The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-Arch Implant Restoration.

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

The effect of milling and postmilling procedures on the surface roughness of CAD/CAM materials.

PURPOSE: The aim of this study was to evaluate the surface roughness and analyze the surface topography of five different CAD/CAM ceramics and one CAD/CAM composite resin for CEREC after milling and postmilling procedures. MATERIALS AND METHODS: Blocks of the ceramics Mark II, IPS Empress CAD, IPS e.max CAD, Suprinity and Enamic, and blocks of the composite resin Lava Ultimate were milled at CEREC MCXL. Ten flat samples of each material were obtained. The surface roughness (Ra) test was performed before and after milling, crystallization, polishing, and glaze when indicated, followed by SEM and AFM analysis. Data were submitted to one-way ANOVA with repeated measures and the Tukey HSD test (α = 0.05). RESULTS: The milling step significantly increased the roughness of all the tested materials (P < .05). Lithium-based ceramics (IPS e.max CAD and Suprinity) were more suitable to roughness than the other tested materials (P < .05). CONCLUSIONS: The polishing methods were able to reduce roughness to baseline values, except for lithium-based ceramics. Glaze reduced significantly the roughness of lithium-based ceramics without a difference from the baseline. SEM and AFM images revealed that glazed surfaces are smoother than polished surfaces. CLINICAL SIGNIFICANCE: All hard-milling CAD/CAM materials, that is, fully sintered, should be only hand polished. The glaze step can be suppressed resulting in time saving. However, the glaze step in soft-milling lithium disilicate is imperative.

Clinical Evaluation of Indirect Composite Resin Restorations Cemented with Different Resin Cements.

PURPOSE: To clinically evaluate the performance of indirect composite resin restorations cemented with conventional and self-adhesive resin cements over a 12-month period. MATERIALS AND METHODS: Ten patients fulfilled all the inclusion criteria. Twenty-four composite resin restorations were performed using an indirect technique and cemented with a resin cement (RelyX ARC) or a self-adhesive resin cement (RelyX U100). Two independent evaluators analyzed the restorations using modified USPHS criteria after periods of two weeks and 6 and 12 months. Statistical significance between the cements at each timepoint was evaluated with the Wilcoxon test and between timepoints with the Mann-Whitney test, both at a significance level of 5%. Fisher's exact test was used to assess the occurrence of absolute failures. RESULTS: No statistically significant differences were found between the groups at the same timepoint nor between groups at different timepoints. The only significant difference was found for color match for both groups after 12 months. CONCLUSION: After 12 months, indirect composite resin restorations cemented with self-adhesive resin cement performed similarly to those cemented with conventional resin cement.

Surface roughness and maintenance of surface sealants for resin composites after toothbrushing.

PURPOSES: (1) To evaluate in vitro the surface roughness of a resin composite covered with three surface sealants and submitted to simulated toothbrushing for different periods; (2) Verify, through scanning electron microscopy (SEM), the presence of surface sealants after simulated toothbrushing; and (3) To evaluate whether the type of dentifrice influences the maintenance of the surface sealant. The study hypothesis was that neither variable would influence the surface roughness of the composite and the maintenance of the surface sealant. METHODS: 108 specimens were prepared with the resin Amelogen Plus, and divided into six groups (n = 18) according to the type of surface sealant [Fortify (F), BisCover LV (B) and Permaseal (P)] and toothpaste [Total 12 Clean Mint (CT) and Colgate Total 12 Professional Whitening (PW)]. The samples were subjected to brushing cycles, simulating periods of 6, 12, 18, and 24 months. After each period, the surface roughness of the samples was measured. An additional group of 48 samples was prepared for SEM analysis. The results were analyzed by ANOVA with three fixed variables (sealants, time and toothpaste) and by Tukey's test (α = 0.05). RESULTS: BisCover had the lowest mean surface roughness (0.06 µm) compared with the sealants Fortify (0.09 µm) and Permaseal (0.08 µm), which were not statistically different. Fortify, at 12 months of brushing, had the highest mean roughness (0.13 µm). The mean roughness for the dentifrice CT was lower (0.07 µm) when compared with PW (0.08 µm) and was statistically different. Roughness increased up to 12 months of simulated brushing (0.04 µm, 0.08 µm and 0.11 µm), decreasing from the 18th month (0.08 µm) to the 24th month of brushing (0.07 µm). None of the sealants was observed (with SEM) to be completely removed from the resin at 24 months of brushing.

Strengthening effect of horizontally placed fiberglass posts in endodontically-treated teeth restored with direct resin composite.

PURPOSE: To assess the fracture strength of cavity preparations, directly restored with resin composite, with and without the presence of fiberglass posts with different diameters. METHODS: 84 extracted third molars were embedded in acrylic resin and divided into six groups (n = 14 per group): healthy (H); cavity preparation (P); cavity preparation + endodontic treatment (PE); PE + resin composite (R); PE + R + 2 horizontally transfixed fiberglass posts 1.1 mm in diameter (PERP1); PE + R + 2 fiberglass posts 1.5 mm in diameter (PERP2). The MOD cavity preparations were standardized with their width corresponding to 2/3 of the buccolingual distance and occlusogingival depth of 4 mm, with 2 mm remaining above the cemento-enamel junction. Endodontic treatments were performed in the PE, R, PERP1 and PERP2 groups. The buccal surface received two demarcations to create orifices for placement of the PERP1 and PERP2 posts. Once the fiberglass posts were placed, the teeth were restored with resin composite. In group R, only resin composite was used. After 24 hours, the teeth were subjected to the fracture toughness test on a universal testing machine. A 10 KN load cell and crosshead speed of 1 mm/minute was used until fracture occurred. After testing, the teeth were inspected for the type of fracture classified as: pulpal floor fracture (AP) or cuspal fracture (CP). RESULTS: The data were subjected to ANOVA and Tukey's test (P < 0.05%), demonstrating a statistical difference between groups: H 3830NA; P 778ND; PE 572.93ND; R 1782NC; PERP1 2988NB; PERP2 3100NAB. The fracture pattern was similar between the tested groups, showing 50% of fracture for cusps and pulpal floor.

The influence of postpouring time on the roughness, compressive strength, and diametric tensile strength of dental stone.

STATEMENT OF PROBLEM: The optimum time after pouring a dental impression before removing the dental cast is unknown with regard to the strength and roughness of the stone. Setting times and the commercial products used are important variables. PURPOSE: The purpose of this study was to evaluate the effect of postpouring time on the surface roughness, compressive strength, and diametric tensile strength of Type IV dental stone. MATERIAL AND METHODS: A total of 270 specimens were prepared from 3 commercial brands of dental stone (Durone, Fuji Rock, and Tuff Rock). Surface roughness, compressive strength, and diametric tensile strength were assessed at 1 hour, 24 hours, and 7 days after pouring. Specimens 6 mm in diameter and 3 mm in height were produced for roughness and diametric tensile strength tests. Specimens 3 mm in diameter and 6 mm in height were used to measure compressive strength. The results were analyzed with the general linear model and Tukey honestly significant difference test (α=.05). RESULTS: The surface roughness measured for the different types of dental stone tested varied from 0.3 µm (Durone, 1 hour) to 0.64 µm (Tuff Rock, 7 days). The diametric tensile strength ranged from 3.94 MPa (Tuff Rock, 1 hour) to 9.20 MPa (Durone, 7 days). The compressive strength varied from 26.67 MPa (Durone, 1 hour) to 65.14 MPa (Fuji Rock, 7 days). CONCLUSIONS: Surface roughness (P=.005), diametric tensile strength (P=.001), and compressive strength (P=.001) increased significantly with time after pouring. The commercial brand used affected roughness (P=.001), diametric tensile strength (P=.004), and compressive strength (P=.001). Tuff Rock exhibited the highest surface roughness. The highest diametric tensile strength values were recorded for Durone and Fuji Rock. Fuji Rock exhibited the highest compressive strength.

Influence of resin cements on cuspal deflection and fracture load of endodontically-treated teeth restored with composite inlays.

OBJECTIVES: To evaluate the influence of resin cements on cuspal deflection, fracture load and failure mode of endodontically-treated teeth restored with composite resin inlays. MATERIALS AND METHODS: Forty maxillary premolars were randomly divided into four groups: G1 (sound teeth, control), G2 (RelyX ARC), G3 (RelyX Unicem) and G4 (Maxcem Elite). The teeth from groups 2, 3 and 4 received mesial-occlusal-distal preparations and endodontic treatments. Impressions were taken with vinyl polysiloxane and poured using type IV die stone. Inlays with Z250 composite resin were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal surface and the cuspal deflection was measured using a micrometer. The specimens were then subjected to an axial load until failure occurred. The resulting failure mode was analyzed. RESULTS: The means for cuspal deflection (µm) and fracture load (N) followed by the same letter represent no statistically significant difference based on ANOVA and Tukey's test (p < 0.05). Cuspal deflection: G1 = 4.7 (± 1.7)(a), G2 = 12.0 (± 8.9)(a), G3 = 39.0 (± 27.0)(b) and G4 = 56.8 (± 18.2)(b). Fracture load: G1 = 1982 (± 893)(a), G2 = 690.9 (± 225.5)(b), G3 = 679 (± 193.6)(b) and G4 = 465.5 (± 121.6)(b). G1 presented cusp fractures only at the cement-enamel junction (CEJ). There was a high frequency of cusp fractures below the CEJ in G2, G3 and G4. CONCLUSIONS: Composite resin inlays luted with resin cements do not recover the strength of sound teeth. However, teeth restored with composite resin inlays and luted with RelyX ARC can withstand mechanical fatigue longer before failure occurs than those luted with RelyX Unicem and Maxcem Elite.

Influence of scanbody design and intraoral scanner on the trueness of complete arch implant digital impressions: An in vitro study.

This study aimed to compare the accuracy of full-arch digital implant impressions using seven different scanbodies and four intraoral scanners. A 3D-printed maxillary model with six implants and their respective multi-unit abutments was used for this study. Seven scanbodies (SB1, SB2, SB3, SB4, SB5, SB6, and SB7) and four intraoral scanners (Primescan®, Omnican®, Trios 3®, and Trios 4®) were assessed. Each combination group was scanned ten times and a dental lab scanner (D2000, 3Shape) was used as a reference. All scans were exported as STL files, imported into Convince software (3Shape) for alignment, and later into Blender software, where their 3D positions were analyzed using a Python script. The 3D deviation, angular deviation, and linear distance between implants #3 and #14 were also measured. Accuracy was measured in terms of "trueness" (scanbody 3D deviation between intraoral scan and desktop scan). Kruskal-Wallis followed by the Bonferroni correction was used to analyze the data (⍺ = .05). The study found statistically significant differences in digital impression accuracy among the scanners and scanbodies (p<0.001). When comparing different intraoral scanners, the Primescan system showed the smallest 3D deviation (median 110.59 µm) and differed statistically from the others, while Trios 4 (median 122.35 µm) and Trios 3 (median 130.62 µm) did not differ from each other (p = .284). No differences were found in the linear distance between implants #3 and #14 between Trios 4, Primescan, and Trios 3 systems. When comparing different scanbodies, the lowest median values for 3D deviation were obtained by SB2 (72.27µm) and SB7 (93.31µm), and they did not differ from each other (p = .116). The implant scanbody and intraoral scanner influenced the accuracy of digital impressions on completely edentulous arches.

Fatigue resistance and failure mode of novel-design anterior single-tooth implant restorations: influence of material selection for type III veneers bonded to zirconia abutments.

OBJECTIVES: This study assessed the fatigue resistance and failure mode of type III porcelain and composite resin veneers bonded to custom zirconia implant abutments. MATERIAL AND METHODS: Twenty-four standardized zirconia implant abutments were fabricated. Using the CEREC 3 machine, type III veneers of standardized shape were milled in ceramic Vita Mark II or in composite resin Paradigm MZ100. The intaglio surfaces of the restorations were hydrofluoric acid etched and silanated (Mark II) or airborne-particle abraded and silanated (MZ100). The fitting surface of the abutments was airborne-particle abraded, cleaned, and inserted into a bone level implant (BLI RC SLActive 10 mm). All veneers (n=24) were adhesively luted with a zirconia primer (Z-Prime Plus), adhesive resin (Optibond FL) and a pre-heated light-curing composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz) was simulated, starting with a load of 40 N, followed by stages of 80, 120, 160, 200, 240, and 280 N (20,000 cycles each). Samples were loaded until fracture or to a maximum of 140,000 cycles. Groups were compared using the life table survival analysis (Logrank test at P=.05). RESULTS: Mark II and MZ100 specimens fractured at an average load of 216 N and 229 N (survival rate of 17% and 8%), respectively, with no difference in survival probability (P=.18). Among the fractured samples, 40% of the failures were at the abutment level for Mark II and 27% were at the abutment level for MZ100. No exclusive adhesive failures were observed. CONCLUSIONS: Type III Mark II and Paradigm MZ100 veneers showed similar fatigue resistance when bonded to custom non-retentive zirconia implant abutments. The bond was strong enough to induce abutment fractures. MZ100 presented a higher percentage of "friendly" failures, i.e. maintaining the restoration-abutment adhesive interface and the abutment itself intact.

Effect of whitening dentifrices on the surface roughness of commercial composites.

PURPOSE: Our study aimed to test the null hypothesis that whitening and non-whitening dentifrices affect similarly the surface roughness of commercial microhybrid composites, independent of the brushing time. MATERIALS AND METHODS: One hundred and ninety-two disc-shaped specimens of Filtek Z250 (3 M/ESPE, St. Paul, MN, USA) and Rok (SDI, Australia) were built up and randomly assigned to 24 groups, based on the dentifrices used (two whitening dentifrices: Colgate Max White-Colgate-Palmolive, São Bernardo do Campo, São Paulo, Brazil and Close Up Extra Whitening-Unilever, Brasil Higiene Pessoal e Limpeza Ltda, Ipojuca, Pernambuco, Brazil; and one non-whitening dentifrice: Colgate Total 12 Clean Mint-Colgate-Palmolive), and on the simulated brushing times (24 hours, 6, 12 and 24 months). The specimens were submitted to the toothbrushing regimens after which the surface roughness (Ra) was measured. Data was submitted to analysis of variance and Tukey test (α=0.05). RESULTS: The composite's surface roughness was significantly affected by the composites (p=0.0007), the dentifrices (p=0.0001), and the simulated brushing time (p=0.0001). Higher roughness was observed when the whitening dentifrices were used and when the brushing time increased. Filtek Z250 was more affected than Rok, especially after 24 months of simulated brushing. CONCLUSION: Whitening dentifrices produced higher surface roughness in the composites tested. The degree of surface compromising increased with brushing time and depends on the composite's microstructure and composition.

Influence of dental crown topography on fracture resistance of premolars with MOD preparation and subjected to different restorative protocols.

To evaluate whether dental crown topography influences the fracture resistance of premolars treated endodontically and with MOD preparation subjected to different restorative protocols. Sixty-four human premolars with one or two roots in equal numerical proportions (n) were selected and randomly divided into four groups (n = 8): (S = single-rooted; D = double-rooted) SS: sound single-rooted; SNR: endodontics (E) + MOD cavity preparation; SR: E + MOD + resin restoration (RS); SP: E + MOD + RS + horizontal zirconia post (ZP); DS: sound double-rooted; DNR: E + MOD; DR: E + MOD + RS; and DP: E + MOD + RS + ZP. After allocation to the groups, the samples were thermocycled and then subjected to the fracture resistance test. Failures after the fracture test were classified as irreparable (with pulp floor fracture) or reparable (without pulp floor fracture). Data were analysed using one-way anova and the Tukey test (α = 0.05). Single-rooted premolars were more resistant to fracture than double-rooted premolars. The restorative treatment using a horizontally transfixed zirconia post improved fracture resistance, resembling that of a healthy tooth.

Effect of conditioner on microtensile bond strength of self-adhesive resin cements to dentin.

OBJECTIVE: Evaluate, in vitro, the microtensile bond strength (µTBS) of RelyX ARC conventional resin cement and RelyX Unicem and Maxcem self-adhesive resin cements to dentin, and the influence of polyacrylic acid pretreatment on the µTBS. MATERIAL AND METHODS: Flat dentin surfaces were obtained in 15 third molars which were randomly divided into 5 groups: Group 1 - RelyX ARC (control); Group 2 - RelyX Unicem; Group 3 - Maxcem Elite; Group 4 - 22.5% polyacrylic acid and RelyX Unicem; Group 5 - 22.5% polyacrylic acid and Maxcem Elite. A block of composite resin was built over the resin cements. The samples were sectioned to obtain beams, and 20 specimens for each group were submitted to µTBS on a universal testing machine. Failure modes were analyzed by scanning electron microscopy. RESULTS: According to ANOVA and Tukey test, the highest µTBS mean (MPa) was obtained with RelyX ARC (21.38), which did not differ statistically from Maxcem Elite with polyacrylic acid pretreatment (19.22) and RelyX Unicem with polyacrylic acid pretreatment (17.75) (p>0.05). The latter two groups did not differ statistically from RelyX Unicem (16.98) (p>0.05). The lowest mean was obtained for Maxcem Elite (6.43), which differed statistically from the other groups (p<0.05). All failures were adhesive for Maxcem Elite without polyacrylic acid pretreatment, and mixed failures were predominant in the other groups. CONCLUSIONS: RelyX ARC achieved higher µTBS to dentin in comparison to the self-adhesive resin cements. Polyacrylic acid pretreatment was effective in improving the µTBS of Maxcem Elite, but did not influence the µTBS for RelyX Unicem.

Fracture strength of endodontically treated molars transfixed horizontally by a fiber glass post.

PURPOSE: To assess the effect of a horizontally transfixed fiber glass post placed between buccal and palatal surfaces, on the fracture strength of endodontically treated molar teeth with MOD cavities, either restored with resin-based composite, or not. METHODS: 75 sound maxillary human third molars were extracted, embedded in acrylic resin blocks and randomly assigned to five groups (n=15). Group A (sound teeth), (control) and Groups B, C, D and E, which were subjected to the following procedures after endodontic treatment: GB--(MOD+Endo), GC--(MOD+Endo+Post), GD--MOD and composite restoration (MOD+Endo+CR), GE--(MOD+Endo+Post+CR). The specimens were stored in distilled water at 37 degrees C for 24 hours. Later, a compressive force was applied by means of a universal testing machine at 1 mm/minute speed, parallel to the long axis of the teeth until fracture occurred. RESULTS: The means of the results (N) followed by the same letter represent no statistical difference by ANOVA and Tukey (P<0.05): GA = 4289.8 (+/- 1128.9)a, GB = 549.6 (+/- 120.7)b, GC = 1474.8 (+/- 338.1)c, GD = 1224.7 (+/- 236.0)c, GE = 2645.4 (+/- 675.1)d. In the analysis of qualitative variables, there was a tendency to cusp fracture in all groups except for Group C. The fiber glass post transfixed horizontally in a MOD cavity significantly increased the fracture resistance of the teeth restored with resin composite.

Microtensile bond strength of contemporary adhesives to primary enamel and dentin.

UNLABELLED: The purpose of this study was to assess bond strength of three self-etching and two total-etch adhesive systems bonded to primary tooth enamel and dentin. MATERIALS AND METHODS: Forty extracted primary human molars were selected and abraded in order to create flat buccal enamel and occlusal dentin surfaces. Teeth were assigned to one of the adhesive systems: Adper Scotch Bond Multi Purpose, Adper Single Bond 2, Adper Prompt L-Pop, Clearfil SE Bond and AdheSE. Immediately to adhesive application, a composite resin (Filtek Z250) block was built up. After 3 months of water storage, each sample was sequentially sectioned in order to obtain sticks with a square cross-sectional area of about 0.72 mm2. The specimens were fixed lengthways to a microtensile device and tested using a universal testing machine with a 50-N load cell at a crosshead speed of 0.5 mm/min. Microtensile bond strength values were recorded in MPa and compared by Analysis of Variance and the post hoc Tukey test (a = 0.05). RESULTS: In enamel, Clearfil SE Bond presented the highest values, followed by Adper Single Bond 2, AdheSE and Adper Scotch Bond Multi Purpose, without significant difference. The highest values in dentin were obtained with Adper Scotch Bond Multi Purpose and all other adhesives did not present significant different values from that, except Adper Prompt L-Pop that achieved the lowest bond strength in both substrates. Adper Scotch Bond Multi Purpose and Adper Single Bond 2 presented significantly lower values in enamel than in dentin although all other adhesives presented similar results in both substrates. CONCLUSIONS: contemporary adhesive systems present similar behaviors when bonded to primary teeth, with the exception of the one-step self-etching system; and self-etching systems can achieve bond strength values as good in enamel as in dentin of primary teeth.

Creating three-dimensional tooth models from tomographic images.

UNLABELLED: The use of Finite Element Analysis (FEA) is becoming very frequent in Dentistry. However, most of the three-dimensional models presented by the literature for teeth are limited in terms of geometry. Discrepancy in shape and dimensions can cause wrong results to occur. Sharp cusps and faceted contour can produce stress concentrations, which are incoherent with the reality. AIM: The aim of this study was the processing of tomographic images in order to develop an advanced three-dimensional reconstruction of the anatomy of a molar tooth and the integration of the resulting solid with commercially available CAD/CAE software. METHODS: Computed tomographic images were obtained from 0.5 mm thick slices of mandibular molar and transferred to commercial cad software. Once the point cloud data have been generated, the work on these points started to get to the solid model of the tooth with Pro/Engineer software. RESULTS: The obtained tooth model showed very accurate shape and dimensions, as it was obtained from real tooth data with error of 0.0 to -0.8 mm. CONCLUSION: The methodology presented was efficient for creating a biomodel of a tooth from tomographic images that realistically represented its anatomy.

Influence of the mechanical properties of composites for indirect dental restorations on pattern failure.

This study evaluated the fracture pattern of four composites for indirect dental restoration relating to three-point flexural strength, compressive strength and modulus of elasticity (Solidex, Artglass, belleGlass, and Targis). Ten specimens of each composite were tested in a universal testing machine at 0.5 mm/min crosshead speed for flexural strength and 1mm/min for compressive strength. Fracture pattern was classified as complete or partial fracture. Modulus of elasticity was calculated from flexural strength data. Composites polymerized under high temperatures (belleGlass and Targis) had higher flexural strength and elastic modulus values than composites polymerized by light (Artglass and Solidex). However, they failed earlier under compression because they were more rigid and showed partial fracture in the material bulk.

Evaluation of diametral tensile strength and Knoop microhardness of five nanofilled composites in dentin and enamel shades.

The purpose of this study was to evaluate and compare the mechanical behavior of five nanofilled composites with dentin and enamel shades trough diametral tensile strength and knoop microhardness. 4 Seasons (Ivoclar Vivadent), Esthet X improved (Dentsply), Filtek Supreme (3M), Grandio (Voco) and Palfique Estelite (Tokuyama Dental Corp.) were used in this research. Twenty samples (6 mm diameter and 3 mm thickness) of each material were used. Ten samples were submitted to knoop microhardness and the others to diametral tensile strength examinations. The results were submitted to ANOVA and Tukey statistical tests (a=0.05). There were significant differences between the tested groups (p<0.05). The diametral tensile strength ranged from 36.08 (4 Seansons dentin) to 49.24 (Grandio enamel). The knoop microhardness ranged from 54.45 (Esthet X improved enamel) to 123.90 (Grandio dentin). A great variability in the mechanical behavior of the nanofilled composites was observed. However it was not recorded with dentin and enamel shades with the exception of Grandio.

Fracture resistance of endodontically treated molars restored with horizontal fiberglass posts or indirect techniques.

BACKGROUND: Because of the many possibilities for endodontically restoring the posterior teeth and the high prevalence of restoration failures, this topic continues to be of major concern. A composite resin (CR) restoration reinforced by a horizontal fiberglass post may improve the fracture resistance of endodontically treated teeth. The authors investigated this possibility by comparing the fracture resistance of molars restored with direct techniques with that of molars restored with indirect techniques. METHODS: The authors divided 50 extracted sound third molars into 5 groups: sound teeth, onlay (ON), inlay (IN), direct CR, and transfixed fiberglass post (TFP) plus direct CR. The authors performed standardized mesio-occlusodistal cavity preparations and endodontic treatments. The authors cemented indirect restorations of Lava Ultimate (3M ESPE) adhesively in the ON and IN groups. The authors restored CR group teeth directly with Filtek Z230 XT (3M ESPE). In the TFP group, the authors transfixed 2 fiberglass posts horizontally and restored the teeth directly with CR. Thereafter, the authors submitted the teeth to cyclic fatigue loading with 500,000 cycles at 200 newtons. The authors tested fracture resistance in newtons in a universal testing machine. The authors analyzed data with 1-way analysis of variance and a Tukey test (P < .05). RESULTS: Sound teeth had the highest fracture resistance. ON had the highest recovery of resistance, followed by TFP. CR had the lowest recovery, which was similar to that of IN. CONCLUSIONS: Endodontically treated molars restored with TFP plus CR had fracture resistance similar to those restored with ON, which was higher than that for IN or CR only. PRACTICAL IMPLICATIONS: Horizontal TFPs placed inside a composite restoration had the same performance as did ON restorations.

Micro-tensile bond strength between a resin cement and an aluminous ceramic treated with Nd:YAG laser, Rocatec System, or aluminum oxide sandblasting.

OBJECTIVE: The aim of this study was to evaluate the effect of different surface treatments on bond strength between In-Ceram Alumina (VITA) and Panavia Fluoro Cement (Kuraray), and to verify the association between bond strength values and the percentage of remaining cement on the ceramic surface. BACKGROUND DATA: Although several conventional surface treatments have been used on aluminous ceramic, no study investigated the effect of the Nd:YAG laser. METHODS: Nine In-Ceram Alumina blocks (10 x 10 x 6 mm) received three surface treatments: group 1, Al(2)O(3) sandblasting + silane; group 2, Al(2)O(3) sandblasting + Rocatec Plus + silane; and group 3, Al(2)O(3) sandblasting + Nd:YAG Laser + silane. Resin cement was applied and light cured, followed by the application of composite. Blocks were sectioned to obtain sticks with a cross-sectional area of 1.0 mm(2). Microtensile bond strength (microTBS) was recorded in a universal testing machine at a crosshead speed of 0.5 mm/min. Scanning electron microscopy images of the fractured areas were used to calculate the amount of remaining cement on the ceramic substrate. RESULTS: All treatments yielded statistically different microTBS values (MPa): group 1, 14.38(A); group 2, 20.09(B); and group 3, 23.21(C) (ANOVAand Tukey's test, alpha = 0.05). Pearson's correlation coefficient for microTBS x percentage of remaining cement was r = 0.92 (p < 0.05). CONCLUSIONS: The Nd:YAG laser was the most effective surface treatment, followed by Rocatec and Al(2)O(3) sandblasting. A strong positive association was found between bond strength values and percentage of remaining cement.

Fracture resistance of computer-aided design and computer-aided manufacturing ceramic crowns cemented on solid abutments.

BACKGROUND: Because no information was found in the dental literature regarding the fracture resistance of all-ceramic crowns using CEREC (Sirona) computer-aided design and computer-aided manufacturing (CAD-CAM) system on solid abutments, the authors conducted a study. METHODS: Sixty synOcta (Straumann) implant replicas and regular neck solid abutments were embedded in acrylic resin and randomly assigned (n = 20 per group). Three types of ceramics were used: feldspathic, CEREC VITABLOCS Mark II (VITA); leucite, IPS Empress CAD (Ivoclar Vivadent); and lithium disilicate, IPS e.max CAD (Ivoclar Vivadent). The crowns were fabricated by the CEREC CAD-CAM system. After receiving glaze, the crowns were cemented with RelyX U200 (3M ESPE) resin cement under load of 1 kilogram. For each ceramic, one-half of the specimens were subjected to the fracture resistance testing in a universal testing machine with a crosshead speed of 1 millimeter per minute, and the other half were subjected to the fractured resistance testing after 1,000,000 cyclic fatigue loading at 100 newtons. RESULTS: According to a 2-way analysis of variance, the interaction between the material and mechanical cycling was significant (P = .0001). According to a Tukey test (α = .05), the fracture resistance findings with or without cyclic fatigue loading were as follows, respectively: CEREC VITABLOCKS Mark II (405 N/454 N) was statistically lower than IPS Empress CAD (1169 N/1240 N) and IPS e.max CAD (1378 N/1025 N) (P < .05). The IPS Empress CAD and IPS e.max CAD did not differ statistically (P > .05). According to a t test, there was no statistical difference in the fracture resistance with and without cyclic fatigue loading for CEREC VITABLOCS Mark II and IPS Empress CAD (P > .05). For IPS e.max CAD, the fracture resistance without cyclic fatigue loading was statistically superior to that obtained with cyclic fatigue loading (P < .05). CONCLUSIONS: The IPS Empress CAD and IPS e.max CAD showed higher fracture resistance compared with CEREC VITABLOCS Mark II. The cyclic fatigue loading negatively influenced only IPS e.max CAD. PRACTICAL IMPLICATIONS: The CEREC VITABLOCS Mark II, IPS Empress CAD, and IPS e.max CAD ceramic crowns cemented on solid abutments showed sufficient resistance to withstand normal chewing forces.