Effect of cyclic loading on reverse torque values of angled screw channel systems.

STATEMENT OF PROBLEM: The angled screw channel concept has become popular. However, research is lacking as to how reverse torque values of nonaxially tightened implant crowns compare with axially tightened cement-retained crowns restored on angle-correcting abutments when subjected to long-term cyclic loading. PURPOSE: The purpose of this in vitro study was to evaluate the ability of different 25-degree angled screw channel hexalobular systems to apply the target torque value on their screws, the effect of cyclic loading on their reverse torque values, and their survival compared with crowns cemented on conventional 0-degree screw channel abutments. MATERIAL AND METHODS: A total of 28 implants were divided into 4 groups. Twenty-one angled screw channel crowns were fabricated at a 25-degree angle correction by using angled titanium (Ti) bases by 3 manufacturers DY (Dynamic Tibase), DE (AngleBase), and ASC (Angulated Screw Channel) (n=7). The fourth group, UB (Universal Base, Control), had cement-retained crowns with 25-degree custom-milled, angled zirconia abutments that were cemented onto their respective Ti bases (n=7). All implants were embedded in epoxy resin blocks and tightened to manufacturer recommended values: 35 Ncm for ASC, UB, and DE and 25 Ncm for DY. Initial torque values (ITV1) were recorded. After 24 hours, the reverse torque values (24hr-RTV1) were recorded. A new set of screws was then used for each group, and the initial torque values (ITV2) were recorded. Specimens were loaded at 2 Hz for 5 million cycles under a 200-N load, and reverse torque values (RTV2) were recorded. ANOVA (α=.05) was used to compare differences in the means of deviation of initial torque values and means of reverse torque values followed by a Tukey-Kramer post hoc analysis (α=.05). Preload efficiency was calculated for each system (RTV2/ITV2), and a survival analysis was performed by using the Lifetest procedure. RESULTS: A significant difference in the means of deviation of initial torque values of the groups with 25-degree torque application (DY, DE, and ASC) was found when compared with UB at 0 degrees. ASC and DE had lower initial torque values than UB (P<.001 and P=.003 for ASC ITV1 and ITV2, P<.001 and P=.006 for DE ITV1 and ITV2). A significant difference was found in mean reverse torque values both for after 24 hours and after cyclic loading among all groups (P<.001). A significant difference was found between mean reverse torque values before and after cyclic loading for each group (P<.001). Preload efficiency was 43.8% for DY, 46.8% for DE, 54.2% for ASC, and 48.5% for UB. No significant difference was found in the time-to-failure survival among groups (P>.05). CONCLUSIONS: The hexalobular system of DY delivered comparable initial torque values to its target value at 25 degrees, similar to how UB (control group) delivered at 0 degrees. ASC and DE scored lower initial torque values than their target value compared with UB. The DY abutment, which had a lower manufacturer recommended torque value, had lower reverse torque values compared with those of other groups. Time-to-failure survival of all groups was similar. Fractures at the zirconia to titanium base connection were seen with ASC crowns.

Displacement and performance of abutments in narrow-diameter implants with different internal connections.

STATEMENT OF PROBLEM: Displacement of abutments into conical connection implants during screw tightening may also occur during functional loading, creating unsettling forces that may cause loss of preload. A recent conical-hexagon connection with double friction fit (conical-hexagon connection) could prevent this axial displacement. PURPOSE: The purpose of this in vitro study was to measure the 3D axial displacement of abutments with a conical-hexagon connection or conical connection in narrow-diameter implants. Removal torque values (RTVs), preload efficiency, and survival after cyclic loading were also compared. MATERIAL AND METHODS: Narrow-diameter implants with a conical connection (Osseospeed EV, 3.0×13 mm-AST) and narrow-diameter implants with a conical-hexagon connection (Eztetic, 3.1×13 mm) were embedded in resin rods (G10) (n=6). Six titanium abutments per system were used, and their spatial relationship to the implant platforms after hand tightening was determined by using 3D digital image correlation. The abutments were tightened to the manufacturers' specified values, and the abutments' relative position was recorded again. The displacement of the abutment after tightening was calculated. The implants were subjected to cyclic loading (5×106 cycles at 2 Hz) under 200-N loads at a 30-degree angle. After cyclic loading, the RTVs of screws were measured and compared with those specified by the manufacturers to calculate preload efficiency. ANOVA was used to compare the differences in displacements after tightening and to compare differences in RTVs after cyclic loading across the groups (α=.05). RESULTS: The mean displacement in the U direction (X-axis) for the AST was -0.7 µm and -4.7 µm for ZIM, with no statistical difference (P=.73). The mean displacement in the V direction (Y-axis) for AST was -37.0 µm, and -150.0 µm for ZIM, with significant statistical difference (P<.001). The mean displacement in the W direction (Z-axis) for AST was -0.9 µm, and -23.0 µm for ZIM, with no statistical difference (P=.35). The survival of groups was similar (P=.058). During cyclic loading, 3 AST specimens fractured. After cyclic loading, mean RTV for AST was -8.77 Ncm, and -14.24 Ncm for ZIM, and these values were significantly different (P=.04). Preload efficiency was 28.1% for AST and 41.5% for ZIM. CONCLUSIONS: Greater abutment displacements were observed with the conical-hexagon connection, which required a higher torque, as specified by its manufacturer. The abutments displaced more in the V-axis in both implants. Only the conical connection implant (Ti Grade 4, commercially pure) had failures during cyclic loading, but the survival of the implants was similar. After cyclic loading, the abutment screws in both systems lost some of their torque value. The abutment screws of the conical-hexagon connection implant maintained preload more efficiently during cyclic loading than those of the conical connection implant.

Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty.

STATEMENT OF PROBLEM: Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented. PURPOSE: The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants. MATERIAL AND METHODS: Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis. RESULTS: The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.

Effect of crown height on the screw joint stability of zirconia screw-retained crowns.

STATEMENT OF PROBLEM: Medium- to long-term data for the performance of zirconia crowns with titanium (Ti) bases are sparse, particularly when the crown height space and occlusal loads are high. PURPOSE: The purpose of this in vitro study was to assess the effect of the height of zirconia screw-retained implant crowns with a Ti base on the screw joint stability after cyclic loading. A secondary aim was to investigate the survival of zirconia crowns of different heights after cyclic loading. MATERIAL AND METHODS: Twenty-one internal connection implants were secured between fiberglass-reinforced epoxy resin sleeves. Mandibular first molar monolithic zirconia crowns with 3 different heights (6 mm, 10 mm, and 14 mm) were milled and bonded to the Ti bases (n=7). The screws were tightened to 30 Ncm, and a 30-degree 120-N cyclic load was applied to the crowns at 2 Hz for 5 million cycles. After 5 million cycles, the crowns were evaluated for stability, and the same protocol was repeated for 275-N and 435-N loads for 5 million cycles each. After loading, the detorque values were recorded. Failure was characterized based on whether the crown, screw, and/or implant fracture was observed. The detorque values were analyzed by using a 1-way-ANOVA with the restricted maximum likelihood estimation. The percentage of torque loss was calculated. The LIFETEST procedure was used to analyze the survival probability of the groups (α=.05). RESULTS: The effect of crown height on the detorque values of screws was not found to be statistically significant (P>.05). The mean detorque value for 6-mm crowns was 23.5 Ncm, 24.4 Ncm for 10-mm crowns, and 22.1 Ncm for 14-mm crowns. A significant effect of crown height was found on the survival (P=.006), and the time-to-failure survival of 14-mm crowns was significantly lower than the survival of 6 mm and 10 mm crowns (P=.020), where no failures were observed. Four 14-mm crowns failed between the 1 and 2 million cycles after the loads were increased to 435 N. The failure modes were the same for all the crowns, implants, and screws fractured. CONCLUSIONS: When the tested internal connection implant was used, the crown height did not affect the detorque values, and 14-mm crowns performed similarly to the shorter crowns in terms of torque loss after cyclic loading. However, survival of the 14-mm crown-implant complex was lower, resulting in screw and implant fractures.

Adhesive strength of 3 long-term resilient liners to CAD-CAM denture base polymers and heat-polymerized polymethyl methacrylate with thermocycling.

STATEMENT OF PROBLEM: Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have become popular for manufacturing complete dentures. However, the adhesive strength of resilient liners to the polymers used to fabricate CAD-CAM complete dentures is unclear. PURPOSE: The purpose of this in vitro study was to determine the adhesive strength of 3 long-term resilient liners to CAD-CAM denture base polymers and heat-polymerized PMMA with thermocycling. MATERIAL AND METHODS: A total of 90 specimens were fabricated, 30 per group of denture base material (Lucitone 199, Ivo Base CAD, Denture Base LP). For each denture base polymer, 10 specimens were relined with 1 of 3 resilient liners (Permasoft, Mucopren Soft, Molloplast-B). Five specimens of each group were thermocycled, and the other 5 specimens were stored in distilled water. Subsequently, the adhesive strength of the specimens was assessed by tensile testing. The resulting data were analyzed by using a 3-way analysis of variance (ANOVA) (α=.05). RESULTS: After thermocycling, the adhesive strengths of all the resilient liners were found to be statistically different from each other for the same denture base polymer (P≤.012). Mucopren Soft displayed a high mean ±standard deviation adhesive strength to Lucitone 199 (1.78 ±0.32 MPa), followed by Molloplast-B (1.27 ±0.21 MPa) and Permasoft (0.66 ±0.06 MPa). For Ivo Base CAD, Molloplast-B exhibited a high mean ±standard deviation adhesive strength (1.70 ±0.36 MPa), followed by Mucopren Soft (1.11 ±0.16 MPa) and Permasoft (0.53 ±0.04 MPa). Molloplast-B displayed high mean ±standard deviation adhesive strength to Denture Base LP (1.37 ±0.08 MPa), followed by Mucopren Soft (0.68 ±0.20 MPa) and Permasoft (0.32 ±0.04 MPa). The adhesive strength of the majority of resilient liners not exposed to thermocycling was statistically different from each other for the same type of denture base polymer (P<.001). The only exception was the difference between the adhesive strength of Molloplast-B and Mucopren Soft to Lucitone 199 with mean ±standard deviation values of 1.42 ±0.18 and 1.66 ±0.40 MPa, respectively, (P=.067). Without thermocycling, the mean ±standard deviation adhesive strength to Lucitone 199 of Permasoft (0.57 ±0.02 MPa) was statistically different from that of Molloplast-B and Mucopren Soft (P<.001). Molloplast-B displayed a high mean ±standard deviation adhesive strength to Ivo Base CAD (1.83 ±0.25 MPa), followed by Mucopren Soft (1.26 ±0.19 MPa) and Permasoft (0.58 ±0.08 MPa). Molloplast-B displayed a high mean ±standard deviation adhesion to Denture Base LP (1.76 ±0.23 MPa), followed by Mucopren Soft (0.88 ±0.14 MPa) and Permasoft (0.25 ±0.06 MPa). Only Molloplast-B was significantly adversely affected by thermocycling (P=.009). CONCLUSIONS: Molloplast-B displayed high adhesive strength to both CAD-CAM denture base polymers regardless of the storage conditions. Mucopren Soft displayed high adhesion to Lucitone 199. Permasoft presented moderate adhesion to PMMA-based denture bases and low adhesion to DBLP. Combining Permasoft with Denture Base LP should be considered carefully and limited to short-term use. Thermocycling had a detrimental effect on the adhesive strength of Molloplast-B.

Comparison of Fracture Resistance for Chairside CAD/CAM Lithium Disilicate Crowns and Overlays with Different Designs.

PURPOSE: To determine the fracture resistance of chairside computer-aided design and computer-assisted manufacturing (CAD/CAM) lithium disilicate full coverage crowns and two different designs of overlay restorations for premolars. MATERIALS AND METHODS: CAD/CAM lithium disilicate (IPS e.max CAD for CEREC/HT A1 C14, Ivoclar Vivadent) restorations (15 specimens/group) with 1.5 mm occlusal thickness and 1.0 mm chamfer were designed and fabricated with a chairside CAD/CAM system (CEREC, Dentsply Sirona). The restorations were prepared in three different designs: (1) full coverage crowns, (2) overlays with the margin located 2 mm above the gingiva, and (3) overlays with the margin located 4 mm above the gingiva. Restorations were cemented using conventional resin luting cement (Multilink, Ivoclar Vivadent) with primer system (Monobond Plus, Ivoclar Vivadent) to resin printed dies, load cycled (2,000,000 load cycles at 1 Hz with 275 N force), and then finally loaded with a steel indenter until failure. Scanning electron microscopy observations of fractured surfaces were also conducted. Group results were analyzed with one-way analysis of variance, and the medians were evaluated independently with Kruskal-Wallis. RESULTS: The fracture force of CAD/CAM lithium disilicate restorations was significantly different (p < 0.001) depending on the design of the restoration. Full coverage crowns showed significantly higher force to fracture (1018.8 N) than both types of overlays (p = 0.002 for overlay 2.0 mm and p < 0.001 for overlay 4.0 mm above gingiva). Among the two overlays, the restoration with the margin located 2 mm above the gingiva showed significantly higher fracture force (813.8 N) than the overlay with margin at 4 mm above the gingiva (436.1 N; p < 0.001). The fracture appearance of the crowns was much more complex than that of the overlay restorations. CONCLUSIONS: Full coverage chairside CAD/CAM lithium disilicate premolar crown showed higher fracture resistance than overlay restorations. Overlays with the margin located 2 mm above the margin demonstrated higher resistance than those with the margin located 4 mm above the gingiva.

Effect of Crown Height on the Screw Stability of Titanium Screw-Retained Crowns.

PURPOSE: The aim of this in vitro study was to evaluate the effect of crown height on the screw stability of screw-retained titanium implant crowns subjected to cyclic loading conditions. MATERIALS AND METHODS: Twenty-one implants with internal hex connections were placed in epoxy resin holders. Mandibular first molar screw-retained titanium implant crowns with UCLA type, crown-abutment connections were CAD/CAM fabricated. Seven crowns of 3 different heights (6 mm, 10 mm, and 14 mm) were made. The crowns were seated onto the implants and screws were tightened to 30 Ncm. The implants were clamped into holders and stepwise cyclic loads were applied to the occlusal surface at 30-degree angles to the long axes of the crowns. The detorque values were measured after each 5 million cycles. Before increasing the applied load, the crowns were secured with new screws and tightened to 30 Ncm. Failure times, survival estimates and detorque values were then analyzed. (alpha = 0.05). RESULTS: Crown height did not significantly affect detorque values. However, five 14-mm crowns failed with varying fractures during the 475 N loading condition. Overall, a significantly lower survival for 14 mm crowns was found compared to 6 mm and 10 mm crowns (p = 0.004). CONCLUSIONS: Crown heights of one-piece screw-retained titanium implant crowns did not significantly affect detorque values. Screw fracture, however, was greater for crown height of 14 mm than those of 6 mm and 10 mm.

Three-body wear potential of dental yttrium-stabilized zirconia ceramic after grinding, polishing, and glazing treatments.

STATEMENT OF PROBLEM: Zirconia complete-coverage crowns are being widely used as restorations because of their improved esthetic characteristics. Data about the enamel wear potential of this ceramic after chair side adjustments are sparse. PURPOSE: The purpose of this study was to investigate the 3-body wear of enamel opposing 3 types of ceramic (dense sintered yttrium-stabilized zirconia; Crystal Zirconia; DLMS) (Z), a lithium disilicate (IPS e-max CAD; Ivoclar Vivadent) (E), and a conventional low-fusing feldspathic porcelain (VitaVMK-Master; Vita Zahnfabrik) (P), treated to impart a rough, smooth, or glazed surface. MATERIAL AND METHODS: Twenty-four specimens of each of the zirconia and the lithium disilicate ceramic were sectioned from computer-aided design and computer-aided manufacturing blocks into rectangular plates (15×12×2 mm). Twenty-four specimens of the feldspathic porcelain were formed into disks (12 mm diameter) from powders compressed in a silicone mold. All specimens (n=72) were prepared according to the manufacturers' recommendations. Specimens of each ceramic group were placed into 1 of 3 groups: group R, rough surface finish; group S, smooth surface finish; and group G, glazed surface finish. A total of 9 groups with 8 specimens each were placed in a 3-body wear simulator, with standardized enamel specimens (n=72) acting as the substrate. The wear of the enamel specimens was evaluated after 50,000 cycles. The data were analyzed with 2-way ANOVA and the Tukey HSD multiple comparison test (α=.05). RESULTS: The data showed that the smooth zirconia group (ZS) was associated with the least amount of enamel wear (1.26 ±0.55 mm(2)). The most antagonistic enamel wear was associated with the glazed groups ZG (5.58 ±0.66 mm(2)), EG (3.29 ±1.29 mm(2)), and PG (4.2 ±1.27 mm(2)). CONCLUSIONS: The degree of enamel wear associated with monolithic zirconia was similar to conventional feldspathic porcelain. Smoothly polished ceramic surfaces resulted in less wear of antagonistic enamel than glazing.

Comparison of retention and stability of two implant-retained overdentures based on implant location.

STATEMENT OF PROBLEM: The location of dental implants and the choice of retentive attachments for implant-retained overdentures are selected based on clinician preference, expert opinion, or empirical information. Limited information is available regarding implant position and the effect on the retention and stability of 2-implant mandibular implant overdentures. PURPOSE: The purpose of this investigation was to evaluate the effect of implant location on the in vitro retention and stability of a simulated 2-implant-supported overdenture and to examine the differences among different attachment systems. MATERIAL AND METHODS: A model that simulates a mandibular edentulous ridge with dental implants in positions that approximate tooth positions, and a cobalt-chromium cast framework attached to a universal testing machine was used to measure the peak load (N) required to disconnect the attachments. Four different types of attachments (Ball/Cap, ERA, Locator, and O-Ring) were used in sequence in various positions on the model to evaluate the effect of implant location on the retention and stability of a simulated 2-implant-retained overdenture. Means were calculated, and differences among the systems, directions, and groups were identified by using a repeated measured ANOVA (α=.05). For differences observed between measurements, the Bonferroni post hoc method at the 5% level of significance was used to determine the location and magnitude of difference. RESULTS: The interactions between the attachment system, direction of force, and implant location were statistically significant (P=.01). The vertical retention and horizontal stability of a simulated overdenture prosthesis increased with the distal implant location up to the second premolar, and the anteroposterior stability increased with distal implant location. The attachment type affected retention and stability differently by location. Ball attachments produced the highest levels of retention and stability, followed by Locator (pink), O-Ring, and ERA (orange). CONCLUSIONS: The retention and stability of a 2-implant simulated overdenture prosthesis is significantly affected by implant location (P=.01) and abutment type (P=.01).

The stress intensity factors for a periodic array of interacting coplanar penny-shaped cracks.

The effect of crack interactions on stress intensity factors is examined for a periodic array of coplanar penny-shaped cracks. Kachanov's approximate method for crack interactions (Int. J. Solid. Struct. 1987; 23(1):23-43) is employed to analyze both hexagonal and square crack configurations. In approximating crack interactions, the solution converges when the total truncation number of the cracks is 109. As expected, due to high density packing crack interaction in the hexagonal configuration is stronger than that in the square configuration. Based on the numerical results, convenient fitting equations for quick evaluation of the mode I stress intensity factors are obtained as a function of crack density and angle around the crack edge for both crack configurations. Numerical results for the mode II and III stress intensity factors are presented in the form of contour lines for the case of Poisson's ratio ν =0.3. Possible errors for these problems due to Kachanov's approximate method are estimated. Good agreement is observed with the limited number of results available in the literature and obtained by different methods.

Effective spring stiffness for a periodic array of interacting coplanar penny-shaped cracks at an interface between two dissimilar isotropic materials.

An effective spring stiffness approximation is proposed for a hexagonal array of coplanar penny shaped cracks located at the interface between two dissimilar solids. The approximation is based on the factorization of the solution on the material dissimilarity factor, the crack interaction factor and the effective spring stiffness solution for non-interacting cracks in a homogeneous material. Such factorization is exact and was validated for 2D collinear cracks between two dissimilar solids. The crack interaction factor is obtained using a recently developed model for stress intensity factors for an array of coplanar penny shaped cracks in a homogeneous material; also the material dissimilarity function recently obtained for non-interacting penny shaped crack at the interface between two dissimilar materials is employed. The obtained solution is useful for an assessment by ultrasonic measurements of the interface stiffness in bonded structures for monitoring the interfacial microdamage growth due to mechanical loading and environmental factors.

Influence of Cyclic Loading on Load to Failure of Different Ceramic CAD/CAM Implant-Supported Single Crowns

PURPOSE: To compare the load to failure values of different ceramic CAD/CAM implant crown materials with drilled screw access holes with and without cyclic loading applied. MATERIALS AND METHODS: Forty zirconia abutments with a titanium base were pre-loaded onto implants to support maxillary right first premolar crowns that were milled from four different CAD/CAM ceramic materials (zirconia reinforced lithium silicate, hybrid ceramic, lithium disilicate, and zirconia; n = 10 each). After cementing the crowns, screw access channels were prepared by drilling through occlusal surfaces. Half of the specimens were subjected to cyclic loading for 5 million cycles at 2 Hz (n = 5/material). After cyclic loading, vertical loads were applied to failure, and the load to failure values of all crowns were recorded and statistically analyzed. Two-way analysis of variance was used with restricted maximum likelihood estimation and Tukey-Kramer adjustments (α = .05). RESULTS: During cyclic loading, the zirconia abutment in one lithium disilicate specimen cracked at 2 million cycles, as well as a zirconia-reinforced lithium silicate crown. Results for the load to failure test series showed statistical differences between the materials. Zirconia resulted in significantly higher failure loads when compared to the other materials (P < .001). Cyclic loading did not significantly affect the load to failure values. CONCLUSION: Cyclic loading did not significantly influence the load to failure of any of the materials tested. Zirconia crowns with drilled screw access channels cemented on zirconia abutments with a titanium base had higher load to failure values compared to the other ceramic crown materials.

Laser retrieval of cemented zirconia single unit implant restoration: A pilot study: Part I - Force values.

PURPOSE: To measure the retrieval force required to remove 1.5-mm-thick CAD/CAM zirconia copings cemented on zirconia (Zr) and titanium (Ti) stock implant abutments after a single application of erbium-doped yttrium scandium gallium garnet (Er:YSGG) laser. MATERIALS AND METHODS: A total of 60 monolithic Zr copings were cemented on Zr and Ti implant abutments with either a resin-modified glass-ionomer (RelyX Luting Plus Cement, 3M ESPE; Rx) or a zinc oxide eugenol cement (Temp-Bond, Kerr; Tb). These abutment-coping specimens were randomly divided into 12 groups based on laser application (vs control [C]), abutment type (Zr vs Ti), cement (Rx vs Tb), and storage condition (dry [D] vs saline water [W]). Er:YSGG laser was applied at 6 W, 30% water-60% air, and 20 Hz (300 mJ/pulse energy) postcementation following a defined pattern. The force required to remove all the cemented copings from their abutments was measured on a universal testing machine (Instron model 4204). Descriptive statistics, multi-factor analysis of variance, and post hoc Tukey honest significant difference tests (α = .05) were performed. RESULTS: The mean peak force values at removal of the Zr abutment groups were 470.3 ± 151.33 N (ZrRxC), 161.7 ± 19.29 N (ZrRxD), 316.03 ± 95.24 N (ZrRxW), 103.27 ± 24.53 N (ZrTbC), 39.33 ± 6.21 N (ZrTbD), and 20.33 ± 6.45 N (ZrTbW); and for the Ti abutment groups were 349.80 ± 106.82 N (TiRxC), 84.63 ± 14.02 N (TiRxD), 177 ± 62.57 N (TiRxW), 54.77 ± 9.10 N (TiTbC), 22.67 ± 4.32 N (TiTbD), and 11.57 ± 2.30 N (TiTbW). CONCLUSION: Within the limitations of this study, it can be concluded that Er:YSGG laser allows for easier removal of cemented Zr copings with lower removal forces, with Ti abutment groups requiring lower forces than Zr abutment specimens. No significant difference was seen between laser and control groups for Tb compared to Rx. Er:YSGG laser shows great clinical promise for predictable retrievability of cemented, monolithic Zr implant crowns, especially with stronger resin-based cement such as Rx. With further clinical evidence, this could be very useful for clinicians managing cement-retained implant crown complications.

Effective Spring Stiffness for a Planar Periodic Array of Collinear Cracks at an Interface between Two Dissimilar Isotropic Materials.

Explicit analytical expressions are obtained for the longitudinal and transverse effective spring stiffnesses of a planar periodic array of collinear cracks at the interface between two dissimilar isotropic materials; they are shown to be identical in a general case of elastic dissimilarity (the well-known open interface crack model is employed for the solution). Since the interfacial spring stiffness can be experimentally determined from ultrasound reflection and transmission analysis, the proposed expressions can be useful in estimating the percentage of disbond area between two dissimilar materials, which is directly related to the residual strength of the interface. The effects of elastic dissimilarity, crack density and crack interaction on the effective spring stiffness are clearly represented in the solution. It is shown that in general the crack interaction weakly depends on material dissimilarity and, for most practical cases, the crack interaction is nearly the same as that for crack arrays between identical solids. This allows approximate factorization of the effective spring stiffness for an array of cracks between dissimilar materials in terms of an elastic dissimilarity factor and two factors obtained for cracks in a homogeneous material: the effective spring stiffness for non-interacting (independent) cracks and the crack interaction factor. In order to avoid the effect of the crack surface interpenetration zones on the effective spring stiffness, the range of the tensile to transverse load ratios is obtained under the assumption of small-scale contact conditions. Since real cracks are often slightly open (due to prior loading history and plastic deformation), it is demonstrated that for ultrasound applications the results obtained are valid for most practical cases of small interfacial cracks as long as the mid-crack opening normalized by the crack length is at least in the order of 10-5.

Effect of substrate shades on the color of ceramic laminate veneers.

STATEMENT OF PROBLEM: Ceramic laminate veneers are generally fabricated with varying thicknesses ranging from 0.3 to 1 mm, depending on the need to mask discolored teeth or slightly correct the contour of malpositioned teeth. Clinical color reproduction poses a challenge because of color interaction with the underlying substrate, whether tooth structure or esthetic restorative material. PURPOSE: The purpose of this in vitro investigation was to measure the effect of color change resulting from applying 2 shades of ceramic material, translucent (T1) and opaque (O2), to 2 shades of composite resin substrate material, light (A3) and dark (C4), on the overall color of ceramic laminates. MATERIAL AND METHODS: Forty disks were fabricated. Twenty disks (15 × 0.5 mm) were cut from pressed ceramic, 10 disks for each shade (translucent and opaque). Additionally, 20 disks (15 × 4.0 mm) were fabricated from light-polymerized composite resin material, 10 disks for each shade (light and dark). The ceramic disks were bonded to the composite resin disks with clear resin cement. The specimen combinations were divided into 4 groups (n=5). Color measurements were done with a colorimeter (Minolta Chroma Meter CR-200b) configured with diffuse illumination/0-degree viewing geometry. Mean CIE lightness (L*), chroma (C*(ab)), and hue angle (h(ab)) values were obtained. A 2-way analysis of variance (ANOVA) was used to compare the means and standard deviations between the different color combinations (α=.05), followed by Tukey's HSD post hoc test for significant interactions. RESULTS: The 2-way ANOVA showed significant differences (P<.001) in L*, C*(ab), and h(ab) for a change in the composite resin substrate, regardless of the ceramic material shade. There was significant color change from dark to light substrate (P=.044). The mean h(ab) (SD) of dark substrate/opaque veneer was 89.62 (1.5), while the mean h(ab) of light substrate/translucent veneer was 81.23 (1.7). CONCLUSIONS: Within the limitations of this study, the selected color of a 0.5 mm ceramic laminate veneer was significantly affected by the change in color of the supporting substrate.

Failure analysis of high performance polymers and new generation cubic zirconia used for implant-supported fixed, cantilevered prostheses.

BACKGROUND: The load-to-failure performance of computer-assisted design and computer-assisted manufacturing (CAD-CAM) high performance polymers (HPP) and new generation cubic zirconia (Zir) material when used with titanium (Ti) bases for implant-supported fixed prostheses with cantilevers is unknown. PURPOSE: To evaluate the load-to-failure performance of different CAD-CAM fabricated HPP and a new generation cubic Zir in a cantilevered situation when used with Ti bases. MATERIALS AND METHODS: Five specimens with a Ti base and five specimens without Ti bases were fabricated from seven different CAD-CAM HPPs (100% PEEK [J and CP], 80% PEEK with 20% filler [BRE], 80% PEKK with 20% filler [PK], ceramic reinforced PEEK [ZZ], interlaced fiberglass and resin [TR], fiber-composite material [T]). Five specimens with Ti base and two specimens without Ti base were prepared from a new generation cubic Zir (DD) and a 3Y-TZP Zir (FZR) as the control group (N = 84). All specimens (8 × 7 × 30 mm) were stabilized using a clamp attached to the first 20 mm of each specimen for a 10 mm cantilever. Static loading was applied vertically on the cantilever and the maximum load-to-failure values (N) were analyzed using a two-way ANOVA and t-test (alpha = .05). RESULTS: HPP and Zir specimens without Ti bases had significantly higher load-to-failure values than Ti based ones in all groups (P < .05). PK with Ti base had significantly lower load-to-failure values than other materials (P < .001). FZR showed significantly higher load-to-failure values than all HPPs and DD (P < .001). CONCLUSIONS: Load-to-failure values of HPPs and Zir were lower when Ti bases were used. New generation cubic Zir and all HPPs had lower load-to-failure values than FZR. HPPs performance varied among tested materials. PEKK with Ti base had the lowest load-to-failure value.

Biomaterials: Ceramic and Adhesive Technologies.

This review highlights ceramic material options and their use. The newer high-strength ceramics in monolithic form have gained popularity despite the lack of long-term clinical data to support this paradigm shift. Although there are some encouraging clinical data available, there is a need to develop laboratory simulation models that can help predict long-term clinical performance for ceramic and adhesive cements.

Approximate relative fatigue life estimation methods for thin-walled monolithic ceramic crowns.

OBJECTIVES: The objective is to establish an approximate relative fatigue life estimation method under simulated mastication load for thin-walled monolithic restorations. METHODS: Experimentally measured fatigue parameters of fluormica, leucite, lithium disilicate and yttrium-stabilized zirconia in the existing literature were expressed in terms of the maximum cyclic stress and stress corresponding to initial crack size prior to N number of loading cycles to assess their differences. Assuming that failures mostly originate from high stress region, an approximate restoration life method was explored by ignoring the multi-axial nature of stress state. Experiments utilizing a simple trilayer restoration model with ceramic LD were performed to test the model validity. RESULTS: Ceramic fatigue was found to be similar for clinically relevant loading range and mastication frequency, resulting in the development of an approximate fatigue equation that is universally applicable to a wide range of dental ceramic materials. The equation was incorporated into the approximate restoration life estimation, leading to a simple expression in terms of fast fracture parameters, high stress area ΔA, the high stress averaged over ΔA and N. The developed method was preliminarily verified by the experiments. The impact of fast fracture parameters on the restoration life was separated from other factors, and the importance of surface preparation was manifested in the simplified equation. Both the maximum stress and the area of high stress region were also shown to play critical roles. SIGNIFICANCE: While nothing can replace actual clinical studies, this method could provide a reasonable preliminary estimation of relative restoration life.

Effect of shading technique and thickness on color stability and translucency of new generation translucent zirconia.

OBJECTIVE: To evaluate the effect of shading technique and thickness on the color stability and translucency of translucent zirconia after coffee thermocycling. METHODS: Specimens in different thicknesses (1; 1.5; 2 mm) (n = 4 for each thickness) were sectioned from translucent preshaded zirconia (Pre) and externally shaded zirconia (Ext). After sintering, specimens were glazed and subjected to 10,000 thermocycling in coffee solution. The color coordinates of specimens were measured with a spectroradiometer before and after coffee thermocyling. Color differences and relative translucency parameter (RTP) values were calculated with CIEDE2000 color difference and TPCIEDE2000 formulas. ANOVA was used to analyze the CIEDE2000 color difference and RTP values (α = 0.05). RESULTS: According to 2-way ANOVA, no significant effect of shading technique and thickness on the color difference values was found (P > .05). According to 3-way ANOVA, a significant interaction between the shading technique and thickness (P < .0001) was found for RTP. The RTP parameter decreased with the increase in the thickness. Ext specimens presented significantly higher RTP than Pre specimens (P < .0001), except for between Ext 1 mm and Pre 1 mm (P = .179). CONCLUSIONS: Neither shading technique nor tested thicknesses affected the color of translucent zirconia. Shading technique and thickness affected the RTP of translucent zirconia. The RTP was inversely affected with the thickness of the material. Externally shaded zirconia presented higher RTP than preshaded zirconia for specimens thicker than 1 mm. CLINICAL SIGNIFICANCE: Discoloration with coffee was insignificant for the tested translucent zirconia in tested thicknesses (1, 1.5, 2 mm). When a translucent restoration is intended, thinner externally shaded translucent zirconia restorations should be preferred instead of preshaded translucent zirconia.

Shear bond strength of the amalgam-resin composite interface.

OBJECTIVE: This study compared the initial and one year shear bond strengths (SBS) of resin composite bonded to amalgam using Amalgambond-Plus. METHODS: Resin composite cylinders (Point 4, Kerr Corporation) were bonded to either etched-enamel (A), 50% etched enamel-50% polished amalgam (B), airborne-particle abraded amalgam (C), carbide bur prepared amalgam (D) and airborne-particle abraded 50% amalgam-50% etched-enamel (E). Shear bond strengths were determined using a standardized testing device (Ultradent Products) in a universal testing machine (Instron model 4204). The failed interfaces were evaluated with SEM to obtain visual evidence of the failure mode. RESULTS: ANOVA indicated significant differences among the groups (p < 0.0001). SBS in MPa (Mean/SD) were for A at year 0: (24.63/4.19), A at year 1: (16.84/7.25), B at year 0: (9.13/2.18), B at year 1: (15.54/6.41), C at year 0: (16.82/3.60), C at year 1: (15.26/3.90), D at year 0: (9.27/4.03), D at year 1: (7.97/7.17), E at year 0: (16.67/4.87) and E at year 1: (8.63/3.64). CONCLUSION: In vitro testing demonstrated that resin composite masking has the strongest, most durable SBS on airborne-particle abraded amalgam and airborne-particle abraded enamel-amalgam surfaces and could be used as a method to improve the esthetics of amalgam restorations.