitable for stress-bearing restorations.

In-lab simulation of CAD/CAM grinding and intaglio surface treatments of 4YSZ monolithic restorations: Effect on its load-bearing capacity under fatigue.

OBJECTIVES: To evaluate the effect of in-lab simulation of CAD/CAM grinding and intaglio surface treatments on the surface characteristics (topography and roughness) and fatigue behavior of adhesively luted 4YSZ simplified restorations. METHODS: Ceramic discs (Ø = 10 mm, thickness = 1 mm) were randomly allocated into 6 groups considering: "In-lab simulation of CAD/CAM grinding" (ground or polished) and "intaglio surface treatments": Ctrl (without surface treatment), AlOx (aluminum oxide air abrasion) or GLZ (glaze spray application). The surface roughness of all samples was measured, the treated discs received a ceramic primer, were luted with resin cement onto a dentin analogue material (woven glass-reinforced epoxy resin) and tested under a cyclic fatigue test (step-stress approach, n = 15; 1.4 Hz, 10,000 cycles/step, step-size of 100N starting at 200N until failure). A complementary analysis was performed to corroborate the findings in the fatigue test that the glaze fill defects increase the mechanical properties of the ceramic. To do so, bars (n= 10; 1.0 × 1.0 × 12 mm; considering the groups: N-ID: non-indented; ID: indented; ID-GLZ: indented plus glaze spray application) were indented in a vickers hardness tester to produce a crack pattern, treated with glaze or not, and then submitted to flexural strength tests (FS). Fractographic and topographic analysis were performed. RESULTS: In-lab simulation of CAD/CAM grinding decreased the fatigue failure load of the 4YSZ ceramic when comparing polished and ground groups, regardless of surface treatment. GLZ induced better fatigue performance compared to the air abrasion, regardless of the grinding condition (ground or polished surface). The results of the flexural strength test corroborated the findings in the fatigue test, as the ID-GLZ group presented superior FS than the ID group, however both had inferior FS than N-ID. There is an inverse association between roughness and fatigue failure load, as the higher the surface roughness, the lower the fatigue failure load. Failures in the fatigue and flexural strength tests started from the face subjected to tensile stresses. CONCLUSION: In-lab simulation of CAD/CAM grinding had a detrimental effect on the fatigue behavior of 4YSZ and glaze spray induced better 4YSZ performance compared to the air abrasion. The intaglio surface treatments differently influenced the 4YSZ fatigue performance, however, only glaze spray can reverse the damage caused by the grinding.

Is the application of a silane-based coupling agent necessary to stabilize the fatigue performance of bonded simplified lithium disilicate restorations?

This study evaluated the influence of ceramic surface conditioning and storage regimen (baseline vs. aging) on the fatigue performance of simplified lithium disilicate glass-ceramic restorations. A total of 90 ceramic discs (Ø= 10 mm; thickness= 1.0 mm) were allocated into 6 groups (n= 15), considering 2 factors: "ceramic surface treatment" - CA (only silane-based coupling agent, Monobond N), HF (5% hydrofluoric acid etching), or HF+CA (5% HF acid etching plus silane-based coupling agent); and "storage regimen" - baseline (24 hours - 5 days of distilled water at 37 °C), or long-term aging (180 days of distilled water at 37 °C + 25,000 thermal cycles). After intaglio ceramic conditioning, adhesive bonding (Multilink N) was performed onto epoxy resin discs (Ø= 10 mm; thickness= 2.5 mm) and the bonded sets were subjected to step-stress fatigue tests (initial load: 200 N; step-size: 50 N; 10,000 cycles per step; 20 Hz). Fatigue data were analyzed using Kaplan-Meier and Weibull statistical analyses. Fractography and topography analyses were also conducted. The fatigue findings demonstrated that the performance among groups for both baseline and aging conditions maintained a tendency: the CA groups had the worst behavior (baseline: 893 N/143,667 cycles; aging: 639 N/84,179 cycles), while the surface etching with HF (baseline: 1247 N/214,333 cycles; aging: 816.67 N/128,333 cycles) and HF+CA groups (baseline: 1290 N/222,333 cycles; aging: 900 N/145,000 cycles) had no statistically significant difference between them. The aging protocol reduced the performance of all groups. The groups with better fatigue performance (HF and HF+CA) did not have statistical differences regarding structural reliability (Weibull modulus). Most failures were radial cracks from the cementation interface, except for CA aging specimens, with 27% failing from debonding. The HF etching led to noteworthy surface topographical alterations. Micromechanical interlocking resulting from HF acid etching remained prevalent in the fatigue behavior. Thus, the silane-based coupling agent (Monobond N) does not need to be applied after HF etching in terms of fatigue behavior outcomes.

Mechanical characterization of a multi-layered zirconia: Flexural strength, hardness, and fracture toughness of the different layers.

This study compared the flexural strength under monotonic (static - sσ) and cyclic load application (fatigue - fσ), hardness (H) and fracture toughness (KIC) of different layers of a multi-layered zirconia (IPS e.max ZirCAD MT Multi, Ivoclar). Each layer was sectioned, classified into three groups according to yttria content (4-YSZ, 4/5-YSZ and 5-YSZ), and shaped on samples for flexural strength and fracture toughness tests (bars: 1.0 × 1.0 × 11 mm); and Vickers hardness test (plates: 1.5 × 4.0 × 5.0 mm). Flexural strength under monotonic load application (sσ; n = 10) was obtained through two different devices (three-point-bending and ball-in-hole device) and fatigue flexural strength (fσ; n = 15; initial load: 10 N; step-size: 5 N; 10,000 cycles/step) was assessed using a ball-in-hole device under cyclic load application. Vickers hardness test (n = 5), fracture toughness test (n = 10), and additional analyzes (Finite Element Analysis - FEA, Energy-dispersive X-ray spectroscopy - EDS and Scanning Electron Microscopy - SEM) were also performed. No differences were found between the different devices in the monotonic flexural strength test, and FEA showed similar tensile stress distribution for the two devices. 4-YSZ showed higher values of flexural strength under monotonic and cyclic load application modes (sσ = 1114.73 MPa; fσ = 798.84 MPa), and fracture toughness (KIC = 3.90 MPa√m). 4/5-YSZ had an intermediate sσ; however, fσ was similar to 5-YSZ (404.00-429.36 MPa) and KIC similar to 4-YSZ (KIC = 3.66 MPa√m). No statistical differences were found for hardness and Weibull modulus for fatigue flexural strength data. The amount of yttria in the layer compositions increased from 4-YSZ to 5-YSZ, and larger zirconia crystals were observed in the topographic images of 5-YSZ. Failures in the flexural strength and toughness tests started from the face subjected to tensile stress. Different layers of the multi-layered zirconia blank presented distinct mechanical properties. 4-YSZ (cervical layer) presented the highest flexural strength under monotonic and cyclic loads (fatigue), and higher fracture toughness even similar to the transition layer (4/5-YSZ). Hardness was similar between the layers. The ball-in-hole device performed similarly to the three-point bending device and can be used as an alternative to the traditional method.

The influence of roughness on the resistance to impact of different CAD/CAM dental ceramics.

This study aimed to investigate the effect of surface roughness (polished vs. CAD/CAM milling simulation) on impact strength of five dental ceramics for manufacturing CAD/CAM monolithic restorations. Specimens of five ceramics (FC- feldspathic glass-ceramic; PICN- polymer-infiltrated ceramic-network; ZLS- zirconia-reinforced lithium silicate glass-ceramic; LD- lithium disilicate glass-ceramic; YZ- yttria-stabilized tetragonal zirconia polycrystal ceramic) to be tested under impact (15×10×2mm3; n= 15) were divided into two groups, according to surface treatment: polishing (pol) and grinding (gri) as CAD/CAM milling simulation. Impact strength was tested using the Dynstat method. Roughness, topographic, fractographic and finite element analyses were performed. The impact strength data were analyzed by Weibull, and Pearson correlation was used to correlate roughness and impact strength data. The CAD/CAM milling simulation led to significantly (p<0.05) greater roughness (Ra and Rz) and statistically reduced the impact strength for PICN (polPICN= 4.59 to griPICN= 1.09; ±76% decrease), for LD (polLD= 17.69 to griLD= 10.09; ±43% decrease) and for YZ (polYZ= 74.99 to griYZ= 20.67; ±72% decrease) ceramics; and also promoted a more irregular topography with scratches and grooves. Fractographic and FEA analyses depicted the origin of failure at the higher stress concentration side during the impact test, where the pendulum impacted. The CAD/CAM milling simulation significantly decreased the impact strength of the evaluated ceramic materials.

Pulsating fluid flow affects pre-osteoblast behavior and osteogenic differentiation through production of soluble factors.

Bone mass increases after error-loading, even in the absence of osteocytes. Loaded osteoblasts may produce a combination of growth factors affecting adjacent osteoblast differentiation. We hypothesized that osteoblasts respond to a single load in the short-term (minutes) by changing F-actin stress fiber distribution, in the intermediate-term (hours) by signaling molecule production, and in the long-term (days) by differentiation. Furthermore, growth factors produced during and after mechanical loading by pulsating fluid flow (PFF) will affect osteogenic differentiation. MC3T3-E1 pre-osteoblasts were either/not stimulated by 60 min PFF (amplitude, 1.0 Pa; frequency, 1 Hz; peak shear stress rate, 6.5 Pa/s) followed by 0-6 h, or 21/28 days of post-incubation without PFF. Computational analysis revealed that PFF immediately changed distribution and magnitude of fluid dynamics over an adherent pre-osteoblast inside a parallel-plate flow chamber (immediate impact). Within 60 min, PFF increased nitric oxide production (5.3-fold), altered actin distribution, but did not affect cell pseudopodia length and cell orientation (initial downstream impact). PFF transiently stimulated Fgf2, Runx2, Ocn, Dmp1, and Col1⍺1 gene expression between 0 and 6 h after PFF cessation. PFF did not affect alkaline phosphatase nor collagen production after 21 days, but altered mineralization after 28 days. In conclusion, a single bout of PFF with indirect associated release of biochemical factors, stimulates osteoblast differentiation in the long-term, which may explain enhanced bone formation resulting from mechanical stimuli.