Survival and complications of monolithic ceramic for tooth-supported fixed dental prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Although recent studies have reported the success of implant-supported monolithic restorations, consensus on the use of monolithic ceramic restorations is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the survival and biological and technical complication rates of monolithic single crowns and fixed partial dentures (FPDs). MATERIAL AND METHODS: An electronic search was conducted by 2 independent authors on the PubMed/MEDLINE, Scopus, and Cochrane Library databases. The Newcastle-Ottawa scale and Cochrane risk of bias tool were used to assess the quality and risk of bias of the included studies. Meta-analysis was performed by using the R software program. RESULTS: The search identified 763 articles, 18 of which met the eligibility criteria. A total of 15 studies evaluated monolithic ceramic single crowns, and 4 studies evaluated FPDs. The studies included 1061 monolithic single crowns (524 lithium disilicate, 461 zirconia, and 76 polymer-infiltrated ceramic network [PICN]) and 104 FPDs (36 lithium disilicate and 68 zirconia). Meta-analysis of single-arm studies indicated the proportion of survival, biological, and technical complication rates of 1% (95% confidence interval [CI]: 0% to 3%), 1% (CI: 0% to 4%), and 2% (CI: 1% to 4%), respectively, for single crowns, independent of ceramic material, and 3% (CI: 0% to 34%), 5% (CI: 1% to 21%), and 5% (CI: 1% to 21%) for FPDs, respectively. Only 5 studies performed a direct comparison between monolithic and veneered ceramic restorations, and no significant difference was observed in terms of survival (risk ratio [RR]: 0.68; CI: 0.25-1.91; P=.96), biological (RR: 0.69; CI: 0.31-1.53; P=.35), and technical complication rates (RR: 0.87; CI: 0.40-1.88; P=.29). CONCLUSIONS: The use of monolithic ceramic can be considered a favorable treatment for tooth-supported single crowns and FPDs, with high survival and low complication rates. However, further randomized controlled trials are needed to reassess these clinical performances, mainly by comparing them with the performance of veneered restorations.

Effect of handling material on mechanical and optical properties of feldspathic porcelain.

OBJECTIVE: To evaluate the optical, chemical, and mechanical properties of feldspathic porcelain after handling with different instrument materials. MATERIAL AND METHODS: Feldspathic porcelain was manipulated with different spatula compositions: metal spatula (MS), plastic spatula (PS), and glass spatula (GS) for the fabrication of 30 (n = 10) disks. Contrast ratio (CR), translucency parameter (TP), and surface Knoop microhardness (KHN) were measured. The color change (ΔE00 ) was evaluated using the CIEDE2000 system. Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were used for surface analysis. Data were analyzed using one-way ANOVA and Tukey test (P < 0.05). RESULTS: All groups presented different morphological surfaces with higher presence of Al on the MS. PS group presented lower Al, Si, K than MS, and GS. Higher CR was observed for PS (0.734; P < 0.043), followed by MS (0.696; P < 0.043) and GS (0.65; P < 0.011). The highest TP (13.06) and KHN (386.27) were presented by GS (P < 0.001). MS and PS presented similar KHN results. The higher ΔE00 were found for plastic/metal comparison. Also, the L* values for the MS group (67.49) were lower than the other groups. CONCLUSION: The use of metal spatula promoted higher color alteration during feldspathic porcelain manipulation than did the other materials. Handling with glass instrument promoted higher microhardness than other spatula materials. CLINICAL SIGNIFICANCE: The effect of the material used for ceramic handling on feldspathic porcelain properties is often ignored. This study shows that the handling spatula material must be carefully chosen to avoid inadvertent changes to the feldspathic porcelain restoration.

Effect of laser irradiation on bond strength between zirconia and resin cement or veneer ceramic: A systematic review and meta-analysis.

Aim: This systematic review with meta-analysis aimed to evaluate the effect of the laser treatment on bond strength between Y-TZP and the resin cement or with the veneering ceramic, and the effect on the alteration of the Y-TZP surface roughness. Settings and Design: Systematic review and meta analysis following PROSPERO guidelines. Materials and Methods: A comprehensive review was performed up to September 2020 on four databases (PubMed/MEDLINE, Embase, Scopus, and Cochrane Library), using the combination of keywords: "laser AND zirconia AND surface treatment AND bond strength". Statistical Analysis Used: The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. The continuous outcome was evaluated by mean difference and the corresponding 95% confidence intervals. Results: A total of 37 studies were identified for the inclusion of data, with only in vitro studies. The types of laser reported in the studies were: Er:YAG, Nd:YAG, Er,Cr:YSGG, CO2, Femtosecond, and Yb lasers. A random-effect model found statistically significant differences between lasers and control groups of Y-TZP (P < 0.00001; MD: 3.08; 95% CI: 2.58 to 3.58). Only the bond strength with the Er:YAG laser did not present statistical difference (P = 0.51; MD: 0.22; 95% CI: -0.44-0.88). In another analysis, a random-effect model found a statistically significant difference between the laser and control groups on surface roughness (P < 0.00001; MD: 0.96; 95% CI: 0.86 to 1.06). Conclusions: Laser irradiation is capable to improve the Y-TZP surface roughness and the bond strength of zirconia with resin cement and veneering ceramics. However, there is a lack of laser protocol for the zirconia surface, a fact that makes a simple and direct comparison difficult.

Cytotoxicity and inflammatory response of different types of provisional restorative materials.

AIM: To evaluate the cytotoxicity and inflammatory response of different types of provisional restorative materials to mice gingival fibroblasts. METHODS: Cytotoxicity of provisional material discs (thermal-polymerized acrylic resin; auto-polymerized acrylic resin; bisacrylic resin; nano-ceramic resin for CAD/CAM and prefabricated polymer block for CAD/CAM) to Mice (Balb/c) gingival cell were investigated under direct and indirect contact (extracts) at 24, 48 and 72 h, using the MTT and Alamar blue assays. Materials extracts (24 h) were applied to the cell culture (indirect contact) or cells were seeded on discs of provisional materials, and the cytotoxicity and production of IL-6, IL-1ß and TNF-α after 24, 48 and 72 h were analyzed through MTT, Alamar Blue® and ELISA. Culture medium was used as control for indirect contact assay (extract) and the surfaces of the wells without discs of provisional materials were used as control for direct contact assay. Results were analysed statistically by ANOVA followed by the Bonferroni-Test correction. Statistically significant differences were considered if P was < .05. RESULTS: Auto-polymerized and bisacrylic resins (direct contact) reduced cell viability after 24, 48 and 72 h compared to control (P < .05). Indirect contact (extract) was not cytotoxic to cells at all periods compared to control (P > .05). Auto-polymerized and bisacrylic resins increased IL-6, IL-1ß and TNF-α levels mainly at 24 h when compared to the other materials (P < .001). CONCLUSION: Auto-polymerized and bisacrylic were more cytotoxic to mice gingival fibroblasts. CAD/CAM nano ceramic resin and prefabricated polymer blocks are more predictable materials to preserve the periodontal soft tissues.