Electrochemical Properties of Nickel-Titanium Rotary Endodontic Instruments.

INTRODUCTION: Nickel-titanium rotary endodontic files have been commercially available for decades, but more recent innovations have introduced heat-treated and surface-treated files. This study investigated the corrosion properties of various nickel-titanium files in normal saline and sodium hypochlorite (NaOCl). METHODS: Ten different file brands of size 40 with a 0.04 taper were subjected to electrochemical testing in 0.9% NaCl (saline) and 5.25% NaOCl at room temperature. The Open Circuit Potential (OCP) was observed for 1 hour followed by a cyclic polarization test from -300 to 700 mV and back to -300 mV (vs OCP). Nonparametric ANOVA and a pairwise comparison (P < .05) were used for statistical analysis of the OCP at 1 hour and the corrosion current (Icorr) obtained via the cyclic polarization test. RESULTS: Significant differences (P < .05) were found between files with respect to OCP and Icorr in both solutions. Nine files exhibited significantly greater (P < .05) Icorrs in NaOCl than in saline. Conversely, pitting corrosion was observed in the saline solution but not NaOCl. Weak and/or moderate correlations existed between OCP and Icorr measures in the 2 solutions. CONCLUSION: Significant differences in electrochemical properties were observed among the 10 brands of files. Overall, there was not a clear trend between conventional, heat-treated, or surface-treated files among OCP or Icorr in either solution.

12-Month flexural mechanical properties of conventional and self-adhesive flowable resin composite materials.

The aim of this study was to investigate the 12-month flexural mechanical properties of 23 flowable resin-based composites (FRBC) that included 5 self-adhesive FRBC materials. Specimens were evaluated following ISO 4049:2019 guidelines, but additionally stored in physiologic 0.2M phosphate buffered saline solution being tested at 24 h, 1 week, 1 month, and at 3-, 6-, 9-, and 12-months. While some deviation and degradation were noted at testing intervals, conventional FRBC materials overall demonstrated greater flexural strength than the self-adhesive and compomer materials. Three self-adhesive materials and the compomer were below recommended ISO 4049:2019 flexural strength values at 24 h with another after 6 months storage. Conventional FRBC materials, except at 1 month, overall demonstrated increased flexural modulus than the self-adhesive FRBC materials. Although results were material dependent, conventional FRBC materials demonstrated overall greater flexural mechanical properties as compared to the self-adhesive FRBC materials and the compomer evaluated.

Sports mouthguard overview: Materials, fabrication techniques, existing standards, and future research needs.

Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.

Dislodgement pushout resistance of five bioceramic root-end filling materials.

This study evaluated the dislodgement push-out resistance of five bioceramic materials. One hundred single-rooted teeth with one canal had the apical 3 mm and crown resected to create a 14 mm standardized length. The canals were instrumented to an apical size 80 with a 3 mm root-end preparation made with ultrasonic diamonds. The prepared roots were randomly divided into 5 root-end restorative groups (n=20). ProRoot MTA, Biodentine, EndoSequence Root Repair Material, EndoSequence Fast Set Putty, and EndoSequence BC Sealer with each material placed following manufacturer's instructions and stored at 100% humidity for 2 weeks. An apical-to-coronal static testing load with the identified dislodgement force converted into MPa with mean results analyzed with Kruskal-Wallis and Dunn's post hoc tests (α=0.05). ProRoot MTA and Biodentine displayed similar push-out stress resistance and exhibited significantly greater stress resistance than the similar Endosequence materials. However, all materials failed cohesively and were not dislodged from the root canal surface.

Long-Term Water Balance Evaluation in Glass Ionomer Restorative Materials.

The complex role of water in glass ionomer cement (polyalkenoate) dental restorative materials has been studied, but much of the present understanding concerning water balance within these materials is based on very early studies and short-term experiments. This study evaluated the nature of the water species of six conventional and four resin modified glass ionomer restorative materials over 3 years using thermogravimetric analysis techniques. Materials were prepared, placed in crucibles, and stored in physiologic phosphate buffered saline and evaluated at 24 h, 1 week, and then at 1, 3, 6, 9, 12, 18, 24, 30 and 36 months. All materials demonstrated a significant increase in unbound water percentage content but except for the resin modified materials, the enthalpy required to remove the unbound water species did not significantly change over 36 months. Also, bound water content percentage and removal enthalpy was established at 24 h, as no significant increase was noted in both bound water content and removal enthalpy over the course of this evaluation. This study suggests that unbound water species may increase with time and is loosely held except for the resin modified materials. Protective coatings placement and re-evaluation are prudent to prevent unbound water loss.

Hardness Development in Resin Composite Core Materials.

PURPOSE: To investigate the hardness characteristics of 13 contemporary resin core materials. MATERIALS AND METHODS: Specimens (n = 12) were fabricated using stainless steel molds with top surfaces of dual-cure products photopolymerized while additional groups were allowed to self-cure. Twelve Knoop hardness indentations 500 microns apart were obtained of photopolymerized top and bottom sample surfaces as well as the self-cured sample surface with the mean recorded as the representative sample hardness. Testing was completed at 10 minutes, 1 hour, and 24 hours. In addition, hardness values were compared to that obtained from polished coronal dentin samples. Mean data between groups were analyzed with Kruskal-Wallis/Dunn's, within groups with repeated measures ANOVA/Tukey's. RESULTS: Hardness results were material dependent. All but two products demonstrated a 0.8 bottom/top Knoop hardness ratio at 10 minutes. Product's self-cure cure reaction did not attain hardness similarity with any photopolymerized top surfaces and while some materials were found to have similar dentin hardness to resin top surface ratio similarity, only one product had hardness equal to or greater than that of dentin during any time period. CONCLUSIONS: Under this study's conditions, hardness development was material dependent and all but two products demonstrated adequate hardness-derived degree of cure assessment at 10 minutes after preparation. Self-cured samples demonstrated hardness increase; however, no self-cured material achieved hardness similarity to photopolymerized top surfaces. None of the materials achieved hardness similarity to dentin and only one product demonstrated hardness greater than that of dentin.

Effect of post-irradiation polymerization on selected mechanical properties of six direct resins.

This study evaluated the post-irradiation mechanical property development of six resin composite-based restorative materials from the same manufacturer starting at 1 h post irradiation, followed by 24 h, 1 week, and 1 month after fabrication. Samples were stored in 0.2M phosphate buffered saline until testing. Flexural strength, flexural modulus, flexural toughness, modulus of resiliency, fracture toughness, and surface microhardness were performed at each time interval. Mean data was analyzed by Kruskal Wallis and Dunn's post hoc testing at a 95% level of confidence (α=0.05). Results were material specific but overall, all resin composite material mechanical properties were found to be immature at 1 h after polymerization as compared to that observed at 24 h. It may be prudent that clinicians advise patients, especially those receiving complex posterior composite restorations, to guard against overly stressing these restorations during the first 24 h.

The effect of endodontic access preparation on the failure load resistance of a 3Y-TZP monolithic zirconia crown.

The effect of endodontic access preparation on the failure load resistance of 3Y-TZP zirconia crowns was accomplished by preparing human molars and luting monolithic zirconia crowns with a self-adhesive resin cement. Besides the intact control, teeth received endodontic access preparations and then grouped (n = 12) into a positive control (no access repair), dentin core replacement only and complete access repair groups. Specimens were axially tested until failure with results of no significant difference between the failure load of intact controls and the complete access repair group. However, the positive control and dentin replacement only groups failed at significantly lower loads. Under the conditions of this study, there was no significant failure load difference between 3Y-TZP monolithic zirconia crowns with repaired endodontic access preparations to that evidenced by an unprepared control. Although this evidence is encouraging, caution is advised and definitive recommendations cannot be made until verified by clinical studies.

Three-dimensional Change of Elastomeric Impression Materials During the First 24 Hours: A Pilot Study.

OBJECTIVES: To evaluate the three-dimensional (3D) changes of three elastomeric impression materials using a novel measurement method for the first 24 hours after preparation. METHODS AND MATERIALS: Three impression materials consisting of a low-viscosity polyvinyl siloxane (PVS) (Aquasil LV, Dentsply Sirona, Charlotte, NC, USA) and two vinyl polyether silicone (VPES) materials consisting of a light body (EXA'lence LB, GC America, Alsip, IL, USA) and monophase (EXA'lence Monophase, GC America) materials were used in this study. All materials were prepared following manufacturer's recommendations with approximately 1-2 millimeters of material placed on the measurement pedestal of a calibrated noncontact, video imaging based, volumetric change measuring device (AcuVol ver 2.5.9, Bisco, Schaumburg, IL, USA). Data collection was initiated immediately, with measurements made every 30 seconds for 24 hours. Each material was evaluated 10 times (n=10). Evaluated parameters included were 24-hour mean shrinkage, mean shrinkage at time of recommended first pour, mean shrinkage between recommended first pour and 24 hours, mean maximum shrinkage, and the time of maximum shrinkage. Mean data, both within and between each group, was evaluated using Kruskal-Wallis/Dunn's tests at a 95% level of confidence (α=0.05). RESULTS: All three materials were found to have significant differences (p<0.001) in volumetric shrinkage over 24 hours. Aquasil LV and EXA'lence LB polymerization shrinkage rates were statistically similar all through the 24-hour evaluation (p=0.92). All three materials demonstrated similar (p=0.19) shrinkage between 10 and 15 minutes after preparation, while between 5 and 16 hours both EXA'lence Monophase and low-viscosity materials demonstrated similar polymerization shrinkage values (p=0.22). EXA'lence Monophase demonstrated significantly greater 24-hour mean shrinkage (p<0.008) as well as shrinkage between recommended first pour time and 24 hours (p=0.003) than Aquasil LV and EXA'lence LB. EXA'lence Monophase demonstrated significantly greater (p=0.002) shrinkage at the recommended time of first pour as compared to Aquasil LV and EXA'lence LB that displayed similar shrinkage (p=0.89). Furthermore, all materials demonstrated increasing polymerization shrinkage values that reached a maximum between 16 for Aquasil LV and 20 hours for EXA'lence LB, after which some relaxation behavior was observed. However, EXA'lence Monophase did not display any relaxation behavior over the 24-hour evaluation. CONCLUSIONS: Under the conditions of this study, volumetric polymerization shrinkage was observed for one polyvinyl siloxane (PVS) and two vinyl polyether silicone (VPES) materials for up to 24 hours. All impression materials exhibited fast early volumetric shrinkage that continued past the manufacturer's recommended removal time. Dimensional change behavior was not uniform within or between groups; resultant volume change between the manufacturer recommended pouring time and 24 hours might represent up to from 20% to 30% of the total material shrinkage. It may be prudent to pour elastomeric impressions at the earliest time possible following the manufacturer's recommendations.

24 hour polymerization shrinkage of resin composite core materials.

PURPOSE: The study's purpose was to evaluate the 24-hour polymerization shrinkage of resin composite core materials. MATERIAL AND METHODS: Eleven resin composite core material samples (n = 12) were evaluated using a non-contact imaging device with measurements obtained over 24 h. Shrinkage values were determined corresponding to proposed times involved with CAD/CAM same-day treatment and at 24 h. Shrinkage data was statistically compared using Friedman/Dunn's test for intragroup analysis and Kruskal Wallis/Dunn's test for intergroup analysis, all at a 95% level of confidence (α = 0.05). RESULTS: Mean results identified a wide volumetric shrinkage range with considerable similarity overlap. Inconsistent shrinkage behavior was evident and all materials reached maximum values before 24 h. No significant difference was observed during proposed digital same day all ceramic crown procedures, but some differences were noted at 24 h. CONCLUSIONS: Under this study's conditions results were material specific, at times inconsistent, with wide variation. Shrinkage consistently increased for all products and it is not known if the continued shrinkage magnitude may compromise the stability and fit of all-ceramic crowns at 24 h.

Anesthesia and Perioperative Considerations for Patients With Myasthenia Gravis.

Patients with neuromuscular diseases such as myasthenia gravis can present as complicated anesthetic cases. This article reviews anesthetic considerations for optimal perioperative care of patients with myasthenia gravis. The pathophysiology of myasthenia gravis, cholinergic and myasthenic crises, and perioperative management are discussed; this includes the pharmacology of acetylcholinesterase inhibitors vs sugammadex, extubation criteria, pain management, and risk factors for postoperative myasthenic crisis. Anesthesia recommendations include reversal of nondepolarizing neuromuscular blockade agents with sugammadex, obtaining sufficient spontaneous breathing with absolutely no residual curarization before extubation, limited use of opioids and sedatives, avoidance of routine admission to the intensive care unit, and consideration of peripheral nerve blocks for adjunct pain control.

Methacrylate perspective in current dental practice.

OBJECTIVE: To provide a current perspective concerning dental personnel sensitivity to methacrylate materials. OVERVIEW: Methacrylate related sensitivity and allergies are currently beyond traditional thoughts concerning denture base resins and methyl methacrylate provisional materials. Methacrylates are now ubiquitous in current dental practice and dental personnel should be aware that dental adhesives contain potent sensitizers that may also cross-sensitize individuals to other methacrylates not experienced. The growing sensitivity to 2-hydroxyethyl methacrylate (HEMA) has been described to be epidemic in nature due to the artificial nail industry with dental patients and dental personnel may be more susceptible to dental methacrylate sensitization. While contact dermatitis remains the most prevalent methacrylate-related clinical presentation, respiratory complications and asthma are increasing associated with methacrylate exposure. While additional personal protective equipment (PPE) is thought to be first protective choice, the National Institute for Occupational Safety and Health (NIOSH) considers PPE overall largely ineffective and should be considered only as a last resort. CONCLUSION: Dental personnel need to be more aware of methacrylate sources and use workplace control measures to limit methacrylate exposures to both dental personnel and patients. CLINICAL SIGNIFICANCE: Sensitivity to methacrylate materials is a growing dental workplace major concern and dental personnel should be aware of both the methacrylate content of current materials and the products that contain ingredients with the most sensitization potential.

Flexural Performance of Direct Resin Composite Restorative Materials Past Expiration Date.

OBJECTIVE: This study' s purpose was to examine the flexural properties of five direct restorative resin composites stored up to 30 months after the expiration date. MATERIALS AND METHODS: Ambient-stored materials had pre-expiration date baseline flexure strength values as per ISO 4049 (n = 20). All materials were used per manufacturer guidelines, photopolymerized on both sides using a LED-based visible light curing unit, and stored in 0.2M phosphate buffered saline. At 24 hours, specimens were stressed to failure in three-point bend at a 0.5 mm/min cross head speed. Additional samples were made at 3, 6, 9, 12, 15, 18, 24, and 30 months past expiration date. Young's modulus (flexural) was ascertained using the linear slope of the stress-stain curve. STATISTICAL ANALYSIS: The mean data was found to contain a non-normal distribution and irregular variance which was compared using Kruskal-Wallis with Dunn's posthoc testing.Also, Pearson's correlation analysis was used to identify possible similar degradation behavior between products within both flexure strength and modulus determinations. A 95% level of confidence (α = 0.05) was used. RESULTS: Materials maintained similar to baseline flexure strength and modulus for up to 15 months past expiration date with two materials being similar at 30 months. However, clinicians were still advised to follow expiration dates, as resin composite degradation mechanisms are complex and vital constituents might degrade that are not overtly identified by clinical handling characteristics. No dental shelf life standards exist and manufacturers are requested to provide protocol information used in determining shelf life expiration.

Microtomographic Analysis of Resin Composite Core Material Porosity.

PURPOSE: To nondestructively evaluate the porosity of ten contemporary resin composite core materials using microtomographic (microCT) analysis. MATERIAL AND METHODS: Resin composite core material samples (n = 12) including dual-cure, visible light cure only, and a self-cure material were fabricated using a standardized mold following manufacturer's recommendations. After storage in phosphate buffered saline for one week, specimens were analyzed using a microCT unit at 5.3-µm resolution over a rotational range of 360°. Image 3D recombination and analysis was accomplished using microCT software. Evaluated parameters included material volume investigated, closed pore number and volume, as well as closed pore percentage. Parameter mean values were evaluated with Kruskal-Wallis/Dunn at a 95% confidence level (α = 0.05). RESULTS: Mean percent total porosity with standard deviation identified significant differences in decreasing order as Ti-Core: 2.2 (0.4) > Ti-Core Auto E: 1.3 (0.3) = Ti-Core Flow Plus: 1.1 (0.02) > Clearfil Photo Core: 0.94 (0.5) = Clearfil DC Core Plus: 0.6 (0.18) = MultiCore Flow: 0.58 (0.1) > Fluorocore 2+: 0.14 (0.2) = Build-It FR: 0.068 (0.02) = Gradia Core: 0.03 (0.02) = Rebilda DC: 0.02 (0.01). A pilot microCT evaluation evaluating a mixing tip revealed incomplete mixture between the two resins with porosity introduced from turbulence as the materials are forced through the tip during preparation. CONCLUSIONS: A wide range of porosity was identified between the ten materials evaluated. These preliminary results warrant more investigation evaluating additional resin composite core materials, the preparation capabilities of automix tips, and porosity presence in the unmixed materials.

Effect of Molar Preparation Axial Height on Retention of Adhesively-luted CAD-CAM Ceramic Crowns.

PURPOSE: To evaluate the effect of axial wall height (AWH) on failure resistance of CAD-CAM adhesively-bonded, all-ceramic crowns on molar preparations with a conservative total occlusal convergence (TOC). MATERIALS AND METHODS: 60 newly extracted maxillary third molars were divided into 5 groups (n = 12) and prepared for all-ceramic crowns with occlusal cervical AWH of 0, 1, 2, 3, and 4 mm, all containing a conservative 10-degree TOC. Scanned preparations were fitted with lithium-disilicate glass-ceramic crowns using a self-adhesive resin-composite luting agent after intaglio surface preparation with hydrofluoric acid and silane. Specimens were stored at 37°C/98% humidity for 24 h and tested to failure at a 45-degree angle applied to the palatal cusp on a universal testing machine. Mean results were analyzed using ANOVA and Tukey's test (p = 0.05). RESULTS: Preparations containing 2, 3, and 4 mm AWH demonstrated similar and higher failure resistance than the 0- and 1-mm axial wall height groups. CONCLUSIONS: Under the conditions of this study, evidence is presented that under certain conditions CAD-CAM adhesive technology may compensate for less than optimal AWH. Based on both failure load results and failure mode analysis, adhesively-luted maxillary molar CAD-CAM crowns based on a preparation containing 10-degree TOC require at least 2 mm AWH for adequate resistance and retention. However, adoption of these findings is cautioned until both fatigue analysis and appropriate clinical evidence has been provided.

Fracture resistance of all-ceramic crowns based on different preparation designs for restoring endodontically treated molars.

OBJECTIVES: To evaluate endodontically treated molar fracture resistance restored with CAD/CAM lithium disilicate (LDS) crowns with different amalgam core preparation design. MATERIALS AND METHODS: Eighty-four recently extracted mandibular third molars were divided into seven groups (n = 12) and embedded in autopolymerizing resin. Coronal tooth structure was removed, pulp chamber exposed, and pulpal remnants removed. One group received LDS endocrowns, while three groups received amalgam cores with 2, 1, and 0 dentin axial wall heights (AWH). Three additional groups were likewise restored using an amalgam adhesive. Scanned preparations were restored with LDS crowns luted with a self-adhesive luting cement. After 24 hours, specimens were loaded to failure with results analyzed with Welch's Test/REGW Range Test at a 95% level of confidence (α = 0.05). RESULTS: The 1 mm-AWH amalgam core group had the highest failure load and was similar to the 2 mm-AWH amalgam, 2 mm-AWH bonded amalgam, and the 1 mm-AWH bonded amalgam core groups. The endocrowns had lower failure load than the 1 mm and 2 mm AWH amalgam groups but was similar to other groups. CONCLUSIONS: Adhesively luted LDS crowns with amalgam core preparations overall displayed similar failure load, as endocrown restorations. However, crowns based on amalgam cores demonstrated favorable failure modes. CLINICAL SIGNIFICANCE: The results of this in vitro test suggests that when suitable tooth structure and sufficient interact restorative space exists, endodontically treated molars restored with lithium disilicate complete crowns based on preparations with amalgam core foundations containing 1 mm and 2 mm of dentin axial wall height could serve as a suitable restorative option that may provide more recoverable failure modes than endocrown restorations.

Preparation Ferrule Design Effect on Endocrown Failure Resistance.

PURPOSE: To evaluate the effect of preparation ferrule inclusion with fracture resistance of mandibular molar endocrowns. MATERIALS AND METHODS: Recently extracted mandibular third molars were randomly divided into 3 groups (n = 12) with the coronal tooth structure removed perpendicular to the root long axis approximately 2 mm above the cemento-enamel junction with a slow-speed diamond saw. The pulp chamber was exposed using a diamond bur in a high-speed handpiece with pulpal remnants removed and canals instrumented using endodontic hand instruments. The chamber floor was restored using a resin core material with a two-step, self-etch adhesive and photopolymerized with a visible light-curing unit to create a 2 mm endocrown preparation pulp chamber extension. One and two millimeter ferrule height groups were prepared using a diamond bur in a high-speed handpiece following CAD/CAM guidelines. Completed preparation surface area was determined using a digital measuring microscope. Scanned preparations were restored with lithium disilicate restorations with a self-adhesive resin luting agent. All manufacturer recommendations were followed. Specimens were stored at 37°C/98% humidity and tested to failure after 24 hours at a 45° angle to the tooth long axis using a universal testing machine. Failure load was converted to MPa using the available bonding surface area with mean data analyzed using Kruskal-Wallis/Dunn (p = 0.05). RESULTS: Calculated failure stress found no difference in failure resistance among the three groups; however, failure load results identified that the endocrown preparations without ferrule had significantly lower fracture load resistance. Failure mode analysis identified that all preparations demonstrated a high number of catastrophic failures. CONCLUSIONS: Under the conditions of this study, ferrule-containing endocrown preparations demonstrated significantly greater failure loads than standard endocrown restorations; however, calculated failure stress based on available surface area for adhesive bonding found no difference between the groups. Lower instances of catastrophic failure were observed with the endocrown preparations containing 1 mm of preparation ferrule design; however, regardless of the presence of ferrule, this study found that all endocrown restorations suffered a high proportion of catastrophic failures but at loads greater than reported under normal masticatory function.

Physical property investigation of contemporary glass ionomer and resin-modified glass ionomer restorative materials.

OBJECTIVES: The objective of this study was to investigate selected physical properties of nine contemporary and recently marketed glass ionomer cement (GIC) and four resin-modified glass ionomer cement (RMGI) dental restorative materials. MATERIALS AND METHODS: Specimens (n = 12) were fabricated for fracture toughness and flexure strength using standardized, stainless steel molds. Testing was completed on a universal testing machine until failure. Knoop hardness was obtained using failed fracture toughness specimens on a microhardness tester, while both flexural modulus and flexural toughness was obtained by analysis of the flexure strength results data. Testing was completed at 1 h, 24 h, 1 week, and then at 1, 3, 6, and 12 months. Mean data was analyzed with Kruskal-Wallis and Mann-Whitney (p = 0.05). RESULTS: Physical properties results were material dependent. Physical properties of the GIC and RMGI products were inferior at 1 h compared to that at 24 h. Some improvement in selected physical properties were noted over time, but development processes were basically concluded by 24 h. A few materials demonstrated improved physical properties over the course of the evaluation. CONCLUSIONS: Under the conditions of this study: 1. GIC and RMGI physical property performance over time was material dependent; 2. Polyalkenoate maturation processes are essentially complete by 24 h; 3. Although differences in GIC physical properties were noted, the small magnitude of the divergences may render such to be unlikely of clinical significance; 4. Modest increases in some GIC physical properties were noted especially flexural modulus and hardness, which lends support to reports of a maturing hydrogel matrix; 5. Overall, GIC product physical properties were more stable than RMGI; 6. A similar modulus reduction at 6 months for both RMGI and GIC produced may suggest a polyalkenoate matrix change; and 7. Globally, RMGI products demonstrated higher values of flexure strength, flexural toughness, and fracture toughness than GIC materials. CLINICAL RELEVANCE: As compared to RMGI materials, conventional glass ionomer restorative materials demonstrate more stability in physical properties.

Effect of Premolar Axial Wall Height on Computer-Aided Design/Computer-Assisted Manufacture Crown Retention.

PURPOSE: To evaluate the effect of premolar axial wall height on the retention of adhesive, full-coverage, computer-aided design/computer-assisted manufacture (CAD/CAM) restorations. MATERIALS AND METHODS: A total of 48 premolar teeth randomized into four groups (n = 12 per group) received all-ceramic CAD/CAM restorations with axial wall heights (AWH) of 3, 2, 1, and 0 mm and 16-degree total occlusal convergence (TOC). Specimens were restored with lithium disilicate material and cemented with self-adhesive resin cement. Specimens were loaded to failure after 24 hours. RESULTS: The 3- and 2-mm AWH specimens demonstrated significantly greater failure load. Failure analysis suggests a 2-mm minimum AWH for premolars with a TOC of 16 degrees. CONCLUSION: Adhesive technology may compensate for compromised AWH.

Failure load effect of molar axial wall height with CAD/CAM ceramic crowns with moderate occlusal convergence.

OBJECTIVES: To evaluate the significance of axial wall height (AWH) in molar fracture resistance involving CAD/CAM adhesively bonded, all-ceramic full coverage restorations on preparations with moderate total occlusal convergence (TOC) (16°). MATERIALS AND METHODS: 60 newly extracted maxillary third molars were divided into 5 groups (n = 12). Specimens were prepared for full-coverage, all ceramic restorations with occlusal cervical AWHs of 4, 3, 2, 1 as well as a flat preparation (0 mm AWH) with all preparations with AWH containing a moderate 16° TOC. Scanned preparations were fitted with a lithium disilicate restoration with a self-adhesive resin luting agent after intaglio surface preparation with hydrofluoric acid and silanation. Specimens were stored at 37°C/98% humidity for 24 hours and tested to failure at a 45° angle applied to the palatal cusp on a universal testing machine. Mean results were analyzed using ANOVA/Tukey's (P = .05). RESULTS: Preparations containing 2, 3, and 4 millimeters of AWH demonstrated similar and higher resistance to fracture than the 1 and zero millimeter AWH groups. CONCLUSIONS: Under the conditions of this study, results suggest that adhesive CAD/CAM technology may compensate for reduced axial wall height. However, more definitive results depend on fatigue testing. CLINICAL SIGNIFICANCE: These in vitro results suggest that adhesive CAD/CAM technology may compensate for less than optimal AWH.