Color Stability of Resin Hybrid Ceramic Materials in Comparison to Zirconia-Reinforced Lithium Silicate Ceramic.

Objectives: This in vitro study aimed to compare the effect of external staining agents (black tea and grape juice) on the color change of three hybrid ceramics including a new material in comparison to zirconia-reinforced lithium silicate. Materials and Methods: Ten samples of two hybrid dental ceramics including Vita Enamic (Vita Zahnfabrik) and Crystal Ultra (Digital Dental) in addition to a resin nanoceramic, Lava Ultimate (3M ESPE); and a zirconia-reinforced lithium silicate glass ceramic, Vita Suprinity (Vita Zahnfabrik) were prepared and immersed in black tea or grape juice for 30 days. A spectrophotometer was used to evaluate color change. All samples were carefully chosen in A3 shades or their equivalent. Two-way ANOVA and Bonferroni tests were used to analyze the color differences (ΔE00) among the materials and the staining solutions at a significant level of 0.05. Results: Significant color changes were observed in Vita Enamic and Lava Ultimate groups after immersion in both solutions (P<0.001). The least color changes (ΔE00) belonged to the Vita Suprinity (1.34) and Crystal Ultra (1.92) groups, respectively. Conclusion: The color changes of Vita Enamic and Lava Ultimate materials were beyond clinical acceptability. However, the mean color changes of Vita Suprinity and Crystal Ultra groups were clinically acceptable.

Fracture Resistance of Zirconia Restorations with Four Different Framework Designs.

Objectives: This study assessed the fracture resistance of zirconia crowns with four framework designs, fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) technology. Materials and Methods: In this experimental study, a maxillary central incisor was prepared and scanned with a CAD/CAM scanner, and 40 frameworks with 4 designs (N=10) were fabricated as follows: simple core, dentine core with a design similar to dentine, 3mm trestle design collar in the lingual aspect with proximal buttresses, and monolithic or full-contour. After porcelain applying and 20h immersion in distilled water (37°C), crowns were cemented on metal dies using zinc phosphate cement. Fracture resistance was measured by a universal testing machine. Data were analyzed with one-way ANOVA (alpha=0.05). Results: Fracture resistance was maximum in the monolithic group, followed by the dentine core, trestle design, and simple core groups, respectively. The mean fracture resistance of the monolithic group was significantly higher than that of the simple core group (P<0.005). Conclusion: Zirconia restorations with frameworks that provided higher and more support for porcelain, showed increased fracture resistance.

Biaxial flexural strength and Weibull characteristics of a resin ceramic material after thermal-cycling.

PURPOSE: The purpose of this in vitro study was to compare the flexural strength and Weibull characteristics of 3 different resin-ceramic materials with a zirconia-reinforced lithium silicate material after thermal-cycling. MATERIAL AND METHODS: Four different computer-aided design and computer-aided manufacturing restorative materials (Vita Enamic, Lava Ultimate, Crystal Ultra, and Vita Suprinity) were tested. A total of 40 Ø12×1.2-mm disks were prepared and divided into 4 groups (n = 10). Their flexural strength was evaluated after 5000 thermal-cycles with a 4-point biaxial flexure test using a universal testing machine. The Weibull modulus and probability of failure were also determined from the biaxial flexural strength data. Data were analyzed with one-way ANOVA and the Tukey pairwise comparison test (α = 0.05). RESULTS: Significant differences were found among the materials in terms of biaxial flexural strength (p < 0.05). Vita Suprinity had the highest mean ±standard deviation flexural strength (289.1 ± 15.1 MPa), and Vita Enamic had the lowest (100.0 ± 3.2 MPa). The highest Weibull modulus was calculated for Crystal Ultra, followed by Vita Enamic, Lava Ultimate, and Vita Suprinity. CONCLUSION: Vita Suprinity had the highest flexural strength when compared with the other materials tested. Crystal Ultra had the highest flexural strength among the resin-ceramic materials. The highest Weibull modulus was calculated for Crystal Ultra and the lowest for Vita Suprinity.

Evaluation of Microshear Bond Strength of Four Different CAD-CAM Polymer-Infiltrated Ceramic Materials after Thermocycling.

PURPOSE: To evaluate the bond strength of three monolithic hybrid ceramics/resin nanoceramics and a zirconia-reinforced lithium silicate to resin cement after thermocycling. MATERIALS AND METHODS: Using four materials, including Vita Enamic (VITA Zahnfabrik), Lava Ultimate (3M ESPE), Crystal Ultra (Digital Dental), and Vita Suprinity (VITA Zahnfabrik), 64 specimens were prepared with dimensions of 4 mm × 3 mm × 1.5 mm. Vita Suprinity samples were sintered at 840°C for 8 min. After polishing and cleaning all the samples in each group (n = 16), they were subjected to their recommended surface treatment: 10% hydrofluoric acid for Vita Enamic (60s) and Vita Suprinity (20s); air abrasion of Lava Ultimate and Crystal Ultra with 50 u Al2 O3 particles. Then, tygon tubes were filled with dual cure resin cement (Panavia F2.0), cured and then subjected to thermal cycling (2000 cycles; 5-55°C). The microshear bond strength was measured using microtensile testing machine. The data were analyzed using Welch and Games-Howell tests (α = 0.05). The mode of failure was also evaluated using a stereomicroscope. RESULTS: The highest and the lowest mean microshear bond strength belonged to the Crystal Ultra (7.71 ± 1.54 MPa) and Vita Suprinity (4.73 ± 1.87 MPa) groups, respectively. The differences between groups were significant and Crystal Ultra had higher bond strength in comparison to all three materials (p < 0.05). CONCLUSION: Hybrid ceramics showed higher bond strength to resin cements in comparison to resin nanoceramics and zirconia-reinforced lithium silicate materials.

Visual and digital tooth shade selection methods, related effective factors and conditions, and their accuracy and precision: A literature review.

OBJECTIVE: Despite developments of dental shade selection methods, shade selection is still a challenge affecting esthetic outcomes. The purpose of this review was to discuss visual and digital shade taking methods, related effective factors and conditions, and their accuracy and precision to find out the most accurate, precise shade selection method available in dentistry. OVERVIEW: The key terms of accuracy, background, ceramic, color, colorimeter, color analysis, color science, color measurement, color measuring instrument, color matching, composite resin, dental/tooth shade guide, digital camera, esthetics, imaging, imaging application/program/ software, intraoral scanner, light source, photography, precision, shade, shade matching/ determination/prediction/reproduction/selection, shade taking device, spectrophotometer, spectrophotometry, tooth color measurement, tooth color/shade, and visual perception were used separately and jointly to detect related English-language articles published between January 1, 1985, and January 1, 2021. Electronic/non-electronic searches of Google Scholar/PubMed/Scopus/Web of Science were accomplished. Consequently, 249 articles were considered. Accordingly, the digital methods show higher accuracy and precision compared to the visual methods while requiring to be enhanced regarding accuracy to achieve ideal shade taking results. CONCLUSIONS: Dental spectrophotometers provide the highest overall accuracy and precision among different shade selection methods while needing clinical setting to control related effective factors/conditions and technological improvement to perform optimally. CLINICAL SIGNIFICANCE: Different factors can affect the accuracy and precision of tooth shade selection methods and devices. The understanding of these effective factors may lead to a standard shade taking protocol using accurate, precise methods and devices.

Microleakage of different temporary luting agents used for cementing provisional restorations on custom cast posts and cores.

BACKGROUND: This study aimed to compare the effect of four temporary luting agents on preventing the coronal microleakage of teeth restored with custom cast post and core. MATERIALS AND METHODS: In this in vitro original study, after removing 9 mm of gutta percha from root canals of 32 single-canaled premolars, the acrylic resin patterns of the post and core were fabricated. Patterns were cast with Ni-Cr metal alloy and then cemented with glass ionomer. Using self-curing acrylic resin, provisional restorations were made. Then, teeth were randomly allocated to four groups for each temporary cement including zinc oxide eugenol (Temp Bond), zinc oxide noneugenol (Temp Bond NE), noneugenol resin-based temporary luting agent (Temp Bond Clear), and noneugenol urethane methacrylate polymer-based temporary luting agent (Dento temp). Teeth were subjected to thermocycling, immersed in silver nitrate for 6 h and then sectioned. The amount of dye penetration in the margin of provisional crown and into the coronal part of the root canals was measured using a stereomicroscope. Data were analyzed using the Kruskal-Wallis and Dunn tests with significance level of 0.05. RESULTS: All the luting agents showed some degree of microleakage (Group 1 showed the most microleakage). According to the pair comparison between the groups, Group 1 revealed a significant difference with others (P < 0.05). Furthermore, Group 2 showed more microleakage as compared to Group 4 (P = 0.037). CONCLUSION: Temp Bond showed the highest microleakage as compared to other luting agents. Furthermore, Temp Bond NE revealed a weaker sealability as compared to Dento temp.

Fabrication of a customized impression metal jig for an implant-supported overdenture with a milled bar.

The use of computer-aided design/computer-aided manufacturing technology simplifies the laboratory and clinical steps for the fabrication of implant prostheses. It also reduces additional costs for the prosthetic components and technical procedures. This article describes a modified impression technique using an impression metal jig to enhance the accuracy of final impression and also to eliminate the need for the try-in of resin pattern of the milled bar.

Effect of Different Nd:YAG Laser Power Outputs on Bond Strength of Resin Cement to Zirconia in Comparison to Sandblasting.

Introduction: This study investigated the effect of various laser powers on the shear bond strength (SBS) of resin cement to the zirconia surface. Methods: Seventy-five zirconia disks were prepared and assigned to five groups including no surface treatment (control group), sandblasting with 50 µ Al2 O3 particles (second group), and Nd:YAG laser treatments with 2 W, 2.5 W and 3 W powers respectively (third, fourth and fifth groups). Afterwards, composite resin cylinders were cemented on zirconia disks using dual-curing resin cement. Before thermocycling (2000 cycles, 5-55°C), all samples were placed in distilled water at 37°C for 24 hours. Using a universal testing machine at the crosshead speed of 0.5 mm/min, the SBS was examined. Also, using a stereomicroscope, the failure type was determined. Data analyses were performed using Welch and Games-Howell tests (P < 0.05). Results: The mean bond strength difference between the control group and the other groups was significant. The respective bond strength from the highest to the lowest was observed in the sandblast group, the laser group with 2.5 W power, the laser group with 3 W power, the laser group with 2 W power, and finally the control group. However, no significant difference was observed between different laser groups (P < 0.05). Also, there was no significant difference between the sandblast and laser groups with 2.5 W and 3 W power (P < 0.05). Most of the failures in the sandblasting and laser groups with powers of 2.5 W and 3 W were mixed, but in the control and 2 W laser groups, most of the failures were of adhesive nature. Conclusion: The highest bond strength was achieved by sandblasting with Al2 O3 particles and then using an Nd: YAG laser with a power of 2.5 W.

Effect of multiple pouring on the accuracy of casts made using 3D-printed custom trays with different spacer thicknesses: A research study.

Background. This study aimed to evaluate the effect of different pouring times and spacer thicknesses on the three-dimensional accuracy of casts made of 3D-printed custom trays. Methods. A partial edentulous maxillary model was scanned for fabricating custom acrylic trays. Twenty custom trays were created using a CAD/CAM system and divided into two groups in terms of their spacer thicknesses (2 mm and 4 mm). All the trays were designed with 2-mm thickness, multiple retentive holes measuring 2 mm in diameter, and three interior seating stops (two on the edentulous ridge and one on the incisal edge of the central incisors). Impressions were made using monophasic polyvinyl siloxane and poured in two different times (one hour and 24 hours after removal) with type IV dental stone. All the casts were scanned to measure three distances (inter-buccal cusps, inter-palatal cusps, and inter-fossa distances) between the two first premolars. The data were analyzed with two-way ANOVA and Bonferroni test at a significance level of 0.05. Results. There was no significant difference between the 3D accuracy of casts made using two different spacer thicknesses poured at 1-hour and 24-hour intervals. However, there was a difference between casts made after 1 hour and 24 hours when using custom trays with 2 mm of spacer thickness in terms of inter-buccal distance. Conclusion. There was no significant difference between the accuracy of casts made using custom trays with either 2 or 4 mm of spacer thickness, which were poured 1 hour or 24 hours after tray removal.

Influence of Different Surface Treatments on the Shear Bond Strength of Resin Cement to Base Metal Alloys.

Introduction: This study aimed to investigate the effect of different surface treatments on the bond strength of resin cement to nickel-chrome (Ni-Cr) alloy. Methods: Forty disk-shaped specimens of Ni-Cr alloy were prepared and divided into 4 groups. In the first group, the specimens' surface was sandblasted with 50 µ Al2 O3 particles. In the second group, the specimens were prepared with the Er:YAG laser. In the third group, the specimens were prepared using the Er:YAG laser after sandblasting. In the fourth group, the specimens' surface was covered with a thin layer of MKZ metal primer after sandblasting. Then the cylinders of composite resin were bonded to the treated metal surfaces using Panavia F2.0 resin cement. All of the samples were subjected to 2000 thermal cycles. The shear bond strength was tested using a universal testing machine at the crosshead speed of 0.5 mm/min. The failure mode was also observed by a stereomicroscope. Data were analyzed using the one-way ANOVA and the Tukey HSD test at a significance level of 0.05. Results: The shear bond strength from the highest to the lowest were as follows: the Er:YAG laser group, the sandblast and MKZ primer combination group, the sandblast group, and the sandblast and Er:YAG laser combination group. The mean differences of shear bond strength between the Er:YAG laser group and the sandblast group (P=0.047) and also between the Er:YAG laser group and the sandblast and Er:YAG laser combination group (P=0.015) were statistically significant. Conclusion: Among the different surface treatments employed in this study, Er:YAG laser treatment increased the shear bond strength between the metal alloy and the resin cement (Pavnavia F2).

Reconstruction of a Mandibular Defect with Toronto Bridge Following Tumor Resection and Bone Graft: A Case Report.

Dental implants are highly recommended to improve the retention, stability, and support of prostheses in edentulous patients with large surgical defects. Depending on the size of the defect, a bone graft procedure might be necessary. However, due to limitations of bone grafts, some complications might negatively affect the prosthetic rehabilitation of the patient. This case report presents some of these prosthetic problems following surgical resection and autogenous bone graft procedures.

Effect of Implant Connection Type and Depth on the Seating Accuracy of Hand-Tightened Abutments.

PURPOSE: Improper seating of abutment on the implant is a common problem. This study investigated the effect of the type of implant/abutment interface on the complete seating of the abutments on the head of implants placed at different gingival depths. MATERIALS AND METHODS: Three implant systems with three different connections including straight external hexagon, butt-joint internal tri-lobed, and conical internal hexagon were used. Two gingival thicknesses (2 and 7 mm) were created using pink baseplate wax around the straight abutments seated on the implants. After placing the implants in acrylic blocks, the wax was replaced with the gingival mask material to simulate the gingival drape around the implant heads. Afterwards, 15 prosthodontists were asked to hand-tighten the straight abutments in the corresponding implant bodies relying only on their tactile sense. At the final stage, the gingival mask was removed, and the seating quality of the abutments on implant bodies was assessed visually. The effect of implant connection and depth on abutment seating accuracy was analyzed using Kruskal-Wallis and multiple-comparison tests. RESULTS: No significant difference was found regarding the effect of either depth or connection design on the accuracy of the abutment seating (p > 0.05); however, pairwise comparison of the combined effect of the depth and connection design was significant (p = 0.009). Accuracy of abutment seating on the Nobel Active implants at both 2 and 7 mm depths were significantly better than Replace system with 7 mm depth (p = 0.027). The same results were obtained in comparison between Nobel Active system at both 2 and 7 mm depths with Branemark system with 7 mm depth (p = 0.006). CONCLUSION: An increase in implant placement depth meant a decrease in accuracy of the abutment seating. The internal conical connection design showed the best result in abutment positioning in deep implants as compared with external and internal butt-joint connection designs.

Marginal Adaptation of CAD/CAM All-Ceramic Crowns Made by Different Impression Methods: A Literature Review.

All-ceramic crowns for teeth are widely used for restoring teeth. Stone casts have been made from conventional impression methods; however, newer techniques have made this process easier and faster for both the patient and the practitioner. Laboratory CAD/CAM technology mainly involves scanning the die stone, while other systems permit impression or intraoral scanning; however, one major concern remaining is the marginal fit of the restorations made using different methods for recording the prepared teeth. This study aims to review studies evaluating the marginal fit of all-ceramic crowns manufactured by CAD/CAM systems using different extra- and intra-oral scanners compared to conventional impressions.

The Effect of Milling Metal Versus Milling Wax on Implant Framework Retention and Adaptation.

PURPOSE: The metal framework of implant-supported restorations can be made using different methods. For a successful outcome, the acceptability of each method depends on the retention and fit of the restoration. The aim of this study was to evaluate and compare the retention and adaptation of copings fabricated using two methods: casting wax patterns made by computer-aided design/computer-aided manufacturing (CAD/CAM) technology, and milling sintered chromium-cobalt (Cr-Co) blocks. MATERIALS AND METHODS: Twenty-four abutment analogs (height, 5.5 mm) were divided into two groups according to the framework fabrication method. In one group, wax patterns were prepared using a CAM milling machine, and they were cast with a Ni-Cr-Ti metal alloy. In the second group, the copings were milled from Cr-Co blocks using a CAD/CAM milling machine. All copings were equal in contour, thickness, and internal relief and were seated on the abutment analogs after the necessary adjustments. The vertical marginal discrepancy was investigated using a silicone replica method and stereomicroscope with 75× magnification. After copings were cemented onto the abutment analogs using zinc phosphate, a tensile resistance test was performed using a universal testing machine. Mann-Whitney U and Student's t-test were used for statistical analyses at a significance level of 0.05. RESULTS: An independent sample t-test revealed a significant difference between the two groups for retention (p = 0.010), and the milled wax group showed higher tensile resistance compared with the milled metal group. There was also a significant difference between the two groups in marginal discrepancy (p < 0.001), with a larger marginal gap in the milled metal group compared with the milled wax group. The milled metal copings required more adjustments to fit on the abutment analogs compared with the wax milled copings (p < 0.001). CONCLUSIONS: The CAD/CAM technique for wax milling resulted in more retentive copings with better marginal and internal adaptations compared with milling the metal blocks.

Coronal Microleakage of Teeth Restored with Cast Posts and Cores Cemented with Four Different Luting Agents after Thermocycling.

PURPOSE: The apical seal provided by a root canal filling may be breached via coronal leakage. This study aimed to compare the teeth restored with custom-made cast metal posts and cores cemented with different luting agents in terms of coronal microleakage after thermocycling. MATERIALS AND METHODS: This in vitro study was conducted on 32 extracted single-canal teeth. Root canals were prepared by step-back technique and filled with gutta percha and sealer. The coronal 7 mm of gutta percha was removed, and post space was prepared using peeso reamers #2 and #3 consecutively. After fabricating the acrylic resin patterns of the posts and cores, they were cast using Ni-Cr metal alloy. The specimens were divided into 4 groups in which the castings were cemented using one of the following luting agents: zinc phosphate (ZP), glass ionomer (GI), Panavia F 2.0, and Speed CEM. After cementation, the teeth were immersed in distilled water and incubated for 7 days. Then, the teeth were subjected to thermocycling, immersed in silver nitrate for 6 hours, and finally sectioned. The degree of dye penetration into the coronal part of the specimens was measured using a stereomicroscope. Data were analyzed using Kruskal-Wallis and Mann-Whitey U tests with significance level of 0.05. RESULTS: The median microleakage in ZP, Speed CEM, GI, and Panavia were 171.89, 114.76, 26.51, and 20.02 µm, respectively. Pairwise comparisons among GI and ZP, GI, and Speed CEM, ZP and Panavia, ZP and Speed CEM, and Panavia and Speed CEM groups yielded significant differences (p < 0.05). CONCLUSION: Complete coronal seal was not achieved with any of the luting agents. The highest and the lowest degree of microleakage was yielded by ZP and Panavia luting agents, respectively.

Full Arch All-on-4 Fixed Implant-Supported Prostheses with 8.5 Years of Follow-Up: A Case Report.

Typically, full arch reconstruction of edentulous ridges requires five to 10 dental implants; however, some patients demanding fixed implant-supported prostheses are not able to medically or economically afford complex bone grafts and/or a greater number of implants. These situations could pivot the treatment plan toward the All-on-4 protocol. Nevertheless, due to less implant support in this treatment option, mechanical and biological complications might arise. This article describes the treatment of a fully edentulous patient with two types of fixed implant-supported prostheses on four dental implants along with the following complications.

Effect of lateral oblique cyclic loading on microleakage and screw loosening of implants with different connections.

Background. The implant connection type might affect microleakage and screw loosening in two-piece implants. The aim of this study was to measure microleakage and screw loosening of two connections of Noble Biocare implant system before and after cyclic loading. Methods. Twelve samples were categorized into two groups: external hexagon (Branemark) and internal hexagon connection (Noble Active) and two implants as controls. The abutments were tightened to a 35 Ncm torque. Initial torque loss (ITL) was measured five minutes after retightening the abutment, using a digital torque wrench. The samples were covered with putty material to the abutment‒implant junction. Customized metal crowns with 45° inclinations were placed on the abutments and cyclic loading was performed accordingly. Thereafter, the secondary torque loss (STL) was measured. Microleakage test was also performed. Data were analyzed with Mann-Whitney and Wilcoxon tests (α=0.05). Results. There were no statistically significant differences between the two phases of gamma counting between and within two groups (P>0.05). However, STL after cyclic loading was less than ITL in both groups (P=0.042). Conclusion. Connection type and cyclic loading had no significant effect on microleakage. Furthermore, the internal connection had less TL as compared to the external connection. In addition, the STLs were less than ITLs in both groups.

Restoring a post-traumatic partial edentulous mandible with the Toronto prosthesis: a clinical report.

Implants provide support, stability and retention for restorations used in fully and partially edentulous patients. This clinical report describes prosthetic treatment of a 30-year-old man suffering from a dentoalveolar deficiency due to an old gunshot trauma to the left side of the mandible. The patient was rehabilitated with implant-supported Toronto prosthesis following surgical placement of three implants with undesirable location and angulations due to lack of sufficient bone. This prosthetic option offers advantages of both screw-retained and cement-retained prostheses and provides acceptable aesthetic and functional results.

Restoring a Partial Maxillectomy Patient by an Implant-Supported Obturator on Two Implants: A Case Report.

This article describes the prosthetic treatment of a patient suffering from a hemimaxillary defect after surgical resection of an adenoid cystic carcinoma (ACC) in the palate. The patient had also received therapeutic irradiation. One year after radiotherapy, three implants were placed in the remaining maxillary bone without any bone augmentation. One of the implants failed during the osseointegration period. The implant replacing the failed one also failed during prosthetic procedures. The patient was unwilling to undergo another surgical episode, and the final prosthesis was completed on the two remaining implants.

Stress distribution pattern of screw-retained restorations with segmented vs. non-segmented abutments: A finite element analysis.

Background. Screw-retained restorations are favored in some clinical situations such as limited inter-occlusal spaces. This study was designed to compare stresses developed in the peri-implant bone in two different types of screw-retained restorations (segmented vs. non-segmented abutment) using a finite element model. Methods. An implant, 4.1 mm in diameter and 10 mm in length, was placed in the first molar site of a mandibular model with 1 mm of cortical bone on the buccal and lingual sides. Segmented and non-segmented screw abutments with their crowns were placed on the simulated implant in each model. After loading (100 N, axial and 45° non-axial), von Mises stress was recorded using ANSYS software, version 12.0.1. Results. The maximum stresses in the non-segmented abutment screw were less than those of segmented abutment (87 vs. 100, and 375 vs. 430 MPa under axial and non-axial loading, respectively). The maximum stresses in the peri-implant bone for the model with segmented abutment were less than those of non-segmented ones (21 vs. 24 MPa, and 31 vs. 126 MPa under vertical and angular loading, respectively). In addition, the micro-strain of peri-implant bone for the segmented abutment restoration was less than that of non-segmented abutment. Conclusion. Under axial and non-axial loadings, non-segmented abutment showed less stress concentration in the screw, while there was less stress and strain in the peri-implant bone in the segmented abutment.