Three-year clinical evaluation of two ceramic crown systems: a preliminary study.

STATEMENT OF PROBLEM: The clinical performance and failure mechanisms of recently introduced ceramic crown systems used to restore posterior teeth have not been adequately examined. PURPOSE: The purpose of this prospective clinical study was to evaluate and compare the clinical performance of 2 new ceramic crown systems with that of metal ceramic crowns using modified United States Public Health Services (USPHS) criteria. MATERIAL AND METHODS: Ninety posterior teeth requiring crown restorations in 48 patients were randomized into 3 equal groups (n=30) for which different crown systems were used: an experimental hot-pressed glass ceramic based on a modified lithium disilicate ceramic (IPS e.max Press), an alumina-coping-based ceramic (Procera AllCeram), and a metal ceramic (Simidur S 2 veneered with IPS Classic Porcelain). The crowns were assessed over 3 years using the modified USPHS criteria. Crowns that developed visible cracks were sectioned and removed, and the surfaces were analyzed using a scanning electron microscope (SEM). The data were analyzed using the Kruskal-Wallis nonparametric statistical test, followed by the Mann-Whitney test with Bonferroni correction (alpha=.05). RESULTS: USPHS evaluation showed that the IPS e.max Press and metal ceramic crowns experienced fewer clinical changes than Procera AllCeram. Visible roughness, wear, and deformity were noticed in occlusal contact areas of Procera AllCeram crowns. SEM images showed well defined wear facets in both ceramic crown systems. Kruskal-Wallis tests showed a significant difference (P<.05) in Alpha scores among the 3 crown systems. Mann-Whitney tests showed significant differences among groups. CONCLUSIONS: IPS e.max Press crowns demonstrated clinical behavior comparable to Procera AllCeram and metal ceramic crowns, but the wear resistance of this crown type was superior to the Procera AllCeram crowns, according to modified USPHS criteria.

Confocal examination of subsurface cracking in ceramic materials.

PURPOSE: The original ceramic surface finish and its microstructure may have an effect on crack propagation. The purpose of this study was to investigate the relation between crack propagation and ceramic microstructure following cyclic fatigue loading, and to qualitatively evaluate and quantitatively measure the surface and subsurface crack depths of three types of ceramic restorations with different microstructures using a Confocal Laser Scanning Microscope (CLSM) and Scanning Electron Microscope (SEM). MATERIALS AND METHODS: Twenty (8 x 4 x 2 mm(3)) blocks of AllCeram (AC), experimental ceramic (EC, IPS e.max Press), and Sensation SL (SSL) were prepared, ten glazed and ten polished of each material. Sixty antagonist enamel specimens were made from the labial surfaces of permanent incisors. The ceramic abraders were attached to a wear machine, so that each enamel specimen presented at 45 degrees to the vertical movement of the abraders, and immersed in artificial saliva. Wear was induced for 80K cycles at 60 cycles/min with a load of 40 N and 2-mm horizontal deflection. The specimens were examined for cracks at baseline, 5K, 10K, 20K, 40K, and 80K cycles. RESULTS: Twenty- to 30-microm deep subsurface cracking appeared in SSL, with 8 to 10 microm in AC, and 7 microm close to the margin of the wear facets in glazed EC after 5K cycles. The EC showed no cracks with increasing wear cycles. Seventy-microm deep subsurface cracks were detected in SSL and 45 microm in AC after 80K cycles. Statistically, there was significant difference among the three materials (p < 0.05). Bonferroni multiple comparison of means test confirmed the ANOVA test and showed that there was no statistical difference (p > 0.05) in crack depth within the same ceramic material with different surface finishes. CONCLUSIONS: The ceramic materials with different microstructures showed different patterns of subsurface cracking.

Quantitative measurement of tooth and ceramic wear: in vivo study.

PURPOSE: The aim of this study was to quantitatively measure tooth and ceramic wear over a 2-year period using a novel superimposition technique. Three ceramic systems--experimental hot-pressed ceramic (EC), Procera AllCeram (PA), and metal-ceramic--were used. MATERIALS AND METHODS: A total of 90 posterior crowns in 48 patients were randomized into 3 groups, and impressions were made at baseline and at 6-month intervals for 2 years. Clinical images were taken after using a dye to highlight surface changes. The impressions were digitized and modeled as superimposable 3-dimensional colored surface images. The depth of wear at the occlusal contact areas was quantitatively measured at 6, 12, 18, and 24 months. RESULTS: The quantitative evaluation showed more wear in Procera AllCeram at the occlusal contact areas, whereas the experimental and metal-ceramic systems showed less wear. There was a significant difference in the amount of enamel worn between all types of restorations (P < .05). There was a statistically significant difference (P < .05) in the mean depth of wear between all systems. CONCLUSIONS: The metal-ceramic and experimental systems showed less change, indicating improved wear resistance compared with Procera AllCeram. In addition, enamel opposing metal-ceramic and experimental crowns showed less wear compared to enamel opposed by Procera AIICeram crowns.