Comparison of mechanical properties of different reinforced glass-ceramics.

STATEMENT OF PROBLEM: Data concerning the mechanical properties of the newly developed lithium disilicate ceramic HS10PC are lacking. PURPOSE: The purpose of this in vitro study was to investigate the flexural strength (FS), Martens hardness (HM), indentation modulus (EIT), fracture load (FL), and wear resistance (WR) of HS10PC compared with those of the established glass-ceramics IPS e.max Press and IPS Empress Esthetic. MATERIAL AND METHODS: Four pressable glass-ceramics were examined: HS10PC (estetic ceram ag), IPS e.max Press low translucency (LT) and high translucency (HT; Ivoclar Vivadent AG), and IPS Empress Esthetic (ES; Ivoclar Vivadent AG). For each material, a total of 85 specimens were fabricated. Specimens were subdivided into 4 groups for FS (n=30), HM, EIT (n=10), and FL measurement according to the Voss test after artificial aging in an autoclave (n=15), artificial aging in a mastication simulator (n=15), and no artificial aging (n=15). In addition, WR (n=10) was measured after 240 000, 600 000, and 1 200 000 masticatory cycles. Data were statistically analyzed using the global univariate ANOVA, the Scheffé post hoc and paired t tests, and Weibull distribution (α=.05). RESULTS: HT showed the highest FS, while ES presented the lowest FS of all groups (P<.001). ES showed lower values for HM (P<.001), EIT (P<.001), and FL for specimens treated in an autoclave and mastication simulator (P<.001) compared with all other groups. An increase in the wear of the ceramic and enamel antagonist between 240 000 and 1 200 000 masticatory cycles was observed for all groups (P<.001). After 1 200 000 masticatory cycles, HS10PC presented less wear of the ceramic than the other 3 materials (P=.003). CONCLUSIONS: The newly developed lithium disilicate ceramic HS10PC showed comparable results with the established IPS e.max Press for FS, HM, EIT, FL, and WR. Lithium disilicate ceramics presented higher mechanical results than the leucite-reinforced ES, with all the ceramics showing similar results for the WR of the enamel antagonist.

Three-dimensionally printed and milled polyphenylene sulfone materials in dentistry: Tensile bond strength to veneering composite resin and surface properties after different pretreatments.

STATEMENT OF PROBLEM: Polyphenylene sulfone (PPSU) is a thermoplastic that can be processed using 3-dimensional printing. PPSU is new to dentistry, and scientific data on its properties are lacking. PURPOSE: The purpose of this in vitro study was to test the surface properties and the tensile bond strength (TBS) between PPSU and a veneering composite resin in comparison with a polyetheretherketone (PEEK). MATERIAL AND METHODS: Gehr PPSU (PPSU-B1), Radel R-5000 NT (PPSU-B2), and Juvora Dental Disc (PEEK-CG) substrates were cut from bulk material, while FIL-A-GEHR PPSU (PPSU-3D) was 3-dimensionally printed (N=504, n=126/material). TBS to veneering composite resin (CeramageUp) was tested initially and after 5000 and 10 000 thermocycles, and fracture types were analyzed. Surface free energy (SFE) and surface roughness (Ra) were determined after pretreatment with aluminum oxide (Al2O3) of different grain sizes (50 and 110 µm) applied with different pressures (0.1, 0.2, 0.4 MPa), silicon dioxide (SiO2)-coated Al2O3 (0.28 MPa), sulfuric acid, or polished. Qualitative surface characterization was performed by using a scanning electron microscope (SEM). One-way ANOVA, the Kruskal-Wallis, Mann-Whitney U, and the Spearman correlation tests were computed (α=.05). RESULTS: PPSU-3D and PEEK-CG presented higher TBS results than PPSU-B1 and PPSU-B2. Initial TBS values were higher than after 10 000 thermocycles. Adhesive fractures between substrate and veneering composite resin occurred most frequently. With a few exceptions, PEEK-CG presented higher SFE values than all other materials within a pretreatment group, while PPSU-3D and PEEK-CG showed consistently high Ra values. An increase in pressure and particle size increased SFE and Ra. CONCLUSIONS: FFF-printed PPSU-3D showed similar TBS values with the veneering composite resin to the more established PEEK. Pretreatment methods devised for PEEK represent valid strategies for increasing both the SFE and Ra of the high-performance polymer PPSU.

Measuring the polymerization stress of self-adhesive resin composite cements by crack propagation.

OBJECTIVES: To test the polymerization stress of nine self-adhesive resin composite cements (G-CEM, iCEM, Bifix SE, Maxcem Elite, PANAVIA SA, SoloCem, SmartCem 2, SpeedCEM, RelyX Unicem 2) and one glass ionomer cement (control group; Ketac Cem). MATERIALS AND METHODS: The crack propagation of a feldspar ceramic (n = 130) was determined by measuring crack lengths that originated from Vickers indentations, prior to and after the application and polymerization of the self-adhesive resin cements. Results for crack propagation were converted to polymerization stress values, and statistical analysis was performed using one-way ANOVA followed by Scheffé post hoc test. RESULTS: SmartCem 2 presented higher stress values than iCEM, SoloCem, and Ketac Cem, while Ketac Cem showed lower values than Bifix SE, Maxcem Elite, SmartCem 2, SpeedCEM, and RelyX Unicem 2. CONCLUSIONS: Self-adhesive resin composite cements differ in their polymerization stress, which may affect the durability of the restoration. For restorations made from ceramics with lower flexural strength, such as feldspar ceramics, resin composite cement materials with less polymerization stress should be preferred. CLINICAL RELEVANCE: As a high polymerization shrinkage may increase crack propagation, the determination of the polymerization stress of self-adhesive resin composite cements employed for fixing all-ceramic restorations is an important factor.

Retention force of polyetheretherketone and cobalt-chrome-molybdenum removable dental prosthesis clasps after artificial aging.

OBJECTIVES: To examine the retention force of removable dental prosthesis (RDP) clasps made from polyetheretherketone (PEEK) and cobalt-chrome-molybdenum (CoCrMo, control group) after storage in water and artificial aging. MATERIALS AND METHODS: For each material, 15 Bonwill clasps with retentive buccal and reciprocal lingual arms situated between the second pre- and first molar were manufactured by milling (Dentokeep [PEEKmilled1], NT digital implant technology; breCAM BioHPP Blank [PEEKmilled2], bredent), pressing (BioHPP Granulat for 2 press [PEEKpressed], bredent), or casting (remanium GM 800+ [CoCrMo], Dentaurum); N = 60, n = 15/subgroup. A total of 50 retention force measurements were performed for each specimen per aging level (initial; after storage [30 days, 37 °C] and 10,000 thermal cycles; after storage [60 days, 37 °C] and 20,000 thermal cycles) in a pull-off test. Data were statistically analyzed using one-way ANOVA, post hoc Scheffé and mixed models (p < 0.05). RESULTS: Initial, PEEKpressed (80.2 ± 35.2) and PEEKmilled1 (98.9 ± 40.3) presented the lowest results, while PEEKmilled2 (170.2 ± 51.8) showed the highest values. After artificial aging, the highest retention force was observed for the control group (131.4 ± 56.8). The influence of artificial aging was significantly higher for PEEK-based materials. While PEEKmilled2 and PEEKpressed showed an initial decline in retention force, all other groups presented no impact or an increase in retention force over a repetitive insertion and removal of the clasps. CONCLUSIONS: Within the tested PEEK materials, PEEKmilled2 presented superior results than PEEKpressed. Although CoCrMo showed higher values after artificial aging, all materials exhibited sufficient retention to recommend usage under clinical conditions. CLINICAL RELEVANCE: As RDPs are still employed for a wide range of indications, esthetic alternatives to conventional CoCrMo clasps are sought.

Is the high-performance thermoplastic polyetheretherketone indicated as a clasp material for removable dental prostheses?

OBJECTIVES: To investigate the retention force of polyetheretherketone (PEEK) removable dental prosthesis clasps in comparison with a cobalt-chrome-molybdenum control group after storage in artificial saliva. MATERIALS AND METHODS: Clasps were milled (Dentokeep (PEEKmilled1), NT digital implant technology; breCAM BioHPP Blank (PEEKmilled2), bredent), pressed (BioHPP Granulat for 2 press (PEEKpressed), bredent), or cast (remanium GM 800+ (cobalt-chrome-molybdenum), Dentaurum); N = 60, n = 15/subgroup. Retention force was examined 50 times/specimen in a pull-off test using the universal testing machine (Zwick 1445), where pull-off force was applied with a crosshead speed of 5 mm/minute until the maximum force dropped by 10%, at different aging levels: (1) initial, after storage in artificial saliva for (2) 90 and (3) 180 days. Statistical analysis was performed using one-way ANOVA followed by post hoc Scheffé-test and mixed models (p < 0.05). RESULTS: Cobalt-chrome-molybdenum presented the highest retention force. No differences were observed between polyetheretherketone materials. Cobalt-chrome-molybdenum showed a significant decrease of its values after artificial aging, while polyetheretherketone materials presented similar results over the course of aging. Regarding a repetitive insertion and removal, even though PEEKmilled2 and cobalt-chrome-molybdenum showed an initial increase, ultimately, a decrease in retention force was observed for all tested groups. CONCLUSIONS: Although the control group showed significantly higher results, the retention force of polyetheretherketone materials indicate a potential clinical application. Neither the manufacturing process nor artificial aging showed an impact on the retention force of polyetheretherketone clasps. CLINICAL RELEVANCE: Mechanical properties of novel removable dental prosthesis clasp materials devised to meet the growing esthetic demands of patients need to be investigated to ensure a successful long-term clinical application.

Impact of resin composite cement on color of computer-aided design/computer-aided manufacturing ceramics.

OBJECTIVE: To analyze the impact of the color of a resin composite cement (RCC) on the optical properties of different computer-aided design and computer-aided manufacturing (CAD/CAM) ceramics. MATERIALS AND METHODS: Specimens (N = 220, thickness: 0.9 ± 0.03 mm) were fabricated from: leucite (Initial LRF Block/IPS Empress CAD), lithium disilicate (Amber Mill/IPS e.max CAD), lithium metasilicate (Celtra Duo), and lithium alumina silicate ceramic (n!ce) in translucency levels HT and LT. All specimens were bonded with an RCC (Light+/Warm+). Color was analyzed (spectrophotometer) initially as well as after bonding of RCC with CAD/CAM ceramics using CIELab and CIEDE2000. Kolmogorov-Smirnov test, one-way ANOVA and t test served for analyzing (α = 0.05). RESULTS: Highest impact on ΔE presented the choice of ceramic (ηp2  = 0.155/p < 0.001), followed by translucency level (HT/LT; ηp2  = 0.050/p = 0.001) as well as interaction between ceramic and translucency level (ηp2  = 0.175/p < 0.001). ΔE00 was mainly influenced by the choice of ceramic (ηp2  = 0.490/p < 0.001), the shade of resin composite (ηp2  = 0.031/p = 0.012) as well as the interaction between ceramic and resin composite (ηp2  = 0.258/p < 0.001). CONCLUSIONS: RCC shades presented differential impacts on color change of CAD/CAM ceramics. CLINICAL SIGNIFICANCE: Knowledge of the impact of available RCC shades on different CAD/CAM ceramics is crucial for an esthetic outcome and proper selection of ceramic restorations.

Impact of thermocycling on mechanical properties and discoloration of veneering composite resins after storage in various staining media.

STATEMENT OF PROBLEM: Veneering composite resins (VCRs) are often used to veneer frameworks, but knowledge of mechanical, surface, and discoloring properties is scarce. PURPOSE: The purpose of this in vitro study was to evaluate the impact of thermocycling on flexural strength (FS) and the influence of different staining media on the discoloration (ΔE) and surface free energy (SFE) of VCRs. MATERIAL AND METHODS: The following VCRs were tested: Ceramage, dialog Vario, Gradia Plus, in:joy, Signum composite, and SR Nexco. FS was tested with enamel and dentin pastes (except SR Nexco: only enamel paste), whereas ΔE and SFE were analyzed for enamel pastes. ΔE was determined by using a spectrophotometer, and SFE was evaluated with contact angle measurements. For FS, rod-shaped specimens (N=660, n=10/subgroup; 25×2×2 mm) were fabricated, thermocycled for 220, 1500, 10 000, 20 000, and 40 000 cycles (5 °C/55 °C). and tested immediately after fabrication (initial) and after aging. For ΔE and SFE, disc-shaped specimens (N=300, n=10/subgroup; 15x15x1.4 mm) were fabricated and stored for 14 days in coffee, red wine, carrot juice, beetroot juice, or curry solution. ΔE and SFE were measured initially after polishing, after discoloration, and after repolishing. Data were analyzed using univariate analysis, 1-way ANOVA followed by the Scheffé post hoc test, Kolmogorov-Smirnov test, Kruskal-Wallis test, Mann-Whitney U test, and Wilcoxon test (α=.05). RESULTS: Ceramage had the highest FS, followed by dialog Vario and SR Nexco. Gradia Plus, and in:joy had the lowest FS, followed by Signum composite. FS was reduced by increasing of thermocycles. The highest ΔE was measured for curry and the lowest for carrot juice and red wine, followed by beetroot juice and coffee. The highest ΔE between the initial polished specimens and repolished specimens were observed for Ceramage. The remaining VCRs showed differences in ΔE between 0.95 (Signum composite) and 1.30 (SR Nexco). The SFE of the VCRs was similar. After storage in discoloring media, all VCRs had higher SFE than directly after polishing (initial). Repolishing decreased the SFE values compared with those of specimens measured after storage. CONCLUSIONS: FS, ΔE, and SFE differed between the VCRs tested. Discoloration of the VCRs depended on the food and beverage and could be corrected to a clinically acceptable range by repolishing.

Influence of different surface treatments on two-body wear and fracture load of monolithic CAD/CAM ceramics.

OBJECTIVES: To investigate two-body wear (2BW) and fracture load (FL) of monolithic ceramics after different surface pretreatments. MATERIALS AND METHODS: Zirconia (MOZ), lithium-disilicate (LIT), and leucite-reinforced (LEU) specimens (n = 60/group) were manufactured with CAD/CAM-technology and underwent (n = 15/subgroup): 1) grinding + polishing (GrPo), 2) grinding + glazing (GrGz), 3) grinding (Gr), or 4) glazing (Gz). Scanning electron microscope (n = 3/subgroup) and 3D measurements of the ceramic crowns and antagonists (N = 180) were performed to determine 2BW before and after 120,000/1,200,000 masticatory cycles. FL was examined for all specimens (N = 180). Data were analyzed using Kolmogorov-Smirnov, one-way ANOVA, Scheffé post hoc, Kruskal-Wallis, Mann-Whitney-U, and Wilcoxon (p < 0.05). RESULTS: MOZ presented the highest FL independent on pretreatment (6960-9250 N), while LEU (1405-2320 N) showed the lowest (p < 0.001). Ceramic and antagonist wear increased between 120,000 and 1,200,000 masticatory cycles (p < 0.001). For pretreatments GrPo, GrGz, and Gz, MOZ showed the lowest wear of the ceramic, while causing the highest antagonist wear (p < 0.001). GrPo resulted in the lowest wear for MOZ (p < 0.001), with Gr leading to the highest antagonist wear (p = 0.008). LIT specimens presented the highest wear of the ceramic and antagonist after Gz (p < 0.001), while GrPo resulted in the lowest antagonist wear (p < 0.001). GrGz led to the highest antagonist wear for LEU (p < 0.001). CONCLUSIONS: With FL exceeding maximum masticatory forces, the three tested ceramics can be recommended for restorations, even in posterior regions. While glazing resulted in higher wear and impaired FL, polishing improved mechanical properties while largely preserving the antagonist. CLINICAL RELEVANCE: While surface pretreatment after grinding is vital to ensure a ceramic's optimal mechanical properties, glazing and polishing varies with regard to material properties, costs, and time.

Bond strength between a high-performance thermoplastic and a veneering resin.

STATEMENT OF PROBLEM: High-performance thermoplastics have been adopted as framework materials. However, their bond strength to an esthetic veneering material is unclear. PURPOSE: The purpose of this in vitro study was to test the tensile bond strength (TBS) between an aryl-ketone polymer (Ultaire AKP) and veneering resins. MATERIAL AND METHODS: AKP substrates (N=324) were prepared, airborne-particle abraded (Al2O3, 50 µm, 0.2 MPa), and divided into 9 groups (n=36) with different bonding systems (visio.link, Adhese Universal, All-Bond Universal, CLEARFIL UNIVERSAL BOND, G-Premio BOND, iBOND Universal, ONE COAT 7 UNIVERSAL, Scotchbond Universal) and without a bonding system as a control. Each group was further divided for opaquer (n=18). Further subdivision followed according to flowable or paste veneering resin (n=9). Specimens were stored in distilled water for 24 hours at 37 °C and thermocycled (×5000, 5/55 °C). TBS was measured and analyzed with the Kolmogorov-Smirnov test and 3-way ANOVA with partial eta squared (ηP2), followed by the Kruskal-Wallis and Mann-Whitney-U tests. Relative frequency of failure types was analyzed with the Chi2-test and a Ciba-Geigy table. RESULTS: The highest impact on TBS was exerted by the adhesive (ηP2=0.458, P<.001), followed by opaquer (ηP2=0.288, P<.001). The binary combination of the 3 variables was significant for opaquer coupled with adhesive (ηP2=0.173, P<.001). Visio.link showed the highest TBS followed by All-Bond Universal and Scotchbond Universal. Opaquer increased the TBS for all adhesives except for visio.link. Without adhesive, opaquer obtained comparable TBS to visio.link. Flowable veneering resin showed higher TBS than paste resin. CONCLUSIONS: The application of opaquer increased TBS for all universal adhesives. Using opaquer and flowable veneering resin is beneficial for bonding to Ultaire AKP.

Different surface modifications combined with universal adhesives: the impact on the bonding properties of zirconia to composite resin cement.

OBJECTIVE: The purpose of this study was to analyze the impact of plasma treatment and (universal adhesives) UAs on the bonding properties of zirconia. MATERIAL AND METHODS: Zirconia specimens (N = 744; n = 186/pretreatment) were prepared, highly polished, and pretreated: (i) plasma (oxygen plasma, 10s, 5 mm), (ii) airborne-particle abrasion (alumina, 50 µm, 0.05 MPa, 5 s, 10 mm), (iii) airborne-particle abrasion + plasma, and (iv) without pretreatment (highly polished surface). Surface roughness (Ra) and surface free energy (SFE) were measured (n = 6/pretreatment). Tensile bond strength (TBS) specimens (n = 180/pretreatment) were further divided (n = 18/conditioning): Clearfil Ceramic Primer (PCG), All-Bond Universal (ABU), Adhese Universal (AU), Clearfil Universal Bond (CUB), G-Premio Bond (GPB), Futurabond U (FBU), iBond Universal (IBU), One Coat 7 Universal (OCU), Scotchbond Universal (SBU), and no conditioning. PCG was luted with Panavia F2.0 and the remaining groups with DuoCem. After storage in distilled water (24 h; 37 °C) and thermocycling (5000×; 5 °C/55 °C), TBS was measured and fracture types (FTs) were determined. Data were analyzed using univariate ANOVA with a partial eta square (ƞP2), the Kruskal-Wallis H, the Mann-Whitney U, and the Chi2 test (P < .05). RESULTS: Plasma treatment resulted in an increase of SFE but had no impact on Ra. Airborne-particle abrasion resulted in the highest Ra and a higher TBS when compared with plasma and non-treatment. SBU and AU obtained a higher TBS when compared with PCG. OCU, FBU, ABU, IBU, and GPB indicated comparable TBS to PCG. CUB revealed the lowest TBS. CONCLUSIONS: Plasma treatment cannot substitute airborne-particle abrasion when bonding zirconia but MDP-containing adhesives are essential for successful clinical outcomes. CLINICAL RELEVANCE: Airborne-particle abrasion with a low pressure (0.05 MPa) in combination with UAs promotes the clinical success of adhesively bonded zirconia restorations.

Bonding to new CAD/CAM resin composites: influence of air abrasion and conditioning agents as pretreatment strategy.

OBJECTIVES: Because of their industrially standardized process of manufacturing, CAD/CAM resin composites show a high degree of conversion, making a reliable bond difficult to achieve. PURPOSE: The purpose of this experiment was to investigate the tensile bond strength (TBS) of luting composite to CAD/CAM resin composite materials as influenced by air abrasion and pretreatment strategies. MATERIAL AND METHODS: The treatment factors of the present study were (1) brand of the CAD/CAM resin composite (Brilliant Crios [Coltene/Whaledent], Cerasmart [GC Europe], Shofu Block HC [Shofu], and Lava Ultimate [3M]); (2) air abrasion vs. no air abrasion; and (3) pretreatment using a silane primer (Clearfil Ceramic Primer, Kuraray) vs. a resin primer (One Coat 7 Universal, Coltene/Whaledent). Subsequently, luting composite (DuoCem, Coltene/Whaledent) was polymerized onto the substrate surface using a mold. For each combination of the levels of the three treatment factors (4 (materials) × 2 (air abrasion vs. no air abrasion; resin) × 2 (primer vs. silane primer)), n = 15, specimens were prepared. After 24 h of water storage at 37 °C and 5000 thermo-cycles (5/55 °C), TBS was measured and failure types were examined. The resulting data was analyzed using Kaplan-Meier estimates of the cumulative failure distribution function with Breslow-Gehan tests and non-parametric ANOVA (Kruskal-Wallis test) followed by the multiple pairwise Mann-Whitney U test with α-error adjustment using the Benjamini-Hochberg procedure and chi-square test (p < 0.05). RESULTS: The additional air abrasion step increased TBS values and lowered failure rates. Specimens pretreated using a resin primer showed significantly higher TBS and lower failure rates than those pretreated using a silane primer. The highest failure rates were observed for groups pretreated with a silane primer. Within the Shofu Block HC group, all specimens without air abrasion and pretreatment with a silane primer debonded during the aging procedure. CONCLUSIONS: Before fixation of CAD/CAM resin composites, the restorations should be air abraded and pretreated using a resin primer containing methyl-methacrylate to successfully bond to the luting composite. The pretreatment of the CAD/CAM resin composite using merely a silane primer results in deficient adhesion. CLINICAL RELEVANCE: For a reliable bond of CAD/CAM resin composites to the luting composite, air abrasion and a special pretreatment strategy are necessary in order to achieve promising long-term results.

Fracture resistance and 2-body wear of 3-dimensional-printed occlusal devices.

STATEMENT OF PROBLEM: Polymeric material for 3-dimensional printing can be used to fabricate occlusal devices. However, information about fracture resistance and wear is scarce. PURPOSE: The purpose of this in vitro study was to investigate the fracture resistance and 2-body wear of 3-dimensional-printed (3DP) (FotoDent splint; Dreve Dentamid GmbH), milled polymethylmethacrylate (CAM) (Temp Basic; Transpa 95H16, Zirkonzahn GmbH), and conventionally fabricated polymethylmethacrylate (CAST) (Castdon; Dreve Dentamid GmbH) occlusal devices. MATERIAL AND METHODS: A total of 96 occlusal devices were prepared according to the 3 different manufacturing techniques 3DP, CAM, and CAST (n=32). For each manufacturing technique, specimens were further divided into initial fracture resistance tests (n=16) and artificial aging in the mastication simulator (50 N, 37°C) with 2-body wear followed by fracture resistance tests (n=16). The fracture resistance was determined using a universal testing machine (1 mm/min). The wear was measured after 20 000 and 120 000 mastication cycles with the replica technique, mapped with a laser scanner, and quantified in R software. Data were analyzed using a 2-way ANOVA followed by a 1-way ANOVA with Scheffé or Games-Howell post hoc tests, repeated measures ANOVA with corrected Greenhouse-Geisser P values, and the Levene, Mann-Whitney, and paired t tests (α=.05). RESULTS: CAM presented higher initial fracture resistance than 3DP or CAST (P<.001). After mastication simulation, CAM followed by 3DP showed higher fracture resistance than CAST (P<.001). Mastication simulation decreased the fracture resistance for CAM and CAST (P<.001) but not for 3DP (P=.78). Three-dimensional-printed occlusal devices showed the highest material volume loss, followed by CAM and the lowest in CAST (P<.001). CONCLUSIONS: Three-dimensional-printed occlusal devices showed lower wear resistance and lower fracture resistance than those milled or conventionally fabricated. Therefore, only short-term application in the mouth is recommended. Further developments of occlusal device material for 3-dimensional printing are necessary.

Accuracy of digitally fabricated trial dentures.

STATEMENT OF PROBLEM: Information about the accuracy of digital computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures is scarce. PURPOSE: The purpose of this in vitro study was to assess the reproducibility of the occlusion of wax dentures fabricated with digital steps and the contraction behavior of wax trial dentures processed with combined conventional-digital steps. These were compared with those fabricated completely conventionally in terms of storage duration. MATERIAL AND METHODS: Five sets of maxillary and mandibular wax trial dentures were milled from a gingiva-colored wax blank (Ceramill D-Wax, Amann Girrbach AG) using the Ceramill Motion 2 System (Amann Girrbach), scanned, and matched by best-fit triangulation for each of the 5 denture pairs. Processing deformation was measured and the maximum deviations calculated. A 3-dimensional color-coded mapping of the differences between each pair of dentures was generated. Five sets of maxillary and mandibular wax trial dentures were processed with digital steps, and 5 sets of maxillary and mandibular wax trial dentures were fabricated in the conventional way with the help of a silicone index from a CAM-fabricated wax trial denture to standardize the wax amount. All dentures were scanned immediately after waxing and after 1 week of storage. After surface matching, the deformation was measured, and the milled wax bases were compared with those conventionally fabricated. Data were interpreted using descriptive statistics. RESULTS: The occlusion of wax trial dentures fabricated with digital steps was not reproducible. The deviations in the maxillary dentures were mostly marginal, with exceptions for single teeth/tooth groups in denture No. 2 (occlusal areas of teeth in second quadrant, second molars) and No. 4 (central incisor and canine in second quadrant inclined to palatal side, and first premolar in first quadrant and first molar in second quadrant displayed greater deviations). Among the mandibular dentures, denture Nos. 4 and 5 the central incisor (fourth quadrant) inclined to the labial side. Additionally, in denture No. 5 the lateral incisor (fourth quadrant) inclined to the lingual side. CONCLUSIONS: In digitally fabricated dentures, the manual placing of the teeth into the denture base sockets can lead to deviations from the planned arrangement. The deviations were greater in the area of the denture bases in the conventionally fabricated dentures compared with those processed with combined conventional-digital steps. The milled wax bases showed better contraction behavior than the conventionally fabricated wax bases.

Flexural strength, fracture toughness, and translucency of cubic/tetragonal zirconia materials.

STATEMENT OF PROBLEM: The development of zirconia materials with optimized properties has been rapid, and studies comparing the mechanical and optical properties of recently introduced zirconia with lithium disilicate materials are limited. PURPOSE: The purpose of this in vitro study was to compare the mechanical and optical properties of cubic/tetragonal zirconia materials with those of a lithium disilicate ceramic. MATERIAL AND METHODS: Specimens were fabricated from 6 different noncolored zirconia materials: Ceramill Zolid FX (CZ), CopraSmile (CS), DD cubeX2 (DD), NOVAZIR MaxT (NZ), priti multidisc ZrO2 (PD), and StarCeram Z-Smile (SC), and 1 lithium disilicate ceramic as a control, IPS e.max Press LT A2 (CG). Four-point flexural strength (N=105/n=15) and fracture toughness using the single-edge V-notched beam (N=105/n=15) were examined according to International Organization for Standardization standard 6872:2015. Translucency (N=70/n=10) was evaluated with an ultraviolet spectrophotometer. Grain size (N=6/n=1) of zirconia was investigated by using scanning electron microscopy. Data were analyzed using the Kolmogorov-Smirnov test, multivariate analysis, 1-way analysis of variance, followed by the post hoc Scheffé test and Kruskal-Wallis and Mann-Whitney U tests, and Weibull analysis, using the maximum likelihood estimation method at 95% confidence level (α=.05). RESULTS: Zirconia materials showed higher mechanical and lower optical properties than CG (P<.001). No differences were observed among the zirconia materials with respect to flexural strength (P=.259) or fracture toughness (P=.408). CG and CS showed significantly higher Weibull modulus than SC and PD. The lowest translucency values were measured for NZ and SC, followed by CS, DD, and PD (P<.001). CZ showed the highest translucency values (P<.001). The lowest grain sizes were found for NZ, DD, and SC; the largest were shown for CS (P<.001). CONCLUSIONS: Cubic/tetragonal zirconia showed better mechanical properties than lithium disilicate ceramic. However, the optical properties and the reliability of zirconia are lower than those of lithium disilicate ceramic.

Color change of CAD-CAM materials and composite resin cements after thermocycling.

STATEMENT OF PROBLEM: The color of resin cements and computer-aided-design and computer-aided-manufacturing (CAD-CAM) restorations may change with aging. PURPOSE: The purpose of this in vitro study was to analyze the influence of thermocycling on the color of CAD-CAM materials with underlying resin cement. MATERIAL AND METHODS: Seven different CAD-CAM materials, composite resins and glass-ceramics were cut into 0.7-mm and 1.2-mm thicknesses (n=10) and cemented with a dual-polymerizing resin cement, a light-polymerizing resin cement, and a preheated composite resin (N=420). Color values were measured by using spectrophotometry. Specimens were subjected to thermocycling (5°C and 55°C; 5000 cycles). The measured color difference (ΔE) data were analyzed by using descriptive statistics. Normality of data distribution was tested by using the Kolmogorov-Smirnov test. Three-way and 1-way ANOVA followed by the Scheffé post hoc test and unpaired 2-sample Student t test were computed to determine the significant differences among the tested parameters (α=.05). RESULTS: ΔE values were significantly influenced by the CAD-CAM material (ηp2=0.85, P<.001) and the resin composite cement (ηP2=0.03, P=.003) but were not influenced by thickness (P=.179). Significant interactions were present among thickness, cement, and CAD-CAM materials (P<.001). Vita Suprinity and GC Cerasmart showed significantly the lowest ΔE values (P<.001). The highest ΔE values were observed for IPS Empress CAD. The dual-polymerizing resin cement showed significantly lower ΔE values than the preheated composite resin (P=.003). CONCLUSIONS: Restoration materials and composite resin cement types used for cementation influence the amount of color change due to aging.

Retention Load of Telescopic Crowns with Different Taper Angles between Cobalt-Chromium and Polyetheretherketone Made with Three Different Manufacturing Processes Examined by Pull-Off Test.

PURPOSE: To investigate the retention loads of differently fabricated secondary telescopic polyetheretherketone (PEEK) crowns on cobalt-chromium primary crowns with different tapers. MATERIALS AND METHODS: Cobalt-chromium primary crowns with 0°, 1°, and 2° tapers were constructed, milled, and sintered. Corresponding secondary crowns were fabricated by milling, pressing from pellets, and pressing from granules. For these nine test groups, the pull-off tests of each crown combination were performed 20 times, and the retention loads were measured (Zwick 1445, 50 mm/min). Data were analyzed using linear regression, covariance analysis, mixed models, Kruskal-Wallis, and Mann-Whitney U-test, together with the Benferroni-Holm correction. RESULTS: The mixed models covariance analysis reinforced stable retention load values (p = 0.162) for each single test sequence. There was no interaction between the groups and the separation cycles (p = 0.179). Milled secondary crowns with 0° showed the lowest mean retention load values compared to all tested groups (p = 0.003) followed by those pressed form pellets with 1°. Regarding the different tapers, no effect of manufacturing method on the results was observed within 1° and 2° groups (p = 0.540; p = 0.052); however, among the 0° groups, the milled ones showed significantly the lowest retention load values (p = 0.002). Among the manufacturing methods, both pressed groups showed no impact of taper on the retention load values (p > 0.324 and p > 0.123, respectively), whereas among the milled secondary crowns, the 0° taper showed significantly lower retention load values than the 1° and 2° taper (p < 0.002). CONCLUSION: Based on these results, telescopic crowns made of PEEK seem to show stable retention load values for each test sequence; however, data with thermo-mechanical aging are still required. In addition, further developments in CAD/CAM manufacturing of PEEK materials for telescopic crowns are warranted, especially for 0°.

Bonding Behaviour of Polyetherketoneketone to Methylmethacrylate- and Dimethacrylate-based Polymers.

PURPOSE: To investigate the impact of pretreatment and conditioning on bonding behavior of polyetherketoneketone (PEKK) to methylmethacrylate(MMA)- and dimethacrylate(DMA)-based polymers. MATERIALS AND METHODS: 1200 PEKK substrates (Pekkton ivory) were fabricated, air abraded (110 µm, Al2O3) and divided into 8 pretreatment groups as follows: 1. Visio.link (VL); 2. VL+ opaquer; 3. Pekk Bond (PB); 4. PB + opaquer; 5. plasma; 6. plasma + opaquer; 7. plasma + VL+ opaquer; 8. plasma + PB + opaquer. A low-density cold oxygen plasma was used to treat specimens in groups 5-8. All pretreated PEKK substrates were bonded with either MMA-based polymers (denture acrylic: "Anaxdent acryline") or DMA-based polymers (veneering composites: flowable "Anaxdent dentin flow" or packable "Anaxdent dentin paste"). On denture acrylic, the anaxgum opaquer paste was applied, and on veneering composites, the anaxblend opaquer paste. All specimens were stored in water for 24 h at 37°C, and 20 specimens of each subgroup were additionally thermocycled (5°C/55°C, 10,000x). Tensile bond strength (TBS) was measured and analyzed with the general linear model analysis, Kaplan-Meier survival estimates, and Breslow-Gehan tests. RESULTS: The combination of plasma and VL showed the highest TBS results, followed by VL and the combination of plasma and PB. The lowest TBS was observed among PEKK specimens treated with plasma and without pretreatment, followed by specimens conditioned with PB. The application of an opaquer layer increased the TBS. Bonding to PEKK with MMA-based polymers showed higher TBS results than with DMA-based polymers. Among DMA-based polymers, the flowable polymer bonded significantly better to PEKK compared to paste polymer. After thermocycling, the TBS decreased. CONCLUSION: Sufficient bonding to PEKK is possible when plasma treatment is used in combination with the tested adhesives and an opaquer layer.

Fracture load and failure types of different veneered polyetheretherketone fixed dental prostheses.

OBJECTIVE: The aim of this study is to investigate the fracture load of different veneered PEEK 3-unit fixed dental prosthesis (FDPs) after different aging regimens. METHODS: Congruently anatomically shaped 3-unit FDPs were milled using a master stl-data set and randomly divided into four groups (N = 120, n = 30 per veneering group), which were veneered using different veneering methods: (i) digital veneering with breCAM.HIPC, (ii) conventional veneering with crea.lign, (iii) conventional with crea.lign paste, and (iv) using pre-manufactured veneers visio.lign. The FDPs were then adhesively cemented on a metal abutment and fracture loads were measured in a universal testing machine (1 mm/min) before and after aging (10,000 thermal cycles, 5/55 °C). Two- and one-way ANOVA followed by post hoc Scheffé tests were used for data analysis (p < 0.05). RESULTS: This investigation showed an influence of the veneering method on the fracture load results independent of the aging level. The highest fracture load was measured for the FDPs with digital veneering (1882 ± 152 N at baseline, 2021 ± 184 N after thermocycling). The remaining groups showed comparable results, and no impact of thermal aging was observed. Digital and conventional veneers showed cracks in the pontic region starting from the connector area as a main failure type after loading, while the pre-manufactured veneers showed predominantly adhesive failures. CONCLUSIONS: The digital veneering method showed the highest fracture load resistance. Thermal aging showed no impact on the fracture load of all tested veneered PEEK 3-unit FDPs. CLINICAL RELEVANCE: According to this study results, reliable veneering of PEEK FDPs can be achieved with digital veneering.

Complete denture fabrication supported by CAD/CAM.

The inclusion of computer-aided design/computer-aided manufacturing (CAD/CAM) technology into complete denture fabrication facilitates the procedures. The presented workflow for complete denture fabrication combines conventional and digitally supported treatment steps for improving dental care. With the presented technique, the registration of the occlusal plane, the determination of the ideal lip support, and the verification of the maxillomandibular relationship record are considered.

Comparison of fracture loads of CAD/CAM and conventionally fabricated temporary fixed dental prostheses after different aging regimens.

This study evaluated the fracture loads of different threeunit fixed dental prostheses (FDPs) for temporary restorations. In total, three CAD/CAM materials (VITA CADTemp [CT], Telio CAD [TC], and ZENO ProFix [ZP]) and two chairside materials (Protemp 4 [PT], and Dentalon Plus [DP]) were used for the fabrication of the FDPs. Sixteen FDPs were fabricated from each material in an anatomical shape and stored in 0.9% NaCl solution at 37°C for 14 days. Thereafter, one half of the specimens from each group (n = 8) were additionally mechanically and thermally loaded (240,000 chewing cycles, 50 N, 5°/55°C, 2,100 thermal cycles). Fracture loads were measured and data analyzed using two- and one-way ANOVA, followed by Scheffé's post hoc test. ZP showed the highest mean fracture loads, regardless of the aging regime. Significantly lowest values were identified for DP and TC within the non-thermal loaded group, and for PT and CT within the thermal loaded group. No negative impact of aging regimes could be observed.