Fracture behaviour of zirconia FPDs substructures.

The purpose of this study was to evaluate the occurrence of superficial flaws after machining and to identify fracture initiation and propagation in three-unit heat-treated machined fixed partial dentures (FPDs) substructures made of hot isostatic pressed (HIPed) yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) after loaded to fracture. Four three-unit HIPed Y-TZP-based FPDs substructures were examined. To evaluate the occurrence of superficial flaws after machining, the surfaces were studied utilizing a fluorescent penetrant method. After static loading to fracture, characteristic fracture features on both mating halves of the fractured specimens were studied using a stereomicroscope and a scanning electron microscope. Grinding grooves were clearly visible on the surfaces of the machined FPDs substructures, but no other flaws could be seen with the fluorescent penetrant method. After loading to fracture, the characteristic fracture features of arrest lines, compression curl, fracture mirror, fracture origin, hackle and twist hackle were detected. These findings indicated that the decisive fracture was initiated at the gingival embrasure of the pontic in association with a grinding groove. Thus, in three-unit heat-treated machined HIPed Y-TZP FPDs substructures, with the shape studied in this study, the gingival embrasure of the pontic seems to be a weak area providing a location for tensile stresses when they are occlusally loaded. In this area, fracture initiation may be located to a grinding groove.

Fracture resistance of all-ceramic crowns placed on a preparation with a slice-formed finishing line.

The purpose of this study was to determine the fracture resistance of all-ceramic crowns with a core of a zirconia ceramic, using various stabilizing oxides and luted on a preparation with a slice-formed finishing line. Ten cores made of HIPed yttrium-oxide partially stabilized zirconia (HIPed Y-TZP) and five cores of densely-sintered magnesia partially stabilized zirconia (Mg-PSZ) were made. The Mg-PSZ cores and five of the HIPed Y-TZP cores were made with a thickness of 0.2 mm. A further five cores 0.1-mm thick were made of HIPed Y-TZP. All 15 cores were then veneered with a feldspar ceramic and luted onto a stylized steel master die model with a slice-formed finishing line. The specimens were then loaded until fracture occurred. The HIPed Y-TZP specimens with the 0.2 mm core exhibited significantly higher fracture resistance than the Mg-PSZ specimens (P = 0.004) and the HIPed Y-TZP specimens with the 0.1 mm core (P = 0.001). The fracture resistance of the Mg-PSZ specimens was significantly (P = 0.015) higher than that of the HIPed Y-TZP specimens with the 0.1 mm core. The fracture resistance determined was equal or superior to reported values for bite forces and all-ceramic crowns. Thus, it seems likely that the type of restorations evaluated have the potential for successful use on a slice-formed preparation. However, long-term studies are essential in order to assess the performance of this ceramic system in a clinical context.

Effects of Pretreatment, Specimen Thickness, and Artificial Aging on Biaxial Flexural Strength of Two Types of Y-TZP Ceramics.

OBJECTIVES: To evaluate the effects of surface treatment, specimen thickness, and aging on the biaxial flexural strength (BFS) of two types of yttria-stabilized, tetragonal zirconia polycrystal (Y-TZP) ceramics. METHODS AND MATERIALS: Disc-shaped specimens, 0.4 and 1.3 mm thick, made from hot isostatic pressed (Denzir) and non-hot isostatic pressed (ZirPlus) Y-TZP, were sandblasted, heat treated, and autoclaved. The surface topography was assessed in accordance with European Standard 623-624:2004 and the BFS tests in accordance with International Organization for Standardization Standard 6872:2008. For statistical analyses, one-way Shapiro-Wilk test, analysis of variance (post hoc: least significant differences), Mann-Whitney U-test, and Pearson correlation tests (p<0.05) were used. RESULTS: As delivered, the BFS of the 0.4-mm ZirPlus was >1.3-mm ZirPlus (p<0.01), and the BFS of the 0.4-mm Denzir was >1.3-mm Denzir (p<0.001). Sandblasting with 0.2 MPa reduced the BFS of the ZirPlus and Denzir discs (p<0.01), whereas sandblasting with 0.6 MPa increased the BFS of the 0.4-mm Denzir (p<0.001) and reduced the BFS of the 0.4-mm ZirPlus (p<0.05). Heat treatment significantly reduced the BFS of all the groups except for the 0.6 MPa sandblasted 0.4-mm ZirPlus. Autoclaving reduced the BFS of the as-delivered ZirPlus and Denzir specimens (p<0.001), whereas autoclaving the 0.6 MPa sandblasted and heat-treated specimens had no effect (p>0.05) on the BFS. The 0.6 MPa sandblasted, heat-treated, and autoclaved 0.4-mm Denzir exhibited higher BFS than the 0.6 MPa sandblasted, heat-treated, and autoclaved 0.4-mm ZirPlus (p<0.05). CONCLUSIONS: Thickness and surface treatment of Y-TZP-based ceramics should be considered since those factors could influence the BFS of the material.

Retention of prefabricated and individually cast root canal posts in vitro.

OBJECTIVES: The aim of the study was to evaluate the retention of prefabricated root canal posts made of a variety of materials that have recently been introduced into dentistry. MATERIALS AND METHODS: The posts studied were CosmoPost, Composipost carbon fibres, Composipost Aestheti-Plus, Composipost Light-Post and Para Post Fiber White. The posts were luted in extracted human premolars and the cores were built up with the resin composites recommended by the manufacturers. The retention of individually cast gold alloy posts luted with zinc-phosphate cement were used as reference. A universal testing machine was used to determine the retention of each cemented post Data were compared using ANOVA supplemented with Fisher's PLSD at a significance level of p < 0.05. RESULTS: Only the CosmoPost system exhibited retention values that were significantly lower than for the conventionally cast gold alloy posts luted with zinc-phosphate cement The force necessary to loosen the CosmoPost specimens was significantly less than that needed to loosen the Composipost. Estheti-Plus (p < 0.05) and the Composipost Ught-Post systems (p < 0.001]. The force necessary to loosen the ParaPost Fiber White specimens was significantly less than for the Composipost Light-Post system (p < 0.01). Other combinations did not differ significantly (p > 0.05). CONCLUSIONS: When zirconium oxide ceramic posts are luted with resin composites the bonding between the ceramic and resin composite seems to be weak. Further studies are thus necessary to achieve improved retention of all-ceramic root canal posts.

A 3-year follow-up study of preformed beta-quartz glass-ceramic insert restorations.

OBJECTIVE: The purpose of this study was to evaluate the clinical performance of preformed beta-quartz glass-ceramic insert restorations. METHODS AND MATERIALS: Nine Class I and 30 Class II beta-quartz glass-ceramic insert restorations were placed in 16 patients who were seen regularly by personnel at Umeå University Dental School. The California Dental Association criteria were used to evaluate the restorations at baseline, 6 months, and 1, 2, and 3 years after luting. The occurrence of postoperative sensitivity, the time taken to manufacture each restoration, and certain periodontal conditions were also evaluated. RESULTS: Sixty-nine percent of the restorations were rated satisfactory at the 3-year examination. During the follow-up period, 4 became loose and 7 were fractured or had flaking surfaces. Caries was registered in connection with 1 restoration. Excellent ratings were obtained for marginal integrity, anatomic form, surface, and color in 62%, 84%, 32%, and 44% of the restorations, respectively. There was no statistically significant difference in the occurrence of plaque and bleeding on probing in comparison with the controls. The mean overall time for placement was 38 minutes. The estimated survival rate (Kaplan-Meier) was 59% after 3.5 years. CONCLUSION: The quality of the beta-quartz glass-ceramic restorations in the present study was inferior to that presented in most earlier studies of ceramic or resin composite posterior restorations placed in patients treated at university clinics. Both the technique and the beta-quartz glass-ceramic inserts have to be evaluated in more long-term studies to assess the possibility of their serving as an alternative restorative technique.

Relationship between compressive strength and cervical shaping of the all-ceramic Cerestore crown.

The two types of cervical shaping recommended for the preparation of Cerestore crowns are shoulder or deep chamfer. 14 specimens shaped like stylized Cerestore crowns on a shoulder preparation and 14 on a deep chamfer preparation were produced. Thereafter each crown was placed on the epoxy resin die on which it had been produced. 7 epoxy dies from each of the two series were shortened 1 mm occlusally in order to elucidate the importance of the cervical shaping. Placed on its own epoxy die each of the 28 Cerestore crowns was then subjected to occlusal stress until fracture occurred. The force needed for fracture was three times greater for the crowns produced on a shoulder preparation than for those produced on a chamfer preparation. No significant differences was obtained when crowns with the same cervical shaping were tested on intact and shortened dies respectively.

Influence of supply of heat to cobalt-chromium frameworks during soldering and subsequent hardening heat treatment of wrought clasps.

Retentive clasp arms of wrought gold alloy wire were soldered to frameworks made of three dental cobalt-chromium alloys. The clasps were then subjected to a conventional hardening heat treatment. Microstructure and hardness of the cobalt-chromium alloys were determined before and after these operations. The results reveal that the supply of heat during soldering and hardening heat treatment of the clasp does not influence the microstructure and hardness of the cobalt-chromium alloys.

Corrosion and strength of dental low-gold brazing materials.

Previous studies have shown the clinical feasibility of using three alternatives to dental casting gold alloys Type 3. In the present study brazed specimens of these alternatives were evaluated using a corrosion test and a tensile test according to a proposed ISO Standard (ISO/DIS 9333). Brazed specimens of a high-gold alloy were used as a reference. Furthermore, the microstructure of the brazed joints and the fracture surface characteristics were monitored. The present study revealed that none of the specimens exhibited any visual sign of chemical attack after suspension in the test solution for 7 days. The tensile strength testing resulted in stresses at fracture point that met the requirements of the proposed ISO Standard. All fractures were of the ductile type. Cohesive failures were seen in all specimens except in the reference alloy (JS C) specimens. No clear relationship between fracture surface appearance and tensile strength was found. Distinct demarcation lines between brazing and parent materials were seen. Based on the present results there seems to be no reason to reject the use of brazed constructions made of the alternative alloys Midas, Rajah, and Albacast.

Tensile and shear strength of orthodontic bracket bonding with glass ionomer cement and acrylic resin. An in vitro comparison.

The tensile and shear strength for a polyalkeonate luting cement (AquaCEM) and a no-mix acrylic resin (Unite) in orthodontic bracket bonding were compared in an in vitro test. Brackets bonded/cemented to extracted premolar teeth were subjected to loads in a universal testing apparatus and the dislodging forces were recorded. The possible influences of setting time and of bracket base design were also studied. No significant differences between the cement and the resin were found after allowing 24 hours of setting time. This in contrast to the significantly stronger tensile strength but inferior shear strength for the polyalkeonate cement when stress was applied after 15 minutes. A significantly higher tensile strength value was recorded for a foil-meshed bracket base type compared to an integral base type with cut grooves after 15 minutes, but not after 24 hours. While the polyalkeonate cement adhesion mostly fractured within the cement layer, the acrylic bond more often failed in the enamel-adhesive interface. The results support the use of the fluoride-containing cement as an alternative to acrylic adhesives in orthodontic bracket bonding, especially in high-risk caries patients.

Accuracy of ceramic restorations made using an in-office optical scanning technique: an in vitro study.

The present in vitro study concerns determination of the pre-cementation gap width of all-ceramic crowns made using an in-office digital-impression technique and subsequent computer-aided design/computer-aided manufacturing (CAD/CAM) production. Two chairside video camera systems were used: the Lava Oral scanner and Cadent's iTero scanner. Digital scans were made of a first molar typodont tooth that was suitably prepared for an all-ceramic crown. The digital impressions were sent via the Internet to commercial dental laboratories, where the crowns were made. Also, an impression of the typodont tooth was made, poured, and scanned in order to evaluate the pre-cementation gap of crowns produced from scanning stone dies. These methods and systems were evaluated by creating replicas of the intermediate space using an addition-cured silicone, and the gap widths were determined using a measuring microscope. Hot-pressed leucite-reinforced glass-ceramic crowns were selected as a reference. The mean value for the marginal measuring points of the control was 170 µm, and the values for all the evaluated crowns ranged from 107 to 128 µm. Corresponding figures for the internal measuring points were 141-210 µm and 115-237 µm, respectively. Based on the findings in the present study, an in-office digital-impression technique can be used to fabricate CAD/CAM ceramic single crowns with a marginal and internal accuracy that is on the same level as that of a conventional hot-pressed glass-ceramic crown. In the present study, however, slight differences could be seen between the two types of ceramic crowns studied with respect to the internal fit obtained.

Surface roughness of five different dental ceramic core materials after grinding and polishing.

In clinical practice, core materials can be exposed after adjustments are made to previously-luted all-ceramic restorations. The purpose of this study was to evaluate the surface roughness of five different dental ceramic core materials after grinding and polishing. Five different ceramic core materials, Vita In-Ceram Alumina, Vita In-Ceram Zirconia, IPS Empress 2, Procera AllCeram, and Denzir were evaluated. Vita Mark II was used as a reference material. The surface roughness, Ra value (mum), was registered using a profilometer. The measurements were made before and after grinding with diamond rotary cutting instruments and after polishing with the Sof-Lex system. The surface of representative specimens was evaluated qualitatively using scanning electron microscopy (SEM). Results were statistically analysed using analysis of variance (anova) supplemented with Scheffè's and Bonferroni multiple-comparison tests. Before grinding, Procera AllCeram and Denzir had the smoothest surfaces, while IPS Empress 2 had the coarsest. After grinding, all materials except IPS Empress 2 became coarser. Polishing with Sof-Lex provided no significant (P > 0.05) differences between Denzir, Vita Mark II and IPS Empress 2 or between Procera AllCeram and In-Ceram Zirconia. There were no significant differences (P > 0.05) either between the ground and the polished Procera AllCeram or In-Ceram Alumina specimens. Polishing of Denzir, IPS Empress 2 and In-Ceram Zirconia made the surfaces smoother compared with the state after grinding, whereas the polishing effect on Procera AllCeram and In-Ceram Alumina was ineffective. The findings of the SEM evaluation were consistent with the profilometer readings.

Marginal and internal fit of four different types of ceramic inlays after luting. An in vitro study.

The marginal and internal fit of four different types of ceramic inlays--Cerec, Celay, Empress, and Vita In-Ceram Spinell--was determined after they had been luted on extracted premolars. For the Cerec inlays sharp and U-shaped proximal box shapings were also compared. There was no statistically significant difference either in the proximal fit or in the gingivoproximal fit between the four inlay systems studied, with the exception of the Cerec inlays made for preparations with sharp proximal boxes, which had wider marginal gaps. At the occlusal margins a significant-principle order of the gap width was established. The best internal fit was recorded for the Celay inlays, whereas there was no significant difference in the internal fit between the other systems. For the Cerec inlays the U-shaped proximal box shaping improved the marginal accuracy all around the restoration.

A comparison of fracture strength of yttrium-oxide- partially-stabilized zirconia ceramic crowns with varying core thickness, shapes and veneer ceramics.

The fracture strengths of stylized all-ceramic crowns manufactured using an yttrium-oxide-partially-stabilized (Y-TZP) zirconia ceramic core (Denzir) veneered with lithium disilicate glass-ceramics (IPS Empress 2 or IPS Eris) were evaluated. The Denzir cores were manufactured in two ways: either with different thickness in different parts of the restoration, called an 'adapted Denzir core'; or with a uniform core thickness of 0.5 mm. IPS Empress 2 all-ceramic crowns served as reference. There was no significant difference between the crowns with an 'adapted Denzir core' veneered with the two brands of glass-ceramics. No significant difference was seen between the crowns with a 0.5 mm Denzir core veneered with the two brands of glass-ceramics. The crowns with an 'adapted Denzir core' exhibited significantly higher values than those with a 0.5 mm Denzir core and than the IPS Empress 2 crowns used as reference. No significant differences were seen among the IPS Empress 2 crowns used as reference and the crowns with a 0.5 mm Denzir core. The mode of failure varied among the Empress 2 crowns and the crowns with a core of a Y-TZP zirconia ceramic. Long-term studies are necessary to assess the clinical performance of this restorative system.

Charges extracted from dental ceramics: an indication of piezoelectric activity?

A method was established for demonstrating charge generation on the surfaces of dental materials by means of mechanical loading with different forces. With this experimental set-up charges could be extracted both from the surfaces that were mechanically loaded and from the surfaces perpendicular to the applied force. When specimens of certain ceramics were subjected to mechanical loading and the charges extracted were related to the applied force, charges of up to 3 x 10(-3) pC/N were recorded from the surfaces perpendicular to the applied force and charges of up to 8 x 10(-3) pC/N from the surfaces that were mechanically loaded. The results from this study indicate support for the hypothesis that the extracted charges were created by direct piezoelectricity. However, further studies are necessary for decisive proof that true piezoelectricity occurs in these materials.

Laser welding of titanium in dentistry.

Unalloyed titanium of the quality used for osseointegrated implants by the method of Brånemark is also sometimes used for the metallic part of the prosthetic superstructure placed on the fixtures and for crowns and bridges of conventional type. Forty bars of titanium, 8 of ASTM B 348 grade-1 quality and 32 of ASTM B 348 grade-2 quality, were laser-welded, using dissimilar laser joint variables. Tensile strength, 0.2% proof stress, and percentage elongation of the welded bars were measured and compared with the corresponding values for the titanium bars as delivered and with those of brazed type-3 gold alloy bars of similar dimensions. The type of fracture was evaluated from fractographs. The results showed that the use of certain defined laser joint variables during welding produced values for the mechanical properties studied which were more favorable than those obtained from the brazed gold bars. The fracture of the titanium specimens was ductile, with dimples occurring at the fracture surfaces.

Filler content and gap width after luting of ceramic inlays, using the ultrasonic insertion technique and composite resin cements. An in vitro study.

The effect of ultrasonic insertion on the filler content and the gap width for two brands of composite resin luting agents, intended for luting with the ultrasonic insertion technique, were studied after MOD ceramic inlays (Cerec) had been placed. In addition, the internal and marginal gap widths were determined after MOD ceramic inlays (Celay) bad been luted on extracted premolars with this technique. No statistically significant differences (P > 0.05) were observed for either brand between the filler content obtained from the internal surfaces, from the excess luting agent, or from the luting agent as delivered. There were no statistically significant differences (P > 0.05) between the final internal and marginal gap widths when the two brands of luting agent were compared with each other. Except for the final occlusal and internal gap widths obtained for the inlays luted with the Sono-Cem luting agent, no statistically significant differences (P > 0.05) were observed between the gap widths at the different locations determined. Thus, the ultrasonic insertion technique used did not significantly influence the filler ratio of the hybrid luting agents studied. Judged by the findings in this study, the properties of luting agents seem to greatly influence the final marginal and internal gap widths.

Piezoelectricity in dental materials, a conceivable cause of postrestorative sensitivity.

With the increased use of tooth-colored posterior inlays reports of postrestorative sensitivity have also increased. One of the symptoms the patients complain of is a sharp pain when the inlays are loaded through chewing and biting. Many explanations for the causes of dissimilar types of postrestorative sensitivity have been offered, but one conceivable explanation that has not hitherto been studied is the direct piezoelectric effect in dental materials. Direct piezoelectric effect means that when certain anisotropic crystals are mechanically loaded, a charge is generated on the surface. The aim of the present study was to examine whether this physical phenomenon occurs in certain materials intended for dental use. Specimens of four different dental ceramics and one indirect composite resin for inlays were mechanically loaded with various forces, and the current was directly recorded. Currents of up to 0.9 microA with a pulse duraton of 0.4 msec were extracted, and it cannot be excluded that the piezoelectric phenomenon and related properties may cause postrestorative sensitivity. This has to be taken into consideration when posterior inlays of the types concerned are used.

The cytology of joint exudates in rheumatoid arthritis. Morphology and preparation techniques.

The cytology of joint exudates from patients with rheumatoid arthritis was examined by preparation of air-dried smears; a procedure that involved cytocentrifugation of synovial fluids following dilution in a balanced salt solution containing albumin. This procedure provided a monolayer of homogeneously distributed exudate cells with excellent preservation of morphological details. The dominant cell type in the exudates was polymorphonuclear leukocytes, often with signs of necrobiosis. The small and medium-sized mononuclear cells were lymphocyte-like and vital-looking. The large mononuclear cells displayed signs of extensive phagocytosis, especially phagocytosis of polymorphonuclear leukocytes. It is suggested that the granulocytes of the synovial fluid are cells which have reached their function compartment, where they work and die.