Laboratory aspects of zirconia restorations.

UNLABELLED: Zirconia restorations are now accepted and commonly prescribed in dentistry. However, these materials undergo hydrothermal ageing which can reduce their clinical performance. Appropriate handling is essential to limit the restorations' susceptibility to low temperature degradation/ageing. Through appropriate clinical prescribing and laboratory manufacture, an aesthetic, strong and long-lasting restoration can be fabricated. CLINICAL RELEVANCE: This article will inform the reader about zirconia as a dental material as well as how best to handle a zirconia restoration.

A study of temperature rise in the pulp chamber during composite polymerization with different light-curing units.

AIM: The study compared pulp temperature rise during polymerization of resin-based composites (RBCs) using halogen and LED light-curing units (LCUs). METHODS AND MATERIALS: A total of 32 teeth extracted from patients aged 11-18 years were used in the study. Thermocouples placed on the roof of the pulp chamber using a novel 'split-tooth' method. In Group 1 a halogen LCU with a light intensity of 450 mW cm(-2) was used and in Group 2, an LED LCU with a light intensity of 1100 mW cm(-2) was used. The teeth were placed in a water bath with the temperature regulated until both the pulp temperature and the ambient temperature were stable at 37 degrees C. Continuous temperature records were made via a data logger and computer. The increase in temperature from baseline to maximum was calculated for each specimen during the curing of both the bonding agent and the RBC. RESULTS: The rise in pulp temperature was significantly higher with the LED LCU than with the halogen LCU for bonding and RBC curing (p<0.05). The major rise in temperature occurred during the curing of the bonding agent. During the curing of the RBC, rises were smaller. CONCLUSIONS: Curing of bonding agents should be done with low intensity light and high intensity used only for curing RBC regardless of whether LED or halogen LCUs are used.

Esthetic Evaluation of Implant Crowns and Peri-Implant Soft Tissue in the Anterior Maxilla: Comparison and Reproducibility of Three Different Indices.

BACKGROUND: A successful implant reconstruction with optimal esthetics consists of a visually pleasing prosthesis and complete and healthy surrounding soft tissue. In the current literature, numerous indices used to qualitatively assess esthetics have been described. However, studies comparing the indices and their reproducibility are scarce. PURPOSE: The aim of this study was to compare three different esthetic indices for the evaluation of single implant-supported crowns. MATERIALS AND METHODS: A total of 10 prosthodontists (P), 10 orthodontists (O), 10 general dentists (G), and 10 lay people (L) independently performed the same assessment using 30 photographs and corresponding casts with three different esthetic indices (Peri-Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], "Pink Esthetic Score/White Esthetic Score [PES/WES]) and repeated the evaluations 4 weeks later. RESULTS: The PES/WES and the PICI showed significantly higher esthetic scores (pink, white, total) and clinical acceptance compared with the ICAI in all four groups and in both assessments. The highest intraobserver agreement was achieved using the PES/WES and the least with the ICAI. The mean Kappa per group ranged from 0.18 (group L with ICAI) to 0.63 (group G with PICI). CONCLUSION: In comparison with the ICAI, the PES/WES and PICI were more reproducible. Therefore, PES/WES and PICI seem to be more suitable as esthetic indices for single implant crowns.

Influence of prosthesis type and retention mechanism on complications with fixed implant-supported prostheses: a systematic review applying multivariate analyses.

PURPOSE: To identify the influence of fixed prosthesis type on biologic and technical complication rates in the context of screw versus cement retention. Furthermore, a multivariate analysis was conducted to determine which factors, when considered together, influence the complication and failure rates of fixed implant-supported prostheses. MATERIALS AND METHODS: Electronic searches of MEDLINE (PubMed), EMBASE, and the Cochrane Library were conducted. Selected inclusion and exclusion criteria were used to limit the search. Data were analyzed statistically with simple and multivariate random-effects Poisson regressions. RESULTS: Seventy-three articles qualified for inclusion in the study. Screw-retained prostheses showed a tendency toward and significantly more technical complications than cemented prostheses with single crowns and fixed partial prostheses, respectively. Resin chipping and ceramic veneer chipping had high mean event rates, at 10.04 and 8.95 per 100 years, respectively, for full-arch screwed prostheses. For "all fixed prostheses" (prosthesis type not reported or not known), significantly fewer biologic and technical complications were seen with screw retention. Multivariate analysis revealed a significantly greater incidence of technical complications with cemented prostheses. Full-arch prostheses, cantilevered prostheses, and "all fixed prostheses" had significantly higher complication rates than single crowns. A significantly greater incidence of technical and biologic complications was seen with cemented prostheses. CONCLUSION: Screw-retained fixed partial prostheses demonstrated a significantly higher rate of technical complications and screw-retained full-arch prostheses demonstrated a notably high rate of veneer chipping. When "all fixed prostheses" were considered, significantly higher rates of technical and biologic complications were seen for cement-retained prostheses. Multivariate Poisson regression analysis failed to show a significant difference between screw- and cement-retained prostheses with respect to the incidence of failure but demonstrated a higher rate of technical and biologic complications for cement-retained prostheses. The incidence of technical complications was more dependent upon prosthesis and retention type than prosthesis or abutment material.

Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions--a systematic review.

PURPOSE: To assess the survival outcomes and reported complications of screw- and cement-retained fixed reconstructions supported on dental implants. MATERIALS AND METHODS: A Medline (PubMed), Embase, and Cochrane electronic database search from 2000 to September 2012 using MeSH and free-text terms was conducted. Selected inclusion and exclusion criteria guided the search. All studies were first reviewed by abstract and subsequently by full-text reading by two examiners independently. Data were extracted by two examiners and statistically analyzed using a random effects Poisson regression. RESULTS: From 4,324 abstracts, 321 full-text articles were reviewed. Seventy-three articles were found to qualify for inclusion. Five-year survival rates of 96.03% (95% confidence interval [CI]: 93.85% to 97.43%) and 95.55% (95% CI: 92.96% to 97.19%) were calculated for cemented and screw-retained reconstructions, respectively (P = .69). Comparison of cement and screw retention showed no difference when grouped as single crowns (I-SC) (P = .10) or fixed partial dentures (I-FDP) (P = .49). The 5-year survival rate for screw-retained full-arch reconstructions was 96.71% (95% CI: 93.66% to 98.31). All-ceramic reconstruction material exhibited a significantly higher failure rate than porcelain-fused-to-metal (PFM) in cemented reconstructions (P = .01) but not when comparing screw-retained reconstructions (P = .66). Technical and biologic complications demonstrating a statistically significant difference included loss of retention (P ≤ .01), abutment loosening (P ≤ .01), porcelain fracture and/or chipping (P = .02), presence of fistula/suppuration (P ≤ .001), total technical events (P = .03), and total biologic events (P = .02). CONCLUSIONS: Although no statistical difference was found between cement- and screw-retained reconstructions for survival or failure rates, screw-retained reconstructions exhibited fewer technical and biologic complications overall. There were no statistically significant differences between the failure rates of the different reconstruction types (I-SCs, I-FDPs, full-arch I-FDPs) or abutment materials (titanium, gold, ceramic). The failure rate of cemented reconstructions was not influenced by the choice of a specific cement, though cement type did influence loss of retention.

The effect of coping/veneer thickness on the fracture toughness and residual stress of implant supported, cement retained zirconia and metal-ceramic crowns.

OBJECTIVES: The aim of the work was to assess the influence of coping and veneer thickness on the fracture resistance of porcelain-metal and porcelain-zirconia crowns in a clinically representative model. METHODS: A total of 30 zirconia and 30 precious metal copings were fabricated. There were 10 copings in each group of 0.5mm, 1mm and 1.5mm thickness. Each group of 10 was further divided into two groups with a total thickness of three and four millimeters inclusive of veneering ceramic. The specimens were cemented to a titanium abutment with zinc oxide cement and tested using a microindenter. Crack length, hardness and spalling (chipping) were recorded using an optical microscope from which fracture toughness was calculated. RESULTS: Kruskal-Wallis tests and simple linear regression analysis were used to analyze the results, revealing a significant difference between zirconia (ZrCC) and metal (MCC) specimens for crack length. 0.5mm coping thicknesses and MCC specimens showed the highest fracture toughness values. Simple linear regression analysis showed a limited effect of the overall thickness or veneer thickness on crack length and hardness; however coping thickness showed a positive correlation with both. Spalling was higher in zirconia specimens. Residual stresses were higher for ZrCC specimens and showed a positive correlation with crack length. The ratio of veneer to coping thickness was negatively correlated with residual stress. SIGNIFICANCE: Residual stresses due to thermal mismatch between the coping and the veneering ceramic should be kept to a minimum. The ZrCC specimens were found to have lower apparent fracture toughness than MCC specimens. Thermal mismatch caused a larger drop in apparent fracture toughness than the inherent differences in the materials used.