[Types and colors of 1 374 chair-side CAD/CAM all-ceramic restorations].

PURPOSE: To analyse the types of chairside CAD/CAM all-ceramic restorations and the color range of all-ceramic materials used so as to provide reference for the application of clinical chairside all-ceramic restoration and the color selection of all-ceramic materials. METHODS: IPS e.max CAD prostheses and related data were collected from January 2021 to December 2021 from the Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The number and type of restorations and the color of materials were investigated and analyzed by descriptive statistics. RESULTS: A total of 1 374 restorations were included, of which 624 were crown restorations, accounting for 45.41% of the total restorations. 516 cases were veneer, accounting for 37.55%; 219 were inlays, accounting for 15.94%; fixed bridges were all adhesive bridges, with the least number with only 15 cases, accounting for 1.09%. In terms of the selection of restoration materials, the use rate of low-transparent(LT) ceramic blocks was significantly higher than that of other transparent ceramic blocks. A was the most frequently used ceramic color. The most frequently used porcelain blocks for veneers were LTA2 and LTA1; for inlay were LTA3; for crowns were LTA2 and LTA3. The blocks used in the fixed bridges were all LT, and A3 color was the majority. CONCLUSIONS: Chairside CAD/CAM all-ceramic prostheses made of IPS e.max CAD materials have been widely used in clinical practice. The types of prostheses include veneer, inset, crown and fixed bridge. The most commonly used IPS e.max CAD blocks are LTA2, LTA3 and LTA1. These findings have certain guiding significance for the clinical restoration decision and the reserve of porcelain blocks in primary hospitals.

Emerging trends and clinical recommendations for zirconia ceramic crowns: a concise review.

Introduction A little over ten years ago, zirconia crowns made their debut in the field of dentistry. Despite early problems with the chipping of veneering porcelain, clinical studies have demonstrated excellent performance. It is essential for a ceramic crown to have good aesthetic qualities, in addition to having good mechanical characteristics. The exceptional mechanical qualities of zirconia crowns and the simplicity with which they may be machined, employing computer-aided design and computer-aided manufacturing schemes, are primarily responsible for the widespread use of these materials in clinical settings. New ceramic-based materials, including monolithic zirconia, zirconia-containing lithium disilicate ceramics, and graded glass/zirconia/glass, have recently been launched in the field of dentistry. These newly discovered zirconia crown materials stem from varied technological approaches, each likely to lead to additional clinical advancements. At this point, it seems imperative to offer a concentrated report on the newer developments, along with essential clinical recommendations for best clinical outcomes with zirconia crowns.Types of studies This review article is a consolidation of several case studies, cohort studies and systematic reviews, as well as experimental and observational randomised control trials and other peer-reviewed articles.Results On reviewing, a concise list of clinical recommendations is generated, demonstrating that monolithic zirconia offers some clinical advantages over veneered zirconia crowns.Conclusion This review article discloses various clinical revelations and in-office recommendations for favourable usage of zirconia ceramic crowns that can lead to better patient outcomes and long-term clinical success rates.

Effect of different occlusal materials on peri-implant stress distribution with different osseointegration condition: A finite element analysis.

AIM: Studies have not been done to evaluate the peri-implant stress exerted by materials(like PEEK and resin matrix ceramics) in different osseointegration conditions. To investigate the effect of different occlusal materials on peri-implant stress distribution with different osseointegration condition using finite element analysis. SETTINGS AND DESIGN: Eighteen different 3D FEA models of implant fixed with abutment were created involving 6 different occlusal materials (Heat cured temporary acrylic resin (PMMA), Bis-GMA, PEEK, Lithium disilicate, Resin matrix ceramics and translucent Zirconia) and different osseointegrated conditions (50%, 75%, 100%). MATERIALS AND METHODS: Models were subjected to loading vertically and obliquely followed by evaluation of stress distribution. STATISTICAL ANALYSIS USED: The results of the simulation obtained were analysed in terms of Von mises, maximum principal and minimal principal stresses using descriptive stastistics. RESULTS: PMMA (40.14 MPa on vertical loading and 66 MPa on oblique loading) resulted in the highest stresses and lithium disilicate (24 MPa on vertical loading and 52.40 MPa on oblique loading) resulted in least stresses among all the crown materials. Upon oblique loading, von Mises stress increases except for translucent zirconia and lithium disilicate (52.444 MPa on 50%, 47.733 MPa on 75%, and 43.973 MPa on 100% osseointegration). Minimal principal stress values decreased with increase in osseointegration upon oblique loading for PMMA, BisGMA, and PEEK. CONCLUSION: Translucent zirconia and lithium disilicate offer a better stress transmission. Minimal principal stress values of PEEK and BisGMA decreased with increasing osseointegration.

Effect of conventional cigarette smoking and recent heated tobacco products on CAD/CAM restorative materials.

OBJECTIVE: To determine the effects of conventional cigarette smoking (CS) and recent heated tobacco products (HTPs) on the surface roughness and color stability of different indirect restorative materials. MATERIALS AND METHODS: One hundred disc-shaped samples were constructed of three different restorative CAD/CAM materials: lithium disilicate glass-ceramic (IPS e.max CAD; Ivoclar Vivadent, Liechtenstein), zirconia (BruxZir® Zirconia, Glidewell, USA) and polyetheretherketone (BioHPP® bredent GmbH, Germany). Of the IPS e.max CAD and the Bruxzir samples, 20 samples were glazed, and 20 samples were polished, while the BioHPP samples were all polished according to the manufacturer's instructions. Fifty samples were subjected to conventional cigarette smoking (LM, Philip Morris International Inc., Egypt) (Groups: IPS e.max CAD_Glazed exposed to CS (LD_G_Cig), IPS e.max CAD_Polished exposed to CS (LD_P_Cig), Bruxzir_Glazed exposed to CS (Zr_G_Cig), Bruxzir _Polished exposed to CS (Zr_P_Cig) and BioHPP exposed to CS (PEEK_Cig) and fifty samples were exposed to heated tobacco product smoking (Heets, Russet selection, Philip Morris International Inc., Italy) (Groups: IPS e.max CAD_Glazed exposed to HTP (LD_G_HTP), IPS e.max CAD_Polished exposed to HTP (LD_P_HTP), Bruxzir_Glazed exposed to HTP (Zr_G_HTP), Bruxzir CAD_Polished exposed to HTP (Zr_P_HTP) and BioHPP exposed to HTP (PEEK_HTP).. Six hundred cigarettes/heets representing 30 days of medium smoking behavior (20 cigarettes/day) were used. Before and after exposure to smoke, the surface roughness of all the samples was measured using JITAI8101 surface roughness tester (Beijing Jitai Tech Detection Device Co., Ltd, China, and the color parameters were assessed using VITA Easyshade Advance 4.01 (VITA shade, VITA made, VITA). The data were analyzed using One-way ANOVA, paired sample t-test and independent sample t-test. The significance level was set at α < 0.05. The surface topography was evaluated by scanning electron microscopy (SEM) and analyzed using energy-dispersive X-ray (EDX) spectroscopy to determine changes in the surface chemical composition. RESULTS: Both types of smoking caused significant increases in the surface roughness of all the samples. There was a significant difference in color change between CS and HTP for all materials with different surface finish (P < 0.01) and zirconia had the greatest effect on color change (P < 0.001). In contrast, polyetheretherketone (PEEK) "BioHPP" had the least effect (P < 0.001). CONCLUSION: Exposure to different types of smoking induce changes in the surface topography and color of different esthetic restorative materials. Compared with HTP, conventional cigarette smoke has a greater effect on the surface roughness and color stability of esthetic restorative materials. The glazed surfaces showed less change in surface topography than did the polished surfaces. Zirconia showed better color stability when compared to polyetheretherketone (PEEK).

Effect of Coffee Thermocycling on Color Stability and Translucency of CAD-CAM Polychromatic High Translucent Zirconia Compared With Lithium Disilicate Glass Ceramic.

AIMS AND OBJECTIVES: To evaluate the effect of coffee thermocycling on color stability and translucency of CAD-CAM polychromatic high translucent zirconia compared with lithium disilicate glass ceramic. METHODS: Sixteen rectangular plates (14 × 16 × 1.0 mm) of two ceramic materials (IPS E.max CAD (IEC), IPS E.max ZirCAD Prime [IZP]) were prepared. Each specimen was measured for color coordinates using a spectrophotometer following 30,000 cycles of coffee thermocycling. CIELAB formula was used to determine color and translucency differences (ΔE and ΔTP). The means of ΔE and ΔTP were compared using independent samples t-test and were evaluated using their respective 50%:50% perceptibility and acceptability thresholds (PT and AT). One-way analysis of variance was performed to evaluate the translucency parameter (TP) and surface roughness (Ra) of each material. RESULTS: Mean ΔE values of IEC (4.69) and IZP (4.64) were higher than the AT (ΔE ≤ 2.7) with no significant difference found between the two groups (p = 0.202). Considering the TP, only IEC showed a statistically significant increase in TP value (p < 0.001). However, the mean ΔTP of IEC (3.25) remained within the range of acceptability (1.3 < ΔTP ≤ 4.4). CONCLUSIONS: Within the limitations of this current study, the color stability of all materials was clinically affected by coffee thermocycling. In terms of translucency, only lithium disilicate glass ceramic was influenced by coffee thermocycling. High translucent zirconia had superior translucency stability compared to lithium disilicate glass ceramic.

Effects of Different Concentrations of Carbamide Peroxide on Color, Surface Roughness, and Hardness of CAD/CAM Dental Ceramics.

OBJECTIVES: This study assessed the effects of 15% and 20% carbamide peroxide (CP) on color, surface roughness, and hardness of computer-aided design/computer-aided manufacturing (CAD/CAM) dental ceramics. MATERIALS AND METHODS: This in vitro study was conducted on 120 Vita Mark II, Celtra Duo, and Suprinity CAD/CAM ceramic specimens. The ceramic specimens in each group (n = 40) were randomly assigned to two subgroups (n = 20) for polishing and glazing, and their baseline color, surface roughness (Ra), and hardness were assessed. In each subgroup, half of the specimens were exposed to 15% CP, while the other half were exposed to 20% CP. Their color change (ΔE), surface roughness, and hardness were then measured again. Surface roughness, hardness, and color were analyzed sequentially by profilometer, Vickers hardness tester, and spectrophotometer, respectively. Data were analyzed by repeated measures ANOVA, one-way ANOVA, and post hoc Bonferroni test (α = 0.05). RESULTS: The surface roughness of all groups significantly increased after bleaching treatment (p < 0.05). Surface hardness of all groups decreased after bleaching treatment, but this reduction was only significant in Vita Mark II subgroups (glazed, polished, 15%, and 20% CP). The ΔE was not clinically and visually perceivable in any group. CONCLUSION: The present results revealed that concentration of CP and type of surface treatment affected the surface properties of CAD/CAM ceramics. Type of surface treatment only affected the surface hardness of Vita Mark II ceramics (p < 0.05). Concentration of CP had a significant effect only on polished Vita Mark II.

Effect of different design and surface treatment on the load-to-failure of ceramic repaired with composite.

Glass ceramics are widely used to manufacture esthetic veneers, inlays, onlays, and crowns. Although the clinical survival rates ofglass-ceramic restorations arefavorable,fractures or chips are common. Certain cases can be repaired with direct composite. AIM: The aim of this study was to investigate the interaction effect of different designs and surface treatments on the load-to-failure of lithium disilicate glass-ceramic repaired with nanofilled composite. MATERIALS AND METHOD: Lithium-disilicate glass-ceramic slabs (IPS e.max Press, Ivoclar Vivadent) with three different designs of the top surface (flat, single plateau, or doubleplateau) (n=U) received 'no treatment', '5% HF etching', or "AI2O3 sandblasting". HF-etched and sandblasted slabs also received silane and universal one-step adhesive application. All slabs were incrementally repaired with nanofilled composite (Filtek Z350, 3M ESPE) up to6 mm above the highest ceramic top plateau. Specimens were stored in artificial saliva at 37 °C for 21 days and then subjected to 1,000 thermocycles between 5 and 55 °C. The interface composite-ceramic of each specimen was tensile tested until failure in a universal testing machine and the mode of failure was determined under a stereomicroscope. The ceramic surface morphology of one representative tested specimen from each subgroup (design/surface treatment) was observed through scanning electron microscopy (SEM). RESULTS: Regardless of ceramic design, the absence of surface treatment resulted in significantly lower load-to-failure values. No significant differences in load-to-failure values were observed between HF-etched and sandblasted specimens for the flat design; however, HF etching resulted in significantly higher load-to-failure values than sandblasting for both single plateau and double plateau designs. The majority (60%) of HF-etched specimens with single plateau or double plateau presented mixed failures. SEM photomicrographs showed that HF-etched specimens had smoother surfaces than sandblasted specimens. CONCLUSION: The surface treatment of a defective lithium disilicate glass-ceramic restoration has more influence than its macroscopic design on the retention of the composite repair. HF etching seems to provide higher bond strength to the composite repair.

Embora fraturas e lascamento de restauragoes vitrocerámicas sejam comuns, alguns casos podem ser reparados com compósito direto. OBJETIVO: investigar o efeito da interagao de diferentes formas e tratamentos de superficie na carga de ruptura de uma vitrocerámica reforgada com dissilicato de litio reparada com compósito nanoparticulado. MATERIAIS E MÉTODOS: A superficie superior de espécimes de vitroceramica (IPS e.max Press, Ivoclar Vivadent) foi preparada com tres formas (plana, plato único, ou duplo) e recebeu (n=11): 'nenhum tratamento', 'condicionamento com ácido hidrofluoridrico 5%', ou 'jateamento com AfOf. Ambos espécimes condicionados e jateados receberam silano e adesivo universal. Todos os espécimes foram reparados incrementalmente com compósito (Filtek Z350, 3M ESPE) até6 mm acima do plato cerámico mais alto, armazenados em saliva artificial á 37 °C por 21 dias, e submetidos á 1.000 termociclos (5 e 55 °C). A interface compósito-cerámica de cada amostra foi testada á tragao até sua falha em máquina universal e o modo de falha foi determinado com estereomicroscópio. A morfologia da superficie de uma amostra representativa de forma/tratamento de superficie foi observada através de microscopia eletronica de varredura (MEV). RESULTADOS: Independentemente da forma ceramica, a ausencia de tratamento superficial resultou em valores de carga de ruptura significativamente menores. Nao foi observada differenga significativa entre os espécimes planos condicionados ou jateados; no entanto, o condicionamento resultou em valores significativamente maiores que o jateamento para espécimes com plato único e duplo. A maioria (60%) dos espécimes condicionados e com plato único ou duplo apresentou falhas mistas. Imagens SEM demonstraram rugosidade superficial mais regular dos espécimes condicionados que os jateados. CONCLUSÕES: O tratamento superficial de uma restauragao defeituosa de vitrocerámica reforgada por dissilicato de litio tem maior influencia na retengao do reparo de compósito do que sua forma macroscópica; ainda, o condicionamento com ácido hidrofluoridrico parece proporcionar maior resistencia de uniao ao reparo com compósito.

Resistance of CAD/CAM composite resin and ceramic occlusal veneers to fatigue and fracture in worn posterior teeth: A systematic review.

Severe tooth wear is related to substantial loss of tooth structure, with dentin exposure and significant loss (≥1/3) of the clinical crown. The objective of this systematic review was to summarize and analyze the scientific evidence regarding the mechanical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin and CAD/CAM lithium disilicate ceramic occlusal veneers, in terms of fatigue and fracture resistance, on severely worn posterior teeth. Currently, occlusal veneers are an alternative for treating worn posterior teeth. Although scientific evidence demonstrates the good performance of lithium disilicate occlusal veneers, there are less brittle materials with a modulus of elasticity more similar to dentin than ceramics, such as resin CAD/CAM blocks. Therefore, it is important to identify which type of material is best for restoring teeth with occlusal wear defects and which material can provide better clinical performance. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the PubMed, Embase, Web of Science, Scopus, Cochrane, OpenGrey, Redalyc, DSpace, and Grey Literature Report databases was conducted and supplemented by a manual search, with no time or language limitations, until January 2022. We aimed to identify studies evaluating the fatigue and fracture resistance of CAD/CAM composite resin and ceramic occlusal veneers. The quality of the full-text articles was evaluated according to the modified Consolidated Standards of Reporting Trials (CONSORT) criteria for in vitro studies, and 400 articles were initially identified. After removing duplicates and applying the selection criteria, 6 studies were included in the review. The results demonstrated that the mechanical performance of CAD/CAM composite resin occlusal veneers is comparable to that of CAD/CAM lithium disilicate occlusal veneers in terms of fatigue and fracture resistance.

The influence of hygroscopic expansion of resin supporting dies on the fracture resistance of ceramic restorations during thermal cycling.

OBJECTIVES: To evaluate the hygroscopic expansion characterization of resin composite dies during thermal cycling, and their influence on the fracture resistance of dental ceramic materials as well as the effect of pre-immersion on these measurements. METHODS: Disc-shaped specimens (φ = 15.0 mm, h = 1.2 mm) and anatomical crown dies of four resin composites (epoxy, Z350, P60, G10) were fabricated. Disc-shaped samples were continuously soaked in distilled water and the volume expansion was measured at different time point by Archimedes method. Disc-shaped samples were pre-immersed for 0, 7, or 30 days, elastic modulus and hardness were measured using Nanoindentation test; thermal cycling (TC) test was performed (5 °C-55 °C, 104 cycles), and volume expansion during TC was measured. Four kinds of resin die with pre-immersion for 0, 7, or 30 days were cemented to 5Y-Z crown, or epoxy dies without pre-immersion were cemented to 5Y-Z, 3Y-Z and lithium disilicate glass (LDG) crowns, and load-to-failure testing was performed before and after TC. Finite element analysis (FEA) and fractography analysis were also conducted. RESULTS: The hygroscopic expansion was in the order: epoxy > Z350 > P60 > G10. Except for G10, the other three resin composites exhibited different degrees of hygroscopic expansion during TC. Only the elastic modulus and hardness of epoxy decreased after water storage. However, only the fracture loads of 5Y-Z and LDG crowns supported by epoxy dies were significantly decreased after TC. FEA showed a stress concentration at the cervical region of the crown after volume expansion of the die, leading to the increase of the peak stress at the crown during loading. SIGNIFICANCE: Only the hygroscopic expansion of epoxy dies caused by TC led to the decrease in the fracture resistance of the 5Y-Z and LDG crown, which may be related to the decrease in the elastic modulus of the epoxy die and the tensile stress caused by it.

Comparative evaluation of marginal adaptation and fatigue resistance of endodontically treated premolars restored with direct and indirect coronal restorations: an in vitro study.

BACKGROUND: An optimum restoration for reconstructing endodontically treated teeth should provide excellent marginal adaptation, high fracture resistance as well as maximum tooth structure conservation. The purpose of this study was to evaluate the marginal adaptation and fatigue resistance of different coronal restorations in endodontically treated premolars. METHODS: Thirty sound maxillary first premolars were endodontically treated and received MOD cavities. Teeth were randomly allocated into three groups (n = 10) according to the type of coronal restoration: Group R: polyethylene fibers (ribbond), fibers-reinforced composite (everX posterior) and final layer of nano-hybrid composite. Group O: indirect lithium disilicate overlay and Group C: fiber-post, resin composite restoration, and lithium disilicate crown. Marginal gap assessment was performed before and after thermocycling (5000 cycles) using stereomicroscope. Samples were subjected to stepwise-stress loading starting at 200 N, and increased by 100 N in each step until failure occurred. Statistical analysis was done by One-way ANOVA followed Tukey`s Post Hoc test for multiple comparison. Paired t test was used to compare the marginal adaptation before and after thermocycling. Survival probability was evaluated by Life table survival analysis. Failure mode analysis was performed with Chi-square test. RESULTS: Marginal gap was significantly the lowest in group R (37.49 ± 5.05) and (42.68 ± 2.38), while being the highest in group C (59.78 ± 5.67) and (71.52 ± 5.18) in before and after thermocycling respectively (P < 0.0001). Fatigue resistance was the highest for group O (1310.8 ± 196.7), and the lowest for group R (905.4 ± 170.51) with a significant difference between groups (P < 0.0001). Crown group had the highest percentage (80%) of catastrophic failure, while, overlay group exhibited the lowest (20%). CONCLUSIONS: Direct restoration without cuspal coverage using ribbon fibers with short FRC provided better marginal adaptation than indirect overlays and crowns, but fatigue resistance wasn't significantly improved. Adhesive ceramic overlays showed the best fatigue performance and the least catastrophic failure rate compared to both direct fiber-reinforced composite and indirect ceramic full coverage restorations. CLINICAL SIGNIFICANCE: Indirect adhesive overlays are a suitable, more conservative restorative option for endodontically treated teeth than full coverage restorations, especially when tooth structure is severely compromised.

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

OBJECTIVES: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

Quantitative examination of factors influencing the colour reproduction ability of lithium disilicate glass-ceramics.

BACKGROUND: Effects of ceramic translucency, layer thickness, and substrate colour on the shade of lithium disilicate glass-ceramic restorations proved to be significant in several studies, however, quantitative, numerical results on the relationship between the colour difference and these parameters are still lacking. The purpose of this in vitro study was to quantitatively determine how the colour reproduction ability of a lithium disilicate glass-ceramic is affected by its translucency, layer thickness, and substrate colour. METHODS: Ceramic samples were prepared from A2 shade IPS e.max CAD blocks with high and low translucencies (HT and LT) in a thickness range of 0.5-2.5 mm (+/- 0.05 mm). Layered samples were acquired utilizing composite substrates in 9 shades; transparent try-in paste was used. The spectral reflectance of the specimens was assessed under D65 standard illumination with a Konica Minolta CM-3720d spectrophotometer. The CIEDE2000 colour difference (ΔE00) between two samples was analysed using perceptibility and acceptability thresholds set at 50:50%. Statistical analysis involved linear regression analysis and the Kruskal-Wallis test. RESULTS: An increase in the thickness of 0.5 mm reduced the ΔE00 of the HT samples to 72.8%, and that of the T samples to 71.1% (p < 0.0001). 7 substrates with HT and LT specimens had significantly different results from the mean (p < 0.05). A thickness of 0.5 mm is not sufficient to achieve an acceptable result at any level of translucency, while the low translucency ceramic at a thickness of 1.5 mm gave acceptable results, except for severely discoloured substrates (ND8 and ND9). CONCLUSIONS: The colour reproduction ability of lithium disilicate glass-ceramics is significantly affected by their translucency, layer thickness, and 7 substrates out of 9 substrates examined.

The effect of restorative material selection and cementation procedures on the durability of endocrowns in the anterior teeth: an in-vitro study.

OBJECTIVE: To investigate the fracture resistance and failure modalities of anterior endocrown restorations fabricated employing diverse ceramic materials, and bonded using various cementation methodologies. MATERIALS AND METHODS: Forty maxillary central incisors were divided into two main groups based on the ceramic materials used; GroupI (Zir): zirconia endocrwons (Zolid HT+, Ceramill, Amanngirrbach) and GroupII (E-Max): e-max endocrowns (IPS e.max CAD, Ivoclar Vivadent). Both groups were further split into two subgroups depending on the cementation protocols; subgroup IA "ZirMDP": endocowns cemented with MDP primer + MDP resin cement, subgroup IB (ZirNon-MDP): cemented with MDP primer + non-MDP resin cement, subgroup IIA (E-maxMDP): cemented with MDP primer + MDP resin cement, subgroup IIB (E-maxNon-MDP): cemented with MDP primer + non-MDP resin cement. (n = 10/subgroup). Endocrowns were manufactured using CAD/ CAM. Teeth were subjected to 10,000 thermal cycles. The fracture test was performed at 45o with a palatal force direction until the fracture occurred. Test results were recorded in Newton. The failure mode was examined using a stereomicroscope. A One-way ANOVA test was utilized to compare different groups regarding fracture strength values. Tukey`s Post Hoc was utilized for multiple comparisons. RESULTS: The comparative analysis of fracture strength across the diverse groups yielded non-significant differences, as indicated by a p-value exceeding 0.05. Nonetheless, an observable trend emerged regarding the mode of failure. Specifically, a statistically significant prevalence was noted in fractures localized within the endocrown/tooth complex below the cementoenamel junction (CEJ) across all groups, except for Group IIB, "E-max Non-MDP," where fractures within the endocrown/tooth complex occurred above the CEJ. CONCLUSIONS: Combining an MDP-based primer with an MDP-based resin cement did not result in a significant effect on the anterior endocrown fracture strength. CLINICAL RELEVANCE: Regardless of the presence of the MDP monomer in its composition, adhesive resin cement achieved highly successful fracture strength when used with MDP-based ceramic primers. Additionally, ceramic materials exhibiting elastic moduli surpassing those of dentin are discouraged due to their propensity to induce catastrophic fractures within the tooth structure.

The effect of aging on the translucency of contemporary zirconia generations: in-vitro study.

BACKGROUND: The translucency of different zirconia generations at each time point after thermocycling aging is still lacking. METHODS: Four zirconia materials were used with a total of 60 samples produced from monolithic third generation (5Y) 5 mol% yttria-stabilized zirconia polycrystalline ceramic and fourth generation zirconia (4Y) 4 mol% yttria-stabilized zirconia polycrystalline ceramic, represented by [group1:[CM-5Y] Ceramill Zolid fx (3rd generation zirconia) (Amann Girrbach, Koblach, Austria), group 2:[CM-4Y] Ceramill Zolid HT + (4th generation zirconia) (Amann Girrbach, Koblach, Austria), group 3:[CC-5Y] Cercon XT/ML (Dentsply Sirona, Germany) (3rd generation), and group 4:[CC-4Y] Cercon HT/ML (Dentsply Sirona, Germany) (4th generation)]. The L*a*b* figures were measured by using a spectrophotometer at baseline and after 10,000, 30,000, and 50,000 cycles of thermocycling. At each interval, the translucency of the samples was estimated by using the translucency formula CIEDE2000. The Scheffe post-hoc compared differences among each of the four materials. The Repeated measures ANOVA tested the differences between the materials at each of the different thermocycling intervals (p < .001). Data analyses were evaluated at a significance level of p < .05 (CI 95%). RESULTS: Two-way ANOVA revealed that at baseline the third and fourth generation's zirconia showed statistically significant differences in translucency (P < .001). Translucency values at baseline and after thermocycling exhibited statistically significant changes (p = .003). At each of the time interval; CM-4Y had the highest translucency values followed by CM-5Y, CC-4Y and CC-5Y had the least translucency values. CONCLUSIONS: The third and fourth generations of zirconia displayed different translucencies. Thermocycling affected the translucency of both third and fourth generations of zirconia. At each of the time intervals group 2:[CM-4Y] had the highest TP followed by group1:[CM-5Y], while, group 3:[CC-5Y] and group 4:[CC-4Y] had the least TP.

Effect of multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness.

OBJECTIVES: To investigate the effect of multiple firings on color, translucency, and biaxial flexure strength of Virgilite-containing (Li0.5Al0.5Si2.5O6) lithium disilicate glass ceramics of varying thickness. MATERIALS AND METHODS: Sixty discs were prepared from Virgilite-containing lithium disilicate blocks. Discs were divided according to thickness (n = 30) into T0.5 (0.5 mm) and T1.0 (1.0 mm). Each thickness was divided according to the number of firing cycles (n = 10); F1 (Control group): 1 firing cycle; F3: 3 firing cycles, and F5: 5 firing cycles. The discs were tested for color change (ΔE00) and translucency (TP00) using a spectrophotometer. Then, all samples were subjected to biaxial flexure strength testing using a universal testing machine. Data were collected and statistically analyzed (α = 0.5). For chemical analysis, six additional T0.5 discs (2 for each firing cycle) were prepared; for each firing cycle one disc was subjected to X-ray diffraction analysis (XRD) and another disc was subjected to Energy dispersive X-ray spectroscopy (EDX) and Scanning electron microscope (SEM). RESULTS: Repeated firing significantly reduced the translucency of F3 and F5 compared to F1 in T0.5 (p < 0.001), while for T1.0 only F5 showed a significant decrease in TP00 (p < 0.001). For ΔE00, a significant increase was recorded with repeated firings (p < 0.05) while a significant decrease resulted in the biaxial flexure strength regardless of thickness. CONCLUSIONS: Repeated firings had a negative effect on both the optical and mechanical properties of the Virgilite-containing lithium disilicate glass ceramics. CLINICAL RELEVANCE: Repeated firings should be avoided with Virgilite-containing lithium disilicate ceramics to decrease fracture liability and preserve restoration esthetics.

Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns.

OBJECTIVES: The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments. METHODS: A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 µm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05). RESULTS: Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials. CONCLUSIONS: The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials. CLINICAL RELEVANCE: Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.

Functionally graded bi-material interface for Porcelain Veneered Zirconia dental crowns: A study using viscoelastic finite element analysis.

OBJECTIVES: During the manufacturing of Porcelain Veneered Zirconia (PVZ) dental crowns, the veneer-core system undergoes high-temperature firing cycles and gets fused together which is then, under a controlled setting, cooled down to room temperature. During this cooling process, the mismatch in thermal properties between zirconia and porcelain leads to the development of transient and residual thermal stresses within the crown. These thermal stresses are inherent to the PVZ dental crown systems and render the crown structure weak, acting as a precursor to veneer chipping, fracture, and delamination. In this study, the introduction of an intermediate functionally graded material (FGM) layer at the bi-material interface is investigated as a potentially viable alternative for providing a smoother transition of properties between zirconia and porcelain in a PVZ crown system. METHODS: Anatomically correct 3D crown models were developed for this study, with and without the FGM layer modeled at the bi-material interface. A viscoelastic finite element model was developed and validated for an anatomically correct bilayer PVZ crown system which was then used for predicting residual and transient stresses in the bilayer PVZ crown. Subsequently, the viscoelastic finite element model was further extended for the analysis of graded sublayers within the FGM layer, and this extended model was used for predicting the residual and transient stresses in the functionally graded PVZ crown, with an FGM layer at the bi-material interface. RESULTS: The study showed that the introduction of an FGM layer at the bi-material interface has the potential to reduce the effects from transient and residual stresses within the PVZ crown system relative to a bilayer PVZ crown structure. Furthermore, the study revealed that the FGM layer causes stress redistribution to alleviate the stress concentration at the interfacial surface between porcelain and zirconia which can potentially enhance the durability of the PVZ crowns towards interfacial debonding or fracture. SIGNIFICANCE: Thus, the use of an FGM layer at the bi-material interface shows a good prospect for enhancing the longevity of the PVZ dental crown restorations by alleviating the abrupt thermal property difference and relaxing thermal stresses.

Influence of crown-lengthening surgery on teeth rehabilitated with ceramic single crowns: A 12-month prospective clinical study.

OBJECTIVE: To compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure. METHODS: This prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent - ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %. RESULTS: PI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not. CONCLUSION: Crown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites. CLINICAL RELEVANCE: These findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

Effect of thickness on the translucency of machinable and printable ceramic-glass polymer materials.

OBJECTIVES: To assess the translucency of machinable and printable ceramic-glass polymer materials with different thicknesses. METHODS: Five ceramic-glass polymer materials were tested: one 3D-printable material, Permanent Crown resin (3D), two machinable materials available at low translucency (LT) and high translucency (HT) levels, VITA Enamic (VE) HT/LT, and Cerasmart 270 (CS) HT/LT. A total of 100 specimens were produced across 10 subgroups (n = 10) with thicknesses of 1 mm and 1.5 mm. The colour coordinates of the specimens were measured against black and white backgrounds using a spectrophotometer. Translucency was quantified using the Relative Translucency Parameter (RTP), calculated via the CIEDE2000 formula. A two-way ANOVA followed by post-hoc tests with Bonferroni correction (α = 0.05) was used for statistical analysis. RESULTS: The RTP for both thicknesses were ranked as follows: CSHT > VEHT > CSLT > 3D > VELT. The RTP of the 3D was lower than that of the HT machinable materials (CSHT and VEHT) for both thicknesses (p < 0.05). No significant difference was observed between the RTP of 3D and CSLT at 1.5 mm (p = 1.000); however, at 1 mm, the RTP of the 3D was lower than that of the CSLT (p < 0.05). Notably, the 3D showed the least translucency difference with a 0.5 mm increase in thickness. CONCLUSIONS: Printable ceramic-glass polymer materials demonstrated lower translucency than HT machinable ceramic-glass polymer materials. Both the thickness and type significantly influenced the translucency of the LT machinable counterparts compared to the printable ceramic-glass polymer material. CLINICAL SIGNIFICANCE: Printable ceramic-glass polymer resins may be a suitable option for minimally invasive procedures, especially when attempting to mask undesirable-coloured abutments. When selecting HT machinable ceramic-glass polymers, clinicians should pay greater attention to the abutment colour and thickness of the restorative material.

The effects of monomer type, filler size, and filler content of three resin cements on the color stability of laminate veneers exposed to accelerated aging.

STATEMENT OF PROBLEM: Commercially available resin cements consist of various filler sizes, filler content and monomers, and it is unclear which of these factors have the greatest effect on the color stability of laminate veneers. OBJECTIVES: To evaluate the color stability of lithium disilicate-reinforced laminate veneers inserted with three commercial resin cements with various filler sizes/contents and monomers upon accelerated aging. METHODS: Veneers were fabricated and cemented on resin abutments using three commercially available resin cements comprised of two different monomers and varying filler sizes/contents: 1) triethylene glycol dimethacrylate, TEGDMA (RelyX™ Veneer = 0.6 µm/66 %, Calibra® Esthetic Light Cure =1.2 µm/65 %); and 2) urethane dimethacrylate, UDMA (Variolink Esthetic LC = 0.1 µm/38 %). A total of 60 specimens were fabricated (n = 20 for each cement). The relative number of particles (N) and relative surface area (A) were calculated for each filler size/content. Color coordinates (L*, a*, b*) were measured, and color change (ΔE00) was calculated after cementation and following aging at 150, 300, 450, and 600 h using xenon light. Differences in color coordinates and color change were determined using repeated measures ANOVA followed by Tukey's post hoc test (α = .05). A post-hoc power analysis was performed to confirm reliability of the results. RESULTS: Based on a post-hoc power analysis of a repeated measures ANOVA with two between-factors and 1 within-factor, we had 89 % power to detect a difference of effect by cement type, 10 % power to detect a difference by shade, and 100 % power to detect a difference of effect by aging. The UDMA-based cement (0.1 µm/38 %) was least affected by aging, despite having the largest number of particles (N = 1010) and largest particle surface area (A = 7.02). The TEGDMA-based cements exhibited a significant color change, with 0.6 µm/66 % (A = 2.03, N = 8.12) producing a larger ΔE00 than 1.2 µm/65 % (A = 1.00, N = 1.00). CONCLUSIONS: Among the commercial cements tested, UDMA-based resin (0.1 µm/38 %) provided better color stability than TEGDMA-based resin cements. The color change after aging was affected by the relative surface area and relative number of particles for the TEGDMA-based resin cement (0.6 µm/66 % and 1.2 µm/65 %), with a larger surface area and a higher relative number of particles, accelerated color change with aging. The present study demonstrates a novel approach to determine color stability for any resin cement with particulate filler. CLINICAL IMPLICATIONS: The dental practitioner should be selective in choosing a commercial light cure cementation product for laminate veneers, as UDMA containing resin cement is more resistant to color changes over time than TEGDMA, regardless of the filler size/content.