Impact of varnishing, coating, and polishing on the chemical and mechanical properties of a 3D printed resin and two veneering composite resins.

STATEMENT OF PROBLEM: Three-dimensional (3D) printing enables the fast fabrication of definitive fixed dental prostheses (FDPs). However, data on the effects of surface treatments on their chemical and mechanical properties are lacking. PURPOSE: The purpose of this in vitro study was to examine the influence of different surface treatments on a 3D printed resin in comparison with 2 veneering composite resins. MATERIAL AND METHODS: A total of 288 specimens were manufactured from a 3D printed resin (VarseoSmile Crownplus) or veneering composite resins (GRADIA PLUS; VITA VM LC flow). Surfaces underwent varnishing, coating, polishing or remain untreated. Conversion rate (DC), surface roughness (SR), Martens parameter, flexural strength (FS), and 3-body wear (3BW) were determined (n=12). Statistical analysis was performed using Mann-Whitney-U, Kruskal-Wallis, and Spearman correlation tests (α=.05). RESULTS: After polishing, the 3D printed resin showed higher DC, SR, and 3BW but lower Martens parameters compared with veneering composite resins (P<.007). After goat hair brushing, the 3D printed resin showed lower FS than VITA-VCR (P=.043). For the 3D printed resin, goat hair brushing or GC-Varnish reduced SR, while VITA-Varnish showed the lowest 3BW (P<.045). For both veneering composite resins, goat hair brushing led to low SR and 3BW and high EIT and FS (P<.043). Silicone polishing led to low EIT of the 3D printed resin and low EIT and FS of GC-VCR (P<.009). Coating resulted in a lower EIT than the untreated surface and higher 3BW than GC-Varnish (P<.030). CONCLUSIONS: The 3D printed resin showed higher DC, SR, 3BW and lower HM, EIT, and FS values than the veneering composite resins. Polishing with a goat hair brush can be recommended for all tested materials. For the 3D printed resin, varnishing presents a promising alternative with regard to SR and 3BW. Silicone polishing and coating cannot be recommended.

Bond strength between temporary 3D printable resin and conventional resin composite: influence of cleaning methods and air-abrasion parameters.

OBJECTIVES: The influence of different cleaning methods, air-abrasion parameters, and aging on shear bond strength (SBS) and tensile bond strength (TBS) of 3D resin luted to composite resin. MATERIALS AND METHODS: Nine hundred resin substrates were 3D printed (D20II, Rapid Shape) and cleaned with either isopropanol (ISO), butyldiglycol-based solution (BUT), or centrifugation (CEN). After 24-h storage in 37 °C water, specimens were air-abraded (mean particle size 50 µm; n = 60) with either alumina at 0.1 MPa (AL0.1) or 0.4 MPa (AL0.4) and glass pearls at 0.1 MPa (GP0.1) and 0.4 MPa (GP0.4) or conditioned with visio.link (control) and luted with PanaviaV5. Initially (24 h, 37 °C water storage) or after aging (10,000 thermal cycles), SBS and TBS were measured, and fracture types were examined. Surface free energy (SFE) and roughness (Ra) were determined after air-abrasion. Kolmogorov-Smirnov, Kruskal-Wallis H, Mann-Whitney U, chi-square, and partial eta-squared were computed. RESULTS: SBS measurements presented higher values than TBS (p < 0.001-0.033). Within the pretreatment groups, CEN showed the highest SBS and TBS values compared to cleaning with ISO or BUT (p < 0.001-0.040). Pretreatment with GP0.1 displayed the lowest bond strength values (p < 0.001-0.049), and mostly adhesive fractures occurred. The highest Ra values (p < 0.001) were observed for AL0.4 pretreatment. CONCLUSIONS: Pretreatment with AL0.4 and the control group mainly presented the highest bond strength values. Thermocycling had a positive effect on the bond strength. CLINICAL RELEVANCE: According to this study, 3D-printed restorations should be pretreated with AL0.4 or with visio.link before adhesive luting, regardless of their cleaning.

An investigation on fatigue, fracture resistance, and color properties of aesthetic CAD/CAM monolithic ceramics.

OBJECTIVES: To evaluate and compare fracture resistance, translucency, and color reproducibility, as well as the effect of aging on the fracture load and color stability of novel monolithic CAD/CAM ceramics. MATERIALS AND METHODS: One hundred crowns of uniform thickness were milled from five ceramic blocks (n = 20): partially crystallized lithium disilicate (PLD) and fully crystallized lithium disilicate (FLD), lithium metasilicate (LMS), 4Y-TZP (SMZ), and 5Y-TZP (UMZ) monolithic zirconia. PLD crowns were glazed, LMS was fired, and FLD was polished. SMZ and UMZ crowns were sintered and polished. Crowns were adhesively cemented to epoxy dies. Half of the crowns (n = 10) were subjected to 1.200.000 load cycles with thermal cycling. Color space values L, a, b defined by the Commission Internationale de l´Eclairage (CIELAB) were measured before and after aging, and (∆E) was calculated. Both aged and non-aged specimens were loaded until fracture in a universal testing machine and the fracture load was recorded. X-ray diffraction (XRD) and scanning electron microscope (SEM) fractographic analysis were carried out on fractured fragments of representative samples. For translucency and color reproducibility, 50 rectangular-shaped specimens were fabricated and processed as described previously. Color values were measured over black and white backgrounds, and the translucency parameter (TP) was computed. Using the shade verification mode, (∆E) to shade A3 was calculated. Data were statistically analyzed using one-way and two-way ANOVA, and t-test. RESULTS: Aging did not affect fracture resistance significantly (p > 0.05). The highest mean fracture load was obtained for the SMZ and UMZ. A significant color change was observed after aging in all groups. The highest TP was noted for FLD. SMZ and UMZ had the best shade match. CONCLUSIONS: Zirconia showed higher fracture resistance and color stability than lithium silicate ceramics. Lithium silicate ceramics were more translucent. The experimental FLD demonstrated high translucency. CLINICAL RELEVANCE: Tested ceramics showed sufficient stability to withstand masticatory forces. Characterization of final restorations might be mandatory for better color match.

Surface properties and initial bacterial biofilm growth on 3D-printed oral appliances: a comparative in vitro study.

OBJECTIVES: To investigate the initial bacterial adhesion on 3D-printed splint materials in relation to their surface properties. MATERIALS AND METHODS: Specimens of five printable splint resins (SHERAprint-ortho plus UV, NextDent Ortho Rigid, LuxaPrint Ortho Plus, V-Print Splint, KeySplint Soft), one polymethylmethacrylate (PMMA) block for subtractive manufacturing (Astron CLEARsplint Disc), two conventional powder/liquid PMMA materials (FuturaGen, Astron CLEARsplint), and one polyethylene terephthalate glycol (PETG) thermoplastic sheet for vacuum forming (Erkodur Thermoforming Foil) were produced and finished. Surface roughness Ra was determined via contact profilometry. Surface morphology was examined under a scanning electron microscope. Multi-species bacterial biofilms were grown on entire splints. Total biofilm mass and viable bacterial counts (CFU/ml) within the biofilms were determined. Statistical analyses were performed with a one-way ANOVA, Tukey's post hoc test, and Pearson's test (p < 0.05). RESULTS: Astron CLEARsplint and KeySplint Soft specimens showed the highest surface roughness. The mean total biofilm mass on KeySplint Soft splints was higher compared to all other materials (p < 0.05). Colony-forming unit per milliliter on FuturaGen, Astron CLEARsplint, and KeySplint Soft splints was one log scale higher compared to all other materials. The other four printable resins displayed overall lower Ra, biofilm mass, and CFU/ml. A positive correlation was found between Ra and CFU/ml (r = 0.69, p = 0.04). CONCLUSIONS: The 3D-printed splints showed overall favorable results regarding surface roughness and bacterial adhesion. Thermoplastic materials seem to display a higher surface roughness, making them more susceptible to microbial adhesion. CLINICAL RELEVANCE: The development of caries and gingivitis in patients with oral appliances may be affected by the type of material.

Impact of polishing system on surface roughness of different ceramic surfaces after various pretreatments and bracket debonding.

OBJECTIVE: Evaluating various polishing methods after bracket debonding and excessive attachment material removal for different ceramics and pretreatments. MATERIAL AND METHODS: Zirconia (ZrO2), leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with a) silica coated alumina particles (CoJet); LEU and LiSi additionally with b) hydrofluoric acid (HF), c) Monobond Etch&Prime (MEP), d) silicium carbide grinder (SiC) before bracket bonding, shearing off, ARI evaluation, excessive attachment material removal and polishing with i) Sof-Lex Discs (Soflex), ii) polishing paste (Paste), iii) polishing set (Set). Before/after polishing surface roughness (Ra) was measured with a profilometer. Martens hardness parameter were also assessed. RESULTS: Irrespective of pretreatment Ra of LEU increased the most, followed by LiSi and ZrO2 (p < 0.001, SiC: p = 0.012), in accordance with the measured Martens hardness parameter. CoJet/SiC caused greater roughness as HF/MEP (p < 0.001). The ZrO2 surface was rougher after polishing with Paste/Set (p < 0.001; p = 0.047). Ra improved in the LEU/CoJet, LEU/SiC and LiSi/SiC groups with Soflex/Set (p < 0.001), in the LiSi/CoJet and LEU/HF groups by Soflex (p = 0.003, p < 0.001) and worsened by Paste (p = 0.017, p < 0.001). Polishing of HF or MEP pretreated LiSi with Set increased Ra (p = 0.001, p < 0.001), so did Paste in the LEU/MEP group (p < 0.001). CONCLUSIONS: Paste couldn't improve the surfaces. Soflex was the only method decreasing Ra on rough surfaces and not causing roughness worsening. Polishing of LEU/LiSi after MEP, LEU after HF pretreatment doesn´t seem to have any benefit. CLINICAL RELEVANCE: To avoid long-term damage to ceramic restorations, special attention should be paid to the polishing method after orthodontic treatment.

Impact of material combinations and removal and insertion cycles on the retention force of telescopic systems.

OBJECTIVES: A variety of dental materials are available for the fabrication of telescopic crowns. The aim was to investigate the impact of material combinations and removal and insertion cycles on their retention forces. MATERIALS AND METHODS: CAD/CAM-fabricated cobalt-chromium-molybdenum (CoCr) and zirconia (ZrO2) primary crowns were combined with polyetheretherketone (PEEK), polyetherketoneketone (PEKK), CoCr, and ZrO2 secondary crowns (four combinations included PEEK/PEKK secondary crowns in a thickness of 0.5 mm bonded to the CoCr tertiary construction), resulting in 12 different material combinations: CoCr-PEEK; CoCr-PEKK; CoCr-ZrO2; CoCr-CoCr; CoCr-PEEK 0.5; CoCr-PEKK 0.5; ZrO2-PEEK; ZrO2-PEKK; ZrO2-ZrO2, ZrO2-CoCr; ZrO2-PEEK 0.5; and ZrO2-PEKK 0.5 (n = 15 pairings per material combination). Pull-off tests were performed with a universal testing machine initially and after 500, 5000, and 10,000 removal and insertion cycles in a mastication simulator. Descriptive statistics with the Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests were computed (α = 0.05). RESULTS: The tested parameters, material combination, and removal and insertion cycles had significant impact on the retention force values (p < 0.001). An increase in removal and insertion cycles was associated with a decrease in retention forces within CoCr and ZrO2 secondary crowns, regardless of the primary crown material. In contrast, PEEK and PEKK secondary crowns presented higher retention load values after 10,000 cycles than initially. CONCLUSION: Different material combinations behaved differently after simulated removal and insertion regimens. This difference should be considered during treatment planning. CLINICAL RELEVANCE: Telescopic crown systems should be made of materials with predictable retention forces that do not deteriorate with time. The implementation of new materials and technologies facilitates reproducibility and time-saving fabrication.

Pressable lithium disilicate ceramic versus CAD/CAM resin composite restorations in patients with moderate to severe tooth wear: Clinical observations up to 13 years.

OBJECTIVE: To report the long-term clinical survival and failure rates of single-tooth restorations made of pressable lithium disilicate ceramics (LS2 ) and CAD/CAM resin composite (RC) by two separate clinical observations. MATERIALS AND METHODS: Twenty-one patients (12 female, nine male) were treated with 436 minimally invasive single-tooth restorations made of 274 pressed LS2 (n = 12; posterior: monolithic IPS e.max Press; anterior: IPS e.max Ceram veneered, Ivoclar) or 162 milled from RC (n = 9; monolithic exp. CAD/CAM resin composite, Ivoclar). The mean age of patients was 44.1 ± 9.3 years and the mean observation time was 86.2 ± 13.5 months (7.7 ± 1.1 years), with 8.5 ± 2.7 years for LS2 and 6.7 ± 0.5 years for RC. All restorations were observed for technical/biological failures using the modified criteria of the United States Public Health Service (USPHS). Collected data were analyzed using Kaplan-Meier survival analysis and log-rank test (α < 0.025). RESULTS: The 274 LS2 restorations showed a survival of 100% and a total failure rate of 5.5%. The 162 RC restorations showed a survival of 100% and a total failure rate of 25.3%. RC restorations exhibited more material fractures (p = 0.020) and higher discoloration rates (p < 0.001). CONCLUSIONS: Pressed LS2 single-tooth restorations showed lower long-term failure rates than restorations made of RC. CLINICAL SIGNIFICANCE: Despite the limitations of the clinical observations, single-tooth restorations of both materials can be recommended for permanent use in patients with severe tooth wear.

Impact of high-speed sintering and choice of preshaded monochrome or multilayered blanks on fatigue behavior of 4 mol% yttria-stabilized tetragonal zirconia polycrystal.

STATEMENT OF PROBLEM: High-speed sintering allows the rapid fabrication of esthetic restorations with adequate flexural strength. However, data on the fatigue behavior of high-speed sintered 4 mol% yttria-stabilized tetragonal zirconia polycrystal (4Y-TZP) are lacking. PURPOSE: The purpose of this in vitro study was to examine the effect of high-speed sintering and the preshading of blanks (monochrome versus multilayer) on the fatigue behavior of 4Y-TZP ceramics. MATERIAL AND METHODS: Four-point flexural strength specimens (N=405) were fabricated from high-speed sintered multilayer 4Y-TZP (Zolid DRS) processed at 1580 °C for about 20 minutes and conventionally sintered at 1450 °C for about 10 hours, multilayer 4Y-TZP (Zolid Gen-x), and monochrome 4Y-TZP (Ceramill Zolid HT+PS), the control group. The specimens were loaded under 5 different dynamic test conditions for fatigue testing (P1-P5). Three were step-stress protocols (P1: 50 N for 5000 cycles; P2: 10 N for 1000 cycles, P3: 5% for 5000 cycles), 1 was tested with a constant force of 720 N (P4), and 1 was tested for different constant load levels (P5). For analysis of P1-P3, the Kaplan-Meier test and Mantel Cox test were performed (α=.05). P4 was analyzed with the Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests, and P5 by creating a load-cycle diagram. A fracture analysis was performed. RESULTS: ZMLC showed better fatigue behavior than ZMLH (P≤.006) and ZMOC (P≤.002) in all 3 step-stress protocols (P1-P3). ZMLH showed results comparable with those for ZMOC (P≥.285). In P4 and P5, all materials showed comparable values (P=.163 for P4). CONCLUSIONS: The multilayer technique showed a positive effect on the fatigue behavior of 4Y-TZP. In contrast, high-speed sintering negatively influenced the fatigue behavior of multilayer 4Y-TZP. The high-speed sintered material showed no deterioration compared with the conventional sintered monochrome material.

Digital versus conventional veneering of zirconia and cobalt chromium crowns: Fracture load before and after thermomechanical aging.

STATEMENT OF PROBLEM: To complement the digital workflow for manufacturing fixed dental prostheses, both high-strength frameworks and esthetic veneers should be designed and fabricated digitally. However, how the fracture load of digitally veneered restorations compares with conventionally fabricated restorations is unclear. PURPOSE: The purpose of this in vitro study was to examine the fracture load of digitally and conventionally veneered zirconia and cobalt chromium crowns initially and after thermomechanical aging. MATERIAL AND METHODS: Milled zirconia and cobalt chromium copings for a maxillary canine were fabricated (N=96). Digital veneers were milled and connected to the copings with a sintered ceramic slurry. The conventional veneers were fabricated by using a master mold, and the crowns were bonded to the cobalt chromium abutments. Half the specimens were subjected to 6000 thermal (5 °C to 55 °C, 60 seconds) and 1 200 000 mechanical (50 N, 1.5 Hz, 0.7 mm lateral movement) cycles opposed by steatite antagonists, and the fracture load was determined. Fracture types were categorized, and scanning electron microscopy performed. The data were analyzed with a 3-way global univariate analysis of variance, t test, the Pearson chi-squared test, and the Weibull modulus (α=.05). RESULTS: Unlike the framework material (P=.316) and artificial aging (P=.064), the veneering protocol affected the fracture load (P=.007). Digital veneers (range: 2242 to 2929 N) led to lower values than conventional veneers (range: 2825 to 3166 N), which was significant for aged cobalt chromium copings (P=.024; 2242 versus 3107 N). Conventionally veneered crowns showed lower Weibull moduli after thermomechanical aging (range: 3.2 to 3.5) than initially (range: 7.8 to 11.4). The copings of all the zirconia specimens fractured, while chipping occurred with the cobalt chromium specimens. CONCLUSIONS: The high fracture load values of the veneered crowns, even after simulated 5-year aging, indicated sufficient mechanical properties (nearly 4-fold the average occlusal force of 600 N) for the successful clinical application of digitally veneered zirconia and cobalt chromium copings.

Chemical and mechanical properties of dual-polymerizing core build-up materials.

OBJECTIVES: To investigate the chemical (degree of conversion (DC)) and mechanical properties (Martens hardness (HM), elastic indentation modulus (EIT), and biaxial flexural strength (BFS)) of four dual-polymerizing resin composite core build-up materials after light- and self-polymerization. MATERIALS AND METHODS: Round specimens with a diameter of 12 mm and a thickness of 1.5 mm were manufactured from CLEARFIL DC CORE PLUS (CLE; Kuraray), core·X flow (COR; Dentsply Sirona), MultiCore Flow (MUL; Ivoclar Vivadent), and Rebilda DC (REB; VOCO) (N = 96, n = 24/material). Half of the specimens were light-polymerized (Elipar DeepCure-S, 3 M), while the other half cured by self-polymerization (n = 12/group). Immediately after fabrication, the DC, HM, EIT, and BFS were determined. Data was analyzed using Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis tests, Spearman's correlation, and Weibull statistics (p < 0.05). RESULTS: Light-polymerization either led to similar EIT (MUL; p = 0.119) and BFS (MUL and REB; p = 0.094-0.326) values or higher DC, HM, EIT, and BFS results (all other groups; p < 0.001-0.009). When compared with the other materials, COR showed a high DC (p < 0.001) and HM (p < 0.001) after self-polymerization and the highest BFS (p = 0.020) and Weibull modulus after light-polymerization. Positive correlations between all four tested parameters (R = 0.527-0.963, p < 0.001) were found. CONCLUSIONS: For the tested resin composite core build-up materials, light-polymerization led to similar or superior values for the degree of conversion, Martens hardness, elastic indentation modulus, and biaxial flexural strength than observed after self-polymerization. Among the tested materials, COR should represent the resin composite core build-up material of choice due to its high chemical (degree of conversion) and mechanical (Martens hardness, elastic indentation modulus, and biaxial flexural strength) properties and its high reliability after light-polymerization. The examined chemical and mechanical properties showed a positive correlation. CLINICAL RELEVANCE: The chemical and mechanical performance of dual-polymerizing resin composite core build-up materials is significantly affected by the chosen polymerization mode.

Two-body wear of occlusal splint materials from subtractive computer-aided manufacturing and three-dimensional printing.

OBJECTIVES: To investigate the two-body wear of occlusal splint materials fabricated from subtractive computer-aided manufacturing (CAM) compared to three-dimensional printing (3DP). MATERIAL AND METHODS: Forty-eight substrates (n = 12/material) in the design of a mandibular first molar were fabricated using CAM (CAM-TD, Thermeo, pro3dure medical GmbH, Iserlohn, Germany; CAM-CL, CLEARsplint, Astron Dental Corporation, Lake Zurich, USA) and 3DP (3DP-GI, GR22 flex, pro3dure medical GmbH; 3DP-KY, KeySplint soft, Keystone Industries, Gibbstown, USA). The substrates were subjected to mastication simulation (120,000 cycles, 37 °C, 50 N, 1.3 Hz) opposed to enamel antagonists. The two-body wear was measured through matching of the scanned substrates before and after aging using Gaussian best-fit method. The damage patterns were categorized and evaluated based on microscopic examinations. Data was analyzed using Kolmogorov-Smirnov test followed by 1-way analysis of variance (ANOVA). Pearson correlation was calculated between vertical and volumetric material loss. The failure types were analyzed with Chi2-test and Ciba Geigy table. RESULTS: No difference in two-body wear results between all materials was found (p = 0.102). Fatigue substrates showed a perforation for CAM and a fracture for 3DP. No abrasion losses on the antagonists were detected. CONCLUSIONS: 3DP substrates showed no differences in two-body wear compared to CAM ones but are more likely to show a fracture. None of the tested materials caused an abrasion on human teeth structure. CLINICAL RELEVANCE: While therapies with occlusal splint materials are rising, 3DP offers a promising alternative to CAM in terms of production accuracy and therapeutic success at reduced costs.

Time-dependent degree of conversion, Martens parameters, and flexural strength of different dual-polymerizing resin composite luting materials.

OBJECTIVE: To investigate the degree of conversion (DC), Martens hardness (HM), elastic indentation modulus (EIT), and biaxial flexural strength (BFS) of six dual-polymerizing resin composite luting materials initially and after 2 and 7 days of aging. MATERIALS AND METHODS: Specimens fabricated from Bifix QM (BIF; VOCO), Calibra Ceram (CAL; Dentsply Sirona), DuoCem (DUO; Coltène/Whaledent), G-CEM LinkForce (GCE; GC Europe), PANAVIA V5 (PAN; Kuraray Europe), and Variolink Esthetic DC (VAR; Ivoclar Vivadent) (n = 12 per material) were light-polymerized through 1 mm thick discs (Celtra Duo, Dentsply Sirona). DC, HM, and EIT were recorded directly after fabrication, and after 2 and 7 days of aging. As a final test, BFS was measured. Univariate ANOVAs, Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon tests, and Weibull modulus were computed (p < 0.05). RESULTS: While CAL presented low DC, HM, EIT, and BFS values, DUO and BIF showed high results. Highest Weibull moduli were observed for VAR and DUO. DC and Martens parameters increased between the initial measurement and 2 days of aging, while aging for 7 days provided no further improvement. CONCLUSIONS: The choice of dual-polymerizing resin composite luting material plays an important role regarding chemical and mechanical properties, especially with patients sensitive to toxicological issues. DUO may be recommended for bonding fixed dental prostheses, as it demonstrated significantly highest and reliable results regarding DC, HM, and BFS. As DC and HM showed an increase in the first 48 h, it may be assumed that the polymerization reaction is not completed directly after initial polymerization, which is of practical importance to dentists and patients. CLINICAL RELEVANCE: The chemical and mechanical properties of dual-polymerizing resin composite luting materials influence the overall stability and long-term performance of the restoration.

Orthodontic bonding to silicate ceramics: impact of different pretreatment methods on shear bond strength between ceramic restorations and ceramic brackets.

OBJECTIVE: The study aims to investigate the shear bond strength (SBS) between silicate ceramic restorations and ceramic brackets after different pretreatments and aging methods. MATERIAL AND METHODS: Leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with (i) 4% hydrofluoric acid + silane (HF), (ii) Monobond Etch&Prime (MEP), (iii) silicatization + silane (CoJet), and (iv) SiC grinder + silane (SiC). Molars etched (phosphoric acid) and conditioned acted as comparison group. SBS was measured after 24 h (distilled water, 37 °C), 500 × thermocycling (5/55 °C), and 90 days (distilled water, 37 °C). Data was analyzed using Shapiro-Wilk, Kruskal-Wallis with Dunn's post hoc test and Bonferroni correction, Mann-Whitney U, and Chi2 test (p < 0.05). The adhesive remnant index (ARI) was determined. RESULTS: LEU pretreated with MEP showed lower SBS than pretreated with HF, CoJet, or SiC. LiSi pretreated with MEP resulted in lower initial SBS than pretreated with HF or SiC. After thermocycling, pretreatment using MEP led to lower SBS than with CoJet. Within LiSi group, after 90 days, the pretreatment using SiC resulted in lowest SBS values. After HF and MEP pretreatment, LEU showed lower initial SBS than LiSi. After 90 days of water storage, within specimens pretreated using CoJet or SiC showed LEU higher SBS than LiSi. Enamel presented higher or comparable SBS values to LEU and LiSi. With exception of MEP pretreatment, ARI 3 was predominantly observed, regardless the substrate, pretreatment, and aging level. CONCLUSIONS: MEP pretreatment presented the lowest SBS values, regardless the silicate ceramic and aging level. Further research is necessary. CLINICAL RELEVANCE: There is no need for intraoral application of HF for orthodontic treatment.

Impact of the material and sintering protocol, layer thickness, and thermomechanical aging on the two-body wear and fracture load of 4Y-TZP crowns.

OBJECTIVES: The aim of this study is to investigate the influence of the material and corresponding sintering protocol, layer thickness, and aging on the two-body wear (2BW) and fracture load (FL) of 4Y-TZP crowns. MATERIALS AND METHODS: Multi-layer 4Y-TZP crowns in three thicknesses (0.5 mm/1.0 mm/1.5 mm) were sintered by high-speed (Zolid RS) or conventional (Zolid Gen-X) sintering. 2BW of ceramic and enamel antagonist after aging (1,200,000 mechanical-, 6000 thermal-cycles) was determined by 3D-scanning before and after aging and subsequent matching to determine volume and height loss (6 subgroups, n = 16/subgroup). FL was examined initially and after aging (12 subgroups, n = 16/subgroup). Fractographic analyses were performed using light-microscope imaging. Global univariate analysis of variance, one-way ANOVA, linear regression, Spearman's correlation, Kolgomorov-Smirnov, Mann-Whitney U, and t test were computed (alpha = 0.05). Weibull moduli were determined. Fracture types were analyzed using Ciba Geigy table. RESULTS: Material/sintering protocol did not influence 2BW (crowns: p = 0.908, antagonists: p = 0.059). High-speed sintered Zolid RS presented similar (p = 0.325-0.633) or reduced (p < 0.001-0.047) FL as Zolid Gen-X. Both 4Y-TZPs showed an increased FL with an increasing thickness (0.5(797.3-1429 N) < 1.0(2087-2634 N) < 1.5(2683-3715 N)mm; p < 0.001). For most groups, aging negatively impacted FL (p < 0.001-0.002). Five 0.5 mm specimens fractured, four showed cracks during and after aging. CONCLUSIONS: High-speed sintered crowns with a minimum thickness of 1.0 mm showed sufficient mechanical properties to withstand masticatory forces, even after a simulated aging period of 5 years. CLINICAL RELEVANCE: Despite the manufacturer indicating a thickness of 0.5 mm to be suitable for single crowns, a minimum thickness of 1.0 mm should be used to ensure long-term satisfactory results.

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.

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.

Reduced fracture load of dental implants after implantoplasty with different instrumentation sequences. An in vitro study.

OBJECTIVES: To assess the mechanical stability of implants after implantoplasty and thermocyclic loading, the residual thickness of the instrumented areas and neighbouring tooth injury due to implantoplasty. MATERIALS AND METHODS: Using a phantom head simulator and maxillary model implants were subjected to an implantoplasty procedure. Thirty implants were randomly assigned to receive one of three instrumentation sequences. After instrumentation, injury on neighbouring teeth was assessed. Instrumented implants and non-instrumented controls were subjected to 1.2 million cycles of thermo-mechanical loading in a chewing machine. Afterwards, maximum fracture load for all implants and an additional five pristine control implants was tested. RESULTS: Generally, damage of neighbour teeth was a frequent finding (33 ± 56% of all cases) with considerable inter-group differences. No considerable inter-group difference for the residual implant thickness was found for different areas assessed. No implant fractured during cyclic loading. Fracture load was reduced after cyclic loading of uninstrumented implants from 2,724 ± 70 N to 2,299 ± 127 N, and after implantoplasty to 1,737 ± 165 N, while no effect by the instrumentation sequence could be observed. CONCLUSIONS: Both implantoplasty and cyclic loading were shown to reduce the implants' maximum bending strength. Cyclic loading in a laboratory masticator, simulating a five-year equivalent of chewing, did not result in fractured implants. Since neighbouring tooth injury was assessed often, care should be taken with the selection of suitable instruments.

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.

Influence of cleaning methods after 3D printing on two-body wear and fracture load of resin-based temporary crown and bridge material.

OBJECTIVES: To investigate the impact of different cleaning methods on the fracture load and two-body wear of additively manufactured three-unit fixed dental prostheses (FDP) for long-term temporary use, compared to the respective outcomes of milled provisional PMMA FDPs. MATERIALS AND METHODS: Shape congruent three-unit FDPs were 3D printed using three different resin-based materials [FPT, GCT, NMF] or milled [TEL] (N = 48, n = 16 per group). After printing, the FDPs were cleaned using: Isopropanol (ISO), Yellow Magic 7 (YEL), or centrifugal force (CEN). Chewing simulation was carried out with a vertical load of 50 N (480,000 × 5 °C/55 °C). Two-body wear and fracture load were measured. Data were analyzed using global univariate ANOVA with partial eta squared, Kruskal-Wallis H, Mann-Whitney U, and Spearman's rho test (p < 0.05). RESULTS: TEL showed less wear resistance than FPT (p = 0.001) for all cleaning methods tested. Concerning vertical material loss, NMF and GCT were in the same range of value (p = 0.419-0.997), except within FDPs cleaned in ISO (p = 0.021). FPT showed no impact of cleaning method on wear resistance (p = 0.219-0.692). TEL (p < 0.001) showed the highest and FPT (p < 0.001) the lowest fracture load. Regarding the cleaning methods, specimens treated with ISO showed lower fracture load than specimens cleaned with CEN (p = 0.044) or YEL (p = 0.036). CONCLUSIONS: The material selection and the cleaning method can have an impact on two-body wear and fracture load results. CLINICAL RELEVANCE: Printed restorations showed superior two-body wear resistance compared to milled FDPs but lower fracture load values. Regarding cleaning methods, ISO showed a negative effect on fracture load compared to the other methods tested.

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.