Are CAD-CAM milled glass fiber posts better than prefabricated or custom glass fiber posts for endodontically treated teeth? A systematic review with meta-analysis.

STATEMENT OF PROBLEM: Prefabricated and custom glass fiber posts have been successfully used to reconstruct endodontically treated teeth. However, the performance of computer-aided design and computer-aided manufacture (CAD-CAM) milled glass fiber posts is unclear. PURPOSE: The purpose of this systematic review with meta-analysis was to compare the fracture and bond strength and cement layer thickness of CAD-CAM milled glass fiber posts with prefabricated or custom glass fiber posts. MATERIAL AND METHODS: The protocol was registered in the Open Science Framework (http://osf.io/65jm7). Two reviewers searched the PubMed/MEDLINE, Web of Science, Embase, Scopus, and ProQuest databases for articles up to September 2023. In addition, the reference lists were hand searched. A meta-analysis was performed by using the RevMan 5.4 program. The risk of bias was assessed using the RoBDEMAT tool. RESULTS: After screening, a total of 18 studies were included. The CAD-CAM milled glass fiber posts showed higher fracture strength (P=.02; Standardized Mean Difference [SMD]: 0.57; 95% Confidence Interval [CI]: 0.07 to 1.07), bond strength (P=.010; SMD: 1.07; 95% CI: 0.26 to 1.89), and lower cement layer thickness (P=.009; SMD: -2.94; 95% CI: -5.15 to -0.73) when compared with prefabricated glass fiber posts. However, fracture strength (P=.53; SMD: 0.38; 95% CI: -0.79 to 1.54) and bond strength (P=.90; SMD: -0.05; 95% CI: -0.81 to 0.72) were statistically similar between CAD-CAM milled and custom glass fiber posts. Significant and substantial heterogeneity was observed in all meta-analyzes (P<.01; I>60%). The studies sufficiently reported most domains related to bias, except for randomization of samples, sample size rationale and reporting and operator blinding. CONCLUSIONS: CAD-CAM milled and custom glass fiber posts provide an effective and safe option for restoring endodontically treated teeth, especially for weakened teeth or enlarged root canals. However, further well-designed clinical research is recommended to strengthen these findings.

Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis.

OBJECTIVE: To evaluate systematically the evidence about the failure rates of endodontically treated teeth (ETT) restored with intraradicular metal posts (MPs) or fiber posts (FPs). DATA: The review protocol was registered on PROSPERO (CRD42020189792). Eligibility criteria included randomized clinical trials (RCT) and prospective clinical trials (PCT) that compared the failures between FP and MP restorations for ETT. Meta-analyses were conducted for failure rates using fixed- and random-effects models. Subgroup and funnel plot analyses were performed. SOURCES: Four electronic databases (MEDLINE/PubMed, Web of Science, Scopus, and Cochrane Library), manual, and grey literature were screened by two researchers independently for articles published until November 2020 without language or time restrictions. For the analysis of the risk of bias, the Cochrane collaboration tool and ROBINS-I were used. The certainty of the evidence was evaluated using GRADE. STUDY SELECTION: Ten studies were included. A total of 704 participants with a mean age of 42.7 years with a total of 844 ETT were restored using 453 FPs and 391 MPs. The FPs presented similar failures to that with MPs (P=0.39; risk ratio [RR]:0.82; 95% confidence interval [CI]: 0.52 to 1.29). Subgroup analysis showed no significant differences between the FPs and MPs for the anterior region (P=0.60; RR:0.88; [CI]: 0.54 to 1.42), posterior region (P=0.52; RR:1.18; [CI]: 0.71 to 1.98), root fracture (P=0.44; RR:0.78; [CI]: 0.41 to 1.49), and debonding (P=0.56; RR:1.27; [CI]: 0.57 to 2.80). Additionally, FP showed similar failures compared with those of cast (P=0.36; RR:0.63; [CI]: 0.23 to 1.72) and prefabricated MPs (P=0.68; RR:0.90; [CI]: 0.54 to 1.50). The RCT and PCT studies revealed a low risk of bias for most of the domains. However, the certainty of evidence was considered low. CONCLUSION: No evidence of difference was observed for failure rates between FPs, and MPs, independent of region and different MPs used in ETT. However, further well-conducted clinical studies with high-quality evidence are encouraged. CLINICAL SIGNIFICANCE: Our results indicate that both retainer posts can be considered an adequate alternative in restoring ETT. Therefore, the choice of post (fiber or metal) could be based on dentist preference or individual characteristics of the patient as the failure rates for different posts are similar.

Occlusal device with extraoral retention: An occlusal technique for patients with Down syndrome.

Temporomandibular disorders associated with bruxism have a high prevalence rate in the overall population, including individuals with Down syndrome (DS). Occlusal devices have been prescribed for the treatment of temporomandibular disorders and prevention of tooth wear due to bruxism. Patients with DS have restrictions concerning treatment with occlusal devices, with an increased risk of swallowing and asphyxia, because of limitations with cognitive ability and motor deficiency. Therefore, an occlusal device with extraoral retention was developed to improve the safety for a patient with DS. An extraoral transverse rod was connected to the occlusal device to prevent it from being swallowed. The patient used the device safely for 4 weeks.

Effect of different loading pistons on stress distribution of a CAD/CAM silica-based ceramic: CAD-FEA modeling and fatigue survival analysis.

PURPOSE: This study evaluated the effect of different loading pistons, made of various materials and with different elastic moduli acting as antagonist material, on stress distribution and fatigue behavior of a CAD/CAM silica-based ceramic. MATERIALS AND METHODS: Discs of CAD/CAM made silica-based ceramic (N = 60) (VITA MARK II) were divided into six groups (n = 10 per group), according to the test method (M: Monotonic; F: Fatigue) and the antagonist piston material (T: Tungsten; S: Steel; G: Epoxy resin). FT, FS and FG combinations were submitted to mechanical cycling (2 × 106 cycles, 4 Hz, 45 N). The bending stress after fatigue were also valuated using Weibull analysis and the parameters η (eta), ß (beta) and the mean time to failure (MTTF) were calculated. Fractographic analysis and Finite Element Analysis (FEA) were performed. Data were analyzed using ANOVA and Tukey's tests (alpha=0.05). RESULTS: MG presented significantly less bending strength (MPa) (75.6) compared to MT (87.8) and MS (84.4) (p < 0.05). Six specimens from FT (MMTF: 8.3 × 106; ß:0.60; η:5.6 × 106), four from FS (MMTF: 1.9 × 106; ß:1.2; η:2.0 × 106) and one from FG (MMTF: 1.3 × 106; ß:0.48; η:0.64 × 106) survived the fatigue test. The stress peak on the tensile surface of S was similar to that of T and both were less than that of G. The failure origins were on the tensile surface. CONCLUSION: The epoxy resin pistons were able to decrease the bending stress, and life expectancy (faster failure) of a silica-based ceramic compared to tungsten and steel.

Ceramic Repair Without Hydrofluoric Acid.

PURPOSE: To evaluate the bond strength between composite resin and feldspathic ceramic following repair protocols with and without hydrofluoric acid and aging by thermocycling. MATERIALS AND METHODS: Forty-eight glass feldspathic ceramic blocks (8 x 8 x 6 mm) were divided into three groups on the basis of their surface repair treatment: 1. 10% hydrofluoric acid + Signum Ceramic Primer I + Signum Ceramic Primer II (control group); 2. abrasive rubber tips + Signum Ceramic Primer I + Signum Ceramic Primer II (test group); 3. Signum Ceramic Primer I + Signum Ceramic Primer II (negative control group). The treated surface of each block was built up with composite and then sectioned to produce nontrimmed bars (adhesive area = 1 mm²). Half of the bars from each group were aged by 6000 cycles of 30-s immersions in water baths at 5°C and 55°C, with a transfer time of 2 s. The other bars were immediately subjected to microtensile bond strength testing. The mean bond strength for each block was then recorded and submitted to two-way ANOVA and Tukey's test (α = 0.05). RESULTS: The aging protocol influenced the bond strength values of all groups (p = 0.000). The non-aged groups submitted to surface treatment protocols 1 (13.1 ± 2.5 MPa) and 2 (11.5 ± 5.1 MPa) presented the highest bond strength values. CONCLUSIONS: The interface bond strength of all groups was susceptible to aging. Surface treatment protocol 2, with abrasive rubber tips and no hydrofluoric acid, appeared to be the most promising option, as the resulting bond strength values were similar to those of the control group.

Heat treatment of pre-hydrolyzed silane increases adhesion of phosphate monomer-based resin cement to glass ceramic.

This study evaluated the influence of different forms of heat treatment on a pre-hydrolyzed silane to improve the adhesion of phosphate monomer-based (MDP) resin cement to glass ceramic. Resin and feldspathic ceramic blocks (n=48, n=6 for bond test, n=2 for microscopy) were randomly divided into 6 groups and subject to surface treatments: G1: Hydrofluoric acid (HF) 9.6% for 20 s + Silane + MDP resin cement (Panavia F); G2: HF 9.6% for 20 s + Silane + Heat Treatment (oven) + Panavia F; G3: Silane + Heat Treatment (oven) + Panavia F; G4: HF 9.6% for 20 s + Silane + Heat Treatment (hot air) + Panavia F; G5: Silane + Heat Treatment (hot air) + Panavia F; G6: Silane + Panavia F. Microtensile bond strength (MTBS) test was performed using a universal testing machine (1 mm/min). After debonding, the substrate and adherent surfaces were analyzed using stereomicroscope and scanning electron microscope (SEM) to categorize the failure types. Data were analyzed statistically using two-way test ANOVA and Tukey's test (=0.05). Heat treatment of the silane containing MDP, with prior etching with HF (G2: 13.15 ± 0.89a; G4: 12.58 ± 1.03a) presented significantly higher bond strength values than the control group (G1: 9.16 ± 0.64b). The groups without prior etching (G3: 10.47 ± 0.70b; G5: 9.47 ± 0.32b) showed statistically similar bond strength values between them and the control group (G1). The silane application without prior etching and heat treatment resulted in the lowest mean bond strength (G6: 8.05 ± 0.37c). SEM analysis showed predominantly adhesive failures and EDS analysis showed common elements of spectra (Si, Na, Al, K, O, C) characterizing the microstructure of the glass-ceramic studied. Heat treatment of the pre-hydrolyzed silane containing MDP in an oven at 100 °C for 2 min or with hot air application at 50 ± 5 ºC for 1 min, was effective in increasing the bond strength values between the ceramic and resin cement containing MDP.

Rehabilitación de los Dientes Anteriores con el Sistema Cerámico Disilicato de Litio / Rehabilitation of Anterior Teeth with Ceramic Lithium Disilicate System

Las cerámicas dentales son conocidas por su excelencia en reproducir artificialmente los dientes naturales. Casos clínicos más severos en el sector anterior, con acentuada alteración del color, necesidad de substitución de coronas o amplias restauraciones, asociado a una redefinición y largura de los dientes, son solucionadas satisfactoriamente a través de los nuevos sistemas cerámicos como lo sistema IPS e.Max. Este sistema es basado en una cerámica vítrea reforzada con cristales de disilicato de litio (60­65%). En este artículo sereporta un caso deunapaciente de 47 años de edadque se realizaron cuatro coronas totales con el sistema cerámico IPS e.Max. El resultado final muestra una estética natural y funcional, con óptimas propiedades ópticas, que son peculiares al sistema cerámico empleado. La conclusión es que el sistema cerámico IPS e.Max es un sistema muy versátil, además de convertirse actualmente en una excelente alternativa como sistema de restauración, tanto estética como funcionalmente, consiguiendo una excelente armonía entre la sonrisa del paciente y la estética de las restauraciones.

Dental ceramics are known for their excellence in the artificial reproduction of natural teeth. Clinical cases with severe marked discoloration in the anterior region, need of crown replacement or extensive restorations associated to a redefinition and length of the teeth, are successfully treated with new ceramic systems such as IPS system e. Max. The system is based on glass-reinforced ceramic lithium disilicate crystals (60­65%). This article describes a case of a 47 year old woman with four full crowns made with IPS e.max ceramic system is reported. The final result shows a natural and functional aesthetic with excellent optical properties, which are particular to the ceramic system used. In conclusion the IPS e.max ceramic system is a versatile system in addition to currently becoming an excellent alternative for restoration systems, both aesthetically and functionally, achieving an excellent balance between the patient's smile and aesthetic restorations.

Influence of fiber post cementation length on coronal microleakage values in vitro and finite element analysis.

AIM: This study aims to evaluate, the Influence of different fiber posts cementation lengths by finite element analysis (FEA) and coronal microleakage. MATERIALS AND METHODS: Fifty anterior bovine teeth were sectioned to obtain roots with 16 mm length. The coronal length of the post was 6 mm for all groups, while the radicular length were varied 6, 8, 10 or 12 mm. The fiber posts surfaces were cleaned with alcohol and silanized. Then the posts were cemented using a two steps total etch-and-rinse adhesive system + conventional resin cement. Forty teeth were submitted to mechanical cycling (45°; 2.000.000 cycles; 90N; 4Hz; 37°C) and ten teeth with radicular length of 12 mm was not submitted, ser ving as c ontrol. So, the experimental design was composed by different ratios of post coronal length/post radicular length and mechanical cycling (MC): Gr1- 1/1 + MC; Gr2- 3/4 + MC; Gr3- 3/5 + MC; Gr4- 1/2 + MC. All groups were immersed in a 1% toluidine blue solution. After 24 hours, the teeth were longitudinally sectioned and the microleakage scores was given by a blind operator. Data were submitted to Kruskal-Wallis test (p = 0.05). The experimental variables were simulated in two-dimensional finite element analysis (2D-FEA). The maximum principal stress distributions were compared. RESULTS: No difference was observed in microleakage values between the cycled groups, whilst the control groups showed the lowest values. FEA analysis showed similar maximum principal stress distribution between the groups. CONCLUSION: Mechanical cycling affected the values of coronal microleakage and different cementation length generated similar values of coronal microleakage and stress distribution. CLINICAL SIGNIFICANCE: These results showed that from the microleakage point of view, more conservative cementation lengths have the same effect as longer cementation lengths.

Can heat treatment procedures of pre-hydrolyzed silane replace hydrofluoric acid in the adhesion of resin cement to feldspathic ceramic?

PURPOSE: To evaluate the influence of heat treatment (HT) procedures of a pre-hydrolyzed silane on bond strength of resin cement to a feldspathic ceramic. MATERIALS AND METHODS: Ceramic and composite blocks (N = 30) were divided into six groups (n = 5) and subjected to the following conditioning procedures: G1: 9.6% hydrofluoric acid (HF) for 20 s + silane (RelyX Ceramic Primer, 3M ESPE) + resin cement (Panavia F2.0, Kuraray) (control); G2: HF (20 s) + silane + heat treatment in furnace (HTF) (100°C, 2 min) + resin cement; G3: silane + HTF + resin cement; G4- HF (20 s) + silane + heat treatment with hot air (HTA) (50 ± 5°C for 1 min) + resin cement; G5: silane + HTA + resin cement; G6: silane + resin cement. The microtensile bond strength (MTBS) test was performed using a universal testing machine (1 mm/min). After debonding, the substrate and adherent surfaces were analyzed using a stereomicroscope and SEM to categorize the failure types. The data were statistically evaluated using one-way ANOVA and Tukey's test (5%). RESULTS: The control group (G1) showed no pre-test failures and presented significantly higher mean MTBS (16.01 ± 1.12 MPa) than did other groups (2.63 ± 1.05 to 12.55 ± 1.52 MPa) (p = 0.0001). In the groups where HF was not used, HTF (G3: 12.55 ± 1.52 MPa) showed significantly higher MTBS than did HTA (G5: 2.63 ± 1.05 MPa) (p < 0.05). All failure types were mixed, ie, adhesive between the resin cement and ceramic accompanied by cohesive failure in the cement. CONCLUSION: Heat treatment procedures for the pre-hydrolyzed silane either in a furnace or with the application of hot air cannot replace the use of HF gel for the adhesion of resin cement to feldspathic ceramic. Yet when mean bond strengths and incidence of pre-test failures are considered, furnace heat treatment delivered the second best results after the control group, being considerably better than hot air application.

Influence of silane heat treatment on bond strength of resin cement to a feldspathic ceramic.

This study evaluated the influence of heat treatment (HT) of the silane on the microtensile bond strength of resin cement to a feldspathic ceramic. Ceramic (VITA VM7) and composite blocks (N=32) were divided into four groups (n=6 for bond test, n=2 for SEM) at random and subject to following sequence of conditioning: G1: HF 9.6%+Silane+Panavia F2.0, G2: HF 9.6%+Silane+HT+Panavia F2.0, G3: Silane+HT+Panavia F2.0, and G4: Silane+Panavia F2.0. HT was performed in an oven (100°C, 2 minutes). G1 (17.6±2.3 MPa) and G2 (19±3.2 MPa) showed significantly higher mean bond strength than those of G3 (9.1±2.8 MPa) and G4 (10.9±1.8 MPa). SEM analysis showed exclusively mixed failures. Silane HT did not increase the bond strength.