Repair of monolithic zirconia restorations with different direct resin composites: effect on the fatigue bonding and mechanical performance.

OBJECTIVE: The study aims to evaluate the shear bond and flexural strength fatigue behavior of yttrium-stabilized zirconia (4YSZ) repaired using different resin composites. MATERIALS AND METHODS: Cylindric specimens of 4YSZ were obtained for the bond strength (Ø = 6 mm, 1.5 mm of thickness) and biaxial flexural strength (Ø = 15 mm, 1 mm of thickness) fatigue tests and divided into 3 groups according to the repair resin composite: EVO (nanohybrid), BULK (bulk-fill), and FLOW (flowable). The zirconia surface was air-abraded with alumina particles, a 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer was applied, and the resin composite was build-up over the zirconia. Fatigue shear bond strength and flexural fatigue strength tests were performed (n = 15). One-way ANOVA and Tukey post hoc tests were carried out for both outcomes, besides scanning electron microscopy and finite element analysis. RESULTS: The repair material affected the fatigue shear bond strength of zirconia ceramic. The BULK group (18.9 MPa) depicted higher bond strength values than FLOW (14.8 MPa) (p = 0.04), while EVO (18.0 MPa) showed similar results to both groups. No effect was observed for the mechanical behavior (p = 0.53). The stress distribution was similar for all groups. CONCLUSION: The repair of yttrium-stabilized zirconia (4YSZ) ceramics with bulk-fill resin composites was the best option for high fatigue bond strength. However, the fatigue mechanical performance was similar regardless of the applied repair material. CLINICAL RELEVANCE: The repair of yttrium-stabilized zirconia (4YSZ) monolithic restorations may be performed with nanohybrid and bulk-fill resin composites in order to promote longevity in the treatment.

Sintering mode of a translucent Y-TZP: Effects on its biaxial flexure fatigue strength, surface morphology and translucency.

OBJECTIVE: This investigation evaluated the effect of two sintering modes of a translucent zirconia (Y-TZP) on its surface roughness, topography, phase-transformation (t → m), translucency and biaxial flexure fatigue strength. MATERIALS AND METHODS: To do so, 50 Y-TZP discs (Ø = 15 mm; thickness = 1.2 mm; IPS e.max ZirCAD LT) were prepared and divided into two groups: Standard mode (SM) and Fast mode (FM). Staircase fatigue testing was performed (piston-on-three balls set-up, ISO 6872:2015), as well as surface roughness, profilometry, scanning electron microscopy (SEM-FEG), energy dispersive X-ray spectroscopy (EDX), phase transformation (t → m) using X-ray diffraction analysis (XRD), translucency parameter analysis (TP and TP00 ) and fractography. RESULTS: The results showed no statistical significant differences for roughness parameters (p > 0.05, SM: Ra = 0.13 ± 0.02, Rz = 1.21 ± 0.26 and RSm = 24.91 ± 2.19; FM: Ra = 0.14 ± 0.03, Rz = 1.32 ± 0.25 and RSm = 24.68 ± 2.16) or flexural fatigue strength (SM: 512 (464-560) MPa; FM: 542 (472-611) MPa) between the groups. In addition, similarity in surface morphological features (SEM and profilometry), composition and phases (EDX and XRD) was observed between the firing protocols. Fractography showed that the failure origin occurred on the tensile side. Sintering mode did not affect the TP (F = 0.001, p = 0.97) and TP00 (F = 0.12, p = 0.72). CONCLUSIONS: Therefore, the fast-sintering mode is suggested as a viable alternative to the standard mode since it does not influence the evaluated surface morphology, microstructure, fatigue strength and translucency of a translucent monolithic zirconia. CLINICAL SIGNIFICANCE: The fast sintering mode is a viable alternative for zirconia without compromising its topography, microstructure, mechanical performance or translucency.

Full-Crown Versus Endocrown Approach: A 3D-Analysis of Both Restorations and the Effect of Ferrule and Restoration Material.

PURPOSE: To assess stress distribution in full-crowns with a composite buildup and endocrowns under axial or oblique loads, both with different ferrules (1 or 2 mm) and ceramic materials (glass ceramic or hybrid ceramic). MATERIALS AND METHODS: Sixteen models were analyzed with finite element analysis. No-separation contacts were considered between restoration/resin cement and resin cement/tooth. The contact between the fixation cylinder and the root was considered perfectly bonded. The axial load was applied to the occlusal surface and the oblique load was applied to the buccal cusp. The resulting tensile stresses were shown for the crown, the cement layer and the tooth. RESULTS: Almost all factors influenced the stress distribution significantly in the crown and the cement layer, as well as the tooth. The only exception was found under oblique loading by the restoration material and the type of crown that were of no significant influence on the stress distribution in the tooth. CONCLUSIONS: Under axial load, the endocrown showed the least tensile stresses in the tooth, but under oblique loads, the full-crown showed less tensile stresses than the endocrown. With the hybrid ceramic material, lower stresses were found in the crown, but higher stresses were present in the cement layer. The 2 mm ferrule is beneficial for reducing the resulting tensile stresses in all modalities.

Mouthguard use and TMJ injury prevention with different occlusions: A three-dimensional finite element analysis.

BACKGROUND/AIMS: There is a lack of data regarding the mechanical responses of the temporo-mandibular joints during an impact to the orofacial region. The aim of this study was to analyze the biomechanical effects of wearing a mouthguard (MG) on the impact response of the mandibular condyle and articular disk according to the type of occlusion. The hypothesis was that the MG would minimize the effect in those structures, regardless of the occlusion type. METHODS: Using modeling software, a human skull with jaw, teeth and articular disk was created. The models were divided according to the occlusion type (Class I, II, or III) and the presence of a mouthguard (with or without). The geometries were exported to analysis software, and the materials were considered ideal. Fixation occurred at the base of the foramen magnum. The load (0-500N, 1s) was applied to the upper central incisors with a steel ball. Maximum principal stress and Von Mises results (MPa) were obtained in the mandibular condyle and articular disk. Minimum principal stress and maximum shear stresses were also recorded in the articular disk. RESULTS: For both structures, the MG caused a decrease in stress concentration regardless of the occlusion and stress criteria. The condyle neck was the most tensile-stressed area while for the articular disk, both the superior and inferior surfaces were the most stressed areas. The highest stress peaks in the disk were found for compression followed by tensile and then shear stress. CONCLUSION: This biomechanical analysis of the effects of using a mouthguard exhibited considerably decreased stresses on the mandibular condyle and articular disk, regardless of the occlusion type.

Different combinations of CAD/CAM materials on the biomechanical behavior of a two-piece prosthetic solution.

AIM: This study evaluated the stress distribution of implant-supported prostheses, varying the different combinations of computer-aided design/computer-aided manufacturing (CAD/CAM) materials between the hybrid abutment and the monolithic crown by three-dimensional (3D) finite element analysis (FEA). MATERIALS AND METHODS: Nine models were designed with Rhinoceros 3D and Ansys software. Each model contained a bone block of the molar area, including an implant (IH; Ø 3.75 × 11 mm) supporting a hybrid abutment (ceramic mesostructure (MS) cemented onto a titanium [Ti] base) and a monolithic crown. The occlusal load was applied to the fossa bottom (300 N; 30 degrees). The results were analyzed using the von Mises stress for each separated prosthetic structure and microstrain for the bone tissue. RESULT: Von Mises maps of the crown, ceramic MS, implant, screw, and cement layers showed a decreased stress concentration as the elastic modulus (E modulus) of the ceramic crown (CR) associated with a rigid ceramic MS decreased. No differences in bone tissue regarding microstrain were observed. CONCLUSION: Implant-supported crowns present less stress concentration when a rigid abutment is associated with resilient crowns.

Do Mechanical Advantages Exist in Relining Fiber Posts with Composite Prior to its Cementation?

PURPOSE: To evaluate two different techniques for glass fiber-reinforced resin post (FRC) insertion by assessing the stress distribution under polymerization shrinkage or masticatory loading and measuring the pull-out bond strength to dentin. MATERIALS AND METHODS: A model of an endodontically treated maxillary central incisor was used for three-dimensional simulation with two conditions: conventionally cemented (FRC) and relined (RFRC). The volumetric solids were exported to analysis software (ANSYS 17.2, ANSYS) in STEP (Standard for the Exchange of Product Data) format. All contacts were considered perfectly bonded between the geometries. Numerical models received a load of 100 N (45 degrees) on the lingual surface. The composite cement polymerization shrinkage was simulated by thermal analogy to obtain Von Mises, maximum principal stress, and shear stress. For in vitro evaluation, a pull-out bond strength test (n = 20/N = 40) was performed (50 Kgf, 1 mm/min) after mechanical cycling (in water at 37°C, 84 N, 2 bar, 45 degrees, 106 cycles, 4 Hz), and failure analysis was subsequently performed. The results were analyzed using one-way ANOVA and Tukey's test (α < 0.05). RESULTS: The FRC group showed more stress concentration in the cement layer. The RFRC group [(32 ± 13); (288 ± 129)] presented better performance than the FRC group [(6 ± 7); (152 ± 87)] for stress distribution and bond strength (p < 0.05). Adhesive and mixed failures occurred in both groups. CONCLUSION: Relined fiberglass posts reduced the stress generated by polymerization shrinkage and showed greater bond strength to dentin.

Computer-aided design finite element modeling of different approaches to rehabilitate endodontically treated teeth.

BACKGROUND: Carious lesions and dental fractures cause weakening in the dental structure. In these situations, endodontic treatment and prosthetic rehabilitation using an intraradicular post are indicated. However, the postspace preparation of the root canal further weakens the dental remnant, especially if there is no ferrule present. This study aimed to evaluate the stress distribution in endodontically treated upper premolars treated with different rehabilitation approaches. MATERIALS AND METHODS: An endodontically treated first upper premolar was modeled for finite element analysis. Three different approaches were carried out on this model: rehabilitation with fiberglass post (FCP), endocrown (ECW), or buildup. The models were exported in STEP format to the analysis software (ANSYS 17.2, ANSYS Inc., Houston, TX, USA). The solids were considered isotropic, homogeneous, and linearly elastic. A mechanical, structural static analysis was used as the criterion of maximum principal stress to show regions under tensile stress to evaluate the stress distribution in the restoration, cementation line, and root. A load of 400 N (90°) was applied to the lingual triangular ridge. The values of maximum principal stress in MPa were evaluated through colorimetric graphs. RESULTS: Similar stress concentration was observed for all groups. However, the ECW group presented higher values in the restoration/cement interface and root dentin. CONCLUSIONS: All the treatment modalities had favorable mechanical behavior to support the masticatory loads; nevertheless, the ECW group presented a higher risk of detachment failure.

Surface roughness and bond strength between Y-TZP and self-adhesive resin cement after air particle abrasion protocols.

The aim of this study was to evaluate the influence of different air particle abrasion (APA) protocols-with variations in particle types, duration of application, and the distance between the device tip and the ceramic-on the surface roughness (SR) of zirconia-based ceramic (yttria-stabilized tetragonal zirconia polycrystal [Y-TZP]) and the shear bond strength (SBS) between Y-TZP and resin cement. In total, 135 sintered Y-TZP blocks were polished and divided into 9 groups according to 3 factors: particle (alumina vs alumina coated with silica), duration (5 vs 10 seconds), and distance (contact vs 10 mm away). All 3 factors significantly influenced the SR values between the experimental groups and the control group. For SBS, only the particle type was a statistically significant factor. Results showed that air particle abrasion with silica-coated alumina resulted in higher SBS, even though the SR values associated with those groups were not the highest.

Influence of alveolar bone level on the pull-out bond strength of fiber-reinforced composite posts to root dentin.

This in vitro study evaluated the influence of alveolar bone level and type of cement on pull-out bond strength between different fiber-reinforced composite (FRC) posts and root dentin. Sixty bovine teeth were sectioned, and their root canals were prepared. The specimens were divided into 6 groups (n = 10) according to 2 factors: alveolar bone level and type of cement. Each root was embedded in acrylic resin to the depth of 7, 10, or 14 mm, simulating different alveolar bone levels. After the FRC posts were treated with 37% phosphoric acid and silane was applied, they were cemented with either a conventional resin cement or a self-adhesive resin cement and subjected to mechanical cycling. The results indicated that neither the alveolar bone level nor the type of cement played a significant role in the pull-out bond strength of the FRC posts to root dentin. Therefore, it is concluded that conventional and self-adhesive resin cements can be used to lute FRC posts to tooth roots, even in the presence of significant alveolar bone resorption.

Can application of universal primers alone be a substitute for airborne-particle abrasion to improve adhesion of resin cement to zirconia?

PURPOSE: To determine whether universal primers alone can deliver similar levels of adhesion of resin cement to zirconia ceramic when compared to their application in conjunction with airborne-particle abrasion. MATERIALS AND METHODS: Sintered zirconia blocks (N = 160) (Lava, 3M ESPE), (5.25 × 5.25 × 3 mm3) were embedded in acrylic resin, polished, and randomly distributed into 16 groups (n = 10 per group), according to the factors "universal primer" (8 levels) and "air-particle abrasion" (2 levels): 1. ctr: control, without application of a universal primer; 2. AP: Alloy Primer; 3. MP: Monobond Plus; 4. MZP: Metal Zirconia Primer; 5. MZ: MZ Primer; 6. Sg: Signum Zirconia Bond; 7. SbU: Singlebond Universal; 8. ZP: Z Prime Plus. The universal primers were also used after air abrasion (A) of zirconia to form the following 8 groups: Ctr-A, AP-A, MP-A, MZP-A, MZ-A, Sg-A, SbU-A, and ZP-A. After ultrasonic cleaning, air abrasion was performed using Al2O3 particles (110 µm, 2.5 bar, 20 s at 10 mm) in a chairside air-abrasion device. After ultrasonic cleaning again, universal primers were applied according to each manufacturer's recommendation. The resin cement (RelyX ARC, 3M ESPE) was built up incrementally and photopolymerized on the zirconia surface using a silicone mold (Ø = 3.5, height = 3 mm). All specimens were stored in distilled water (60 days at 37°C) and then subjected to shear bond strength testing (SBS) in a universal testing machine (1 mm/min). On a separate set of zirconia specimens, contact angle measurements were made using the sessile drop technique with a goniometer after the application of universal primers on control and air-abraded zirconia surfaces. Data (MPa) were analyzed using one-way ANOVA, Tukey's test, and Student's t-test (α = 0.05). RESULTS: When universal primers were used alone, SbU presented significantly higher mean SBS (19.5 ± 5.8) that did the other primers (0 to 9.9 ± 6.6) (p = 0.001). When air abraded, the groups AP-A (14.1 ± 6.1), MP-A (15.9 ± 5.4), ZP-A (16.9 ± 7.3), SG-A (19.1 ± 2.1), SbU-A (12 ± 1.5) showed significant differences (p = 0.03). Adhesive performance of all universal primers was enhanced after air abrasion, with the exception of the SbU and MZ primers. After air abrasion, contact angle measurements were lower for the each primer (without air abrasion: 28.9 to 83.9; with air abrasion: 27.1 to 63.0), except for MZP. CONCLUSION: Air abrasion with 110 µm Al2O3 followed by universal primer application increased the bond strength of tested resin cement to zirconia, with the exception of SbU and MZ.

Brittle dental ceramics: A challenge in dentistry.

The challenge of dental ceramic degradation necessitates innovative technology, rigorous testing and proactive dental care, demanding collaboration between researchers, dentists and patients to ensure durable and reliable dental restorations.

Comparative Strength Study of Indirect Permanent Restorations: 3D-Printed, Milled, and Conventional Dental Composites.

Background/Objectives: Limited research has been performed to assess the strength of resin-bonded 3D-printed restorations. Based on that, this study investigates the impact of different manufacturing methods on the fracture load of indirect composite restorations (ICRs) following an aging process. Methods: Three manufacturing techniques-conventional (CRC), milled (MRC), and printed (PRC)-were evaluated using 60 specimens, each with a diameter of 10 mm and a thickness of 1.0 mm. Sandblasting with Al2O3 particles was employed to optimize the bonding process, significantly influencing surface roughness parameters (Ra, Rz, RSm). All specimens were bonded to the dentin analog using composite resin cement and subjected to either 10,000 thermocycles (TC) or storage (ST) at 37 °C in distilled water. Fracture load assessments were performed using a universal testing machine. A finite element analysis was conducted to assess stress distribution. Results: Two-way ANOVA results indicated that the manufacturing method significantly affected mean fracture load values (p < 0.001), with PRC showing the highest mean fracture load (4185 ± 914 N), followed by MRC (2495 ± 941 N) and CRC (599 ± 292 N). The aging protocol did not have a significant impact on fracture load. Conclusions: This study revealed that 3D-printed resin composite exhibited comparable strength to milled resin composite when adhesively cemented, suggesting it is a promising option for indirect composite restorations based on its mechanical performance. However, further research is needed to evaluate its bond strength and optimal surface treatment methods to prevent early debonding.

Effect of printing layer orientation and polishing on the fatigue strength of 3D-printed dental zirconia.

OBJECTIVE: The aim of the study was to evaluate the influence of surface polishing and printing layer orientation on the fatigue behaviour of 3 mol% yttria-stabilized zirconia (3Y-TZP) by stereolithography (SLA) in comparison with subtractive manufacturing. MATERIALS AND METHODS: 60 experimental zirconia bar-shaped specimens were 3D-printed (P) via SLA, and 30 specimens were milled (M) from commercial zirconia block (Lava™ Frame, 3 M ESPE AG). All specimens had the same dimensions (1 mm × 1 mm x 12 mm) after sintering. The 3D-printed specimens were randomly divided according to printing orientations: parallel or perpendicular to the tensile surface in the fatigue test. The specimens were subsequently submitted to two surface finishing protocols (n = 15/gr): unpolished or polished. Their phase compositions were analysed by X-ray diffraction. The fatigue behaviour was evaluated by a stepwise approach. RESULTS: The milled and both 3D-printed groups showed similar phase compositions for the as-sintered condition. Considerable amounts of rhombohedral phase were detected after polishing. Milled unpolished samples presented significantly higher fatigue strength than 3D-printed unpolished samples. Polishing did not improve the fatigue strength for milled zirconia but was advantageous for the 3D-printed specimens. 3D-printed specimens with parallel printing-layer orientation were significantly stronger than specimens with perpendicular layers regardless of surface finishing. CONCLUSION: The manufacturing techniques had a significant influence on the fatigue strength of 3Y-TZP, but not on the phase compositions of the surface. The polishing protocol showed different effects on 3Y-TZP fatigue strength and induced phase transition of the 3Y-TZP from Tetragonal to Rhombohedral. The best fatigue strength was achieved through milling using an unpolished surface and SLA-printed layers that were parallel to the tensile surface, followed by polishing.

Effect of brushing simulation on the wear behavior of repaired CAD-CAM restorations.

OBJECTIVE: The aim of the present study was to evaluate the influence of multidirectional brushing on the surface roughness, morphology, and bonding interface of resin-repaired CAD-CAM ceramic and composite restorations. MATERIALS AND METHODS: Twelve (N = 12) blocks (4 mm × 4 mm × 2 mm for parallel axis; 5 mm × 4 mm × 2 mm for perpendicular axis) of lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar AG) and CAD-CAM resin composite (Tetric CAD, Ivoclar AG) were obtained and repaired with direct resin composite (Clearfil AP-X, Kuraray). An abrasive slurry was prepared and the brushing was performed according to each restorative material and axis of brushing (n = 6; perpendicular to repair interface and parallel to repair interface) during 3,650 cycles (240 strokes per minute) to simulate 3 years of brushing. The surface roughness (Ra) and the profile variation for each material (restoration and direct repair resin composite) were measured at the baseline condition and after brushing, and the mean roughness and presence of steps at the repair interface were evaluated through factorial analysis of Variance (ANOVA). Scanning Electron Microscopy (SEM) images were taken to evaluate the surface topography of the repaired materials after brushing. RESULTS: The mean roughness of the repaired CAD-CAM restorations was affected by the brushing (P < .05), mainly when evaluating the repair material and the interface (P < .05), while the restorative CAD-CAM materials presented more stable values. The profile evaluation showed higher steps at the interface when repairing lithium disilicate than for CAD-CAM resin composite. CONCLUSION: Repaired CAD-CAM restorations were susceptible to wear after brushing simulation. The surface roughness of the direct resin composite was the most affected leading to step development at the interface, particularly in the repaired lithium disilicate samples. Cinical maintenance recalls and polishing protocols must be considered to enhance the longevity of such restorations.

Impact of try-in paste removal on the fatigue behavior of bonded lithium disilicate ceramics.

This in vitro study assessed the effectiveness of three cleaning protocols (air-water spray, 37% phosphoric acid, or Ivoclean) on lithium disilicate restorations' fatigue behavior after try-in paste application, compared to a clean condition. Lithium disilicate discs (IPS e.max CAD, Ivoclar) with Ø-= 12 mm and 1 mm thickness were prepared from prefabricated CAD-CAM blocks, polished, subjected to CAD-CAM milling topography simulation and crystallization. After, etching with 5% hydrofluoric acid and the application of try-in paste (Variolink try-in paste shade white; load of 2.5 N for 5 min) was performed. Discs that received try-in paste were divided into three groups according to the removal protocol: SPRAY - air-water spray for 30 s; HPO - active application of 37% phosphoric acid for 60 s; IVOC - application of Ivoclean for 20 s. Control group (CTRL group) did not receive the try-in paste application. Half of the specimens (n= 15) were tested in the baseline condition (24 h up to 7 days), and the others underwent 25,000 thermal cycles (5 - 55 °C) + 210 days of distilled water storage (37 °C). Additional specimens (n= 3) underwent monotonic testing (1 mm/min). Fatigue testing involved a cyclic fatigue approach (20 Hz, initial load = 100 N - 5000 cycles, step size = 50 N - 10,000 cycles) until a visible crack appeared. Fractographic and topographic analyses were performed. Fatigue data were statistically analyzed with two-way ANOVA, Kaplan-Meier log-rank (Mantel-Cox), and independent t-test (α= 0.05). In the baseline condition, the IVOC group resulted in a superior fatigue behavior compared to the CTRL and SPRAY groups, but similar to the HPO group. The HPO and SPRAY presented a similar fatigue behavior to the CTRL group. It was noticed a decrease in fatigue behavior after aging, which resulted in all the cleaning protocols leading to similar fatigue behavior compared to the CTRL group. On the SPRAY group surface, try-in pastes remnants were noticed. In summary, despite a detrimental impact at baseline conditions, all tested cleaning protocols seem proper to remove the try-in paste from the ceramic's surface in the long-term evaluation.

Fluoride and Calcium Release from Alkasite and Glass Ionomer Restorative Dental Materials: In Vitro Study.

This study evaluated the effect of pH and temperature on the ion (F- and Ca2+) release of a resin-based material containing alkaline fillers and a self-setting high-viscous glass ionomer cement. Disks were prepared according to manufacturers' instructions for both materials: the EF group (Equia Forte HT filling, GC) and the CN group (Cention N, Ivoclar). Specimens were immersed in 50 mL buffer solution with three different pHs (4.8, 6.8, and 8.8), and stored at 0°, 18°, 37°, and 44 °C. After 24 h, 7 d, and 28 d, cumulative F- and Ca2+ releases were analyzed by chromatography and mass spectrometry, and pH was measured. Both materials showed minimal changes in pH with final values after 28 d of 5.17 ± 0.56 for CN and 5.12 ± 0.24 for EF. In all experimental conditions, the percentages of ion release were higher for EF than for CF. In particular, both materials showed a significant difference in temperature in F- release. Regardless of the pH values, the highest Ca2+ ion release was after 28 days, with a significant difference in temperature for CN and EF. Within the limit of this study, the temperature storage influenced ion release and the high-viscous glass ionomer showed the maximum values.

The influence of pre-heating the restoration and luting agent on the flexural strength of indirect ceramic and composite restorations.

Background: This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites. Materials and Methods: 400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated. Results: There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations. Conclusion: Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations.

Different luting procedures significantly impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations, with light-curing cement demonstrating superior performance for specific thicknesses.Pre-heated resin composites, either with or without pre-heated restorations, offer a viable alternative to conventional dual-curing cement for bonding indirect restorations, presenting potential clinical advantages.Restoration thickness plays a crucial role in the mechanical response of restorations, with thinner resin composite restorations benefiting from dual- or light-curing, while thicker ones are less sensitive to luting procedure variations.

Stress Concentration of Hybrid Occlusal Splint-Mouthguard during a Simulated Maxillofacial Traumatic Impact: 3D-FEA.

Mouthguards (MG) are protective devices that can reduce the risks of facial trauma. However, many athletes do not use them. Additionally, MG wear with coincidental parafunctional activity has not been considered. The aim of this study was to evaluate the stress distribution as a consequence of a direct impact comparing a conventional MG with a novel hybrid appliance (HMG). Using computer-aided design (CAD) software, a human skull was modeled with the teeth inserted into their respective alveolus. The models were divided according to the MG type (conventional or hybrid). The geometries were exported to the computer-aided engineering (CAE) software and the materials were considered isotropic. Fixation was defined at the base of the maxilla. The load was applied using a hockey puck. The total deformation (mm) and the von Mises stress (MPa) results were obtained for the MGs (conventional and hybrid), upper teeth, lower teeth, and maxillary bone. Despite the presence of an MG, it is still possible to observe generated stress in all structures. However, the hybrid design was more efficient than the conventional design in reducing the displacement during the impact and consequently the stress on the upper teeth, lower teeth, and maxillary bone. Higher stress magnitude was more concentrated at the inner portion of the hybrid design than the conventional device. The HMG appliance decreased the stress concentration in the teeth and in the bone, limiting the areas susceptible to injuries to the regions directly impacted by the hockey puck. Although the novel HMG may mitigate injury, some stress will still result, and any possible injury should be evaluated by a dental professional.

Mechanical Behavior of Alkasite Posterior Restorations in Comparison to Polymeric Materials: A 3D-FEA Study.

The present investigation evaluated the effect of the combination of different dental filling materials in Class I cavities under occlusal loading using three-dimensional finite elements analysis (FEA). Six computer-generated and restored models of a lower molar were created in the CAD software and compared according to the biomechanical response during chewing load condition. Two adhesively bonded bulk restorative materials [bulk-fill resin composite (BF) or Alkasite (Alk)] were evaluated with or without the presence of a base material below (flowable resin composite or glass ionomer cement). A food bolus was placed on the occlusal surface mimicking the compressive occlusal load (600 N) during the static linear analysis. The maximum principal stress (tensile) was calculated as stress criteria in enamel, dentin and restoration. All models showed high stresses along the enamel/restoration margin with a similar stress trend for models restored with the same upper-layer material. Stress values up to 12.04 MPa (Alk) or up to 11.12 MPa (BF) were recorded at the enamel margins. The use of flexible polymeric or ionic base material in combination with bulk-fill resin composite or Alk did not reduce the stress magnitude in dentine and enamel. Class I cavities adhesively restored with bulk-fill resin composite showed lighter stress concentration as well as Alk. Therefore, adhesively bonded Alk restoration showed a promising mechanical behavior when used with different base materials or as a bulk restoration for posterior Class I cavity.

Substrate Rigidity Effect on CAD/CAM Restorations at Different Thicknesses.

OBJECTIVES: This article evaluated the effect of substrates rigidities on the post-fatigue fracture resistance of adhesively cemented simplified restorations in lithium disilicate glass ceramic. METHODS: Precrystalized computer-aided design/computer-aided manufacturing ceramic blocks were processed into disc-shaped specimens (n = 10, Ø = 10 mm), mimicking a simplified restoration at two thicknesses (0.5 and 1.0 mm). Thereafter, the discs were cemented onto different base substrates (dentin analogue [control], dentin analogue with a central core build-up of resin composite [RC], or glass ionomer cement [GIC]). The specimens were subjected to mechanical cycling in a chewing simulator (100 N, 1 × 106 cycles, 4 Hz) and then subjected to thermocycling aging (10,000 cycles, 5/37/55°C, 30 seconds). After the fatigue protocol, the specimens were loaded until failure (N) in a universal testing machine. Finite element analysis calculated the first principal stress at the center of the adhesive interface. RESULTS: The results showed that "restoration thickness," "type of substrate," and their interaction were statistically significant (one-way analysis of variance; p < 0.001). Regardless the restoration thickness a higher fracture load was observed for specimens cemented to dentin analogue. Among the base materials, RC build-up presented the highest fracture load and lower stress magnitude for both restoration thicknesses in comparison with GIC build-up. The 0.5-mm restoration showed higher stress peak and lower fracture load when submitted to the compressive test. CONCLUSION: More flexible base material reduces the fracture load and increases the stress magnitude of adhesively cemented lithium disilicate restorations regardless the ceramic thickness. Therefore, more rigid substrates are suggested to be used to prevent restoration mechanical failures.