Evaluation of Glazing and Polishing Systems for Novel Chairside CAD/CAM Lithium Disilicate and Virgilite Crowns.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of glazing, two zirconia, and two lithium disilicate polishing systems on surface roughness of a CAD/CAM lithium disilicate and virgilite ceramic with atomic force microscopy (AFM) and visual assessment performed by dental students and faculty. METHODS AND MATERIALS: Sixty maxillary right central incisor crowns made of a novel chairside CAD/CAM lithium disilicate and virgilite (CEREC Tessera) were milled for glazing and polishing. The crowns were divided into six groups: no polishing/glazing provided (NoP/G); glazed (GZ); glazed and polished with Brasseler Dialite LD Lithium Disilicate (DiLD); glazed and polished with Meisinger Luster Lithium Disilicate (LuLD); glazed and polished with Brasseler Dialite ZR Zirconia (DiZR); and glazed and polished with Meisinger Luster Zirconia (LuZR). Surfaces were scanned with AFM to measure roughness (Ra) and root mean square roughness (Rq) and generate micrographs. Crowns were visually assessed by 10 dental students and 10 dental school faculty members to determine clinical acceptableness. RESULTS: Glazing and all polishing kits significantly reduced Ra and Rq compared to no polishing/glazing. No significant Ra differences were found between glazing and all polishing kits (p>0.05). DiZR significantly reduced Rq compared to other groups (p<0.05). Visual assessment showed that GZ, LuLD, and DiZR were the most clinically acceptable crowns. CONCLUSION: Polishing and glazing considerably improve the surface smoothness of maxillary central incisor crowns fabricated out of a chairside CAD/CAM lithium disilicate and virgilite ceramic. Altogether, zirconia polishing systems provided smoother and more clinically acceptable surfaces than the lithium disilicate kits.

Ultrathin Partial Ceramic Veneers in the Esthetic Zone with Tooth Whitening: A 5-year Case Report.

OBJECTIVE: This case report describes a minimally invasive approach with tooth whitening and partial ceramic veneers in the esthetic zone with a 5-year follow-up. CLINICAL CONSIDERATIONS: The patient was initially concerned about the tooth color and previous direct resin composite restorations that chipped on the incisal edges of both maxillary central incisors. Tooth whitening and partial veneers for both central incisors were recommended after clinical evaluation. Two sessions of in-office tooth whitening, first with 35% hydrogen peroxide and later with 10% carbamide peroxide from first premolar to first premolar, were provided. Minimal tooth preparation that only removed the fractured composite restorations was performed followed by placement of feldspathic porcelain ultrathin partial ceramic veneers for both central incisors. We emphasize the benefits of minimal tooth preparation paired with partial ceramic veneers and the importance of masking discolored tooth structure with such thin veneers, including potential tooth whitening. CONCLUSIONS: Overall, we demonstrate a well-planned and executed restorative procedure combining tooth whitening and ultrathin partial ceramic veneers to achieve desired results in the esthetic zone that remained successful for five years.

Polychromatic Composite and Resin Infiltration Restorations in the Esthetic Zone: A Five-year Clinical Report.

OBJECTIVE: This case report describes the use of a combination of a polychromatic resin composite restoration and resin infiltration to achieve a satisfactory esthetic outcome that has lasted over five years. CLINICAL CONSIDERATIONS: The patient's primary complaint was a desire to replace an existing stained resin composite on the facial and mesial surfaces of the maxillary left central incisor, and a white spot on the facial surface of the maxillary right central incisor. After clinical evaluation, the patient was offered either replacement of the restoration with a polychromatic restoration simulating a white spot, or a combined treatment with polychromatic composite and resin infiltration restorations, which was recommended. The patient selected the latter treatment. A putty matrix was fabricated, and a quick mock-up was done using various enamel and dentin shades of resin composite to determine proper material selection. The previous resin composite restoration was removed, and layers of new dentin, body, and enamel composite were placed. An interproximal matrix was used in order to provide ideal contour and contact. Finishing and polishing procedures were performed. The maxillary right central incisor was treated with resin infiltration in order to subdue the white spot on the facial surface. CONCLUSIONS: Polychromatic resin composite and resin infiltration restorations to replace a stained restoration and mask a white spot can achieve desired results in the esthetic zone and maintain them for five years.

Minimally Invasive Multidisciplinary Restorative Approach to the Esthetic Zone Including a Single Discolored Tooth.

OBJECTIVES: The case report describes a minimally invasive, multidisciplinary approach to a single discolored anterior tooth, with internal bleaching using traditional Japanese paper (Washi), a gingivoplasty with a three-dimensional (3D) printed surgical guide, and ultrathin feldspathic porcelain veneers. CLINICAL CONSIDERATION: The patient's primary concern was improving her smile. After clinical evaluation, internal tooth bleaching for the discolored tooth and gingivoplasty with restoration of the maxillary anterior six teeth and first premolars was recommended. The internal tooth whitening was accomplished with sodium perborate mixed with 30% hydrogen peroxide impregnated in Washi and sealed in the root canal with glass ionomer. Once the tooth bleaching was completed, the 3D printed surgical guide was placed in the patient's maxillary anterior region and used to guide soft tissue recontouring. After 6 months, ultrathin feldspathic porcelain veneers were placed. CONCLUSION: Well-planned restorative procedures combining internal tooth bleaching using Washi, gingivoplasty performed with electrosurgery using a 3D printed surgical guide, and ultrathin feldspathic porcelain veneers can achieve the desired results in the esthetic zone and remain successful for 4 years.

Evaluation of Polishing Systems for CAD/CAM Polymer-Infiltrated Ceramic-Network Restorations.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of five different polishing systems on a computer-aided design and computer-aided manufacturing (CAD/CAM) polymer-infiltrated ceramic-network restoration with nanoscale assessment using atomic force microscopy (AFM) and visual assessment performed by dental school senior students and faculty members. METHOD: Forty-eight full coverage crowns were milled out of polymer-infiltrated ceramic-network CAD/CAM blocks (Vita Enamic) for polishing with one company proprietary, two ceramic and two composite polishing systems. The prepared crowns were divided into six groups: (1) no polishing (control); (2) polishing with Vita Enamic Polishing Kit (VEna); (3) polishing with Shofu Porcelain Laminate Polishing Kit (SCer); (4) polishing with Brasseler Dialite Feather lite All-Ceramic Adjusting & Polishing System (BCer); (5) polishing with Shofu Composite Polishing Kit (SCom); and (6) polishing with Brasseler Composite Polishing Kit (BCom). The polished crown surface topography was observed, and surface roughness and area were measured with AFM. In addition, polished crowns were visually assessed by 15 senior dental students and 15 dental school faculty members. RESULTS: All polishing treatments significantly reduced the surface roughness and area of the crown compared with the control. SCom and BCom showed significantly higher surface area than VEna, and the SCer and BCer groups were intermediate, showing no significant difference from either VEna or SCom and BCom. There were no significant differences in surface roughness between any of the systems. Dental students and faculty members classified the groups polished with VEna, SCer, and BCer groups as clinically acceptable, and they selected BCer group as the best polished restorations and the control group as the least polished restorations. CONCLUSIONS: Ceramic and composite polishing systems produced similar polishing results as that observed using a company proprietary polishing system. However, effectiveness for polishing using a company proprietary and ceramic polishing system tends to be higher than composite polishing systems.

Simulated Cuspal Deflection and Flexural Properties of Bulk-Fill and Conventional Flowable Resin Composites.

CLINICAL RELEVANCE: Some bulk-fill flowable resin composites produce less cuspal deflection than a conventional incrementally filled flowable resin composites. SUMMARY: Objective: This study investigated simulated cuspal deflection and flexural properties of bulk-fill and conventional flowable resin composites.Methods and Materials: Five bulk-fill and six conventional flowable resin composites were evaluated. Aluminium blocks with a mesio-occlusal-distal cavity were prepared and randomly divided into groups for each of the different measurement techniques and were further subdivided according to the type of flowable resin composite. The simulated cuspal deflection caused by the polymerization of resin composite within an aluminium block was measured using a highly accurate submicron digimatic micrometer or a confocal laser scanning microscope (CLSM). In addition, the flexural properties of tested resin composites were measured to investigate the relation between cuspal deflection and flexural properties, and the resin composites were observed using scanning electron microscopy.Results: Simulated cuspal deflection of some bulk-fill flowable resin composites was found to be significantly lower than or similar to those for conventional counterparts, regardless of the measurement method. There were statistically significant differences in flexural properties depending on the material, regardless of the type of flowable resin composite. Pearson correlation analysis did not reveal a statistically significant relationship between flexural properties and cuspal deflection.Conclusion: These results indicate that some bulk-fill flowable resin composites exhibit lower cuspal deflection with the bulk-filling technique than is shown by conventional flowable resin composites using the incremental filling technique. Simulated cuspal deflection can be measured using either a micrometer or CLSM, but this experiment failed to show a significant relationship between cuspal deflection and flexural properties of flowable resin composites.

Enamel Etching for Universal Adhesives: Examination of Enamel Etching Protocols for Optimization of Bonding Effectiveness.

OBJECTIVE: The purpose of this study was to evaluate whether different enamel etching methods with reduced etching times would improve the bonding effectiveness of universal adhesives. METHODS AND MATERIALS: Three enamel etching methods, phosphoric acid ester monomer (PPM) etching, phosphoric acid (PPA) etching, and polyalkenoic acid (PLA) etching, and three universal adhesives, G-Premio Bond (GP), Prime&Bond elect (PE), and Scotchbond Universal Adhesive (SU), were evaluated. Initial bond strengths and fatigue strengths of universal adhesives to ground enamel and ground enamel etched for less than one, five, 10, and 15 seconds using different etching methods were determined. The bonded fatigue specimens were loaded using a sine wave at a frequency of 20 Hz for 50,000 cycles or until failure occurred with a staircase method. Atomic force micrograph (AFM) observations along with measurements of surface Ra roughness and modified surface area of enamel with different etching protocols were also conducted. RESULTS: The bond fatigue durability of universal adhesives to enamel with PPA etching from less than one to 15 seconds and PLA etching for 15 seconds was significantly higher than that to ground enamel. The bond fatigue durability to enamel with PPM etching was not increased compared with ground enamel. The surface Ra roughness and surface area obtained with AFM of enamel increased after PPA and PLA etching, and those values were significantly higher than those of ground enamel. Furthermore, surface Ra roughness and surface area with PPA etching were significantly higher than those with PLA etching. However, surface Ra roughness and surface area of enamel with PPM etching were similar to those of ground enamel regardless of etching time. CONCLUSION: PPA etching for less than one to 15 seconds and PLA etching for 15 seconds improve universal adhesive bonding, surface Ra roughness, and surface area of enamel. However, PPM etching is not effective, regardless of etching time, in improving bonds strengths, increasing surface roughness, and increasing surface area.

Dentin Priming with Amphipathic Antimicrobial Peptides.

The evolution of bonded restorations has undergone great progress over several decades. Nonetheless, life spans of bonded restorations are limited mainly because of the eventual incidence of recurrent caries. Over time, water and waterborne agents (acids, enzymes) degrade the components of the dentin/restoration interface, allowing bacterial colonization and dentin reinfection at the margins of the restoration. We developed a 2-tier protective technology consisting of priming/coating dentin with amphipathic and antimicrobial peptides (AAMPs) to obtain hydrophobic/water-repellent and antibiofilm dentin-resisting recurrent caries around bonded restorations. We tested a series of AAMPs to assess their structure-function relationships as well as the effects of different dentin-conditioning methods on the structural features of AAMP-coated dentin. We found relation between the secondary structure of AAMPs (high portion of ß-sheet), the antimicrobial potency of AAMPs, and the AAMPs' ability to form hydrophobic coatings on dentin. We also determined that AAMPs had preferential adsorption on the mineral phase of dentin, which suggested that peptides arrange their cationic and hydrophilic motifs in direct contact with the negatively charged minerals in the hydrophilic dentin. These results led us to explore different dentin-conditioning methods that would increase the mineral/collagen ratio and their effect on AAMP immobilization. We innovatively imaged the spatial distribution of the AAMPs in relation to the dentinal tubules and collagen network using a minimally invasive multimodal imaging technique: multiphoton-second harmonic generation. Using multiphoton-second harmonic generation imaging, we determined that partial deproteinization of dentin increased the amount of immobilized AAMPs as compared with the total etched dentin at the dentin surface and extended deeply around dentinal tubules. Last, we analyzed the release rate of AAMPs from dentin coatings in artificial saliva to predict their stability in the clinical setting. In conclusion, priming dentin with AAMPs is a versatile new approach with potential to fortify the otherwise vulnerable adhesive-based interfaces.

Effect of Reduced Universal Adhesive Application Time on Enamel Bond Fatigue and Surface Morphology.

OBJECTIVE:: The purpose of this study was to evaluate the effect of reduced application times of universal adhesives on enamel bond fatigue and surface morphology of the treated enamel with constant force atomic force microscopy (AFM). METHODS:: Four universal adhesives-Adhese Universal (AU), Clearfil Universal Bond Quick (CU), G-Premio Bond (GP), and Scotchbond Universal Adhesive (SU)-were evaluated in a laboratory for their ability to adhesively bond resin composite to enamel. Shear bond strengths were initially determined using 15 specimens per test group for each adhesive. Shear fatigue strengths were then determined using 20 specimens per test group for each the adhesives. The fatigue specimens were loaded using a sine wave at a frequency of 20 Hz for 50,000 cycles or until failure occurred. AFM observations, surface Ra roughness measurements, and geometric surface area evaluations of enamel surface treated with the adhesive agents were also conducted. RESULTS:: A strong relationship was found between the initial shear bond strength and shear fatigue strength for enamel surface Ra roughness but not for geometric surface area. The initial shear bond strength and shear fatigue strength of CU and GP were not influenced by different application times, unlike those of AU and SU. While the surface area of enamel treated with the adhesive agents was not significantly influenced by different application times and type of adhesive, surface Ra roughness of the enamel in the AU and SU groups significantly increased with increasing application time, unlike CU and GP. CONCLUSIONS:: The results of this study suggest that universal adhesives, used with reduced application times, have adequate Ra surface roughness to provide sufficient resistance to enamel bond fatigue at application times from <1 second to 20 seconds, while the geometric surface area of adhesive-treated enamel did not show any significant changes at these different application times.

Effects of Polishing Bur Application Force and Reuse on Sintered Zirconia Surface Topography.

OBJECTIVE: Limited information is available on how to polish and finish zirconia surfaces following computer-aided design/computer-aided manufacturing (CAD/CAM), specifically, how differing application forces and reuse of zirconia polishing systems affect zirconia topography. PURPOSE: To determine the effect of differing, clinically relevant, polishing application forces and multiple usages of polishing burs on the surface topography of CAD/CAM zirconia. METHODS: One hundred twenty 220-grit carbide finished zirconia disks were sintered according to manufacturer's directions and divided into two groups for the study of two coarse polishing bur types. Each group was divided into subgroups for polishing (15,000 rpm) at 15 seconds for 1.0 N, 4.5 N, or 11 N of force using a purpose-built fixture. Subgroups were further divided to study the effects of polishing for the first, fifth, 15th, and 30th bur use, simulating clinical procedures. Unpolished surfaces served as a control group. Surfaces were imaged with noncontact optical profilometry (OP) and atomic force microscopy (AFM) to measure average roughness values (Ra). Polishing burs were optically examined for wear. Scanning electron microscopy (SEM) was performed on burs and zirconia surfaces. One-way ANOVA with post hoc Tukey HSD (honest significant difference) tests (α=0.05) were used for statistical analyses. RESULTS: AFM and OP Ra values of all polished surfaces were significantly lower than those of the unpolished control. Different polishing forces and bur reuse showed no significant differences in AFM Ra. However, significant differences in OP Ra were found due to differing application forces and bur reuse between the first and subsequent uses. SEM and optical micrographs revealed notable bur wear, increasing with increasing reuse. SEM and AFM micrographs clearly showed polished, periodic zirconia surfaces. Nanoscale topography, as analyzed with kurtosis and average groove depth, was found dependent on the specific polishing bur type. CONCLUSIONS: These in vitro results suggest changes in OP Ra due to bur reuse and polishing application force. Within the parameters of this study, the resultant topography of zirconia polishing is force-dependent and the reuse of coarse polishing burs is possible without statistically significant differences in Ra values after initial use. Nanoscale and microscale topography were shown to depend on specific polishing bur type.