Ultrathin CAD-CAM Ceramic Occlusal Veneers and Anterior Bilaminar Veneers for the Treatment of Moderate Dental Biocorrosion: A 1.5-Year Follow-Up.

Dental biocorrosion can produce a devastating impact on oral health. The restorative phase of the treatment should not cause additional damage of the remaining sound tooth structure. Ultrathin occlusal veneers are a conservative alternative to traditional onlays and complete crowns for the treatment of severe biocorrosive lesions. This strategy is explained in the present case report through a full-mouth rehabilitation of a patient with moderate biocorrosion. Maxillary anterior teeth were restored using the bilaminar technique (lingual direct composite veneers with labial ceramic veneers) and posterior teeth using ultrathin CAD-CAM ceramic occlusal veneers. The technical aspects required for the implementation of this new restorative design are presented with a special emphasis on the control of tooth preparation based on diagnostic wax-up, provisionalization, and the use of CAD-CAM technology.

Ferrule-Effect Dominates Over Use of a Fiber Post When Restoring Endodontically Treated Incisors: An In Vitro Study.

OBJECTIVES: The aim of this study was to investigate the restoration of broken-down endodontically treated incisors with the ferrule effect using glass ceramic crowns bonded to composite resin core buildups with or without a fiber post. A no-ferrule group with post was also included for comparison. METHODS AND MATERIALS: Thirty decoronated endodontically treated bovine incisors with a 2-mm ferrule were restored with a direct buildup using a nanohybrid direct composite resin (Miris 2 and Optibond FL) with or without a glass-fiber-reinforced post. An additional group of 15 teeth without a ferrule were restored with buildup and a fiber post. All teeth were prepared to receive bonded glass ceramic crowns (e.max CAD luted with Variolink Esthetic DC) and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30° and a frequency of 5 Hz, beginning with a load of 100 N (×5000 cycles). A 100 N load increase was applied each 15,000 cycles. Specimens were loaded until failure or to a maximum of 1000 N (×140,000 cycles). Groups were compared using the Kaplan Meier survival analysis (log rank test at p=0.05). RESULTS: None of the tested specimens withstood all 140,000 load cycles. Specimens with posts but without a ferrule were affected by an initial failure phenomenon (wide gap at the lingual margin between the buildup/crown assembly and the root). There was a significant difference in mean survived cycles between the ferrule groups (Fp=73,332× and FNp=73,244×) and the no-ferrule group (50,121×; p=0.001). The addition of a fiber post was not significant in the presence of the ferrule (p=0.884). In both groups with posts, 100% of failures were unrestorable. The no-post group had 47% of restorable and possibly restorable failures. CONCLUSIONS: The survival of broken-down nonvital incisors was improved by the presence of the ferrule but not by the fiber-reinforced post. Fiber posts were always detrimental to the failure mode and were not able to compensate for the absence of a ferrule.

Histo-anatomic 3D printing of dental structures.

The creation of dental restorations with natural appearance and biomechanics represents a major challenge for the restorative team. The manufacturing-process of high-aesthetic restorations from tooth-coloured restorative materials is currently dominated by manual manufacturing procedures and the outcome is highly dependent on the knowledge and skills of the performing dental technician. On the other hand, due to the simplicity of the manufacturing process, CAD/CAM restorations from different material classes gain more and more acceptance in the daily routine. Multi-layered restorations show significant aesthetic advantages versus monolithic ones, but are difficult to fabricate using digital technologies. The key element for the successful automated digital fabrication of aesthetic anterior restorations seems to be the form of the individual dentine core as defined by dentine enamel junction (DEJ) covered by a more transparent layer of material imitating the enamel layer to create the outer enamel surface (OES). This article describes the possibilities and technologies available for so-called '4D-printing'. It introduces the digital manufacturing process of multilayered anterior teeth using 3D multipart printing, taking the example of manufacturing replicas of extracted intact natural teeth.

From 'Direct Versus Indirect' Toward an Integrated Restorative Concept in the Posterior Dentition.

Traditionally, indirect restorations are expected to have better longevity than direct restorations. The introduction of adhesive dentistry and the minimally invasive approach of restorative treatment has changed this. In this article, the differences in longevity between direct and indirect restorations in the posterior dentition are explained. In addition, the advantages and disadvantages of direct and indirect restorations placed in a minimally invasive way and using a proper adhesive technique are described.

CAD/CAM Polymer vs Direct Composite Resin Core Buildups for Endodontically Treated Molars Without Ferrule.

OBJECTIVES: The aim of this study was to investigate the restoration of broken-down endodontically treated molars without ferrule effect using glass ceramic crowns on different composite resin core buildups. METHODS AND MATERIALS: Forty-five decoronated endodontically treated teeth (no ferrule) were restored with a semidirect buildup using an experimental computer-aided design/computer-aided manufacturing (CAD/CAM) high-performance polymer (HPP group) or with light-curing composite core buildups of Tetric EvoCeram with (TECP group) or without (TEC group) a glass-fiber-reinforced post. All teeth were prepared to receive bonded glass ceramic crowns (Empress CAD luted with Variolink II) and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the palatal cusp at an angle of 30° and a frequency of 5 Hz, beginning with a load of 200 N (×5000 cycles) and followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles. Groups were compared using the life-table survival analysis (log rank test at p=0.05). Average fracture loads and number of survived cycles were compared with one-way analysis of variance (Scheffé post hoc at p=0.05). RESULTS: None of the tested specimen withstood all 185,000 load cycles. There was a significant difference in mean fracture load, survived cycles, and survival; the HPP group (fracture load 975.27N±182.74) was significantly higher than the TEC (716.87N±133.43; p=0.001) and TECP (745.67±156.34; p=0.001) groups, and the TEC and TECP groups showed no difference (p=0.884). Specimens in the TECP group were affected by an initial failure phenomenon (wide gap at the margin between the buildup/crown assembly and the root). CONCLUSIONS: Semidirect core buildup made from high-performance polymer enhanced the performance of all-ceramic leucite-reinforced glass ceramic crowns compared with direct light-curing composite resin buildups. The use of a fiber-reinforced post system did not influence the fatigue strength of all-ceramic crowns.

Influence of Adhesive Core Buildup Designs on the Resistance of Endodontically Treated Molars Restored With Lithium Disilicate CAD/CAM Crowns.

OBJECTIVE: To assess the influence of adhesive core buildup designs (4-mm buildup, 2-mm buildup, and no buildup/endocrown) on the fatigue resistance and failure mode of endodontically treated molar teeth restored with lithium disilicate computer-aided design/computer-aided manufacturing (CAD/CAM) complete crowns placed with self-adhesive cement. METHODS AND MATERIALS: Forty-five extracted molars were decoronated at the level of the cementoenamel junction and endodontically treated. Specimens received different Filtek Z100 adhesive core buildups (4-mm buildup; 2-mm buildup; and no buildup endocrown preparation) and were restored with Cerec 3 CAD/CAM lithium disilicate crowns (IPS e.max CAD). The intaglio surfaces of restorations (n=15) were conditioned by hydrofluoric acid etching and silane, and prepared teeth were treated with airborne-particle abrasion, followed by cementation with RelyX Unicem 2 Automix. Specimens were then subjected to cyclic isometric loading at 10 Hz, beginning with a load of 200 N (×5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles. The chewing cycle was simulated by an isometric contraction (load control) applied through a 10-mm in diameter composite resin sphere (Filtek Z100). Surviving specimens were axially loaded until failure or to a maximum load of 4500 N (crosshead speed 0.5 mm/min). The failure mode was assessed, and fractures were designated as catastrophic (tooth/root fracture that would require tooth extraction) or reparable (cohesive or cohesive/adhesive fracture of restoration only). Groups were compared using the life table survival analysis (log-rank test at p=0.05). Surviving specimens were loaded to failure and compared with one-way analysis of variance. RESULTS: The survival rates after the fatigue test were 100%, 93%, and 100% for 4-mm, 2-mm, and no buildup (endocrown), respectively and were not statistically different (only one specimen failed with a 2-mm buildup under a crown that cohesively fractured at 1,400 N). Postfatigue load to failure averaged 3181 N for 4-mm buildups (15 specimens), 3759 N for 2-mm buildups (12 specimens), and 3265 N for endocrowns (14 specimens). The 2-mm buildups were associated with higher loads to failure than endocrowns and 4-mm buildups, but no differences were found between 4-mm buildups and endocrowns (p<0.05.) One endocrown and 2 restorations with a 2-mm buildup survived the load-to-failure test (at 4500 N). Only catastrophic fractures occurred after the load-to-failure test. CONCLUSIONS: The buildup design influenced the performance of endodontically treated molars restored with lithium disilicate CAD/CAM complete crowns placed with self-adhesive resin cement. The 2-mm buildups were associated with higher loads to failure than the endocrown and the 4-mm buildup, but all restoration designs survived far beyond the normal range of masticatory forces.

Composite Resin Core Buildups With and Without Post for the Restoration of Endodontically Treated Molars Without Ferrule.

OBJECTIVE: The aim of this study was to investigate the restoration of highly damaged, broken-down endodontically treated molars without the ferrule effect using glass ceramic crowns on different dual-cure composite resin core buildups. METHODS AND MATERIALS: Thirty (N=30, n=15) decoronated, endodontically treated teeth (no ferrule) were restored without a ferrule with a direct buildup using the dual-curing composite Multicore HB (group MHB) or the dual-curing composite core buildup Multicore Flow in combination with glass-fiber-reinforced composite post (FRC post; group MFP). All teeth were prepared to receive bonded glass ceramic crowns (Empress CAD luted with Variolink II) and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the palatal cusp at an angle of 30 degrees and a frequency of 5 Hz, beginning with a load of 200 N (×5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles. Groups were compared using the life table survival analysis (log rank test at p=0.05). Average fracture loads and number of survived cycles were compared with one-way analysis of variance (Scheffé post hoc at p=0.05). Previously published data from the same authors about core buildups made of high-performance polymers (group HPP, n=15) and light-curing composite resin without FRC posts (group TEC, n=15) and with FRC posts (group TECP, n=15) using the same experimental setup were included for comparison. RESULTS: None of the tested specimen withstood all 185,000 load cycles. There was no significant difference in mean fracture load (p=0.376), survived cycles (p=0.422), and survival (p=0.613) between MHB (facture load 859.4 N±194.92) and MFP (796.13 N±156.34). Group HPP from a previous study appeared to have significantly higher performance than all other groups except MHB. All groups with posts were affected by an initial failure phenomenon (wide gap at the margin between the buildup/crown assembly and the root). CONCLUSIONS: HPP and MHB enhanced the performance of all-ceramic leucite-reinforced glass ceramic crowns, and insertion of a fiber-reinforced composite post was not influential when using other materials.

Influence of no-ferrule and no-post buildup design on the fatigue resistance of endodontically treated molars restored with resin nanoceramic CAD/CAM crowns.

OBJECTIVES: To evaluate the influence of adhesive core buildup designs-4-mm buildup, 2-mm buildup, and no buildup (endocrown)-on the fatigue resistance and failure mode of endodontically treated molar teeth restored with resin nanoceramic (RNC) CAD/CAM complete crowns placed with self-adhesive resin cement. METHODS AND MATERIALS: Forty-five extracted molars were decoronated at the level of the cementoenamel junction, and the roots were endodontically treated. Specimens received different Filtek Z100 adhesive core buildups (4-mm buildup, 2-mm buildup, and no buildup, endocrown preparation) and were restored with Cerec 3 CAD/CAM RNC crowns (Lava Ultimate). Restorations (n=15) and prepared teeth were treated with airborne-particle abrasion, followed by cementation with RelyX Unicem 2 Automix. Specimens were then subjected to cyclic isometric loading at 10 Hz, beginning with a load of 200 N (for 5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles (10-mm-diameter composite resin sphere antagonist). The failure mode was assessed: "catastrophic" (tooth/root fracture that would require tooth extraction), "possibly reparable" (cohesive/adhesive failure with fragment and minor damage, chip or crack, of underlying tooth structure), or "reparable" fracture (cohesive or cohesive/adhesive fracture of restoration only). Groups were compared using the life table survival analysis. Intact specimens were loaded to failure and compared with one-way analysis of variance. RESULTS: All specimens survived the fatigue test until the 800 N-step. The survival rates for 4-mm, 2-mm, and no buildup (endocrown) were 53%, 87%, and 87%, respectively, and were not statistically different even though crowns with 2-mm buildups only started to fail at 1200 N. Minor cohesive chips were detected in many samples despite having survived all 185,000 cycles. Postfatigue load-to-failure ranged from 2969 N with 4-mm buildup (eight specimens), 2794 N for 2-mm buildup (13 specimens), and 2606 N for endocrowns (13 specimens) and were also not statistically different. There were only two catastrophic failures during the fatigue test and small subgingival delamination fractures and cracks (only with 4-mm buildup). All specimens in the load-to-failure test exhibited nonrestorable catastrophic fractures. CONCLUSIONS: There was no influence of the buildup design on the performance of endodontically treated molars restored with RNC CAD/CAM complete crowns placed with self-adhesive cement. All restoration designs survived the normal range of masticatory forces. Failure mode tended to be more favorable with the 2-mm buildup or no buildup (endocrown).

Evaluation of an anatomic dual-laminate composite resin shade guide.

BACKGROUND: Color assessment in aesthetic dentistry is one of the most challenging steps for direct restorative treatment. Shade selection tools should be able to mimic closely the materials and layering technique used in the final restoration, hence the development of prefabricated anatomic dual-laminate shade guides. OBJECTIVE: This study aims to compare different shade selection techniques and determine the suitability of a prefabricated anatomic dual-laminate shade guide and its best mode of use compared to a conventional guide and a layered custom guide. MATERIALS AND METHODS: CIELab coordinates of different shade guides were assessed: Vitapan Classical (tab A2; Vita); Miris2 prefabricated anatomic dual-laminate shade guide, enamel WR tab on top of dentine S3 tab and nothing in-between (M2air) or glycerin gel (M2gly) or water (M2w); custom shade guide using prefabricated silicon moulds, Miris2 enamel WR composite resin moulded directly on dentine S3 pre-polymerised base (M2cus). The average values were obtained to calculate DE and compare the different shade selection techniques. Additional samples and measurements were made to compare Vitapan Classical shade tabs A1, A2 and A3 and all possible combinations of Miris2 and establish the closest matching shade (DE 3.3). RESULTS: High DE values were found (6.51­9.11) when comparing M2air to Vita, M2gly M2w M2cus. Differences appeared acceptable (DE 2.09­2.99) between Vita, M2gly and M2w and M2cus. Seven combinations of M2 were found to match Vita tab A1 and A2 and three Miris2 combinations for Vita A3 (DE 3.3). CONCLUSIONS: The use of Miris2 prefabricated anatomic dual-laminate shade guide with interposition of water or glycerin between the enamel­dentine tabs demonstrated acceptable DE values when compared to Vitapan Classical and custom guides. A chart for matching Vita shades with various combinations of Miris2 enamel/dentine shades was produced to assist the clinician in obtaining acceptable restorations. CLINICAL SIGNIFICANCE: The prefabricated anatomic dual-laminate shade guide is as efficient as a custom shade guide, facilitating clinical steps and saving material when doing compositeresin restorations.

Vision for spatial perception and vision for action: a dissociation between the left-right and near-far dimensions.

Neuropsychological and psychophysical studies have suggested that two distinct visual sub-systems are responsible for perception and action. One of the main psychophysical arguments for this is based on visual illusion such as the Induced Roelofs Effect (IRE), where the location of a visual target presented with an off-centre frame is misperceived when evaluated verbally, but not with a reaching response. This dissociated effect suggests the existence of two independent representations of visual space devoted, respectively, to categorisation and to egocentric localisation of reachable objects. These "cognitive" and "sensorimotor" representations have been assumed to be produced through specific anatomical pathways stemming from the primary visual cortex (respectively, the ventral and dorsal streams). To account for the dissociation found with the IRE, it has been suggested that only the cognitive system is sensitive to contextual information. However this view has been challenged by recent psychophysical studies demonstrating the influence of environmental cues on distance perception and the guiding of movement. In the present study, the IRE is re-evaluated but the near-far and right-left dimensions were dissociated. In agreement with previous findings, our results showed that the IRE in the right-left dimension gives rise to a perceptual misperception of target position with no effect on motor performance. Conversely, when the IRE was induced in the near-far dimension a misperception of the target position affected both perceptual and motor responses. This dissociation indicates that the spatial constraints of the task, and not only the nature of the response, interfere with sensitivity to contextual information leading to visual illusions. It is thus likely that the action system (imputed to the dorsal stream) can be sensitive to contextual information, at least when depth processing is emphasised.

Interaction between bioactive glasses and human dentin.

This study explores the interaction between bioactive glasses and dentin from extracted human teeth in simulated oral conditions. Bioactive glasses in the Na(2)O-CaO-P(2)O(5)-SiO(2) and MgO-CaO-P(2)O(5)-SiO(2) systems were prepared as polished disks. Teeth were prepared by grinding to expose dentin and etching with phosphoric acid. A layer of saliva was placed between the two, and the pair was secured with an elastic band and immersed in saliva at 37 degrees C for 5, 21 or 42 days. The bioactive glasses adhered to dentin, while controls showed no such interaction. A continuous interface between the bioactive glass and dentin was imaged using cryogenic-scanning electron microscopy (SEM). However, after alcohol dehydration and critical point drying, fracture occurred due to stresses from dentin shrinkage. SEM investigations showed a microstructurally different material at the fractured interface. Chemical analyses revealed that ions from the glass penetrated into the dentin and that the surface of the glass in contact with the dentin was modified. Microdiffractometry showed the presence of apatite at the interface. Bonding appears to be due to an affinity of collagen for the glass surface and chemical interaction between the dentin and glass, leading to apatite formation at the interface.

Cumulative effects of successive restorative procedures on anterior crown flexure: intact versus veneered incisors.

OBJECTIVE: When successive restorative procedures (e.g., porcelain veneers, interdental resin composite restorations, and endodontic treatment) are carried out on the same tooth, significant effects on crown flexure can be expected. METHOD AND MATERIALS: Dentin-bonded porcelain veneers (experimental group) were assessed in vitro using functional and cyclic thermal loads. They were compared to natural teeth (control group) with respect to 2 parameters: coronal flexure (investigated using experimental strain gauges) and morphology of the tooth-restoration interface (scanning electron microscopic evaluation). For both veneered and natural teeth, crown deformation was recorded at 5 sequential experimental steps: intact tooth (baseline), Class III cavities, Class III resin composite restorations, endodontic treatment, and endodontic restoration (without posts). RESULTS: No significant differences in crown flexure were found between natural and veneered incisors when compared across experimental steps. The main effect for experimental steps was highly significant. When averaged across all specimens (natural and veneered teeth), the endodontic treatment step resulted in the highest crown flexure (1.55x the baseline value). The unrestored Class III cavities and the endodontic restoration were next highest (1.30x and 1.28x the baseline value, respectively). The lowest crown flexures were found after restoration of the Class III cavities (1.13x the baseline value). No measurable microleakage or gaps were detected at the ceramic-resin, resin-enamel, or resin-dentin interfaces (Optibond FL, Kerr). CONCLUSION: Each subsequent reduction in tooth structure resulted in a substantial increase in crown flexibility, even after restoration. Endodontic procedures were responsible for most of the loss in crown stiffness. Extensive proximal cutting and restorations seemed to minimally affect crown flexure. Porcelain veneers showed perfect biomimetic behavior, because cumulated restoration procedures had the same effect on natural and veneered incisors.

Clinical performance of novel-design porcelain veneers for the recovery of coronal volume and length.

The present study evaluated the clinical performance of bonded porcelain veneers (PV) restoring substantial coronal volume and length in the anterior dentition. Forty-eight PVs were placed in 16 patients, with systematic coverage and reconstitution of the incisal edge, including well-defined anterior guidance. A standardized protocol comprising diagnostic steps that integrate additive waxups and acrylic mockups was used. PVs were fabricated using feldspathic and low-fusing porcelains in a refractory die technique. Incisal overlaps featured freestanding porcelain spans ranging from 1.5 to 5.5 mm. After a mean clinical service of 4.5 years, 13 clinical parameters for each tooth and 4 parameters that applied to persons were recorded. Permutation tests evaluated the effects of margin location, incisal edge span of porcelain, overbite, opposing contact location, and restoration age on ceramic failure and clinical marginal adaptation and seal. At recall, 100% of the veneers were satisfactory with minor interventions. The effect of slight marginal defects and porcelain cracking was negligible. Biologic, periodontal, and esthetic parameters showed excellent results, which were supported by 100% patient-reported satisfaction. All patients felt comfortable with the newly defined anterior guidance. Aging was negligible, and there were no significant effects of margin location (P > 0.08), incisal edge span of the ceramic, or overbite (P > 0.22) on ceramic failure and marginal performance. Minor alterations of the palatal margin, however, tended to be more frequent compared to facial locations, and were found especially when the opposing tooth contact in centric occlusion was located on the palatal margin (P = 0.028). Bonded ceramic restorations represent a reliable, effective procedure to restore extensive coronal volume and length in the anterior dentition.

Interdental design of porcelain veneers in the presence of composite fillings: finite element analysis of composite shrinkage and thermal stresses.

PURPOSE: This study was conducted to optimize the interdental design (wraparound) of porcelain laminates bonded to teeth in the presence of preexisting composite fillings. MATERIALS AND METHODS: A finite element model (2-dimensional mesh generated from a horizontal cross section of a maxillary incisor) was used to evaluate the effects of luting composite shrinkage and thermal changes on the stress distribution within the ceramic. The mesh included 3 restorative designs (3 degrees of interdental wrapping) and a Class III composite filling. Curing contraction of the luting composite was simulated at baseline temperature (37 degrees C). Thermal loads from 37 to 60 degrees C and from 37 to 5 degrees C were assessed with and without preexisting composite shrinkage. Surface tangential stresses were calculated at the ceramic surface and interface. RESULTS: Curing contraction alone generated mostly compressive stresses (peaks at 15 MPa) at both the ceramic surface and interface. Stresses remained compressive (peaks at 20 MPa) when thermal changes were added, except for the conservative veneer with minimum wraparound, the margins of which showed potentially harmful tensile stress peaks (approximately 7 MPa). Deformation of the tooth-restoration complex tended to be more uniform for veneers with maximum wraparound. In the presence of thermal loads alone, opposite effects were observed on the restoration surface and the interface, with compressive stresses on one side (up to 13 MPa) and tensile stresses on the other (up to 9 MPa). This effect of proximal bending (explained by the nearby expansion/contraction of the composite filling) was attenuated by the significant reduction of the bulk of the preexisting interdental composite by the overlapping veneer. CONCLUSION: In the finite element environment, the negative effect of the nearby expanding/contracting composite fillings can be minimized by extending the veneer over the preexisting interdental restoration. Because of the precompressed state resulting from composite shrinkage, ceramics showed lower temperature-induced tensile stresses.

Wear of enamel and veneering ceramics after laboratory and chairside finishing procedures.

PURPOSE: This in vitro study compared the wear of enamel against 3 types of ceramics with high esthetic potential (designed for layering techniques): feldspathic porcelain (Creation), aluminous porcelain (Vitadur alpha), and low-fusing glass (Duceram-LFC). Laboratory finishing (glazing/polishing) and chairside polishing with a Dialite kit were simulated to compare their respective effects on wear. METHODS: Tooth-material specimen pairs were placed in an artificial mouth using closed-loop servohydraulics. Constant masticatory parameters (13.5 N occlusal force, 0.62 mm lateral excursion; 0.23 second cuspal contact time) were maintained for 300, 000 cycles at a rate of 4 Hz. The occlusal surface of each pair was mapped and digitally recorded before and after each masticatory test. Quantitative changes were measured in terms of depth and volume of wear. Quantitative wear characteristics were assessed by SEM. RESULTS: Significant differences were observed (2-factor ANOVA, P <.05). Duceram-LFC generated increased volume loss of enamel (0.197 mm(3)) compared with Creation (0.135 mm(3)) and Vitadur alpha (0.153 mm(3)). Creation exhibited the lowest ceramic wear and lowest combined volume loss (0.260 mm(3); the sum of the data for enamel and the opposing material) compared with Duceram-LFC (0.363 mm(3)) and Vitadur alpha (0.333 mm(3)). The most significant differences among materials were observed in volume loss, not in depth of wear. For all 3 ceramic systems, qualitative SEM evaluation revealed an abrasive type of wear. Wear characteristics of chairside polished specimens were similar to those of laboratory finished specimens (glazed and polished). CONCLUSION: Duceram-LFC was the most abrasive ceramic for the antagonistic tooth. Creation ceramic was the least abrasive material and most resistant to wear. Defects, brittleness, and the possibly insufficient toughness of LFC may explain its increased abrasiveness. Laboratory and chairside finishing procedures generated similar results.

Dental diamond burs made with a new technology.

STATEMENT OF PROBLEM: Conventional diamond burs show several limitations such as the heterogeneity of grain shapes, the difficulty of automation during fabrication, the decrease of cutting effectiveness due to repeated sterilization, and short lifetime. An additional shortcoming may be represented by the potential release of Ni+2 ions from the metallic binder into the body fluids. PURPOSE: This study investigated a new diamond rotative instrument made of a continuous diamond film obtained by chemical vapor deposition (CVD). This bur, characterized by a pure diamond cutting surface without metallic binder between crystals, was compared with a conventional diamond bur. MATERIAL AND METHODS: Cutting tests were followed by SEM examination and electron microprobe analysis (EMA) to trace metallic residues both at the surface of the bur and the substrate. RESULTS: EMA demonstrated that the metals Ni, Cr, Si, and Fe were present in the metallic binder matrix of the conventional bur and could be smeared on the surface of the substrate during cutting. SEM showed that significant loss of diamond particles occurred during cutting. On the other hand, no discrete particles sheared off the CVD bur. The smearing of the metallic binder cannot occur using the new bur. CONCLUSION: The new CVD bur not only proves to be more efficient in its cutting ability and longevity, but also excludes the risk of metal contamination. This last aspect concerns both the pollution of the oral environment and the contamination of the ceramic during the laboratory manufacturing of dental restorations.

Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown.

PURPOSE: The purpose of this study was to investigate the biomimetic principle in porcelain veneer reconstruction, or in other words, to assess the extent to which the restoration can mimic the biomechanics and structural integrity of the original tooth. Using an optimized luting procedure, porcelain veneers are expected to present such features even when bonded to an extensive dentin surface. METHODS AND MATERIALS: Dentin-bonded porcelain veneers were assessed using functional and cyclic thermal loads with respect to two parameters: coronal stiffness (investigated using experimental strain gauges and finite element analysis) and morphology of the tooth-restoration interface (scanning electron microscope evaluation). Two different application modes of the same dentin-bonding agent, Optibond FL, were evaluated: a traditional method (dentin adhesive applied when proceeding to luting the veneer) and an alternative method (dentin adhesive applied to dentin and cured before taking the impression for the veneer). RESULTS: In the finite element model, the crown compliance increased by a factor of 2.16 after facial enamel removal and returned to 96% of its original value after the placement of the veneer. The finite element values showed a good correlation with strain gauge experimental results (one-sample t test, P > 0.35 after facial enamel removal and P > 0.19 after veneer placement). The dentin adhesive application mode was not critical to the recovery of tooth stiffness (analysis of variance, P = 0.10). However, qualitative scanning electron microscope observations demonstrated that the traditional dentin adhesive application was associated with bonding failures between the hybrid layer and the overlying resin, whereas unbroken and continuous interfaces were obtained with the new method using the same dentin adhesive. CONCLUSION: The results of this study definitely favor the biomimetic behavior of porcelain veneers bonded to teeth using an optimized application mode of dentin adhesives, because this treatment modality proved to restore both the mechanical behavior and microstructure of the intact tooth.