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.

Does Luting Strategy Affect the Fatigue Behavior of Bonded Y-TZP Ceramic?

PURPOSE: To evaluate the effect of different luting strategies on the fatigue failure load (FFL) and stress distribution of Y-TZP disks luted to epoxy resin substrate. MATERIALS AND METHODS: Y-TZP disks (diameter = 10 mm; thickness = 0.7 mm) were assigned to five groups according to the luting strategy (n = 15): CC: no zirconia surface treatment, composite cement; G_CC: application of a thin glaze layer on zirconia followed by hydrofluoric acid etching and silanization, composite cement; Al_CC: air abrasion of the zirconia surface with 125-µm Al2O3 particles, composite cement; Si_CC: tribochemical silica coating (30-µm SiO2 particles), composite cement; ZP: air abrasion of the zirconia surface with 125-µm Al2O3 particles, zinc-phosphate cement. The disks were luted to the epoxy resin substrate. The FFL was evaluated by the step-test method. The load was applied in stages of 10,000 cycles, starting with 600 N, followed by increments of 200 N. Samples were loaded until fracture or to a maximum of 100,000 cycles. FFL data were submitted to Kaplan-Meier (α = 0.05) and Weibull analyses. Conditions simulating a strong and a weak bond between Y-TZP and epoxy resin were evaluated in the finite element analysis (FEA). RESULTS: Luting strategy influenced the FFL (p < 0.001) and the stress distribution of Y-TZP disks. Al_CC (2227 ± 149 N) and Si_CC (2133 ± 235 N) showed the highest FFL values, followed by CC (1800 ± 293 N) and G_CC (1280 ± 147 N), while ZP showed the lowest FFL value (680 ± 101 N). The highest Weibull modulus occurred in Al_CC (18.2). A strong bond reduced the tensile stress concentration in the Y-TZP luting surface, while a weak bond between Y-TZP and the epoxy resin favored the concentration of tensile stresses. CONCLUSION: Air abrasion with aluminum oxide and silica-coated alumina particles improves the FFL of bonded Y-TZP. Zinc-phosphate cement should be used very carefully in the cementation of zirconia restorations, since it results in lower values of FFL than composite cements.

Elastic Properties of Lithium Disilicate Versus Feldspathic Inlays: Effect on the Bonding by 3D Finite Element Analysis.

PURPOSE: To determine the elastic properties of five ceramic systems with different compositions (lithium disilicate vs. feldspathic ceramics) and processing methods and compare the stress distribution in premolars in the interface with inlays made with these systems loaded with the maximum normal bite force (665 N) using 3D finite element analysis (FEA). MATERIALS AND METHODS: The elastic properties of five ceramic restoration materials (IPS e.max Press, IPS e.max CAD, Vita PM9, Vita Mark II, Vita VM7) were obtained using the ultrasonic pulse-echo method. Three-dimensional FEA simplified models of maxillary premolars restored with these ceramic materials were created. The models were loaded with a load at the two nodes on the occlusal surface in the middle of the tooth, 2 mm from the outside of the tooth, simulating a loading ball with a radius of 6 mm. RESULTS: The means values of density (g/cm³), Young's modulus (GPa), and Poison's ratio was 2.6 ± 0.3, 82.3 ± 18.3, and 0.22 ± 0.01 for IPS e.max Press; 2.3 ± 0.1, 83.5 ± 15.0, and 0.21 ± 0.01 for IPS e.max CAD; 2.5 ± 0.1, 44.4 ± 11.5, and 0.26 ± 0.08 for PM9; 2.4 ± 0.1, 70.6 ± 4.9, and 0.22 ± 0.01 for Vitamark II; 2.4 ± 0.1, 63.3 ± 3.9, and 0.23 ± 0.01 for VM7, respectively. The 3D FEA showed the tensile stress at the interface between the tooth and the inlay was dependent on the elastic properties of the materials, since the Vita PM9 and IPS e.max CAD ceramics presented the lowest and the highest stress concentration in the interface, respectively. CONCLUSIONS: The elastic properties of ceramic materials were influenced by composition and processing methods, and these differences influenced the stress concentration at the bonding interface between tooth and restoration. The lower the elastic modulus of inlays, the lower is the stress concentration at the bonding interfaces.

Effect of a retention groove on the shear bond strength of dentin-bonded restorations.

STATEMENT OF PROBLEM: With the increasing use of minimally invasive restorations, effective adhesion becomes more important. Applying mechanical retention to a flat dentin surface might improve the adhesion of ceramic and composite resin restorations. PURPOSE: The purpose of this in vitro study was to evaluate the effect of a groove in a flat dentin surface on the bond strength of various restorative materials. MATERIAL AND METHODS: Dentin specimens of bovine teeth were prepared with or without a groove. Identical disks were fabricated from direct composite resins (Filtek Supreme XTE [FS] and Clearfil AP-X [AP]) and indirect ceramics (Vita Mark II [VM] and IPS E.max CAD [EM]). These materials were bonded directly or cemented adhesively to the dentin specimens. Shear bond strength was tested with a universal testing machine. Finite element analysis (FEA) models of the test arrangement were made to further analyze the stress distribution. RESULTS: VM (no groove, 5.1 ±3.0 MPa; groove, 8.7 ±1.5 MPa) and EM (no groove, 11.4 ±3.7 MPa; groove, 17.7 ±5.2 MPa) showed significant effect of a groove on the shear bond strength. FS (no groove, 18.6 ±4.9 MPa; groove, 16.3 ±4.3 MPa) and AP (no groove, 25.8 ±3.8 MPa; groove, 24.2 ±7.2 MPa) showed no significant effect of a groove. For the composite resins, the retention groove increased the shear stress along the dentin-restoration interface, and debonding at the contact surface started at lower load values than for the specimens without a groove. CONCLUSIONS: Application of a groove to a flat dentin surface improved the shear bond strength for ceramic restorations. For direct composite resin restorations, exhibiting a lower elastic modulus, a groove had no significant effect on the shear bond strength, while it increased the shear stress along the dentin-restoration interface for composite resin.

Mechanical performance of implant-supported posterior crowns.

STATEMENT OF PROBLEM: The fracture of implant-supported restorations, especially of the veneering layer, is a common problem in dentistry. Monolithic ceramic or resin restorations might help solve this problem. PURPOSE: The purpose of this in vitro study was to obtain additional insight into the risk of fracture of implant-supported restorations. MATERIAL AND METHODS: Identical crowns (n=10) of 10 different ceramic and composite resin materials were cemented on conventional abutments on implant replicas embedded in polymethyl methacrylate blocks. The specimens were subjected to compressive load in a universal testing machine to record initial load to failure (ILF). Additionally, the flexural strength (FS), compressive strength (CS), and elastic modulus (E) of the investigated materials were determined. These results were used in a finite element analysis model of a composite resin and a lithium disilicate crown. RESULTS: Anatomic contour zirconia (Lava Plus) crowns had the highest ILF (6065 N), followed by lithium disilicate (IPS e.max) (2788 N) and the composite resin materials (Protemp 4, Majesty Flow, Telio CAD, Estenia C&B, Lava Ultimate, VITA Enamic) (2386 to 1935 N). Veneered zirconia (Lava) crowns showed the lowest ILF (1477 N). The highest FS, CS, and E were found for Lava Plus and IPS e.max. No direct relationship was found between ILF and the FS, CS, or E. The finite element analysis showed stresses that did not exceed the FS or CS of IPS e.max. The surface roughness of these crowns might have caused initial failure at relatively low stresses. CONCLUSIONS: In this laboratory study, monolithic implant-supported crowns showed a higher ILF than conventional veneered ceramic crowns. Monolithic ceramic restorations might perform better than composite resin crowns.

In vitro debonding of orthodontic retainers analyzed with finite element analysis.

OBJECTIVE: The aim of this in vitro study was to determine the load and deflection at failure of different lingual retainers bonded with composite to enamel in a standardized three-point bending test. The results were rationalized with finite element analysis (FEA) models. MATERIALS AND METHODS: Four types of multistranded wires, Dead Soft Respond, Twisted ligature, Penta-One, Gold-plated Penta-One, and two glass fibre-reinforced composite retainers, Fibre 07 and Fibre 09, were bonded to enamel with composite and submitted to a three-point bending test. The load and deflection at failure and the mode of debonding were recorded. The stiffness of the wires was determined and all experimental data were used in FEA models to rationalize the observed values and mode of debonding. RESULTS: Significant higher load and deflection were found for the most flexible retainers Twisted ligature and Dead Soft Respond. All retainers failed between the wire and composite, which was confirmed by FEA showing the highest stress in the composite around the retainer. The FEA models showed that the amount of composite used for bonding the retainers should be 2-4mm. CONCLUSIONS: Based on the in vitro results, optimal bonding of lingual retainers can be achieved by flexible retainers, bonded with intrinsically strong composites. According to the FEA models the retainer should be bonded with 2-4mm composite, leaving the critical 'free-wire' length for the success of the retainer system.

Effect of crown retention systems and loading direction on the stress magnitude of posterior implant-supported restorations: A 3D-FEA.

This study aimed to investigate the effect of four retention systems for implant-supported posterior crowns under compressive loading using three-dimensional finite element analysis. A morse-taper dental implant (4.1 × 10 mm) was designed with Computer Aided Design software based on non-uniform rational B-spline surfaces. According to International Organization for Standardization 14,801:2016, the implant was positioned at 3 mm above the crestal level. Then four models were designed with different crown retention systems: screw-retained (A), cement-retained (B), lateral-screw-retained (C), and modified lateral-screw-retained (D). The models were imported to the analysis software and mesh was generated based on the coincident nodes between the juxtaposed lines. For the boundary conditions, two loads (600 N) were applied (axial to the implant fixture and oblique at 30°) totaling 8 conditions according to retention design and loading. The von-Mises stress analysis showed that different retention systems modify the stress magnitude in the implant-supported posterior crown. There is a similar stress pattern in the implant threads. However, models C and D presented higher stress concentrations in the crown margin in comparison with A and B. The oblique loading highly increased the stress magnitude for all models. In the simulated conditions, part of the stress was concentrated at the lateral screw under axial loading for model C and oblique loading for model D. The results indicate a possible new failure origin for crown retained using lateral screws in comparison to conventional cement-retained or screw-retained systems.

Mechanical characterization of a multi-layered zirconia: Flexural strength, hardness, and fracture toughness of the different layers.

This study compared the flexural strength under monotonic (static - sσ) and cyclic load application (fatigue - fσ), hardness (H) and fracture toughness (KIC) of different layers of a multi-layered zirconia (IPS e.max ZirCAD MT Multi, Ivoclar). Each layer was sectioned, classified into three groups according to yttria content (4-YSZ, 4/5-YSZ and 5-YSZ), and shaped on samples for flexural strength and fracture toughness tests (bars: 1.0 × 1.0 × 11 mm); and Vickers hardness test (plates: 1.5 × 4.0 × 5.0 mm). Flexural strength under monotonic load application (sσ; n = 10) was obtained through two different devices (three-point-bending and ball-in-hole device) and fatigue flexural strength (fσ; n = 15; initial load: 10 N; step-size: 5 N; 10,000 cycles/step) was assessed using a ball-in-hole device under cyclic load application. Vickers hardness test (n = 5), fracture toughness test (n = 10), and additional analyzes (Finite Element Analysis - FEA, Energy-dispersive X-ray spectroscopy - EDS and Scanning Electron Microscopy - SEM) were also performed. No differences were found between the different devices in the monotonic flexural strength test, and FEA showed similar tensile stress distribution for the two devices. 4-YSZ showed higher values of flexural strength under monotonic and cyclic load application modes (sσ = 1114.73 MPa; fσ = 798.84 MPa), and fracture toughness (KIC = 3.90 MPa√m). 4/5-YSZ had an intermediate sσ; however, fσ was similar to 5-YSZ (404.00-429.36 MPa) and KIC similar to 4-YSZ (KIC = 3.66 MPa√m). No statistical differences were found for hardness and Weibull modulus for fatigue flexural strength data. The amount of yttria in the layer compositions increased from 4-YSZ to 5-YSZ, and larger zirconia crystals were observed in the topographic images of 5-YSZ. Failures in the flexural strength and toughness tests started from the face subjected to tensile stress. Different layers of the multi-layered zirconia blank presented distinct mechanical properties. 4-YSZ (cervical layer) presented the highest flexural strength under monotonic and cyclic loads (fatigue), and higher fracture toughness even similar to the transition layer (4/5-YSZ). Hardness was similar between the layers. The ball-in-hole device performed similarly to the three-point bending device and can be used as an alternative to the traditional method.

Cyclic fatigue vs static loading for shear bond strength test of lithium disilicate and dentin substrates: A comparison of resin cement viscosities.

OBJECTIVE: To explore the effect of resin cement viscosities on the shear bond strength under static and fatigue load of lithium disilicate and dentin substrates. METHODS: Bonded tri-layer samples (lithium disilicate ceramic cylinder, resin cement, and substrate - ceramic or dentin) was performed considering 2 factors (n = 15): "resin cement viscosity" (high, HV; or low, LV) and "loading mode" (static, s-SBS; or fatigue shear bond strength, f-SBS). The specimens were subjected to s-SBS (1 mm/min, 1 kN load cell) and f-SBS (cyclic fatigue, initial load: 10 N; step-size: 5 N; 10,000 cycles/step; underwater). Failure mode, topography, and finite element analysis (FEA) were performed. RESULTS: The resin cement viscosity did not influence the s-SBS and f-SBS of lithium disilicate substrate; however, it affected the bond strength to dentin, with HV presenting the worst fatigue behavior (f-SBS = 6.89 MPa). Cyclic loading in shear testing induced a notorious detrimental effect with a relevant decrease (16-56 %) in bond strength and survival rates, except for dentin substrate and LV. Most failures were adhesive. A distinct pattern comparing the disilicate and dentin was identified and FEA demonstrated that there was a stress concentration on the top of the cement layer. SIGNIFICANCE: Cyclic fatigue loading in shear testing has detrimental effects on the adhesive behavior and survival probabilities of bonded lithium disilicate sets, regardless of resin cement viscosity. In contrast, resin cement viscosity affects the bond strength and the survival rates of dentin substrate submitted to cyclic loading mode, in which a low viscosity results in better performance.

The relation between impact strength and flexural strength of dental materials.

AIM: The aim of this study was to investigate whether there is a relation between impact strength and flexural strength of different composite and ceramic materials used in dental restorations. MATERIALS AND METHODS: The three-point-bending test was used to determine the flexural strength and flexural modulus, and the Dynstat impact test was used to determine the impact strength of different composite and ceramic dental materials. The relation between the flexural strength and impact strength was mathematically investigated and a three-dimensional finite element analysis model of the impact test set-up was created to verify these results. RESULTS: We found a relation between the impact strength, adU, the flexural strength, σ, and the flexural modulus, E, which can be represented by the formula: adU=λDK(σ2/E), where λDK is a constant dependent on the test set-up. CONCLUSION: The obtained impact strength of materials is specific to the test set-up and dependent on the geometric configuration of the test set-up and the specimen thickness. The clinical significance of this investigation is that roughness and fatigue have far more influence on the impact strength than the flexure strength.

Effect of different materials and undercut on the removal force and stress distribution in circumferential clasps during direct retainer action in removable partial dentures.

OBJECTIVES: This study aimed to evaluate the effect of different materials and undercut on the removal force and stress distribution in the supporting tooth and in the circumferential clasp used in removable partial prosthesis. METHODS: Upper molars prepared for Akers circumferential clasp with retention and opposing arm were modeled, scanned, elaborated with CAD software and the geometries imported in FEA and analyzed. Six different materials were selected for the clasp (Polyamide, Polyoxymethylene, Polyetheretherketone - PEEK, Gold alloy, Titanium and CoCr) and 3 different undercuts (0.25, 0.50 and 0.75mm), totaling 18 groups. RESULTS: The clasps presented greater stress in their structure and potentially greater damage to the dental enamel when made with rigid materials and with more undercut; however, they presented greater ability to remain in position. SIGNIFICANCE: Polyamide with a higher undercut is an esthetic alternative to rigid metallic clasps. It showed promising behavior because it strongly reduces the damage to the enamel, and even with an undercut of 0.75, the retention is lower than for CoCr with a 0.25 undercut, and this retention might still be sufficient. Polyoxymethylene and Polyetheretherketone (PEEK) are not suitable materials for the clasps, because the maximum stress occurring during removal with higher undercuts is higher than the material strength.

Properties of an In Vivo Fractured Poly(Methyl Methacrylate) Cranioplasty After 15 Years.

BACKGROUND: In 2001, a 27-year-old man was diagnosed with a meningioma with skull bone involvement. A craniectomy was performed and a CMW-3 poly(methyl methacrylate) cranioplasty was manually manufactured to reconstruct the remaining cranial defect. In 2016, he complained about progressive neurologic impairment. A computed tomography scan revealed that the cranioplasty had fractured into 4 dislocated pieces. Removal was indicated, and during the same operation a polyetheretherketone patient-specific implant was inserted. METHODS: The fractured cranioplasty was compared with freshly prepared CMW-3 specimens to determine whether the material properties had changed during 15 years in vivo. Gel permeation chromatography, microcomputed tomography, and flexural strength tests were performed. The fracture itself was analyzed using finite element analysis. RESULTS: The polydispersity index and molecular weight were not significantly different for the fractured cranioplasty and CMW-3. The fractured cranioplasty contained a total porosity of 10.7%, fresh CMW-3 cured at atmospheric pressure contained 4.1%, and 0.06% when cured at 2.2 bar. The flexural strength of the CMW-3 cured at 2.2 bar was significantly higher than both the fractured cranioplasty and CMW-3 cured at atmospheric pressure. Finite element analysis showed stress of 12.2 MPa under a load of 100 N on a weak spot. CONCLUSIONS: This ex vivo study shows that CMW-3 after 15 years in vivo was not influenced in molecular weight or flexural strength. However, the design of the implant and the handling of the poly(methyl methacrylate) seem to be important factors to improve mechanical properties of cranial reconstructions.

Influence of retainer design on two-unit cantilever resin-bonded glass fiber reinforced composite fixed dental prostheses: an in vitro and finite element analysis study.

PURPOSE: The aim of this study was to evaluate in vitro the influence of retainer design on the strength of two-unit cantilever resin-bonded glass fiber-reinforced composite (FRC) fixed dental prostheses (FDP). MATERIALS AND METHODS: Four retainer designs were tested: a proximal box, a step-box, a dual wing, and a step-box-wing. Of each design on 8 human mandibular molars, FRC-FDPs of a premolar size were produced. The FRC framework was made of resin impregnated unidirectional glass fibers (Estenia C&B EG Fiber, Kuraray) and veneered with hybrid resin composite (Estenia C&B, Kuraray). Panavia F 2.0 (Kuraray) was used as resin luting cement. FRC-FDPs were loaded to failure in a universal testing machine. One-way ANOVA and Tukey's post-hoc test were used to evaluate the data. The four designs were analyzed with finite element analysis (FEA) to reveal the stress distribution within the tooth/restoration complex. RESULTS: Significantly lower fracture strengths were observed with inlay-retained FDPs (proximal box: 300 +/- 65 N; step-box: 309 +/- 37 N) compared to wing-retained FDPs (p < 0.05) (step-box-wing: 662 +/- 99 N; dual wing: 697 +/- 67 N). Proximal-box-, step-box-, and step-box-wing-retained FDPs mainly failed with catastrophic cusp fracture (proximal box 100%, step-box 100%, and step-box-wing 75%), while dual-wing-retained FDPs mainly failed at the adhesive interface and/or due to pontic failure (75%). FEA showed more favorable stress distributions within the tooth/restoration complex for dual wing retainers. CONCLUSION: A dual-wing retainer is the optimal design for replacement of a single premolar by means of a two-unit cantilever FRC-FDPs.

Effect of loading method on the fracture mechanics of two layered all-ceramic restorative systems.

OBJECTIVE: The aim of this research was to evaluate both the fracture and impact strength of two core veneered all-ceramic systems and to reveal whether the speed of loading affects fracture mechanism. METHODS: The absorbed energy by (IPS)Empress-Eris crowns and Cercon-Ceram S crowns in a fracture strength test was compared by the energy absorbed in an impact strength test. The principles of fractography were used to identify fracture origin and dimensions and to calculate the stress at failure. Finite element analysis (FEA) was used to rationalize the results. RESULTS: For the (IPS)Empress 2-Eris crowns, there was a significant difference in the energy absorbed for the fracture test and the impact test, where for the Cercon-Ceram S, there was no significant difference. Despite the high strength of the zirconia cores there was no significant difference in the energy absorbed between the two systems in the impact strength test. The dominant mode of failure of layered all-ceramic restorations under occlusal loading is cone cracking in the veneering ceramic. SIGNIFICANCE: It was concluded that to exploit the high strength of the zirconia cores the strength of the veneering ceramic has to improve as delamination and cone cracking of the veneer are the most expected failure modes.

The effect of internal roughness and bonding on the fracture resistance and structural reliability of lithium disilicate ceramic.

OBJECTIVE: To evaluate the effect of internal roughness and bonding on the load to failure and structural reliability (Weibull analysis) of a lithium disilicate-based glass ceramic under different testing scenarios. METHODS: IPS e.max CAD blocks (Ivoclar Vivadent AG) were shaped into cylinders (N=100), crystalized according to the manufacturer's instructions, and randomly assigned into two surface conditions: (1) polished surface (600-grit SiC polish papers), and (2) a roughened surface (air-abrasion with 50µm Al2O3). Two assemblies were investigated: a ceramic disc isolated (to isolate the effect of roughness); and a simplified tri-layer setup simulating the restoration of a posterior tooth (ceramic+cement+epoxy resin) to evaluated the influence of bonding isolated and the associated effect of both factors. Four different scenarios were tested: (1) isolated disc under static load (n=10); (2) disc bonded to an epoxy resin substrate and tested under a static load (n=10); (3) disc bonded and tested under fatigue (n=20); and (4) simulated-bonding tested statically (n=10). The data of load to failure were submitted to One-way ANOVA and Weibull analysis. RESULTS: At a non-bonded scenario (isolated disc and simulated-bonding) a polished internal surface presented a higher characteristic strength. However, when bonding was present this difference became inexistent. No difference was found in terms of structural reliability (Weibull moduli) among the groups. FEA analysis shows that with bonding the tensile stress is better distributed, while in a non-bonded scenario higher tensile stresses occur at the bonding interface. SIGNIFICANCE: A rough internal surface impacted deleteriously the mechanical properties of lithium disilicate ceramic when it was not properly bonded to the substrate. However, bonding to the substrate appeared to play a more significant role in the fracture resistance than internal roughness.

The influence of different core material on the FEA-determined stress distribution in dental crowns.

OBJECTIVES: All ceramic restorations without metal have great advantages in their biocompatibility and aesthetic aspects. With the introduction of new core materials, the cores are sufficiently strong to produce long lasting all-ceramic restorations; however, the stresses in the veneering porcelain could still determine the longevity. The objective of this study was to evaluate, by finite element analysis (FEA), the influence of different core materials on the stress distribution in dental crowns. METHODS: The model of a multi-layer all-ceramic crown for posterior tooth 46 produced with CAD-CAM-technology was translated into a three-dimensional FEA program. This crown model was made with gold, zirconia, and alumina-based porcelain core and their matching veneering porcelains. The stress distribution due to the combined influences of bite forces, residual stresses caused by the difference in expansion coefficient of the core material and the veneering porcelain, and the influence of shrinkage of the cement was investigated. RESULTS: Stiffer core material does not always for various reasons result in lower stresses in the veneering porcelain. SIGNIFICANCE: This study indicates that the actual distribution of the tensile stresses and the design of restorations must be taken into account; otherwise, the significant contribution of stronger and tougher core materials to the performance of all-ceramic restorations may be offset by the weaker veneering porcelain.

Finite element analysis model to simulate the behavior of luting cements during setting.

OBJECTIVES: Besides the fixation of the restoration, an important function of dental luting cements is to seal the gap between tooth and restoration. However, as a result of adhesion, curing contraction is hindered, creating stresses. To maintain the seal these stresses neither exceed the bond nor the cohesive strength of the cement. The aim of this study was to evaluate a rather simple model, which mimics the setting behavior of luting cements based on the division of the setting process into a liquid, visco-elastic and elastic phase, for its suitability to predict in Finite Element Analysis (FEA) the magnitude of the setting stresses occurring clinically. METHODS: Commercial luting cement, RelyX ARC, was used in this study. In a dynamic test set-up the stresses, the elastic strain, and the shrinkage were determined. Two layers with different thicknesses and different ratios between bonded and free surface (C-factor) were examined. The parameters were used in three-dimensional FEA models. The experimental contraction stresses were compared with the results of the FEA. RESULTS: In cement layers with uniform layer thickness, it is possible to predict the contraction stresses with the found parameters. The smallest plastic deformations and contraction stresses were found in the thinnest layer. The studied model was reliable in predicting the experimental stresses. SIGNIFICANCE: The results of this study may be used for the prediction using FEA of the actual stresses occurring in dental restorations.

The influence of design parameters on the FEA-determined stress distribution in CAD-CAM produced all-ceramic dental crowns.

INTRODUCTION: Knowledge of factors, which influence stress and its distribution is of key importance to the successful production of durable all-ceramic restorations. The objective of this study was to evaluate, by finite element analysis (FEA), the influence of the shape of the preparation and the cement layer on the stress distribution in CAD-CAM produced all-ceramic crowns and in their cement layer. MATERIAL AND METHODS: The CAD models of multi-layer all-ceramic crowns for posterior tooth 46 of three patients produced with CAD-CAM-technology were translated into a three-dimensional FEA program. The stress distribution due to the combined influences of bite forces, residual stresses caused by the difference in expansion coefficient of the two ceramic layers, and the influence of shrinkage of the cement was investigated. RESULTS: The tensile stresses in the crown for the chamfer knife-edge preparation might put the integrity of the currently available ceramic materials at risk, while a non-uniform cement layer might result in stresses exceeding the bond strength. It was concluded that for long lasting restorations in the posterior region it is advisable to make a chamfer with collar preparation, the cement layer as uniform, and the difference in thermal expansion for the two ceramics as small as possible. SIGNIFICANCE: This study indicates that for full ceramic crowns in the posterior region, specific design rules should be followed, and that FEA utilizing CAD-CAM data can be a successful tool to develop design guidelines for all-ceramic restorations.

Microtensile bond strength of different components of core veneered all-ceramic restorations.

OBJECTIVES: The present study aims to evaluate the core-veneer bond strength and the cohesive strength of the components of three commercial layered all-ceramic systems. Two surface treatments for the core surface finish and different veneering ceramics with different thermal expansion coefficients (TEC) were applied. The selected systems were two CAD-CAM ceramics; Cercon and Vita Mark II and one pressable system; (IPS)Empress 2 for layering technique. METHODS: Standardized core specimens were fabricated according to the manufacturer's instructions, or polished with 1200 siliconcarbide polishing paper. The core specimens were veneered with either its manufacturer's veneer or an experimental veneer with higher TEC. The obtained micro-bars were subjected to the microtensile bond strength test. The obtained data were analyzed using one and two-way ANOVA. A finite element analysis (FEA) model of the test setup was analyzed. Scanning Electron Microscopy (SEM) was carried out at the fracture surface. RESULTS: The core materials were significantly stronger than the veneering materials and the layered core-veneer specimens of which the results were statistically comparable. Polishing the core surfaces did not have an effect on the core-veneer bond strength. Experimental veneer with higher TEC resulted in massive fractures in both the core and veneering material. SEM and FEA demonstrated fracture pattern and mechanism of failure. SIGNIFICANCE: The core-veneer bond strength is one of the weakest links of layered all-ceramic restorations and has a significant role in their success. To exploit fully the high strength of zirconium oxide cores, further research work is needed to improve its bond with its corresponding veneering material.

The apparent increase of the Young's modulus in thin cement layers.

OBJECTIVES: The bond of adhesive luting cements to the tooth tissues and restorative materials is expected to hinder their transverse contraction for the layer thickness applied in dental restorations. It was hypothesized that the hindering of the transverse deformation will influence the relation between stress and strain (the stiffness) in the direction perpendicular to the substrate surface. The aim of this study was to investigate the relation between cement layers with different ratio between bonded and free surface (C-factor) and the stiffness of these layers, i.e. an apparent increase of the Young's modulus of the dental luting cement. METHODS: A commercial luting cement RelyX ARC (3M, St Paul, MN, USA) was used in this study. The 'real" Young's modulus and the Poisson ratio were determined and these values were used in models with layers with different C-factors (0.5, 1.0, 2.0, 3.0, 4.0, 5.0 and 6.0) in a three-dimensional Finite Element Analysis program (FEMAP, E.S.P., Maryland Height, MO, USA). The apparent Young's modulus was measured for layers with thicknesses of 0.5 mm (C = 6.0) and 6.0 mm (C = 0.5) and compared with the results of the Finite Element Analysis (FEA) analysis. RESULTS: The apparent Young's modulus in the 0.5 mm layer was 20% higher than the apparent Young's modulus in the 6.0 mm layer. This result was confirmed by the results of the F.E. analysis. For very thin layers the stiffness will be 25% higher than the Young's modulus. SIGNIFICANCE: The hindering of the transverse contraction has to be taken into account studying the mechanical properties of dental luting cements because it influences the behavior of these luting cements in thin layers.