Repair protocols for indirect monolithic restorations: a literature review.

Despite the advancements in indirect monolithic restorations, technical complications may occur during function. To overcome this issues, intraoral repair using resin composite is a practical and low-cost procedure, being able to increase the restoration's longevity. This review aimed to evaluate the need for repair and suggest a standardized repair protocol to the main indirect restorative materials. For this, studies were surveyed from PubMed with no language or date restriction, to investigate the scientific evidence of indirect monolithic restoration repair with direct resin composite. A classification to guide clinical decisions was made based on the FDI World Dental Federation criteria about defective indirect restorations considering esthetic and functional standards, along with the patient's view, to decide when polishing, repairing or replacing a defective restoration. Based on 38 surveyed studies, different resin composite intraoral repair protocols, that included mechanical and chemical aspects, were defined depending on the substrate considering resin-based, glass-ceramic or zirconia restorations. The presented criteria and protocols were developed to guide the clinician's decision-making process regarding defective indirect monolithic restorations, prolonging longevity and increasing clinical success.

The optical behavior of pressable lithia-based glass-ceramics under two different heat treatment protocols / O comportamento óptico de vitrocerâmicas prensadas à base de lítio sob dois protocolos diferentes de tratamento térmico

Objective: This study aimed to evaluate the optical behavior of pressable lithia-silicate and lithia-zirconia-silicate glass ceramics toward additional heat treatment protocols. Material and Methods: 40 lithia-silicate discs (15mm x 1mm) were heat pressed following the manufacturers' instructions. Discs were divided into four groups (n=10) according to type as follows: two groups of lithia-silicate-glass ceramics; Gp(E) (IPS e.max Press; Ivoclar Vivadent AG), Gp(L) (GC Initial LiSi Press, GC), two lithia-zirconia-silicate pressable glass ceramics; Gp(C) (Celtra Press, Dentsply Sirona) and Gp(A) (VITA Ambria, VITA Zahnfabrik). Each group was subdivided into (n=5): Subgroup(T1): the thermal tempering temperature was set 9% below the pressing temperature, Subgroup(T2): the temperature was set 5% below the pressing temperature. Optical properties: color, translucency parameter (TP), and contrast ratio (CR) were evaluated by spectrophotometer (Aglient Cary 5000 UV-Vis­NIR) after pressing and after thermal tempering. Results: Thermal tempering regardless of temperature resulted in a color shift within the acceptability level as ΔE for Gp(E) (3.18±2) followed by ΔE for Gp(L) (2.47±0.19) by ΔE for Gp(C) (2.26±0.14) and the last ΔE for Gp(A) (1.62±0.13). Subgroup(T2) showed a significantly higher color shift with mean ΔE(2.55±0.63) compared to Subgroup(T1) ΔE(2.35±0.59). There was a statistically significant increase in TP after tempering for all tested groups parallelled with a decrease in CR values. Conclusion: Heat tempering of the tested lithia-silicate pressable ceramics had a significant effect on the optical outcome of these materials, being lithia-zirconia-silicate ceramics more stable and less affected optically than other lithia-silicate-glass ceramics.(AU)

Objetivo: Avaliar o comportamento óptico de cerâmicas pressionáveis de vidro de litia-silicato e litia-zircônia-silicato sob protocolos adicionais de tratamento térmico. Materiais e métodos: 40 discos de litia-silicato (15mm x 1mm) foram prensados a quente conforme instruções dos fabricantes. Material e Métodos: 40 discos de litia-silicato (15mm x 1mm) foram prensados e divididos em quatro grupos (n=10): dois de lithia-silicato-vidro, Gp(E) (IPS e.max Imprensa) e Gp(L) (GC inicial LiSi Press), e dois de vidro prensado de litia-zircônia-silicato, Gp(C) (Celtra Press) e Gp(A) (VITA Ambria). Cada grupo foi subdividido em (n=5): Subgrupo(T1): amostras temperadas a 9% abaixo da temperatura de prensagem, e Subgrupo(T2): a temperatura foi ajustada 5% abaixo da temperatura de prensagem. As propriedades ópticas, incluindo cor, translucidez (TP) e contraste (CR), foram avaliadas com um espectrofotômetro (Aglient Cary 5000 UV-Vis-NIR) após prensagem e temperagem térmica. Resultados: O tratamento térmico resultou em mudança de cor dentro do nível aceitável, com ΔE mais alto para Gp(E) (3,18±2), seguido por Gp(L) (2,47±0,19), Gp(C) (2,26±0,14), e Gp(A) (1,62±0,13). No subgrupo (T2), houve uma mudança de cor mais significativa, com ΔE médio de (2,55±0,63), comparado ao subgrupo (T1) com ΔE médio de (2,35±0,59). Houve aumento significativo na TP e redução nos valores de RC após o tratamento térmico em todos os grupos testados. Conclusão: O tratamento térmico das cerâmicas prensadas de litia-silicato teve um efeito significativo na sua qualidade ótica, com as cerâmicas de litia-zircônia-silicato mostrando-se mais estáveis e menos afetadas visualmente em comparação com outras cerâmicas de litia-silicato-vidro(AU)

Effect of resin cement elastic modulus on the biaxial flexural strength and structural reliability of an ultra-thin lithium disilicate glass-ceramic material.

OBJECTIVES: Photo- and dual-polymerized resin-based luting agent was evaluated for elastic moduli effects on ultra-thin lithium disilicate (LD) glass-ceramic strengthening, structural reliability, and stress distribution. MATERIALS AND METHODS: One hundred-sixty LD discs (IPS e.max CAD, Ivoclar/Vivadent) were produced in ultra-thin thicknesses (half with 0.3 mm and the other half with 0.5 mm). The ultra-thin ceramic disks were coated with two different cement types (Variolink Veneer - V and Panavia F 2.0 - P). Two positive control groups were tested following hydrofluoric (HF) acid etching (LDt3, LDt5) and two negative control groups were tested for untreated ceramic (LD 3, LD 5). Biaxial flexural strength (BFS), characteristic strength (σ0) and Weibull modulus (m) were the response variables (n = 20) at the ceramic/resin cement interface (z = 0). Finite element analysis (FEA) was used to calculate maximum principal stress. Data were analyzed using two-way ANOVA, and Tukey's test. Scanning electron microscopy (SEM) was used to analyze the failed specimens using fractography and surface morphology. RESULTS: The BFS of LD at either thickness was not affected by cement types, as also demonstrated by FEA. Structural reliability significantly improved in the positive control group (LDt5). CONCLUSION: The cementation of ultra-thin LD with a resin-cement of varying elastic moduli did not influence BFS. LD surface modification by HF acid-etching increased the reliability. CLINICAL RELEVANCE: Ultra-thin anterior veneer designs made from lithium disilicate have been widely proposed and the apparent success of LD ultra-thin veneers was not influenced by the cement choice in the current studies albeit the elastic moduli luting agents used were of similar values.

Biaxial flexure strength and physicochemical characterization of a CAD/CAM lithium disilicate ceramic: effect of etching time, silane, and adhesive applications.

OBJECTIVE: To evaluate the effect of different acid etching time and bonding agent (silane and/or adhesive system) on biaxial flexural strength and physico-chemical properties of a lithium disilicate ceramic. MATERIAL AND METHODS: One hundred twenty ceramic discs were made and divided into 8 groups (n = 15) according to factors "etching time" (20 and 120 s) with hydrofluoric acid (HF) and "bonding agent" (C, no bonding agent; S, silane, A, adhesive; and SA, silane + adhesive). After surface treatment, a resin cement layer was applied to the surface and all specimens were subjected to biaxial flexural strength (BFS) test with treated surfaces loaded in tension (1 mm/min). The Weibull analyses and complementary analyses were also performed. Statistical analysis was done with 2-way ANOVA and the Tukey test (α = 0.05). RESULTS: ANOVA revealed that the factors "etching time" (p = 0.0003) and "bonding agent" (p = 0.007) were statistically significant. In the overall analysis, the HF120S group (272.02 ± 35.30A MPa) presented significantly higher BFS than that of HF120C (218.45 ± 17.15CD MPa) and HF20S (228.40 ± 37.83BCDMPa). On the other hand, the HF20A group (208.92 ± 31.16D MPa) had significantly lower BFS than HF120S (272.02 ± 35.30A), HF120A (254.42 ± 26.87ABC) and HF120SA (259.30 ± 36.55AB) groups (Tukey). The Weibull modulus (m) of all groups was significantly different from each other (p = 0.000). CONCLUSIONS: Regardless of etching time, the application of silane alone is sufficient to increase the flexural strength of glass ceramic, eliminating the need for the application of adhesive systems. Moreover, if only silane or adhesive is applied, 120-s HF application should increase the flexural resistance of the lithium disilicate ceramic. CLINICAL SIGNIFICANCE: Applications of adhesive systems after silanization can be suppressed from the surface treatment protocol of glass ceramics, since it does not improve their mechanical strength.

Study of crystallization, microstructure and mechanical properties of lithium disilicate glass-ceramics as a function of the sintering temperature / Estudo da cristalização, microestrutura e propriedades mecânicas de uma vitrocerâmica de dissilicato de lítio em função da temperatura de sinterização

Objective: The purpose of the present study was to synthesize and characterize lithium disilicate glass-ceramics through the Li2O-SiO2system for determining the most satisfactory sintering parameter by evaluating the crystalline composition, microstructure and mechanical properties. Material and methods: The glass-ceramics were prepared from a glass precursor by means of the melting/cooling technique with a composition of 33.33 Li2O and 66.67 SiO2 (mol.%). The specimens were compressed by the uniaxial pressing technique and three different thermal treatments were used for sintering: 850 °C (Group 1), 900 °C (Group 2), and 950 °C (Group 3), which were determined based on the differential scanning calorimetry (DSC) result. The glass-ceramics were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), Archimedes method, microhardness and biaxial flexural strength analyses. Results: The results regarding XRD predominantly showed lithium disilicate phase for all the heat treatments performed. Moreover, grains with a needle form were more predominantly observed in the SEM images for Group 3, as well as a higher densification and consequently higher mechanical properties. In contrast, Group 1 presented the lowest mechanical properties and densification, as well as the highest porosity. Conclusion: The present study demonstrated how extremely important it is to follow the heat treatment recommended by the manufacturers of ceramics, including time and temperature, which possess direct effects in the crystalline phase formation, as well as in the material's microstructure and mechanical properties (AU)

Objetivo: O presente estudo teve como objetivo sintetizar e caracterizar uma vitrocerâmica de dissilicato de lítio através do sistema Li2O-SiO2para determinar o parâmetro de sinterização mais satisfatório através da avaliação da composição cristalina, microestrutura e propriedades mecânicas. Material e Métodos: As vitrocerâmicas foram preparadas a partir de um vidro precursor pelo método fusão/resfriamento utilizando a composição de 33.33 Li2O e 66.67 SiO2 (mol.%). As amostras foram prensadas utilizando uma técnica de prensagem uniaxial e três tratamentos térmicos diferentes foram utilizadas para sinterização: 850 °C (Grupo 1), 900 °C (Grupo 2), e 950 °C (Grupo 3), que foram determinados através do resultado da análise diferencial de calorimetria. As vitrocerâmicas foram caracterizadas através das análises de difração de raios X (DRX), microscopia eletrônica de varredura (MEV), métodos de Arquimedes, microdureza e ensaio de flexão biaxial. Resultados: Os resultados de DRX mostraram predominantemente a fase de dissilicato de lítio para todos os tratamentos realizados. Além disso, grãos com forma agulhada foram mais predominantemente observados por MEV no grupo 3, assim como uma densificação maior e consequentemente valores maiores das propriedades mecânicas. Em contraste, o grupo 1 apresentou os menores valores de propriedades mecânicas e densificação, e também a maior porosidade. Conclusão: O presente estudo demonstrou como é extremamente importante seguir o tratamento térmico recomendado pelos fabricantes de cerâmica, incluindo tempo e temperatura, que possuem efeitos diretos na formação da fase cristalina, assim como na microestrutura do material e propriedades mecânicas. (AU)

The Effect of Different Surface Treatment Protocols on the Shear Bond Strength to Repressed Lithium Disilicate Glass Ceramics / Efeito de diferentes protocolos de tratamento de superfície na resistência ao cisalhamento de vitrocerâmica de dissilicato de lítio reprensado

Objective: The present study aimed to evaluate the effect of repressing and different surface treatment protocols on the shear bond strength of lithium disilicate glass-ceramics. Material and Methods: A total of 52 lithium disilicate glass-ceramic discs (IPS emax Press, Ivoclar Vivadent) were fabricated using the heat-press technique. The discs were divided into two groups; group (P): discs fabricated from new e.max ingots (n=26), group (R): discs fabricated from reused e.max buttons (n=26). Each group was subdivided into subgroup (E): discs were etched with hydrofluoric acid (9.5%) (n=13), subgroup (S): discs were air-abraded with 110 µm alumina particles. All specimens were subjected to X-ray Diffraction analysis, Scanning Electron Microscope, Energy Dispersive X-Ray, Thermo-Cycling, and Shear Bond Strength Testing. Results: Repressed Etched subgroup (RE) recorded the statistically highest shear bond strength value, followed by the Pressed Etched subgroup (PE), while the statistically lowest shear bond strength value was recorded for the Pressed Air-Abraded subgroup (PS) and Repressed Air-Abraded subgroup (RS). Conclusion: Repressing the leftover buttons for the construction of new lithium disilicate glass-ceramic restorations has no adverse effect on the bond strength of the resin cement to the ceramic. Hydrofluoric acid surface treatment improves the shear bond strength and durability of resin cement bond to both pressed and repressed lithium disilicate glass-ceramic. Air-abrasion cannot be considered as a reliable surface treatment when bonding to lithium disilicate glass-ceramics. (AU)

Objetivo: O presente estudo teve como objetivo avaliar o efeito da reprensagem e de diferentes protocolos de tratamento de superfície na resistência ao cisalhamento de vitrocerâmica de dissilicato de lítio. Materiais e Métodos: Um total de 52 discos de vitrocerâmica de dissilicato de lítio (IPS emax Press, Ivoclar Vivadent) foram fabricadas usando a técnica de prensagem quente. Os discos foram divididos em dois grupos: grupo (P): discos fabricados a partir de novo lingotes de e-max (n=26), grupo (R): discos fabricados a partir de botões de emax reutilizados (n=26). Cada grupo foi subdividido em subgrupo (E): discos condicionados com ácido fluorídrico (9,5%) (n=13), subgrupo (S) discos foram abrasivos com partícula 110 µm de alumínio. Todos os espécimes foram submetidos a analise de difração de raio-x, microscópio eletrônico de varredura, raio-x de energia dispersiva, termociclagem e teste de resistência de cisalhamento. Resultados: O subgrupo Reprensado-condicionado (RE) registrou o valor estatisticamente mais alta em relação a resistência ao cisalhamento, seguido pelo subgrupo Prensado-condicionado (PE), enquanto o valor estatisticamente mais baixo de resistência ao cisalhamento foi o subgrupo Prensado-Jateado (OS) e o subgrupo Reprensado-Jateado (RS). Conclusão: A reprensagem dos botões restantes para a construção de novas restaurações vitrocarâmicas de dissilicato de lítio não apresentou efeitos adversos na resistência de unicãp do cimento resinoso à cerâmica. O tratamento de superfície com ácido fluorídrico melhora a resistência ao cisalhamento e a durabilidade do cimento resinoso para vitrocerâmica de dissilicato de lítio prensada e reprimida. A abrasão por ar não pode ser considerada um tratamento de superfície confiável quanto a colagem da vitrocerâmica de dissilicato de lítio (AU)

Machinability of Zirconia Toughened Mica Glass Ceramics for Dental Restorations / Usinabilidade de cerâmica de vidro de mica temperada com zircônia para restaurações dentárias

Objective: For a dental material to be machinable for CAD/CAM technology, it must offer convenient machining, under a given set of cutting conditions. Quantitative evaluation of machinability has been assessed in literature through various parameters such as tool wear, penetration rates, surface roughness, cutting force and power. A machinable ceramic will typically demonstrate a higher tool penetration rate with signs of reduced diamond tool wear and edge chipping. The purpose of this in vitro study was to evaluate the feasibility of machining an experimental ceramic, 20 wt.% zirconia reinforced mica glass ceramics (G20Z) for indirect dental restorations and compare the tool penetration rates of G20Z to commercially available dental ceramics, Presintered Zirconia (PSZ) and IPS emax CAD. Material and Methods: Precursors of base glass (SiO2 -Al2O3 -K2O -MgO-B2O3 -F) were melted at 15000C for 2 h in a platinum crucible and quenched in deionised water. The glass frit was ball milled with 20 wt. % YSZ (G20Z) and subject to two stage heat treatment in a muffle furnace. Specimens of G20Z (12 X 2 mm) were evaluated for their feasibility of machining under varying spindle speed, depth of cut, and feed rates. Influence of depth of cut, spindle speed and feed rate (vc=8000-16000 rpm, d=0.4-0.8 mm, f=0.1- 0.3 mm/tooth) on cutting forces, material response, surface roughness and tool wear were investigated. Tool penetration rates, tool wear and margin chipping were also evaluated and compared with Pre-sintered Zirconia (PSZ) and e.max CAD in a custom dental milling surveyor at 30,000 rpm with a load of 0.98 N under water lubrication for 6 min. Tool penetration rates were calculated as the ratio of length of cut and milling time with a measuring microscope and scanning electron microscope was used for tool wear and edge chipping. ANOVA and Tukey Kramer tests were used for statistically comparing the means of each group. Results: Spindle speed and feed rate play a significant role in influencing surface roughness, thrust force, cutting forces and tool wear. Penetration rates of G20Z (0.32 ±0.12 mm/min) was significantly greater than PSZ (0.26 ±0.06 mm/min) and IPS e.max CAD (0.21 ±0.05 mm/min). SEM observations reveal tool abrasion and edge chipping regardless of the ceramic type. Conclusion: High spindle speeds delivers low cutting forces with an average surface roughness of 1.61 µm, with abrasive wear of the tool insert and brittle fracture of zirconia mica glass ceramic composites. G20Z with its machinable nature demonstrates greater tool penetration rates than PSZ and IPS e.max CAD. Tool wear and edge chipping is seen in all the investigated ceramics. (AU)

Objetivo: Para que um material odontológico seja usinável para a tecnologia CAD / CAM, ele deve oferecer uma usinagem conveniente, sob um determinado conjunto de condições de corte. A avaliação quantitativa da usinabilidade tem sido avaliada na literatura por meio de vários parâmetros, como desgaste da ferramenta, taxas de penetração, rugosidade da superfície, força de corte e potência. Uma cerâmica usinável normalmente demonstrará uma maior taxa de penetração da ferramenta com sinais de desgaste reduzido da ferramenta de diamante e lascamento da borda. O objetivo deste estudo in vitro foi avaliar a viabilidade da usinagem de uma cerâmica experimental, 20% em peso de cerâmica de vidro de mica reforçada com zircônia (G20Z) para restaurações dentárias indiretas e comparar as taxas de penetração da ferramenta de G20Z com as cerâmicas dentais comercialmente disponíveis, Zircônia Presinterizada (PSZ) e IPS emax CAD. Material e Métodos: Precursores de vidro base (SiO2-Al2O3-K2O -MgO-B2O3 -F) foram fundidos a 15000C por 2 h em um cadinho de platina e temperados em água deionizada. A frita de vidro foi moída com 20% em peso de YSZ (G20Z) e submetida a tratamento térmico em duas fases em mufla. Amostras de G20Z (12 x 2 mm) foram avaliadas quanto à sua viabilidade de usinagem sob variação de velocidade do fuso, profundidade de corte e taxas de avanço. A influência da profundidade de corte, velocidade do fuso e taxa de avanço (vc = 8000-16000 rpm, d = 0,4-0,8 mm, f = 0,1- 0,3 mm / dente) nas forças de corte, resposta do material, rugosidade da superfície e desgaste da ferramenta foram investigadas. As taxas de penetração da ferramenta, o desgaste da ferramenta e o lascamento da margem também foram avaliados e comparados com Zircônia pré-sinterizada (PSZ) e e.max CAD em um topógrafo de fresamento dentário personalizado a 30.000 rpm com uma carga de 0,98 N de lubrificação subaquática por 6 min. As taxas de penetração da ferramenta foram calculadas como a razão entre o comprimento de corte e o tempo de fresamento com um microscópio de medição e um microscópio eletrônico de varredura foi usado para o desgaste da ferramenta e lascamento da borda. Os testes ANOVA e Tukey Kramer foram usados para comparar estatisticamente as médias de cada grupo. Resultados: a velocidade do fuso e a taxa de avanço desempenham um papel significativo em influenciar a rugosidade da superfície, força de impulso, forças de corte e desgaste da ferramenta. As taxas de penetração de G20Z (0,32 ± 0,12 mm / min) foram significativamente maiores do que PSZ (0,26 ± 0,06 mm / min) e IPS e.max CAD (0,21 ± 0,05 mm / min). As observações do SEM revelam a abrasão da ferramenta e o lascamento da borda, independentemente do tipo de cerâmica. Conclusão: As altas velocidades do fuso proporcionam baixas forças de corte com uma rugosidade superficial média de 1,61 µm, com desgaste abrasivo do inserto da ferramenta e fratura frágil de compósitos de cerâmica de vidro de zircônia. G20Z com sua natureza usinável demonstra maiores taxas de penetração da ferramenta do que PSZ e IPS e.max CAD. O desgaste da ferramenta e o lascamento da borda são vistos em todas as cerâmicas investigadas. (AU)

New Na1+xGe2(SiO4)x(PO4)3-x NASICON Series with Improved Grain and Grain Boundary Conductivities.

In this study, we synthesize glass-ceramics of the new Na1+xGe2(SiO4)x(PO4)3-x NASICON (Na super-ionic conductor) series to evaluate the effect of Si4+/P5+ substitution on the structural, microstructural, and electrical properties of the NaGe2(PO4)3 system. From X-ray diffraction, the presence of the NASICON phase is confirmed in all glass-ceramics. An expansion of the unit cell volume suggesting an increase in the bottleneck of the NASICON structure is also observed. Impedance spectroscopy allowed the separation of grain and grain boundary contributions. We observe that the grain conductivity is higher than the specific grain boundary conductivity in all of the investigated compositions (0 ≤ x ≤ 0.8). The Si4+/P5+ substitution causes an enhancement of about 2 and 3 orders of magnitude in the grain and specific grain boundary conductivities, respectively. This behavior is attributable to the introduction of new charge carriers (Na+) in the NASICON structure and a decrease in the activation energy. Finally, the lowest activation energy for grain (0.586 eV) is observed in the x = 0.6 sample, which indicates the easiest displacement of ions in the investigated series, suggesting that this composition presents the most suitable bottleneck size for (Na+) sodium ion conduction.

Wear behavior of monolithic zirconia against natural teeth in comparison to two glass ceramics with two surface finishing protocols: an in-vitro study / Comportamento do desgaste da zircônia monolítica frente a dentes naturais em comparação com duas cerâmicas de vidro com diferentes protocolos de acabamento superficial: um estudo in vitro

Objective: To evaluate and compare the wear behavior of three different ceramic systems; monolithic zirconia, lithium di-silicate and nano-fluorapatite glass ceramic with two finishing procedures polishing and glazing, and their effect on the wear of natural tooth antagonists. Material and Methods: Forty two ceramic disc specimens (10mm x3mm) and forty two natural tooth antagonists were used. Samples were divided according to ceramic materials into 3 groups (n = 14). Group I: nano-fluorapatite glass ceramic (FLU) (IPS e.max Ceram), Group II: lithium disilicate (LD) (IPS e.max CAD) and group III: monolithic zirconia (ZIR) (ZirkoZahn Prettau). Each group was further subdivided into two subgroups (n = 7), according to the surface finish: Polishing (P) and glazing (G). Specimens were subjected to a custom designed two-body wear simulator. Quantitative wear assessment was carried out using weight loss measurements. Scanning electron microscope was used for characterization of wear patterns. Kruscal Wallis and Dunn's tests were used to compare between weight loss of the three ceramic materials. Whitney U test was used to compare the weight loss between the two surface finish protocols. Wilcoxon Signed rank test was used to compare the weight loss between ceramic specimens and antagonist teeth (p ≤ 0.05). Paired t-test was used to compare weight loss before and after wear test. Results: After wear, LD and FLU had the highest weight loss values compared to ZIR (p < 0.05). For teeth, there was no significant difference between the weight loss values with the three materials (p > 0.05). P and G specimens showed no significant difference in weight loss values. SEM images of the wear patterns verified the previous analysis. Conclusion: ZIR is more wear resistant than LD and FLU. However, the surface treatment had no impact on the wear behavior. (AU)

Objetivo: Avaliar e comparar o comportamento ao desgaste de três diferentes sistemas cerâmicos; zircônia monolítica, di-silicato de lítio e vitrocerâmica de nano-fluorapatita com dois procedimentos de polimento e glaze, e seu efeito no desgaste de dentes naturais antagonistas. Material e Métodos: Foram utilizadas quarenta e duas amostras de discos cerâmicos (10 mm x 3 mm) e quarenta e dois dentes naturais como antagonistas. As amostras foram divididas de acordo com o material cerâmico em 3 grupos (n = 14). Grupo I: vitrocerâmica nano-fluorapatita (FLU) (IPS e.max Ceram), Grupo II: dissilicato de lítio (LD) (IPS e.max CAD) e grupo III: zircônia monolítica (ZIR) (ZirkoZahn Prettau). Cada grupo foi subdividido em dois subgrupos (n = 7), de acordo com o acabamento da superfície: Polimento (P) e Glaze (G). As amostras foram submetidas a um simulador de desgaste de dois corpos projetado. A avaliação quantitativa do desgaste foi realizada usando medidas de perda de massa. Microscópio eletrônico de varredura foi utilizado para caracterização de padrões de desgaste. Os testes de Kruscal Wallis e Dunn foram usados para comparar a perda de massa dos três materiais cerâmicos. O teste U de Whitney foi utilizado para comparar a perda de massa entre os dois protocolos de acabamento superficial. O teste de Wilcoxon Signed Rank foi utilizado para comparar a perda de massa entre amostras de cerâmica e os dentes antagonistas (p ≤ 0,05). O teste t pareado foi utilizado para comparar a perda de massa antes e depois do teste de desgaste. Resultados: Após o desgaste, LD e FLU apresentaram os maiores valores de perda de massa em comparação ao ZIR (p < 0,05). Para os dentes, não houve diferença significativa entre os valores de perda de massa com os três materiais (p > 0,05). As amostras de P e G não mostraram diferença significativa nos valores de perda de massa. Imagens SEM dos padrões de desgaste confirmaram a análise anterior. Conclusão: O ZIR é mais resistente ao desgaste do que LD e FLU. No entanto, o tratamento de superfície não teve impacto no comportamento do desgaste. (AU)

Development and Characterization of Glass-Ceramics from Combinations of Slag, Fly Ash, and Glass Cullet without Adding Nucleating Agents.

Developments in the field of materials science are contributing to providing solutions for the recycling of industrial residues to develop new materials. Such approaches generate new products and provide optimal alternatives to the final disposal of different types of industrial wastes. This research focused on identifying and characterizing slag, fly ash, and glass cullet from the Boyacá region in Colombia as raw materials for producing glass-ceramics, with the innovative aspect of the use of these three residues without the addition of nucleating agents to produce the glass-ceramics. To characterize the starting materials, X-ray diffraction (XRD), X-ray fluorescence (XRF), and Scanning Electron Microscopy (SEM) techniques were used. The results were used to evaluate the best conditions to produce mixtures of the three waste components and to determine the specific compositions of glass-ceramics to achieve products with attractive technical properties for potential industrial applications. The proposed mixtures were based on three compositions: Mixture 1, 2, and 3. The materials were obtained through thermal treatment at 1200 °C in a tubular furnace in accordance with the results of a comprehensive characterization using thermal analysis. The microstructure, thermal stability, and structural characteristics of the samples were examined through SEM, differential thermal analysis (DTA), and XRD analyses, which showed that the main crystalline phases were diopside and anorthite, with a small amount of enstatite and gehlenite. The obtained glass-ceramics showed properties of technical significance for structural applications.

Alternativas de tratamientos de superficie para adhesión de cerámica de disilicado de litio / Alternatives of surface treatments for adhesion of lithium disilicate ceramics

Introduction: the clinical success of a restoration is strongly associated with the quality and durability of the ceramic-cement resin interface. In order to obtain an adequate union between these materials of different nature surface treatments are used and achieve mechanical retention or chemical interaction. Objectives: to check if any method promotes a true chemical bond between lithium disilicate ceramics and resin cement. As well as determineif there is any treatment that reports bonding values comparable to hydrofluoric acid and silane (gold standard). Methods: a systematic literature review was developed based on the PRISMA strategy, where the databases were searched: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO with MeSH and free terms from 2005 to November 2016 for articles in English and Spanish on surface treatments for lithium disilicate. Results: from 58 publications selected a sample of 21 articles. Two articles reported high risk of bias. Conclusions: hydrofluoric acid and silane continue to be the method with the highest and most reliable adhesion values in the literature. Universal adhesives are an alternative to promote chemical adhesion additional to the silane. Diamond burs, Nd: YAG and Er: YAG laser are not recommended as surface treatments(AU)

Introducción: el éxito clínico de una restauración se asocia fuertemente a la calidad y duración de la interface cerámica-cemento resinoso. Para que exista una adecuada unión entre estos materiales de distinta naturaleza se emplean tratamientos de superficie para lograr una buena retención mecánica o interacción química. Objetivos: revisar si algún método promueve una verdadera adhesión química entre la cerámica de disilicato de litio y el cemento resinoso, así como determinar si existe algún tratamiento que reporte valores de unión comparables al ácido fluorhídrico y silano (patrón de oro). Métodos: se desarrolló una revisión sistemática de literatura basada en la estrategia PRISMA, donde se buscó en las bases de datos: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO con términos MeSH y libres desde el 2005 a noviembre de 2016 para artículos en inglés y español sobre tratamientos de superficie para disilicato de litio. Resultados: de 58 publicaciones, se seleccionó una muestra de 21 artículos. Dos artículos reportaron riesgo de sesgo alto. Conclusiones: el ácido fluorhídrico y silano continúan siendo el método con los valores de adhesión más altos y confiables de la literatura. Los adhesivos universales son una alternativa para promover adhesión química adicional al silano. Fresas diamantadas, laser Nd: YAG y Er:YAG no se recomienda como tratamientos de superficie(AU)

Alternativas de tratamientos de superficie para adhesión de cerámica de disilicado de litio / Alternatives of surface treatments for adhesion of lithium disilicate ceramics

Introduction: the clinical success of a restoration is strongly associated with the quality and durability of the ceramic-cement resin interface. In order to obtain an adequate union between these materials of different nature surface treatments are used and achieve mechanical retention or chemical interaction. Objectives: to check if any method promotes a true chemical bond between lithium disilicate ceramics and resin cement. As well as determineif there is any treatment that reports bonding values comparable to hydrofluoric acid and silane (gold standard). Methods: a systematic literature review was developed based on the PRISMA strategy, where the databases were searched: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO with MeSH and free terms from 2005 to November 2016 for articles in English and Spanish on surface treatments for lithium disilicate. Results: from 58 publications selected a sample of 21 articles. Two articles reported high risk of bias. Conclusions: hydrofluoric acid and silane continue to be the method with the highest and most reliable adhesion values in the literature. Universal adhesives are an alternative to promote chemical adhesion additional to the silane. Diamond burs, Nd: YAG and Er: YAG laser are not recommended as surface treatments(AU)

Introducción: el éxito clínico de una restauración se asocia fuertemente a la calidad y duración de la interface cerámica-cemento resinoso. Para que exista una adecuada unión entre estos materiales de distinta naturaleza se emplean tratamientos de superficie para lograr una buena retención mecánica o interacción química. Objetivos: revisar si algún método promueve una verdadera adhesión química entre la cerámica de disilicato de litio y el cemento resinoso, así como determinar si existe algún tratamiento que reporte valores de unión comparables al ácido fluorhídrico y silano (patrón de oro). Métodos: se desarrolló una revisión sistemática de literatura basada en la estrategia PRISMA, donde se buscó en las bases de datos: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO con términos MeSH y libres desde el 2005 a noviembre de 2016 para artículos en inglés y español sobre tratamientos de superficie para disilicato de litio. Resultados: de 58 publicaciones, se seleccionó una muestra de 21 artículos. Dos artículos reportaron riesgo de sesgo alto. Conclusiones: el ácido fluorhídrico y silano continúan siendo el método con los valores de adhesión más altos y confiables de la literatura. Los adhesivos universales son una alternativa para promover adhesión química adicional al silano. Fresas diamantadas, laser Nd: YAG y Er:YAG no se recomienda como tratamientos de superficie(AU)

Crystal Modification on Lithium Disilicate Glass Ceramics Sintered Using Microwaves / Modificación de Cristales de Cerémicas de Vidrio de Disilicato de Litio Sinterizadas con Microondas

ABSTRACT: Microwaves are an interesting alternative to process dental ceramics. It is well documented that Microwave Hybrid Sintering (MHS) allows important savings in time and energy consumption. However, little is known about its effect on lithium disilicate glass ceramics, a popular material in dentistry today. We analyzed the microstructure of lithium disilicate glass ceramics sintered with MHS compared with conventional sintering. We sintered lithium disilicate glass ceramics using MHS and conventional furnaces, and we analyzed the samples using X-Ray diffraction and SEM. Samples sintered with MHS showed an increased crystalline phase, with an increased number of crystals. These crystals have larger perimeters compared with samples sintered in conventional furnaces. MHS produced a different crystallization pattern and crystal/ matrix ration in lithium disilicate glass ceramics when compared to conventional sintering. This can be associated with the improved mechanical properties of these materials reported previously.

RESUMEN: Las microondas son una interesante alternativa para procesar cerámicas dentales. Está bien documentado que el Sinterizado Híbrido por Microondas (MHS) permite ahorros importantes de tiempo y energía. Sin embargo, poco se ha publicado respecto a sus efectos en cerámicas de disilicato de litio, un material bastante popular en odontología en estos días. En este artículo analizamos la micro estructura de cerámicas de disilicato de litio sinterizada con MHS comparada con el sinterizado convencional. Sinterizamos muestras de cerámicas de disilicato de litio usando MHS y hornos convencionales, y analizamos las muestras usando difracción de rayos X y SEM. Las muestras sintetizadas usando MHS tienen una mayor fase cristalina, con mayor número de cristales. Estos cristales tienen además perímetros mayores, comparados con las muestras sinterizadas en hornos convencionales. MHS produce patrones de cristalización y proporción de cristal/matrix diferentes a las producidos por sinterizado convencional. Esto puede asociarse a las mejoras en propiedades mecánicas reportadas previamente.

The In Vitro Bioactivity, Degradation, and Cytotoxicity of Polymer-Derived Wollastonite-Diopside Glass-Ceramics.

Ca-Mg silicates are receiving a growing interest in the field of bioceramics. In a previous study, wollastonite-diopside (WD) glass-ceramics were successfully prepared by a new processing route, consisting of the heat treatment of a silicone resin embedding reactive oxide particles and a Ca/Mg-rich glass. The in vitro degradation, bioactivity, and cell response of these new WD glass-ceramics, fired at 900-1100 °C for 1 h, as a function of the Ca/Mg-rich glass content, are the aim of this investigation The results showed that WD glass-ceramics from formulations comprising different glass contents (70-100% at 900 °C, 30% at 1100 °C) exhibit the formation of an apatite-like layer on their surface after immersion in SBF for seven days, thus confirming their surface bioactivity. The XRD results showed that these samples crystallized, mainly forming wollastonite (CaSiO3) and diopside (CaMgSi2O6), but combeite (Na2Ca2Si3O9) crystalline phase was also detected. Besides in vitro bioactivity, cytotoxicity and osteoblast adhesion and proliferation tests were applied after all characterizations, and the formulation comprising 70% glass was demonstrated to be promising for further in vivo studies.

Effect of Different Silane Treatments on Long-Term Bonding Between Non-Etched Glass-Ceramic and Resin Cement

he present study evaluated the bond strength between glass-ceramic and resin cement, using different silane treatments, performing no previous hydrofluoric acid (HF) etching on ceramic surface, after short- and long- term storage. One hundred and eighty glass-ceramic plaques (IPS e.max CAD®) were polished and divided into six groups (n=30) to receive different silane treatments: (1) RCP-RelyX Ceramic Primer® (one-bottle silane), (2) RCP+SB-RelyX Ceramic Primer and Adper Singlebond2® (silane plus separated adhesive), (3) SBU-Scotchbond Universal® (silane-containing universal adhesive), (4) CP-Clearfil Ceramic Primer® (silane/MDP primer), (5) NC-no-silane (negative control) and (6) PC-Previous HF etching (5%, 20s) plus RelyX Ceramic Primer® (positive control). Two resin cement cylinders (Rely X Ultimate®) were built on each plaque. Each group was divided into two sub-groups to be stored for 24 hours (24h) or 6 months (6mo) in distilled water at 37°C (n=15). Then microshear (µSBS) testing was performed. Failure mode was analyzed using scanning electron microscopy (SEM). Data were statistically analyzed by two-way ANOVA and Tukey´s test (α=0.05). Both factors and their interaction resulted statistically significant (p≤0.05). PC obtained the highest µSBS values (in MPa) at both storage times (24h: 28.11±2.44; 6mo: 19.10±3.85). After 24h storage, groups RCP+SB (10.86±3.62), SBU (8.37±4.33) and CP (8.05±3.62) were not statistically different from NC (8.00±2.51); only RCP (19.73±4.63) and PC obtained higher values. After 6 months, only PC showed higher values than NC (0.04±0.01). Cohesive failure in resin cement was more prevalent for RCP-24h and PC, while adhesive failure was more frequent among all other groups. Clinical relevance: None of the commercially available silane primers tested, improve long- term ceramic/cement bonding without performing HF etching on ceramic surface. Combination of HF acid and silane, remain as a gold standard treatment for glass-ceramic materials.

ste estudio evaluó la resistencia de unión entre cerámica vítrea y cemento resinoso, utilizando diferentes tratamientos de silano, sin realizar condicionamiento previo de la cerámica con ácido fluorhídrico (HF), después de almacenamiento en corto y largo plazo. Ciento ochenta placas de cerámica (IPS e.max CAD®) fueron pulidas y divididas en 6 grupos (n=30) para ser tratadas como sigue: (1) RCPRelyX Ceramic Primer® (silano de 1 frasco), (2) RCP+SB-RelyX Ceramic Primer y Adper Singlebond2® (silano más adhesivo separado), (3) SBU-Scotchbond Universal® (adhesivo universal conteniendo silano), (4) CP-Clearfil Ceramic Primer® (primer cerámico conteniendo silano y MDP), (5) NC-ningún silano (control negativo) y (6) PC-Condicionamiento con HF previo (5%, 20s) y silano (RelyX Ceramic Primer®) (control positivo). Dos cilindros de cemento resinoso (Rely X Ultimate®) fueron construidos en cada placa. Cada grupo fue dividido en 2 sub-grupos para ser almacenados por 24 horas (24h) y 6 meses (6mo) en agua destilada a 37°C (n=15). Luego fue realizada la prueba de microcizallamiento (µSBS). El tipo de fractura fue analizado con microscopio electrónico de barrido (SEM) y los datos analizados con las pruebas estadísticas ANOVA de dos factores y Tukey (α=0.05). Ambos factores y su interacción resultaron estadísticamente significativos (p≤0.05). PC presentó los valores más altos de µSBS (MPa) para ambos tiempos de almacenamiento (24h: 28.11±2.44; 6mo: 19.10±3.85). Luego de 24h, los grupos RCP+SB (10.86±3.62), SBU (8.37±4.33) y CP (8.05±3.62) no fueron estadísticamente diferentes del grupo control negativo (NC: 8.00±2.51); sólo RCP (19.73±4.63) y PC obtuvieron resultados mayores. Después de 6 meses de almacenaje, sólo el grupo PC obtuvo valores estadísticamente mayores que NC (0.04±0.01). Fractura cohesiva en el cemento fue más prevalente para RCP-24h y PC, mientras que el tipo adhesivo fue el más frecuente para todos los demás grupos. Relevancia Clínica: Ninguno de los tratamientos de silano evaluados, mejoró significativamente la adhesión a largo plazo entre cerámica vítrea no condicionada y cemento resinoso. La combinación de HF y silano, continúa siendo el tratamiento de preferencia para cerámica vítrea durante el proceso de cementación.

Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y (n = 5,811 restorations) and were 91% at 10 y (n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.

Microstructure characterization and SCG of newly engineered dental ceramics.

OBJECTIVES: The aim of this study was to characterize the microstructure of four dental CAD-CAM ceramics and evaluate their susceptibility to stress corrosion. METHODS: SEM and EDS were performed for microstructural characterization. For evaluation of the pattern of crystallization of the ceramics and the molecular composition, XRD and FTIR, respectively, were used. Elastic modulus, Poisson's ratio, density and fracture toughness were also measured. The specimens were subjected to biaxial flexure under five stress rates (0.006, 0.06, 0.6, 6 and 60MPa/s) to determine the subcritical crack growth parameters (n and D). Twenty-five specimens were further tested in mineral oil for determination of Weibull parameters. Two hundred forty ceramic discs (12mm diameter and 1.2mm thick) were made from four ceramics: feldspathic ceramic - FEL (Vita Mark II, Vita Zahnfabrik), ceramic-infiltrated polymer - PIC (Vita Enamic, Vita Zahnfabrik), lithium disilicate - LD (IPS e.max CAD, Ivoclar Vivadent) and zirconia-reinforced lithium silicate - LS (Vita Suprinity, Vita Zahnfabrik). RESULTS: PIC discs presented organic and inorganic phases (n=29.1±7.7) and Weibull modulus (m) of 8.96. The FEL discs showed n=36.6±6.8 and m=8.02. The LD discs showed a structure with needle-like disilicate grains in a glassy matrix and had the lowest value of n (8.4±0.8) and m=6.19. The ZLS discs showed similar rod-like grains, n=11.2±1.4 and m=9.98. SIGNIFICANCE: The FEL and PIC discs showed the lowest susceptibility to slow crack growth (SCG), whereas the LD and ZLS discs presented the highest. PIC presented the lowest elastic modulus and no crystals in its composition, while ZLS presented tetragonal zirconia. The overall strength and SCG of the new materials did not benefit from the additional phase or microconstituents present in them.

LED and Halogen Light Transmission through a CAD/CAM Lithium Disilicate Glass-Ceramic

The effect of thickness, shade and translucency of CAD/CAM lithium disilicate glass-ceramic on light transmission of light-emitting diode (LED) and quartz-tungsten-halogen units (QTH) were evaluated. Ceramic IPS e.max CAD shades A1, A2, A3, A3.5, high (HT) and low (LT) translucency were cut (1, 2, 3, 4 and 5 mm). Light sources emission spectra were determined. Light intensity incident and transmitted through each ceramic sample was measured to determine light transmission percentage (TP). Statistical analysis used a linear regression model. There was significant interaction between light source and ceramic translucency (p=0.008) and strong negative correlation (R=-0.845, p<0.001) between ceramic thickness and TP. Increasing one unit in thickness led to 3.17 reduction in TP. There was no significant difference in TP (p=0.124) between shades A1 (ß1=0) and A2 (ß1=-0.45) but significant reduction occurred for A3 (ß1=-0.83) and A3.5 (ß1=-2.18). The interaction QTH/HT provided higher TP (ß1=0) than LED/HT (ß1=-2.92), QTH/LT (ß1=-3.75) and LED/LT (ß1=-5.58). Light transmission was more effective using halogen source and high-translucency ceramics, decreased as the ceramic thickness increased and was higher for the lighter shades, A1 and A2. From the regression model (R2=0.85), an equation was obtained to estimate TP value using each variable ß1 found. A maximum TP of 25% for QTH and 20% for LED was found, suggesting that ceramic light attenuation could compromise light cured and dual cure resin cements polymerization.

Resumo Avaliou-se o efeito da espessura, cor e translucidez de uma cerâmica vítrea a base de dissilicato de lítio para CAD / CAM sobre a transmissão da luz de unidades de diodos emissores de luz (LED) e de quartzo-tungstênio-halogênio (QTH). Cerâmica IPS e.max CAD nas cores A1, A2, A3, A3.5 de translucidez alta (HT) e baixa (LT) foram cortadas (1, 2, 3, 4, 5 mm). Os espectros de emissão das fontes de luz foram determinados. A intensidade da luz incidente e transmitida através de cada espécime de cerâmica foi medida para determinar a percentagem de transmissão de luz (TP). Um modelo de regressão linear foi utilizado para a análise estatística. Houve interação significativa entre a fonte de luz e translucidez cerâmica (p = 0.008) e forte correlação negativa (r = -0.845, p <0.001) entre a espessura da cerâmica e TP. O aumento da espessura em uma unidade levou a uma redução média de 3.17 em TP. Não houve diferença significativa em TP (p = 0.124) entre as cores A1 (ß1 = 0) e A2 (ß1 = -0.45), mas ocorreu redução significativa para as cores A3 (ß1 = -0.83) e A3.5 (ß1 = -2.18). A interação QTH/HT proporcionou maior TP (ß1 = 0) do que LED/HT (ß1 = -2.92), QTH/LT (ß1 = -3.75) e LED/LT (ß1 = -5.58). A transmissão de luz foi mais eficaz utilizando QTH e cerâmica de alta translucidez, diminuiu à medida que a espessura de cerâmica aumentou, e foi maior para as cores A1 e A2. A partir do modelo de regressão (R2 = 0.85), obteve-se uma equação para estimar o valor de TP utilizando os valores de ß1 encontrado. Foi observada TP máxima de 25% para QTH e 20% para LED, sugerindo que a atenuação promovida pela cerâmica pode comprometer a ativação de um cimento resinoso fotoativado e de ativação dupla.

Changes in actin and tubulin expression in osteogenic cells cultured on bioactive glass-based surfaces.

The present study evaluated whether the changes in the labeling pattern of cytoskeletal proteins in osteogenic cells cultured on bioactive glass-based materials are due to altered mRNA and protein levels. Primary rat-derived osteogenic cells were plated on Bioglass® 45S5, Biosilicate®, and borosilicate (bioinert control). The following parameters were assayed: (i) qualitative epifluorescence analysis of actin and tubulin; (ii) quantitative mRNA and protein expression for actin and tubulin by real-time PCR and ELISA, respectively, and (iii) qualitative analysis of cell morphology by scanning electron microscopy (SEM). At days 3 and 7, the cells grown on borosilicate showed typical actin and tubulin labeling patterns, whereas those on the bioactive materials showed roundish areas devoid of fluorescence signals. The cultures grown on bioactive materials showed significant changes in actin and tubulin mRNA expression that were not reflected in the corresponding protein levels. A positive correlation between the mRNA and protein as well as an association between epifluorescence imaging and quantitative data were only detected for the borosilicate. SEM imaging of the cultures on the bioactive surfaces revealed cells partly or totally coated with material aggregates, whose characteristics resembled the substrate topography. The culturing of osteogenic cells on Bioglass® 45S5 and Biosilicate® affect actin and tubulin mRNA expression but not the corresponding protein levels. Changes in the labeling pattern of these proteins should then be attributed, at least in part, to the presence of a physical barrier on the cell surface as a result of the material surface reactions, thus limiting fluorescence signals.

Solución estética a un dilema en las restauraciones indirectas con corona y carillas simultáneas: Reporte de un caso / Dental restoration with laminate veneers and ceramic crown, aesthetic solution to a routine dilemma. Case Report

El presente artículo presenta una alternativa de solución ante la necesidad de resolver el sector anterior con combinaciones de carillas y corona. Se confeccionó una infraestructura que simula a un diente natural tallado para carilla y luego la cementación de las carillas sobre dientes preparados y sobre la infraestructura adhoc.Esta es una alternativa ante la imposibilidad de coincidir estéticamente de manera adecuada una situación clínica en la cual la coincidencia estética sea un reto; el manejo del caso estuvo basado en una planificación precisa que inicia con un diseño digital personalizado, recogiendo las expectativas estéticas de la paciente y luego en una traducción a modelos encerados, para transitoriamente pre visualizar el diseño en un ensayo restaurador en boca, el cual sirvió también como guía precisa para las preparaciones dentarias de las carillas a manera de pre-provisionales, finalmente para confeccionar los provisionales y orientar el formato de las futuras cerámicas. La predictibilidad de los resultados conseguidos fue gracias a una adecuada planificación y las cualidades estéticas y mecánicas de los materiales dentales restauradores indirectos empleados en este caso.

The following article presents an alternative to resolve the esthetic zone with a combined treatment, consisting of laminate veneers and full coverage crown. A substructure that simulates natural tooth structure prepared for veneer was built, and then laminate veneers were fabricated and cemented over these adhoc substructures. The case was based in a meticulous treatment planning, which starts with custom smile design, gathering the patients´ expectations and appropriate principles in dental esthetics. The result is then rendered in a diagnostic wax up, so the final outcome can be pre-visualized in the mouth by a mock-up. This mock-up will be later on used as a precise guide for the reduction required for the veneers, and serving as pre-provisionals. Predictability of the excellent results obtained is due to an adequate planning and of course quality and good handling of the dental materials used in the present case.