Mechanical and physical properties of splint materials for oral appliances produced by additive, subtractive and conventional manufacturing.

OBJECTIVES: To investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (wsp), water solubility (wsl) and degree of conversion (DC) of 3D-printed, milled and injection molded splint materials. METHODS: Specimens (N = 1140) were fabricated from five 3D-printed (GR-22 flex, GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five milled (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and two injection molded (PalaXPress clear, Pro Base Cold) materials. FS, E, HM, wsp, wsl and DC were tested initially (24 h, 37 °C, H2O), after water storage (90 d, 37 °C, H2O) as well as after thermal cycling (5000 thermal cycles, 5/55 °C). Data were analyzed with Kolmogorov-Smirnov, Kruskal- Wallis, Mann-Whitney U test and Spearman's correlation (p < 0.05). RESULTS: Initially, the mean flexural strength values ranged from 1.9 to 90.7 MPa for printed, 3.8 to 107 MPa for milled and 99.7 to 102 MPa for injection molded materials. The initial mean elastic modulus values were 0.0 to 2.4 GPa for printed, 0.1 to 2.7 GPa for milled and 2.8 GPa for injection molded materials. The initial mean Martens hardness values were 14.5 to 126 N/mm2 for printed, 50.2 to 171 N/mm2 for milled and 143 to 151 N/mm2 for injection molded materials. Initially, the mean water sorption values ranged from 23.1 to 41.2 µg/mm3 for printed, 4.5 to 23.5 µg/mm3 for milled and from 22.5 to 23.3 µg/ mm3 for injection molded materials. The initial mean water solubility values ranged from 2.2 to 7.1 µg/mm3 for printed, 0.0 to 0.5 µg/mm3 for milled and 0.1 to 0.3 µg/mm3 for injection molded materials. After water storage and thermal cycling most of the values decreased and some increased. The mean DC values ranged initially from 72.3 to 94.5 %, after water storage from 74.2 to 96.8 % and after thermal cycling from 75.6 to 95.4 % for the printed materials. SIGNIFICANCE: The mechanical and physical properties of printed, milled and injection molded materials for occlusal devices vary and are influenced by aging processes. For clinical applications, materials need to be chosen according to the specific indications.

Impact of the sintering parameters on the grain size, crystal phases, translucency, biaxial flexural strength, and fracture load of zirconia materials.

OBJECTIVES: To investigate the influence of the zirconia and sintering parameters on the optical and mechanical properties. METHODS: Three zirconia materials (3/4Y-TZP, 4Y-TZP, 3Y-TZP) were high-speed (HSS), speed (SS) or conventionally (CS) sintered. Disc-shaped specimens nested in 4 vertical layers of the blank were examined for grain size (GS), crystal phases (c/t'/t/m-phase), translucency (T), and biaxial flexural strength. Fracture load (FL) of three-unit fixed dental prostheses was determined initially and after thermomechanical aging. Fracture types were classified, and data statistically analyzed. RESULTS: 4Y-TZP showed a higher amount of c + t'-phase and lower amount of t-phase, and higher optical and lower mechanical properties than 3Y-TZP. In all materials, T declined from Layer 1 to 4. 3/4Y-TZP showed the highest FL, followed by 3Y-TZP, while 4Y-TZP showed the lowest. In 4Y-TZP, the sintering parameters exercised a direct impact on GS and T, while mechanical properties were largely unaffected. The sintering parameters showed a varying influence on 3Y-TZP. Thermomechanical aging resulted in comparable or higher FL. CONCLUSION: 3/4Y-TZP presenting the highest FL underscores the principle of using strength-gradient multi-layer blanks to profit from high optical properties in the incisal area, while ensuring high mechanical properties in the lower areas subject to tensile forces. With all groups exceeding maximum bite forces, the examined three-unit FDPs showed promising long-term mechanical properties.

Mechanical Properties of High- and Low-Fusing Zirconia Veneering Ceramics Fired on Different Trays and Substrates.

This study aimed to evaluate the effect of ceramic type, firing tray, and firing substrate on the density, shrinkage, biaxial flexural strength, Martens' hardness, and elastic indentation modulus of zirconia veneering ceramics. Disk-shaped specimens were fabricated from a high-fusing (HFZ) and a low-fusing (STR) zirconia veneering ceramic. These specimens were then divided into 10 groups according to firing trays (round, small honeycomb-shaped, cordierite [RSC]; round, large honeycomb-shaped, aluminum oxide [RLA]; rectangular, plane, silicon nitride [RCPS]; round, plane, silicon nitride [RPS]; and rectangular, plane, calcium silicate [RCPC]) and firing substrates (firing cotton and platinum foil) used (n = 12). The density, shrinkage, biaxial flexural strength, Martens' hardness, and indentation modulus were measured, and analyzed with generalized linear model analysis (α = 0.05). The interaction between the ceramic type and firing substrate affected density (p < 0.001), and the other outcomes were affected by the interaction among all main factors (p ≤ 0.045). Higher density was observed with HFZ or platinum foil (p ≤ 0.007). RSC and RLA led to a higher density than RCPS within HFZ and led to the lowest density within STR (p ≤ 0.046). STR had a higher shrinkage (p < 0.001). RSC mostly led to a lower shrinkage of HFZ (p ≤ 0.045). The effect of ceramic type and firing substrates on the biaxial flexural strength, Martens' hardness, and indentation modulus was minimal while there was no clear trend on the effect of firing tray on these properties. Ceramic type, firing tray, and firing substrate affected the mechanical properties of the tested zirconia veneering ceramics. Firing the tested zirconia veneering ceramics over a round and small honeycomb-shaped cordierite firing tray with firing cotton mostly led to improved mechanical properties.

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.

A proof of concept on implant-supported bilateral cantilever bridges: The T-Bridge approach.

The concept of bilateral cantilevers on a single central implant (T-design) for three-unit implant-supported fixed dental prostheses (ISFDPs) has not been explored nor tested. This technical hypothesis aimed to explore the feasibility of such an approach as a cost-effective alternative to conventional treatments. Careful considerations regarding implant diameter, length, ideal position, occlusal scheme, and bone remodeling are essential to ensure adequate support, stability, and prevention of complications. In this proof of concept, we present a preliminary case with this novel design to replace missing posterior teeth in a patient with narrow bone conditions. In addition, a series of planned investigations and preliminary results, including preclinical studies, are presented to illustrate our concept and its potential clinical implications. Clinically, after two-year follow-up, healthy and stable peri-implant tissues around the ISFDP exemplarily demonstrated excellent stability, functionality, and comfort, which is supported by acceptable fracture resistance data in vitro, suggesting indeed the practical potential and suitability. Thus, we claim that such a treatment modality has the at least theoretical potential to revolutionize implant dentistry by providing innovative and cost-effective treatment options for patients with partial ISFDPs in very specific cases. Of course, further research and evaluations are necessary to validate the clinical implications of this innovative hypothesis. Implementing the 3-on-1 T-bridge approach in partial ISFDPs could offer a promising alternative to traditional methods. If proven successful, this technique may lead to significant advancements in clinical practice, providing a less invasive cost-effective treatment option.

Influence of additives and binder on the physical properties of dental silicate glass-ceramic feedstock for additive manufacturing.

OBJECTIVES: The aim of the study was to investigate the impact of organic additives (binder, plasticizer, and the cross-linking ink) in the formulation of water-based feedstocks on the properties of a dental feldspathic glass-ceramic material developed for the slurry-based additive manufacturing technology "LSD-print." MATERIAL AND METHODS: Three water-based feldspathic feedstocks were produced to study the effects of polyvinyl alcohol (AC1) and poly (sodium 4-styrenesulfonate) (AC2) as binder systems. A feedstock without organic additives was tested as the control group (CG). Disc-shaped (n = 15) and bar (n = 7) specimens were slip-cast and characterized in the green and fired states. In the green state, density and flexural strength were measured. In the fired state, density, shrinkage, flexural strength (FS), Weibull modulus, fracture toughness (KIC), Martens parameters, and microstructure were analyzed. Disc-shaped and bar specimens were also cut from commercially available CAD/CAM blocks and used as a target reference (TR) for the fired state. RESULTS: In the green state, CG showed the highest bulk density but the lowest FS, while the highest FS in the green state was achieved with the addition of a cross-linking ink. After firing, no significant differences in density and a similar microstructure were observed for all slip-cast groups, indicating that almost complete densification could be achieved. The CAD/CAM specimens showed the highest mean FS, Weibull modulus, and KIC, with significant differences between some of the slip-cast groups. SIGNIFICANCE: These results suggest that the investigated feedstocks are promising candidates for the slurry-based additive manufacturing of restorations meeting the class 1a requirements according to DIN EN ISO 6871:2019-01.

Two-body wear of novel monolithic lithium-silicate ceramic materials and their corresponding different antagonists.

OBJECTIVES: Evaluation of the two-body wear of lithium-silicate ceramics against different antagonists compared to a direct resin composite and human teeth. METHODS: Initial LiSi Block [LISI], IPS e.max CAD [EMA], and CEREC Tessera [TESE] were investigated and compared with direct resin composite [FILL] and human teeth [tooth]. As antagonists were used: steatite, ceramic, and human enamel. The control group tooth was only tested with enamel antagonist. The combinations underwent thermomechanical aging using a chewing simulator. Material losses were calculated using GOM-analysis software. Kolmogorov-Smirnov test, Kruskal-Wallis H, Mann-Whitney-U-test with Bonferroni correction and Spearman-rho correlation were calculated. A fractographic analysis was performed. RESULTS: Within TESE, enamel antagonists led to lower restoration losses than steatite and ceramic antagonists. Within FILL, enamel and steatite antagonists caused lower material losses compared to ceramic antagonists. Against steatite antagonists, LISI showed lowest material losses. Against ceramic antagonists, the use of LISI led to lower material losses compared to FILL. Against tooth antagonists, TESE showed lower material losses than tooth and FILL and LISI lower than FILL. Within LISI, steatite antagonists showed lower material losses on the antagonist than ceramic. Within EMA, steatite antagonists showed higher material losses than ceramic ones. Within ceramic antagonists, LISI restoration material showed lower material losses than FILL and EMA. CONCLUSIONS: Regardless of the antagonist material, the material losses of LISI and EMA were comparable. However, the abrasion resistance of LISI tended to be higher than EMA. CLINICAL SIGNIFICANCE: LISI is a fully crystallized lithium-silicate ceramic and no longer needs to be processed after milling. In addition, the abrasion resistance is very good, regardless of the antagonist material chosen.

Fracture toughness, work of fracture, flexural strength and elastic modulus of 3D-printed denture base resins in two measurement environments after artificial aging.

OBJECTIVES: To investigate the fracture toughness (KIC), work of fracture (WOF), flexural strength (FS) and elastic modulus (E) of four additively manufactured denture base resins in two different measurement environments after artificial aging. METHODS: Rectangular specimens in two different dimensions (n = 480) were 3D-printed with four denture base resins: Denture 3D+ (DEN; NextDent), Fotodent Denture (FOT; Dreve ProDiMed), Freeprint Denture (FRE; Detax), V-Print dentbase (VPR; VOCO)). KIC, WOF, FS and E were measured after (1) water-storage (37 °C; KIC = 7 d; FS = 50 h); (2) water-storage + hydrothermal-aging (20 min, 0.2 MPa, 134 °C); (3) water storage + thermocycling (10,000 cycles, 5/55 °C) in two measurement environments (i) air-23 °C and (ii) water-37 °C. For FS, fracture types were classified, and relative frequencies determined. Univariate ANOVA, Kruskal-Wallis, Mann-Whitney U, and Spearman's correlation were calculated (p < 0.05, SPSS V.27.0). Weibull modulus (m) was calculated using the maximum likelihood estimation method. RESULTS: DEN showed the highest KIC (5/6 groups), WOF and highest corresponding m (1/6 groups), while FRE presented the highest FS (2/6 groups) and E values. Hydrothermal-aging and thermocycling reduced KIC and WOF, FS and E, and the number of FS fracture pieces. For 6/8 groups, hydrothermal aging resulted in lower FS than thermocycling. Measurement in air-23 °C led to higher FS for 7/12 groups and a more brittle fracture behavior. A positive correlation between KIC and FS was observed. SIGNIFICANCE: With measurements in air-23 °C resulting in higher FS than reported in water-37 °C, the measurement environment should be adapted to the clinical situation to allow valid predictions on the mechanical behavior of denture base resins when in situ.

Influence of different surface finishing procedures of strength-gradient multilayered zirconia crowns on two-body wear and fracture load: Lithium silicate or leucite glazing versus polishing?

OBJECTIVES: To examine the influence of different finishing procedures on the surface roughness, wear resistance and fracture load of strength-gradient multilayered zirconia. MATERIALS AND METHODS: Zirconia crowns (Multilayer 3D pro; n = 96) were manufactured and treated with a lithium-silicate- (LISI_S), leucite-based glaze spray (LEU_S), leucite-based glaze mass (LEU_M) or polished (POL). Natural molars (CG; n = 24) acted as a control. Roughness was determined on flat glazed specimens (n = 28). Two-body wear was examined by digitalizing and matching the occlusal surface before and after thermo-mechanical aging (6,000 thermal and 1,200,000 chewing cycles). The groups were split to measure fracture load initially and after aging. Kolmogorov-Smirnov, Spearman correlation, Kruskal-Wallis-H, Levene's test, one-way ANOVA with Scheffé post-hoc and Weibull modulus were computed. RESULTS: POL presented the lowest and LEU_S the highest roughness. Following POL, no ceramic loss was observed. LISI_S, LEU_S and LEU_M showed lower ceramic wear than the CG. The lowest wear of the antagonist was observed for the CG. LISI_S showed a lower antagonistic wear than LEU_S, LEU_M and POL. LISI_S, LEU_S, LEU_M and POL showed higher fracture load values and Weibull moduli than the CG. Artificial aging did not impact the fracture load or Weibull moduli. SIGNIFICANCE: With glazed groups showing height losses closer to the CG, glazing should be preferred to polishing when approximating the wear behavior of a natural dentition. Finishing of monolithic zirconia by glazing with a lithium silicate-based spray is recommended to preserve the antagonists. All examined zirconia crowns presented sufficient mechanical properties to withstand masticatory forces, even after prolonged aging.

Effect of final temperature and heating rate on the mechanical and optical properties of a zirconia veneering ceramic.

PURPOSE: To evaluate the effect of firing temperature and heating rate on the volumetric shrinkage, translucency, flexural strength, hardness, and fracture toughness of a zirconia veneering ceramic. MATERIAL AND METHODS: Zirconia veneering ceramic specimens (N = 45) with varying final temperatures (730 °C, 750 °C, and 770 °C) and heating rates (70 °C/min, 55 °C/min, and 40 °C/min) were fabricated (n = 5). Each specimen's shrinkage, translucency, flexural strength, hardness, and fracture toughness were determined. Two-way analysis of variance, Scheffé test, and Pearson's correlation analysis were used to evaluate data (α = 0.05). RESULTS: The shrinkage (44.9 ± 3.1-47.5 ± 1.6 vol%) and flexural strength (74.1 ± 17.4-107.0 ± 27.1 MPa) were not affected by tested parameters (P ≥ 0.288). The interaction between the main factors affected the translucency, hardness, and fracture toughness of the specimens (P ≤ 0.007). Specimens with 770 °C final temperature and 70 °C/min heating rate had the lowest (21.8 ± 3.2 %) translucency (P ≤ 0.039). The hardness ranged between 4.98 ± 0.51 GPa (730 °C; 70 °C/min) and 5.60 ± 0.37 GPa (770 °C; 70 °C/min). Fracture toughness ranged between 0.54 ± 0.04 MPa√m and 0.67 ± 0.08 MPa√m with the highest values for specimens fired at 730 °C with 70 °C/min (P ≤ 0.001). There was a positive correlation between translucency and hardness (r = 0.335, P = 0.012), and a negative correlation between fracture toughness and all parameters other than shrinkage (translucency: r = -0.693/P < 0.001, flexural strength: r = -0.258/P = 0.046, hardness: r = -0.457/P < 0.001). CONCLUSIONS: Heating rate and final temperature should be considered while fabricating veneered zirconia restorations with tested ceramic as they affected the translucency, hardness, and fracture toughness.

A New Implant System with Directly Screwed Supraconstructions: Impact of Restoration Material and Artificial Aging on the Bending Moment.

PURPOSE: To investigate the bending moment of implants restored with a directly screwed single-unit fixed dental prosthesis (FDP) compared to implants restored with an FDP polymerized to a titanium base before and after thermomechanical aging. MATERIALS AND METHODS: A total of 240 implants (120 with and 120 without a titanium base) were restored with FDPs manufactured from conventionally sintered 3Y-TZP, 5Y-TZP, 4Y-TZP, and CoCrMo, as well as high-speed sintered 4Y-TZP. Half the specimens per subgroup were aged using chewing simulation combined with thermocycling (1,200,000 cycles at 50 N; 6,000 cycles at 5° to 55°). Initial and aged fracture load were measured. The bending moment was calculated and subjected to statistical analysis (Kolmogorov-Smirnov test, one-way ANOVA followed by post hoc Scheffé, t, and chi-square tests; P < .05). Failure types were analyzed. RESULTS: Implants without a titanium base showed higher bending moments for all initially tested zirconia groups compared to implants with a titanium base. The highest initial values were observed for 4Y-TZP FDPs regardless of implant type. High-speed sintered FDPs demonstrated higher initial bending moments compared to conventionally sintered FDPs. Artificial aging led to a decrease of the bending moment in most subgroups. After aging, no differences were found within the restoration materials, sintering protocols, or implant types. Implant deformation occurred mainly with directly screwed FDPs, whereas FDP mobility was predominantly observed among implants with a titanium base. FDP fractures were mainly observed for 5Y-TZP. CONCLUSIONS: Both implant types exhibited similar values after aging. Thus, implants without a titanium base seem to show equally sufficient stability for clinical applications with all tested materials.

Impact of glazing on wear, fracture load, and optical properties of a new fully crystallized lithium disilicate ceramic material.

OBJECTIVES: Lithium disilicate (LDS) based glass ceramics are indispensable materials in the field of prosthetic dentistry due to their strength and excellent esthetics. Recently, novel fully crystallized LDS for the milling process have been introduced to the market, requiring only chairside polishing before delivery. Since limited data is available about subjecting this material to glazing, this study aimed to evaluate the wear properties, fracture resistance, and optical properties of the newly introduced fully crystallized LDS after glazing. METHODS: Lithium disilicate glass-ceramics (fully crystallized (LiSiCAD) and partially crystallized types (EmaxCAD), of shade A3, were used in the present study. The fully crystallized specimens were subjected to a glazing firing cycle in a furnace (LiSiCAD-G) and compared to a polished fully crystallized counterpart (LiSiCAD-P, negative control) and a glazed partially crystallized LDS (EmaxCAD, positive control). Rectangular-shaped ceramic specimens (n = 10, 12 × 6.5 × 1.5 mm) and enamel antagonists were used to test the wear resistance in a specially designed wear machine built at the Department of Oral Technology, University of Bonn, Germany. The volumetric enamel loss of antagonists was measured by means of overlapping virtual 3D models derived from micro-CT scans for the teeth before and after the wear test. The weight loss of ceramic specimens in milligrams was measured after 100,000 and 200,000 wear cycles. A spectrophotometer was used to calculate the CIELAB color parameters of the ceramic specimens against black and white backgrounds to measure the translucency. Fracture resistance was also assessed after thermodynamic fatigue using a universal testing machine until fracture at a 1 mm/min crosshead speed. Statistical analysis was performed using one-way ANOVA and the significance level was set at α = 0.05. RESULTS: EmaxCAD and LisiCAD-G groups showed significantly higher mean ceramic weight loss after 100,000 cycles (2 ± 0.3 mg and 1.93 ± 0.2 mg, respectively) than LisiCAD-P group (0.78 ± 0.19 mg). Glazed LiSiCAD specimens demonstrated significantly higher ΔE values from shade A3 compared to polished LiSiCAD. There was no significant difference in ΔE between LiSiCAD-G and EmaxCAD. For fracture resistance, no significant difference was observed between LiSiCAD-G and LiSiCAD-P before or after aging. CONCLUSIONS: The glazed fully crystallized LDS was superior to the partially crystallized one with regard to wear resistance but showed more color changes than the polished fully crystallized one. Furthermore, polishing of fully crystallized LDS could still be considered a better option than glazing when aesthetics is a primary prerequisite.

Dimensional Stability and Reproducibility of Varying FFF Models for Aligners in Comparison to Plaster Models.

To test the impact of FFF filaments, printing parameters, thermoforming foils, repeated thermoforming cycles, and type of jaw on the dimensional stability of FFF models for aligners and to compare them with plaster models, FFF models (maxilla, n = 48; mandible, n = 48) from two filaments (SIMPLEX aligner and Renfert PLA HT, both Renfert GmbH) were fabricated using four printing parameters (one, two, or three loops; four loops acted as the default) and conventional plaster models (n = 12) based on a young, female dentition. All models were thermoformed under pressure three times in total using two different thermoforming foils, namely 0.75 mm × 125 mm Ø aligner foil (CA Pro+ Clear Aligner, Scheu Dental) and 1.0 mm × 125 mm Ø Duran foil (Duran+, Scheu Dental). Aligner foil was heated at 220 °C for 25 s and Duran foil at 220 °C for 30 s. All models were scanned after fabrication as well as after each thermoforming cycle. The obtained STL datasets were analyzed using the local best-fit method (GOM Inspect Pro, Carl Zeiss Metrology GmbH). Data were analyzed using a Kolmogorov-Smirnov-test, a one-way ANOVA with post-hoc Scheffé, and a t-test (p < 0.05). The dimensional stability of the models was most strongly affected by the printing parameters (number of loops; ηp2 = 0.768, p < 0.001) followed by the thermoforming foil used (ηp2 = 0.663, p < 0.001) as well as the type of model (ηp2 = 0.588, p < 0.001). In addition, various interactions showed an influence on the dimensional stability (ηp2 = 0.041-0.386, p < 0.035). SIMPLEX maxillary models (default; four loops), thermoformed using aligner foil, showed higher deformation stability than did plaster models. These initial FFF models provide comparable precision to plaster models, but the dimensional stability of the FFF models, in contrast to that of plaster models, decreases with increasing numbers of thermoforming cycles.

Three-Dimensional Printed Resin: Impact of Different Cleaning Protocols on Degree of Conversion and Tensile Bond Strength to a Composite Resin Using Various Adhesive Systems.

The present investigation tested the effect of cleaning methods and adhesives on the tensile bond strength (TBS) of a resin-based composite luted to a temporary 3D printed resin. Substrates (n= 360) were printed using a Rapidshape D20II and cleaned with a butyldiglycol-based solution, isopropanol, or by centrifugation. Specimens were air-abraded with Al2O3 (mean particle size 50 µm) at 0.1 MPa followed by pretreatment (n = 30/subgroup) with: (1) Clearfil Ceramic Primer (CCP); (2) Clearfil Universal Bond (CUB); (3) Scotchbond Universal Plus (SUP) or 4. Visio.link (VL) and luted to PanaviaV5. TBS (n = 15/subgroup) was measured initially (24 h at 37 °C water) or after thermal cycling (10,000×, 5/55 °C). The degree of conversion (DC) for each cleaning method was determined prior and after air-abrasion. Univariate ANOVA followed by post-hoc Scheffé test was computed (p < 0.05). Using Ciba-Geigy tables and chi-square, failure types were analyzed. The DC values were >85% after all cleaning methods, with centrifugation showing the lowest. CCP pretreatment exhibited the lowest TBS values, with predominantly adhesive failures. The combination of CCP and centrifugation increased the TBS values (p < 0.001) compared to the chemical cleaning. CUB, SUP, and VL, regardless of cleaning, can increase the bond strength between the 3D printed resin and the conventional luting resin.

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.

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.

Impact of different pretreatments and attachment materials on shear bond strength of indirectly bonded brackets using CAD/CAM transfer trays to monolithic zirconia.

OBJECTIVE: Investigating the impact of different pretreatment methods, attachment materials and aging regimens on shear bond strength (SBS) between zirconia and indirectly bonded brackets using CAD/CAM transfer trays. METHODS: Zirconia substrates were conditioned with silica coated alumina (CoJet) and a) Clearfil Ceramic Primer Plus (CF), b) RelyX Ceramic Primer (RXP), c) Futurabond U (FU). Brackets were virtually placed, transfer tray designed (OnyxCeph) and 3D-printed for indirect bonding with a) Transbond LV (TBL), b) Nexus NX3 (NX3), c) Maximum Cure (MC). SBS testing was performed with a universal testing machine after 24 h, 500 thermal cycles, 90 d. Directly bonded brackets to human enamel using Transbond XT Adhesive served as control. The adhesive remnant index (ARI) was evaluated. Data was analyzed with Shapiro-Wilk, Kruskal-Wallis and Dunn's post-hoc test with Bonferroni correction, Chi2 test (p < 0.05), and the Weibull modulus was calculated. RESULTS: SBS ranged from 0.1 to 15.5 MPa and were influenced mostly by the attachment material. NX3 generally showed the highest values (9.5-15.8 MPa). Initially RXP/TBL and FU/TBL presented the lowest values (4.3/4.8 MPa). Aging regimens reduced SBS of MC irrespective of pretreatment, after 90 d values ranged from 0.1 to 0.9 MPa. ARI 1 was predominant in all MC groups and FU/NX3, 2 and 3 in the other groups. Weibull moduli ranged between 0.15 (MC/RXP/500 TC) and 6.24 (NX3/RXP/500 TC). SIGNIFICANCE: MC seems not to be suitable for indirect bonding using CAD/CAM transfer trays to zirconia. NX3 showed similar SBS values compared to the control, TBL lower.

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.