Marginal fit of milled versus different 3D-printed materials for provisional fixed dental prostheses: an in vitro comparative study.

Introduction: Provisional dental prostheses are used as interim restorations to help patients perform oral functions between the time of tooth preparation and the placement of the final restoration. A provisional dental prosthesis should protect the abutment from pulpal and gingival aggressions, adapt correctly to keep healthy gingival tissues, be durable, and have a low price. The purpose of this in vitro study was to compare the marginal adaptation of different types of provisional fixed dental prostheses (PFDP), fabricated using 3D printing technology versus the milling (computer-aided manufacturing [CAM]) technique. Method: Two resin teeth (second premolar and second molar) on a typodont were prepared for three-unit provisional fixed dental prostheses. Thirty models were 3D-printed after a digital model was created using an intraoral scanner. Then, 30 provisional fixed dental prostheses (PFDPs) were made from a variety of materials using a digital design of a 3-unit PFDP and STL files delivered to a milling machine and a 3D printer, respectively. Ten PFDP were milled (CAM), and two sets of ten each, were fabricated with 3D printing technology (stereolithography), using two different materials. All restorations were analyzed under a microscope, and marginal gap was then measured using the software Image J. Results: The milled group presented the best marginal gap values (ranging from 86 to 108 µm) and a median value of 93 µm, followed by GC group with (110-251 µm) with a median value of 205 µm and the PR group with median value of 316.5 µm. Conclusion: According to the findings of this in vitro study, the milling (CAM) technique and SLA technology provides acceptable marginal fit values to fabricate provisional fixed partial dentures.

Optical Properties and Color Stability of Dental PEEK Related to Artificial Ageing and Staining.

Considering that the processes of PEEK discoloration caused by either intrinsic or extrinsic factors require elucidation, the aim of this study was to investigate the long-term effect of the combined action of ageing and immersing solutions on the optical properties and color stability of PEEK material, related to surface processing (polishing or glazing). (2) Methods: This study aims to determine the influence of different ageing and staining protocols on optical properties, color changes, and surface roughness of a reinforced PEEK material (bioHPP, Bredent, Senden, Germany). For ageing, specimens were submitted to 5000 cycles in a 55 °C bath and a 5 °C bath filled with distilled water. For staining, thermal cycling was performed in a hot coffee bath (55 °C) and a bath filled with distilled water (37 °C) and in a cold juice bath (5 °C) and a bath filled with distilled water (37 °C). Translucency (TP) and opalescence (OP) parameters were determined, the total color change value (ΔΕ*) was calculated, specimens' surface roughness was analyzed, and statistical analyses were performed. (3) Results: The mean TP values of the studied samples were in the interval of 1.25-3.60, which is lower than those reported for natural teeth or other aesthetic restoration materials. The OP values of PEEK were registered in the range of 0.27-0.75, being also lower than those of natural teeth or other aesthetic restoration materials. OP has a very strong positive relationship with TP. The mean registered Ra values for all subgroups were below 0.13 µm. Artificial ageing and staining in hot coffee proved to increase the roughness values. (4) Conclusions: The glazing of PEEK has a favorable effect on surface roughness and opalescence, irrespective of the artificial ageing or staining protocols. Artificial ageing damages the color stability and roughness of PEEK, regardless of surface processing, and decreases the translucency and opalescence of glazed surfaces. Immersion in hot coffee leads to perceivable discolorations.

Evaluation of the Shaping Ability of Three Thermally Treated Nickel-Titanium Endodontic Instruments on Standardized 3D-printed Dental Replicas Using Cone-Beam Computed Tomography.

Background and Objectives: The aim of the present study is to compare the efficacy of three root canal preparation systems in the shaping of 3D-printed root canal replicas of single rooted teeth. Materials and Methods: Sixty 3D-printed root canal replicas were produced and divided into three groups, each consisting of twenty samples. Each group was shaped with a different instrument: Reciproc Blue R25/08 (VDW GmbH, Munich, Gemany), WaveOne Gold Primary 25/07 (Dentsply Sirona, Ballaigues, Switzerland), and ProTaper Gold F2 25/08 (Denstply Sirona). To ensure the reproducibility of pre- and post-operative CBCT images of the root canals, the endodontic printed replicas were placed in a mould of silicon impression material. A cone-beam computed tomography (CBCT) software was used to compare pre- and post-instrumentation images collected at three levels of the root canal length: 3, 6, and 9 mm from the apical foramen. The amount of transportation, centring ability, and curvature angle after shaping were evaluated for each system. The results were statistically analysed and compared using one-way analysis of variance (ANOVA). Results: Regarding the transportation of the root canal after shaping, significant differences between groups at 3 mm (p = 0.010721) and 6 mm (p = 0.000046) were recorded in the mesio-distal direction, while in the bucco-lingual significant differences were only observed at 6 mm (p = 0.000554). Reciproc Blue removed more dentin from the mesial and buccal wall of the root canal. When evaluating the centring ability of the three systems, significant differences were observed between the groups at the level of 9 mm (p = 0.037258) in the mesio-distal direction, and at the level of 6 mm (p = 0.038197) in the bucco-lingual direction. Significant differences of the canal curvature angle after shaping were also observed between groups (p = 0.000001). Reciproc Blue straightened the curvature the most, while ProTaper Gold the least. Conclusions: All systems produced minor root canal transportation. No instrument was able to achieve a perfect centring preparation of the root canal. All systems produced a small degree of root canal straightening.

Micro-CT and Microscopy Study of Internal and Marginal Gap to Tooth Surface of Crenelated versus Conventional Dental Indirect Veneers.

Background and Objectives: Ceramic veneers represent the most appropriate treatment option for minimally invasive aesthetic rehabilitation. For long-term clinical success, the accurate marginal and internal adaptation of dental restorations are of paramount importance. The aim of this in vitro study is to assess the effect of a novel (patented) design of veneers compared to conventional ones on their marginal and internal gap to the prepared tooth surface. Materials and Methods: Twenty-four lithium disilicate ceramic veneers are obtained using Computer-Aided-Design (CAD) and then milled using Computer-Aided-Manufacturing (CAM). The samples are divided into two groups: 12 conventional (CO) veneers (i.e., with a linear marginal contour) and 12 crenelated (CR) veneers, the latter with the novel sinusoidal marginal design. All samples are bonded to frontal teeth, and the adhesive interfaces are analyzed using two methods, optical microscopy and micro-Computed Tomography (CT): the former for the accuracy of the marginal gap and the latter for the internal gap (as well as for the homogeneity of the luting cement) of ceramic veneers. Results: STATA and one-way ANOVA tests reveal significant differences between CO and CR veneers: (i) the marginal gap is smaller for CR (64 µm) than for CO veneers (236 µm); (ii) the internal adaptation is better for CR veneers: for a cement width of up to 120 µm, the covered surface for the CR group is 81.5%, while for the CO group it is 64.5%; (iii) the mean of the porosities within the cement is not significantly different (3.4·106 µm3 for CO and 3.9·106 µm3 for CR veneers), with a higher standard deviation for the CO group. Analytical modeling is achieved for internal gaps using the micro-CT results. The characteristic functions obtained allow us to compare the volume of luting cement for the two types of veneers. Conclusion: The novel veneers design produces an improvement in the marginal and internal adaptation of the restorations to the prepared tooth surface. Thus, it provides favorable premises for better clinical performances.

En-face optical coherence tomography analysis of gold and silver nanoparticles in endodontic irrigating solutions: An in vitro study.

Optical coherence tomography (OCT) is a non-invasive, non-radioactive optical diagnostic method based on low-coherence interferometry, which achieves images with different orientation. In dentistry, its major advantage is represented by the localization and characterization of the smallest defects in hard dental tissues, dental materials and of the smallest details in dental anatomy (supplementary canals, recesses, isthmuses, or intra-radicular connections). The aim of the present in vitro study was to evaluate using c-scan en-face optical coherence tomography, the optical opacity, and the distribution inside the root canal lumen of several extracted human teeth of silver and gold nanoparticles from special irrigating solutions used in endodontic treatment. Twelve root canals from 5 human teeth were instrumented using the ProTaper Universal system after initial negotiation with hand K-files ISO no. 10 and rotary nickel-titanium PathFile instruments. An initial c-scan OCT analysis was performed for each sample to confirm that the root canal lumen was empty from radiopaque materials (Group 1). Teeth were first irrigated with NanoCare Plus (Group 2) and then with NanoCare Gold (Group 3) and C-scans were repeated after each irrigation method. The OCT investigation started at the tooth apex, at a depth of 1 mm from its tip. Subsequently, 100 slices of 10 microns were obtained from each root canal. Images were captured and then analyzed with ImageJ software to calculate the level of grey inside the root canal lumen. The highest values of grey were obtained in the samples irrigated with NanoCare Gold after NanoCare Plus (Group 3). The present study proved that both nanoparticles inserted in root canal irrigants were evidenced through OCT imagistic analysis due to their optical opacity, which allowed their highlighting in an empty root canal lumen, after the endodontic treatment was performed and the root canal was cleaned and shaped using specific protocols.

Efficacy of PerioTabs, a NitrAdine-based gingiva brushing solution, on periodontally affected patients treated with fixed partial dentures: a randomized controlled study.

Objectives: Recent data show that teeth prepared with horizontal finishing lines supporting crowns and fixed partial dentures present more periodontal disorders than untreated control teeth. Several studies have shown that NitrAdine (bonyf) induces a significant reduction of dental biofilm. The aim of this study was to demonstrate that 10-day use of PerioTabs (bonyf), a NitrAdine-based gingiva brushing solution, is effective in treating gingival inflammation of prosthodontic patients. Method and materials: Forty-nine subjects were instructed to brush their teeth, gingivae, and prostheses with the PerioTabs solution for 10 days (treatment group) and 49 with any toothpaste (control group). The initial and 11-day Plaque Index and Bleeding Index were recorded. A five-point Likert scale was used to evaluate the level of patient satisfaction. The Shapiro-Wilk statistical test was used to compare the results for the two groups. Results: Highly significant differences between the treatment and control group (P < .001) for the Plaque Index and Bleeding Index resulted. The treatment group patients' satisfaction was high: 31 (63.3%) reported the highest level, 5, on the Likert scale, and 18 (36.7%) declared they were satisfied (level 4). Conclusions: The use of a NitrAdine-based gingiva brushing solution (PerioTabs) was effective in reducing the gingival inflammation in periodontally affected patients treated with fixed partial dentures. Clinical relevance: The NitrAdine-based gingiva brushing solution (PerioTabs) was highly accepted by the patients and seems to be a promising alternative to the solutions widely used.

Endodontic fillings evaluated using en face OCT, microCT and SEM.

OBJECTIVES: The goal of endodontic therapy is mechanically cleaning and shaping the root canal system, the removal of organic and inorganic debris followed by sealing with permanent filling materials. MATERIALS AND METHODS: Therefore, the aim of this in vitro study was to engage three imagistic methods: (i) en face (ef) time domain (TD) optical coherence tomography (OCT), (ii) micro-computed tomography (µCT), and (iii) scanning electron microscopy (SEM), in terms of their efficiency in assessing the quality of endodontic fillings. So far, is settled that efOCT images can identify defects∕voids in several of the investigated root canal fillings and identify gaps of 50 µm. RESULTS: The results delivered by µCT technology also showed several imperfections of the endodontic filling but also at the interfaces formed by the sealer and the root canal walls. SEM investigations highlights the complex form of the interface formed the endodontic filling material and the walls of the root canal, as well as shortcomings of the materials from several samples. Gaps of 50 µm are identified with efOCT. CONCLUSIONS: The net advantage of OCT technology, in respect to the other two technologies consists in its non-invasiveness. The OCT axial resolution is also sufficient to see the material gaps. Another advantage of efOCT investigations is that they allow real-time imaging of complex arrangement at the interfaces of the filling material with dentinal root.

Powder and Powder-Free Intra-Oral Scanners: Digital Impression Accuracy.

Aim: The purpose of this study was to evaluate the accuracy of digital impressions taken with two different intra-oral scanners (with and without optical powder), by dentists with different level of experience. Material and Methods: Two intra-oral scanning devices (Apollo DI and Cerec Omnicam, Sirona Dental GmbH, Germany) were used to obtain a digital cast from scanning different preparations on a maxillary typodont. Three operator groups scanned five crown preparations using both powder and powder-free scanning systems. One group consisted of fourth year dental students, a second group consisted of prosthodontic residents, and third group consisted of prosthodontic specialists. The precision of spray application and impression expertise was compared between the three groups. Results: The most frequently encountered errors were non-linear powder application, inappropriate intra-oral scanner manipulation, and insufficient digital data for crown fabrication. Conclusion: Experience is needed in order to achieve high quality digital impressions. A prosthodontic specialist avoided incorrect manipulation of an intra-oral camera, uneven application of powder spray and achieved a better marginal fit.

Effect of frame design and veneering material on biomechanical behavior of zirconia dental crowns veneered with overpressing ceramics.

The objective of this investigation was to compare alternative framework designs of molar zirconia crowns veneered with various overpressing ceramics and to predict the biomechanical behavior based on the stress evaluation. The hypothesis of the study is that the zirconia framework design and type of the veneering material, using the same technological procedure, may influence the biomechanical behavior of the restorations. Three geometric models with differential coping designs (uniform thickness, cutback and buccal reduction) were developed and two types of hot-pressed ceramics (leucite and lithium disilicate reinforced) were analyzed for the veneers. Using finite element analysis (FEA), maximum principle stresses were recorded in the tooth structures and in the restorations for all the developed designs. Results led to the conclusion that the hypothesis was accepted.

Design and testing of prototype handheld scanning probes for optical coherence tomography.

Three simple and low-cost configurations of handheld scanning probes for optical coherence tomography have been developed. Their design and testing for dentistry applications are presented. The first two configurations were built exclusively from available off-the-shelf optomechanical components, which, to the best of our knowledge, are the first designs of this type. The third configuration includes these components in an optimized and ergonomic probe. All the designs are presented in detail to allow for their duplication in any laboratory with a minimum effort, for applications that range from educational to high-end clinical investigations. Requirements that have to be fulfilled to achieve configurations which are reliable, ergonomic-for clinical environments, and easy to build are presented. While a range of applications is possible for the prototypes developed, in this study the handheld probes are tested ex vivo with a spectral domain optical coherence tomography system built in-house, for dental constructs. A previous testing with a swept source optical coherence tomography system has also been performed both in vivo and ex vivo for ear, nose, and throat-in a medical environment. The applications use the capability of optical coherence tomography to achieve real-time, high-resolution, non-contact, and non-destructive interferometric investigations with micrometer resolutions and millimeter penetration depth inside the sample. In this study, testing the quality of the material of one of the most used types of dental prosthesis, metalo-ceramic is thus demonstrated.

Zirconia enriched dental adhesive: a solution for OCT contrast enhancement. Demonstrative study by synchrotron radiation microtomography.

OBJECTIVE: The major aim of this study was to prove the capability of the optical coherence tomography (OCT) method in visualizing the integrity of the adhesive fillings and of the interfaces between the adhesive, tooth structures and composite resin. As zirconium dioxide was added to the composition of the adhesive layer in order to strengthen the backscattered light in the OCT investigation, for a better visualization of the interfaces, the determination of a proper zirconia concentration was another aim of our study. METHOD: Several class II cavities were prepared in human premolars and were filled with dental adhesive containing different zirconia concentrations and light-curing composite resin. Both OCT and synchrotron radiation microtomography (micro-CT) were used to analyse the morphology of the tooth-adhesive-composite interfaces and to investigate the adhesive layer. RESULTS: The pore distribution, both at the interfaces level and in the resin, and the analysis of the adhesive layer integrity were obtained. A good agreement between OCT and micro-CT analyses was observed in terms of detecting discontinuities in the adhesive layer. Furthermore, micro-CT showed that zirconia percentages in the adhesive higher than 20 vol.% lead to conglomerates formation, which can negatively influence mechanical properties. Meanwhile, OCT confirmed a factor of 3 for the contrast enhancement when 20% of zirconia was included in the adhesive composition. SIGNIFICANCE: The present study proved the capability of the OCT method in visualizing the morphology and integrity of zirconia doped tooth adhesive fillings, to be used for a further in vivo tool development.

Quantitative evaluation of dental abfraction and attrition using a swept-source optical coherence tomography system.

A fast swept-source optical coherence tomography (SS-OCT) system is employed to acquire volumes of dental tissue, in order to monitor the temporal evolution of dental wear. An imaging method is developed to evaluate the volume of tissue lost in ex vivo artificially induced abfractions and attritions. The minimal volume (measured in air) that our system could measure is 2352 µm3. A volume of 25,000 A-scans is collected in 2.5 s. All these recommend the SS-OCT method as a valuable tool for dynamic evaluation of the abfraction and attrition with remarkable potential for clinical use.

Stress distribution in retentive arms of combination clasps used on premolars.

INTRODUCTION: Stresses resulting from cast clasp arms during insertion and the removal of removable partial dentures are the main causes of deformations or fractures. Therefore, achieving clasp designs producing less stress is very important. OBJECTIVE: Retentive clasp arms used for premolars were investigated through the reverse engineering approach. The aim was to determine stress distribution in oval and half-oval clasps cross-sections in order to analyse biomechanical behavior. MATERIAL AND METHODS: Purposely designed experimental three-dimensional (3D) models of the clasp arms were constructed on the buccal surface of an upper first premolar, to be used for structural simulations. 3D teeth models obtained after laser scanning were used as a support for retentive clasp arms modeling. Parameters of the clasp arms like length, thickness and cross-section were considered for the simulation of stainless steel wires. A concentrated load of 5 N was applied at the inner tip of the clasp arm. RESULTS: A precise model of the coronal buccal surface of an upper first premolar was generated. This model was a useful tool in designing stainless steel clasp arms of different thickness and cross-section. In all cases, high stress values were located on the inner surface of the clasp arm, in the part located above the height of the contour. A similar bending stiffness was observed between the half-round cross-section design with a diameter of 1 mm and the round cross-section design with a diameter between 0.6 and 0.7 mm. CONCLUSIONS: This in vitro study demonstrated that the reverse engineering approach and structural analyses provide a powerful tool for designing clasps and visualizing fracture risk areas and for choosing the adequate cross-section for each case. Within the limitations of this study, it was suggested that, on premolars, the biomechanical performance of half-round cross-sections for the retentive arms may be higher than round sections of clasp arms showing similar mechanical stiffness.