Crown Material and Occlusal Thickness Affect the Load Stress Dissipation on 3D Molar Crowns: Finite Element Analysis

PURPOSE: To compare the mechanical behavior (stress load dissipation and/or concentration) of posterior crowns made from Lava Ultimate (LU; 3M ESPE) and IPS e.max CAD (LD; Ivoclar Vivadent) using finite element analysis (FEA). MATERIALS AND METHODS: A 3D model of a mandibular first molar was prepared by reducing the occlusal surface by 1 or 2 mm (according to group), the axial walls by 1.5 mm, and using a 0.8-mm-deep shoulder margin as a finish line. A convergence of 6 degrees between opposing walls was set. Subsequently, four 3D crown models were created according to two test groups with two different occlusal thicknesses: (1) LD with 1.0 mm (LD1); (2) LD with 2.0 mm (LD2); (3) LU with 1.0 mm (LU1); and (4) LU with 2.0 mm (LU2). FEA models were constructed using the software Femap (Siemens). A load of 200 N was applied in the axial and oblique (20 degrees) directions for each group, and stress dissipation was viewed using the NEi Nastran software. RESULTS: FEA results demonstrated that the LU crowns dissipated the occlusal load to the tooth structure, whereas the LD material concentrated the load inside the crowns. For the LU material, the lower the occlusal thickness, the higher the stress concentration inside the crown became, and the 2.0-mm occlusal thickness transferred lower stress to the tooth structure. The oblique, rather than the vertical, load caused an increase in the maximum stress concentration at the shoulder margin and axial walls. CONCLUSION: The higher the Young's Modulus mismatch between the crown material and substrate, the higher the load stress concentration inside the material became. The 2-mm occlusal thickness acted by decreasing the load stress to the tooth substrate. Finally, the axial load delivered more favorable stress transmission to the tooth substrate. The crown material and the occlusal thickness appear to be two factors that affect the mechanical behavior of stress dissipation to the tooth structure.

Effect of luting cement thickness on the bond strength of glass fiber posts to dentin.

The objective of this study was to evaluate the effect of cement thickness and luting cement type on the push-out bond strength of glass fiber posts (GFPs) to root dentin. Sixty human maxillary root-filled canines or premolars with single straight roots were randomly divided into 6 groups (n = 10) according to the GFP configuration (conventional or relined with composite resin) and the cement used (RelyX U200, Ketac Cem, or Allcem Core). After endodontic treatment and GFP cementation, all of the roots were sectioned perpendicular to their long axis to obtain 1.0-mm-thick slices (n = 6 per group), which were mounted on a universal testing machine and submitted to a push-out test. The data (n = 45 to 51 specimens per group because of pretest failures) were analyzed by means of 2-way analysis of variance (ANOVA) and Tukey tests (α = 0.05). The type of failure was determined under a stereomicroscope, and representative specimens were observed with scanning electron microscopy. Significant interactions between the cements and GFP configurations were detected in the coronal and apical thirds (P < 0.05; 2-way ANOVA). For the coronal third, both RelyX U200 cement groups exhibited the greatest push-out bond strengths but were not significantly different from the Allcem Core relined group. For the middle third, no statistically significant interactions were observed between the cements and GFP configurations (P = 0.232; 2-way ANOVA). Adhesive failure between the dentin and cement layer was the most frequently observed failure mode. As expected, because of the composite resin added to relined GFPs, the cement layer was thinner in those groups. The type of cement used played an important role in the push-out bond strength.

Resting-state functional brain connectivity predicts cognitive performance: An exploratory study on a time-based prospective memory task.

Resting-state functional brain connectivity (rsFC) is in wide use for the investigation of a variety of cognitive neuroscience phenomena. In the first phase of this study, we explored the changes in EEG-reconstructed rsFC in young vs. older adults, in the both the open-eyes (OE) and the closed-eyes (CE) conditions. The results showed significant differences in several rsFC network metrics in the two age groups, confirming and detailing established knowledge that aging modulates brain functional organisation. In the study's second phase we investigated the role of rsFC architecture on cognitive performance through a time-based Prospective Memory task involving participants who monitored the passage of time to perform a specific action at an appropriate time in the future. Regression models revealed that the monitoring strategy (i.e. the number of clock checks) can be predicted by rsFC graph metric, specifically, eccentricity and betweenness in the OE condition, and assortativity in the CE condition. These results show for the first time how metrics qualifying functional brain connectivity at rest can account for the differences in the way individuals strategically handle cognitive loads in the Prospective Memory domain.

Effect of indenter material on reliability of all-ceramic crowns.

OBJECTIVES: Controversy exists about whether the elastic modulus (E) mismatch between the loading indenter and ceramic materials influences fatigue testing results. The research hypotheses were that for porcelain veneered Y-TZP crowns 1) A low modulus Steatite indenter (SB) leads to higher fatigue reliability compared to a high modulus tungsten carbide indenter (WC); 2) Different surface damage patterns are expected between low and high modulus indenters after sliding contact fatigue testing. All ceramic crowns will exhibit similar step-stress accelerated life testing (SSALT) contact fatigue reliability (hypothesis 1) and failure characteristics (hypothesis 2) when using high stiffness tungsten carbide (WC, E = 600 GPa) vs. enamel like steatite (SB, E = 90 GPa) indenters. METHODS: Manufacturer (3M Oral Care) prepared Y-TZP-veneered all-ceramic molar crowns were bonded to aged resin composite reproductions of a standard tooth preparation and subjected to mouth-motion SSALT fatigue (n = 18 per indenter type). Failure was defined either as initial inner cone crack (IC), or final fracture (FF) when porcelain fractured (chipping). Selected IC specimens that did not progress to FF were embedded in epoxy resin and sectioned for fractographic analysis. RESULTS: The distribution of failures across the load and cycle profiles lead to similar calculated Weibull Use Level Probability Plots with overlap of the 2-sided 90% confidence bounds. The calculated reliability for IC and FF was equivalent at a mission of 300 N or 700 N load and 50,000 cycles, although the WC indenter had a trend for lower reliability for IC at 700 N. Both indenters produced similar patterns of wear and cracking on crown surfaces. Fractographic landmarks showed competing failure modes, but sliding contact partial inner cone cracks were the most dominant for both groups. SIGNIFICANCE: The more compliant Steatite indenter had similar veneered crown fatigue reliability and failure modes to those found with use of a high stiffness tungsten carbide indenter (hypotheses 1 and 2 rejected).

Lifetime prediction of veneered versus monolithic lithium disilicate crowns loaded on marginal ridges.

OBJECTIVE: To evaluate the probability of survival of monolithic and porcelain veneered lithium disilicate crowns comprised by a conventional or modified core when loaded on marginal ridges. METHODS: Lithium disilicate molar crowns (n=30) were fabricated to be tested at mesial and distal marginal ridges and were divided as follows: (1) bilayered crowns with even-thickness 0.5mm framework (Bi-EV); (2) bilayered crowns with modified core design (Bi-M-lingual collar connected to proximal struts), and: (3) monolithic crowns (MON). After adhesively cemented onto composite-resin prepared replicas, mesial and distal marginal ridges of each crown (n=20) were individually cyclic loaded in water (30-300N) with a ceramic indenter at 2Hz until fracture. The 2-parameter Weibull was used to calculate the probability of survival (reliability) (90% 2-sided confidence bounds) at 1, 2, and 3 million cycles and mean life. RESULTS: The reliability at 1 and 2 million cycles was significantly higher for MON (47% and 19%) compared to Bi-EV (20% and 4%) and Bi-M (17% and 2%). No statistical difference was found between bilayered groups. Only the MON group presented crown survival (7%) at 3 million cycles. The mean life was highest for MON (1.73E+06), lowest for Bi-M (573,384) and intermediate for Bi-E (619,774). Fractographic analysis showed that the fracture originated at the occlusal surface. The highest reliability was found for MON crowns. The modified framework design did not improve the fatigue life of crowns. SIGNIFICANCE: Monolithic lithium disilicate crowns presented higher probability of survival and mean life than bilayered crowns with modified framework design when loaded at marginal ridges.

Probability of survival of implant-supported metal ceramic and CAD/CAM resin nanoceramic crowns.

OBJECTIVES: To evaluate the probability of survival and failure modes of implant-supported resin nanoceramic relative to metal-ceramic crowns. METHODS: Resin nanoceramic molar crowns (LU) (Lava Ultimate, 3M ESPE, USA) were milled and metal-ceramic (MC) (Co-Cr alloy, Wirobond C+, Bego, USA) with identical anatomy were fabricated (n=21). The metal coping and a burnout-resin veneer were created by CAD/CAM, using an abutment (Stealth-abutment, Bicon LLC, USA) and a milled crown from the LU group as models for porcelain hot-pressing (GC-Initial IQ-Press, GC, USA). Crowns were cemented, the implants (n=42, Bicon) embedded in acrylic-resin for mechanical testing, and subjected to single-load to fracture (SLF, n=3 each) for determination of step-stress profiles for accelerated-life testing in water (n=18 each). Weibull curves (50,000 cycles at 200N, 90% CI) were plotted. Weibull modulus (m) and characteristic strength (η) were calculated and a contour plot used (m versus η) for determining differences between groups. Fractography was performed in SEM and polarized-light microscopy. RESULTS: SLF mean values were 1871N (±54.03) for MC and 1748N (±50.71) for LU. Beta values were 0.11 for MC and 0.49 for LU. Weibull modulus was 9.56 and η=1038.8N for LU, and m=4.57 and η=945.42N for MC (p>0.10). Probability of survival (50,000 and 100,000 cycles at 200 and 300N) was 100% for LU and 99% for MC. Failures were cohesive within LU. In MC crowns, porcelain veneer fractures frequently extended to the supporting metal coping. CONCLUSION: Probability of survival was not different between crown materials, but failure modes differed. SIGNIFICANCE: In load bearing regions, similar reliability should be expected for metal ceramics, known as the gold standard, and resin nanoceramic crowns over implants. Failure modes involving porcelain veneer fracture and delamination in MC crowns are less likely to be successfully repaired compared to cohesive failures in resin nanoceramic material.

Effects of implant diameter and prosthesis retention system on the reliability of single crowns.

PURPOSE: The probability of survival of implant-supported prostheses may be affected by the interplay between different implant diameters supporting screwed or cemented crowns. The purpose of this study was to investigate the effect of implant diameter and prosthesis retention system on the reliability and failure modes of single crowns. MATERIALS AND METHODS: Internal-hexagon implants were divided into six groups (n = 21 each) according to implant diameter (3.3, 4.0, or 5.0 mm) and crown retention system (screwed or cemented). Abutments were torqued to the implants, and crowns were then fixed and subjected to step-stress accelerated life testing in water. Use-level probability Weibull curves and reliability for missions of 50,000 cycles at 100, 150, and 200 N were calculated. Failure analysis was performed. RESULTS: Cemented systems presented higher reliability than screwed ones, except between 3.3-mm-diameter cemented and screwed systems at a load of 100 or 150 N. Failure modes were restricted to the abutment screw and varied with implant diameter only in the cement-retained groups. CONCLUSION: Higher reliability was observed for cement-retained crowns and implants of larger diameter compared to screw-retained and smaller diameter. Failure modes differed between groups.

Slow cooling protocol improves fatigue life of zirconia crowns.

OBJECTIVE: To compare the fatigue life and damage modes of zirconia crowns fabricated with and without framework design modification when porcelain veneered using a fast or slow cooling protocol. METHODS: Composite resin replicas of a first molar full crown preparation were fabricated. Zirconia copings were milled as conventional (0.5mm even thickness, Zr-C, n=20,) or modified (lingual margin of 1.0mm thickness, 2.0mm height connected to two proximal struts of 3.5mm height, Zr-M, n=20). These groups were subdivided (n=10 each) according to the veneer cooling protocol employed: fast cooling (Zr-CFast and Zr-MFast) and slow cooling (Zr-CSlow and Zr-MSlow). Crowns were cemented and fatigued for 10(6) cycles in water. The number of cycles to failure was recorded and used to determine the interval databased 2-parameter probability Weibull distribution parameter Beta (ß) and characteristic life value Eta (η). RESULTS: 2-parameter Weibull calculation presented ß=5.53 and ß=4.38 for Zr-MFast and Zr-CFast, respectively. Slow cooled crowns did not fail by completion of 10(6) cycles, thereby Weibayes calculation was applied. Increased fatigue life was observed for slow cooled crowns compared to fast cooled ones. Groups Zr-MFast and Zr-MSlow presented no statistical difference. Porcelain cohesive fractures were mainly observed in fast cooled groups. Slow cooled crowns presented in some instances inner cone cracks not reaching the zirconia/veneer interface. SIGNIFICANCE: Improved fatigue life in tandem with the absence of porcelain fractures were observed in slow cooled crowns, regardless of framework design. Crowns fast cooled chiefly failed by porcelain cohesive fractures.

Modification of xenogeneic graft materials for improved release of P-15 peptides in a calvarium defect model.

Particulate bone augmentation is an established clinical alternative to regenerate bone. However, in regions of poor bone quality or previously infected sites, the clinical outcomes are more inconsistent. For that purpose, peptides have been added to particulate materials in an attempt to render them with antibacterial properties or to improve their osseoconductivity. For instance, competence-stimulating peptide (CSP) has been studied to decrease the division rate of Streptococcus mutans. Also, the addition of a specific short amino acid sequence peptide derived from type I collagen (P-15) to the bone substitutes has been introduced in an attempt to increase its osseoconductivity. The present study hypothesized that xenogeneic graft materials with and without CSP would present improved host-to-biomaterial response when used in combination with P-15. Particulate graft materials with and without P-15, OsteoGraf with CSP and OsteoGraf, were implanted in an 8-mm rabbit calvarial defect for 4 weeks, and thereafter, histological and histomorphometrical evaluation was performed. The results showed that both OsteoGraf and CSP groups with the addition of P-15 induced bone growth towards the center of the defect. Furthermore, the addition of CSP to Osteograf showed a tendency to increase its osteoconductivity when combined with P-15. The results of the current study suggested that P-15 had some impact on osteogenesis; however, the effect differed between different bone substitute materials. Further investigation is necessary to clarify its effectiveness when used in combination with bone substitutes.

Bone-Forming Capabilities of a Newly Developed NanoHA Composite Alloplast Infused with Collagen: A Pilot Study in the Sheep Mandible.

Lateral or vertical bone augmentation has always been a challenge, since the site is exposed to constant pressure from the soft tissue, and blood supply only exists from the donor site. Although, for such clinical cases, onlay grafting with autogenous bone is commonly selected, the invasiveness of the secondary surgical site and the relatively fast resorption rate have been reported as a drawback, which motivated the investigation of alternative approaches. This study evaluated the bone-forming capability of a novel nanoHA alloplast infused with collagen graft material made from biodegradable polylactic acid/polyglycolic acid versus a control graft material with the same synthesized alloplast without the nanoHA component and collagen infiltration. The status of newly formed bone and the resorption of the graft material were evaluated at 6 weeks in vivo histologically and three dimensionally by means of 3D microcomputed tomography. The histologic observation showed that newly formed bone ingrowth and internal resorption of the block were observed for the experimental blocks, whereas for the control blocks less bone ingrowth occurred along with lower resorption rate of the block material. The three-dimensional observation indicated that the experimental block maintained the external geometry, but at the same time successfully altered the graft material into bone. It is suggested that the combination of numerous factors contributed to the bone ingrowth and the novel development could be an alternative bone grafting choice.

Push-out bond strengths of different dental cements used to cement glass fiber posts.

STATEMENT OF PROBLEM: Since the introduction of glass fiber posts, irreversible vertical root fractures have become a rare occurrence; however, adhesive failure has become the primary failure mode. PURPOSE: The purpose of this study was to evaluate the push-out bond strength of glass fiber posts cemented with different luting agents on 3 segments of the root. MATERIAL AND METHODS: Eighty human maxillary canines with similar root lengths were randomly divided into 8 groups (n=10) according to the cement assessed (Rely X luting, Luting and Lining, Ketac Cem, Rely X ARC, Biscem, Duo-link, Rely X U100, and Variolink II). After standardized post space preparation, the root dentin was pretreated for dual-polymerizing resin cements and untreated for the other cements. The mixed luting cement paste was inserted into post spaces with a spiral file and applied to the post surface that was seated into the canal. After 7 days, the teeth were sectioned perpendicular to their long axis into 1-mm-thick sections. The push-out test was performed at a speed of 0.5 mm/min until extrusion of the post occurred. The results were evaluated by 2-way ANOVA and the all pairwise multiple comparison procedures (Tukey test) (α=.05). RESULTS: ANOVA showed that the type of interaction between cement and root location significantly influenced the push-out strength (P<.05). The highest push-out strength results with root location were obtained with Luting and Lining (S3) (19.5 ±4.9 MPa), Ketac Cem (S2) (18.6 ±5.5 MPa), and Luting and Lining (S1) (18.0 ±7.6 MPa). The lowest mean values were recorded with Variolink II (S1) (4.6 ±4.0 MPa), Variolink II (S2) (1.6 ±1.5 MPa), and Rely X ARC (S3) (0.9 ±1.1 MPa). CONCLUSIONS: Self-adhesive cements and glass ionomer cements showed significantly higher values compared to dual-polymerizing resin cements. In all root segments, dual-polymerizing resin cements provided significantly lower bond strength. Significant differences among root segments were found only for Duo-link cement.

MicroCT analysis of a retrieved root restored with a bonded fiber-reinforced composite dowel: a pilot study.

PURPOSE: This evaluation aimed to (1) validate micro-computed tomography (microCT) findings using scanning electron microscopy (SEM) imaging, and (2) quantify the volume of voids and the bonded surface area resulting from fiber-reinforced composite (FRC) dowel cementation technique using microCT scanning technology/3D reconstructing software. MATERIALS AND METHODS: A fiberglass dowel was cemented in a condemned maxillary lateral incisor prior to its extraction. A microCT scan was performed of the extracted tooth creating a large volume of data in DICOM format. This set of images was imported to image-processing software to inspect the internal architecture of structures. RESULTS: The outer surface and the spatial relationship of dentin, FRC dowel, cement layer, and voids were reconstructed. Three-dimensional spatial architecture of structures and volumetric analysis revealed that 9.89% of the resin cement was composed of voids and that the bonded area between root dentin and cement was 60.63% larger than that between cement and FRC dowel. CONCLUSIONS: SEM imaging demonstrated the presence of voids similarly observed using microCT technology (aim 1). MicroCT technology was able to nondestructively measure the volume of voids within the cement layer and the bonded surface area at the root/cement/FRC interfaces (aim 2). CLINICAL SIGNIFICANCE: The interfaces at the root dentin/cement/dowel represent a timely and relevant topic where several efforts have been conducted in the past few years to understand their inherent features. MicroCT technology combined with 3D reconstruction allows for not only inspecting the internal arrangement rendered by fiberglass adhesively bonded to root dentin, but also estimating the volume of voids and contacted bond area between the dentin and cement layer.

Surface characterisation and bonding of Y-TZP following non-thermal plasma treatment.

OBJECTIVES: (1) To chemically characterise Y-TZP surface via X-ray photoelectron spectroscopy (XPS) and evaluate the surface energy levels (SE) after non-thermal plasma (NTP). (2) To test the microtensile bond strength (MTBS) of Y-TZP bonded to cured composite disks, after a combination of different surface conditioning methods. METHODS: Twenty-four Y-TZP discs (13.5mm×4mm) were obtained from the manufacturer and composite resin (Z-100) discs with similar dimensions were prepared. All discs were polished to 600 grit and divided into 8 groups (n=3 disks each), four control (non-NTP treated) and four experimental (NTP treated for 10s) groups. All groups received one of the four following treatments prior to cementation with Rely×Unicem cement: sand-blasting (SB), a Clearfil ceramic primer (MDP), sand-blasting+MDP (SBMDP), or baseline (B), no treatment. SE readings and surface roughness parameters were statistically analysed (ANOVA, Tukey's, p<0.05). Mixed model and paired samples t-tests were used to compare groups on MTBS. RESULTS: XPS showed increase in O and decrease in C elements after NTP. The polar component increased for BP (42.20mN/m) and SBP (43.77mN/m). MTBS values for groups BP (21.3MPa), SBP (31MPa), MDPP (30.1MPa) and SBMDPP (32.3MPa) were significantly higher in specimens treated with NTP than their untreated counterparts B (9.1MPa), SB (14.4MPa), MDP (17.8MPa) and SBMDP (24.1MPa). CONCLUSIONS: (1) Increase of O and decrease of C led to higher surface energy levels dictated by the polar component after NTP; (2) NTP application increased MTBS values of Y-TZP surfaces.

Avaliação da confiabilidade e modo de falha de coroas cerâmicas em função do módulo de elasticidade dos endentadores / Effect of indenter material on reliability of all-ceramic crowns

A incompatibilidade entre o módulo de elasticidade (E) do endentador e dos materiais cerâmicos durante os testes de fadiga tem gerado controvérsias. Foram testadas as hipóteses que coroas totalmente cerâmicas apresentarão confiabilidade à fadiga acelerada progressiva do tipo step-stress (hipótese 1) e modos de falha (hipótese 2) similares, quando dois endentadores, um à base de carboneto de tungstênio (WC, E = 600 GPa) e outro de cerâmica esteatite [SB, E = 90 GPa] forem utilizados para transferir a carga. Para avaliar o efeito dos endentadores, um preparo para coroa total em um molar inferior foi realizado. A partir deste modelo mestre, 42 coroas à base de Y-TZP e 42 réplicas em resina composta foram produzidas. As réplicas em resina foram envelhecidas por 30 dias. Todas as coroas foram cimentadas sobre estas réplicas com cimento autoadesivo (Rely X Unicem - 3M/ESPE, St. Paul, EUA) e divididas em dois grupos de acordo com o endentador (WC ou SB). As coroas foram submetidas tanto ao teste de resistência à fratura (n = 3 por grupo), empregado para determinar os perfis de carga (leve, moderado e agressivo) quanto à fadiga (n = 18 por grupo), utilizando um endentador novo para cada coroa. Impressões de todas as coroas e endentadores submetidos ao perfil leve foram obtidas, em pontos específicos do perfil (0, 40k, e, 80k 120k, 160k), vazadas com resina epóxi e avaliadas sob MEV, com a finalidade de inspecionar a morfologia e medir a área endentada. O Use level Probability mostrou sobreposição entre os intervalos de confiança, indicando que não houve diferença significante entre os grupos, independente do critério de falha. O módulo de Weibull Beta (β) calculado para IA (análise inicial) foi de 1,99 e 1,67 para SB e WC, respectivamente, apontando que a fadiga acelerou o fracasso em ambos os grupos. Este não foi o caso para os valores de β para a análise de FA (análise final) (SB = 1,1 e WC = 0,72), revelando que a carga pode ter influenciado sozinha o mecanismo de...

Concerns about elastic modulus (E) mismatch between indenter and ceramic materials during fatigue testing have generated controversy. We hypothesized that all-ceramic crowns will exhibit similar step-stress sliding contact fatigue reliability (hypothesis 1) and failure characteristics (hypothesis 2) when using high stiffness tungsten carbide (WC, E = 600 GPa) vs enamel like steatite (SB, E = 90 GPa) indenters. To evaluate the effect of indenters, a preparation for a full crown was made on a first lower molar. From this master die 42 Y-TZPveneered all-ceramic crowns and 42 tooth-resin réplicas were made. Crowns were cemented onto the aged (30 days) tooth-resin réplicas with self-adhesive resin-based cement (Rely X UniCem - 3M/ESPE, St. Paul, USA). After, crowns were divided into two groups according to indenter (WC or SB). Specimens were subject to single-load to fracture (n = 3 per indenter type) to determine the step-stress profiles (mild, moderate, and aggressive) and to mouthmotion step-stress fatigue-tested (n = 18 per indenter type). Two failure modes were determined (inital analysis [IA] and final analysis [FA]). For each crown, a new indenter was used and labelled accordingly for surface damage evaluation. Impressions from all crowns subjected to mild profile were taken following a pre-arranged number of cycles (0, 40k, 80k, 120k e, 160k), poured with epoxy resin and SEM evaluated to inspect the morphology and to measure the indented area. The use level probability plots of the fatigue data showed overlap between the 2-sided 90% confidence bounds. The calculated Weibull Beta (β) for IA was 1.99 and 1.67 for SB and WC, respectively, pointing out that fatigue accelerated the failure in both groups. This was not the case for the β values for the FA analysis (SB = 1.1 and WC = 0.72), revealing tha the load alone dicted the failure mechanism. Both indenters produced similar pattern of wear on crown surfaces. Fractographic landmarks...

Avaliação da confiabilidade e modo de falha de coroas cerâmicas em função do módulo de elasticidade dos endentadores / Effect of indenter material on reliability of all-ceramic crowns

A incompatibilidade entre o módulo de elasticidade (E) do endentador e dos materiais cerâmicos durante os testes de fadiga tem gerado controvérsias. Foram testadas as hipóteses que coroas totalmente cerâmicas apresentarão confiabilidade à fadiga acelerada progressiva do tipo step-stress (hipótese 1) e modos de falha (hipótese 2) similares, quando dois endentadores, um à base de carboneto de tungstênio (WC, E = 600 GPa) e outro de cerâmica esteatite [SB, E = 90 GPa] forem utilizados para transferir a carga. Para avaliar o efeito dos endentadores, um preparo para coroa total em um molar inferior foi realizado. A partir deste modelo mestre, 42 coroas à base de Y-TZP e 42 réplicas em resina composta foram produzidas. As réplicas em resina foram envelhecidas por 30 dias. Todas as coroas foram cimentadas sobre estas réplicas com cimento autoadesivo (Rely X Unicem - 3M/ESPE, St. Paul, EUA) e divididas em dois grupos de acordo com o endentador (WC ou SB). As coroas foram submetidas tanto ao teste de resistência à fratura (n = 3 por grupo), empregado para determinar os perfis de carga (leve, moderado e agressivo) quanto à fadiga (n = 18 por grupo), utilizando um endentador novo para cada coroa. Impressões de todas as coroas e endentadores submetidos ao perfil leve foram obtidas, em pontos específicos do perfil (0, 40k, e, 80k 120k, 160k), vazadas com resina epóxi e avaliadas sob MEV, com a finalidade de inspecionar a morfologia e medir a área endentada. O Use level Probability mostrou sobreposição entre os intervalos de confiança, indicando que não houve diferença significante entre os grupos, independente do critério de falha. O módulo de Weibull Beta (β) calculado para IA (análise inicial) foi de 1,99 e 1,67 para SB e WC, respectivamente, apontando que a fadiga acelerou o fracasso em ambos os grupos. Este não foi o caso para os valores de β para a análise de FA (análise final) (SB = 1,1 e WC = 0,72), revelando que a carga pode ter influenciado sozinha o mecanismo de...

Concerns about elastic modulus (E) mismatch between indenter and ceramic materials during fatigue testing have generated controversy. We hypothesized that all-ceramic crowns will exhibit similar step-stress sliding contact fatigue reliability (hypothesis 1) and failure characteristics (hypothesis 2) when using high stiffness tungsten carbide (WC, E = 600 GPa) vs enamel like steatite (SB, E = 90 GPa) indenters. To evaluate the effect of indenters, a preparation for a full crown was made on a first lower molar. From this master die 42 Y-TZPveneered all-ceramic crowns and 42 tooth-resin réplicas were made. Crowns were cemented onto the aged (30 days) tooth-resin réplicas with self-adhesive resin-based cement (Rely X UniCem - 3M/ESPE, St. Paul, USA). After, crowns were divided into two groups according to indenter (WC or SB). Specimens were subject to single-load to fracture (n = 3 per indenter type) to determine the step-stress profiles (mild, moderate, and aggressive) and to mouthmotion step-stress fatigue-tested (n = 18 per indenter type). Two failure modes were determined (inital analysis [IA] and final analysis [FA]). For each crown, a new indenter was used and labelled accordingly for surface damage evaluation. Impressions from all crowns subjected to mild profile were taken following a pre-arranged number of cycles (0, 40k, 80k, 120k e, 160k), poured with epoxy resin and SEM evaluated to inspect the morphology and to measure the indented area. The use level probability plots of the fatigue data showed overlap between the 2-sided 90% confidence bounds. The calculated Weibull Beta (β) for IA was 1.99 and 1.67 for SB and WC, respectively, pointing out that fatigue accelerated the failure in both groups. This was not the case for the β values for the FA analysis (SB = 1.1 and WC = 0.72), revealing tha the load alone dicted the failure mechanism. Both indenters produced similar pattern of wear on crown surfaces. Fractographic landmarks...

Seleção do sistema cerâmico na reabilitação estética anterior: relato de caso / Selection of the ceramic system in esthetic rehabilitation: case report

Problemas estéticos relacionados ao sistema metalocerâmico têm impulsionado o desenvolvimento dos sistemas conhecidos como totalmente cerâmicos e que atualmente podem ser considerados a primeira alternativa no tratamento restaurador para próteses unitárias e fixas. O desafio está em conhecer as propriedades de cada um desses sistemas, uma vez que não há, até o momento, um único sistema cerâmico que possa ser empregado em qualquer situação clínica. Este artigo descreve as razões que guiaram a seleção da cerâmica IPS e.max Press à base de dissilicato de lítio, assim como os principais procedimentos clínicos empregados para a reabilitação estética

Esthetic concerns related to porcelain-fused-to-metal restorations driven the development of ceramic systems. Currently, these all-ceramic systems can be regard as the first alternative in the restorative treatment, including unitary and multiple prostheses. Understanding the mechanical and esthetic properties of each material is challenging, since no system can be used for all clinical conditions up to date. This article describes the principles that guide selection of a lithium dissilicate ceramics (IPS e.max Press) as well as the main clinical steps, involved in the rehabilitation of a patient esthetic compromised in the anterior teeth

Internal fit of two all-ceramic systems and metal-ceramic crowns.

OBJECTIVES: The aim of this study was to investigate the internal fit (IF) of glass-infiltrated alumina (ICA--In-Ceram Alumina), yttria-stabilized tetragonal zirconia polycrystals (Y-TZP--IPS e.max ZirCAD), and metal-ceramic (MC--Ni-Cr alloy) crowns. MATERIAL AND METHODS: Sixty standardized resin-tooth replicas of a maxillary first molar were produced for crown placement and divided into 3 groups (n=20 each) according to the core material used (metal, ICA or Y-TZP). The IF of the crowns was measured using the replica technique, which employs a light body polyvinyl siloxane impression material to simulate the cement layer thickness. The data were analyzed according to the surfaces obtained for the occlusal space (OS), axial space (AS) and total mean (TM) using two-way ANOVA with Tukey's multiple comparison test (p<0.05). RESULTS: No differences among the different areas were detected in the MC group. For the Y-TZP and ICA groups, AS was statistically lower than both OS and TM. No differences in AS were observed among the groups. However, OS and TM showed significantly higher values for ICA and Y-TZP groups than MC group. Comparisons of ICA and Y-TZP revealed that OS was significantly lower for Y-TZP group, whereas no differences were observed for TM. CONCLUSIONS: The total mean achieved by all groups was within the range of clinical acceptability. However, the metal-ceramic group demonstrated significantly lower values than the all-ceramic groups, especially in OS.

Internal fit of two all-ceramic systems and metal-ceramic crowns

OBJECTIVES: The aim of this study was to investigate the internal fit (IF) of glass-infiltrated alumina (ICA - In-Ceram Alumina), yttria-stabilized tetragonal zirconia polycrystals (Y-TZP - IPS e.max ZirCAD), and metal-ceramic (MC - Ni-Cr alloy) crowns. MATERIAL AND METHODS: Sixty standardized resin-tooth replicas of a maxillary first molar were produced for crown placement and divided into 3 groups (n=20 each) according to the core material used (metal, ICA or Y-TZP). The IF of the crowns was measured using the replica technique, which employs a light body polyvinyl siloxane impression material to simulate the cement layer thickness. The data were analyzed according to the surfaces obtained for the occlusal space (OS), axial space (AS) and total mean (TM) using two-way ANOVA with Tukey ’s multiple comparison test (p<0.05). RESULTS: No differences among the different areas were detected in the MC group. For the Y-TZP and ICA groups, AS was statistically lower than both OS and TM. No differences in AS were observed among the groups. However, OS and TM showed significantly higher values for ICA and Y-TZP groups than MC group. Comparisons of ICA and Y-TZP revealed that OS was significantly lower for Y-TZP group, whereas no differences were observed for TM. CONCLUSIONS: The total mean achieved by all groups was within the range of clinical acceptability. However, the metal-ceramic group demonstrated significantly lower values than the all-ceramic groups, especially in OS.

Próteses parciais removíveis não convencionais parte II / Non-conventional removable partial denture part II

Dentes perdidos podem ser melhores substituídosempregando próteses fixas (dento ouimplanto suportadas). Contudo, algumas limitaçõescomo fatores econômicos, culturais, sociais,distribuição dos dentes, extensão do espaçoprotético e espessura do rebordo, podemlimitar o emprego dessas próteses. Dessa forma,a prótese parcial removível (PPR) torna-se umaalternativa segura e confiável quando a prótesefixa não pode ser indicada. Embora apresentedesvantagens, a PPR convencional preenche todosos requisitos para reabilitar qualquer áreaedêntula, pois recupera dentes e estruturas associadasperdidas (osso e tecidos moles). Entretanto,algumas alterações como modificaçõesdo desenho da infraestrutura, mudança do eixode inserção, tipo de dente usado na prótese(artificial ou natural), dentre outras, podem serrealizadas para melhorar o conforto, satisfaçãoe estética do paciente. Nesses casos, há a transformaçãoda PPR convencional em não convencional.Este trabalho tem objetivo de revisaras categorias de PPR não convencionais, assimcomo suas vantagens, desvantagens, indicaçõese contraindicações, na esperança que mais dentistaspossam considerar seu uso quando a situaçãoaparecer.

Fixed partial prostheses (tooth or implant based)are considerated as the best choice to replacemissing teeth. However, some clinical (teethdistribution, prosthetic space extension and residualbone thickness) or individual (economical,cultural and social factors) conditions may limitits indication. In such situations, the removablepartial denture (RPD) is a reliable alternative.Although the conventional RPD shows somedisadvantages, it presents all requirements torehabilitate any edentulous space. Moreover,RPD replaces both teeth and adjacent structures(soft and hard tissues) missed. Nevertheless,in order to delivery esthetic, comfort andself-confidence to patient, some specific clinicalconditions require a non-conventional RPD. Thisprosthesis is characterized by presenting a changedframework design, or a different insertionpath, or due to its association with implants,among others. Thus, understanding the nonconventionalRPDs concept is a subject matterimportant and pertinent. The present studysought to review the relevant literature aboutnon-conventional RPDs, including vantages, disadvantages,indications and contraindications,expecting that more dentists may consider thenon-conventional RPD as a treatment option.

Avaliação da resistência ao cisalhamento por extrusão (push-out) de pinos de fibra de vidro cimentados com diferentes cimentos resinosos em um ambiente úmido: Estudo Piloto / Evaluation of shear bond strength (push-out) of glass fiber posts cemented with different resin cements in humid ambient. Pilot study

Objetivo: O objetivo deste trabalho foi analisar a resistência ao cisalhamento por extrusão de diferentes cimentos empregados na cimentação de pinos de fibra de vidro em ambiente úmido. Material e métodos: Para tanto, 21 caninos humanos tiveram suas coroas removidas, de modo que se obtiveram 15 mm de remanescente radicular. Depois de tratados endodonticamente, os dentes foram preparados para receber pinos de fibra de vidro. Os dentes selecionados foram divididos aleatoriamente em sete grupos: Grupo I - RelyX ARC, Grupo II - Enforce, Grupo III - BISCEM, Grupo IV - DUO-LINK, Grupo V - Cemente Post, Grupo VI - Variolink II e Grupo VII - RelyX U100. Cada dente foi seccionado perpendicularmente ao longo do eixo do pino com disco diamantado de alta concentração, obtendo-se uma fatia de cada profundidade com espessura de, aproximadamente, 1 mm, retiradas a partir de 1 mm, 5 mm e 9 mm do limite cervical de cada raiz, totalizando-se 63 espécimes. A análise microscópica foi realizada nesses três níveis: superficial, médio e profundo. Após análise, os espécimes foram avaliados pelo teste de push-out. Resultados: O teste Anova a dois critérios mostrou diferenças estatisticamente significativas entre os terços, cimentos e interação entre eles (p < 0,05). O teste de Tukey mostrou que os cimentos resinosos autoadesivos (Biscem e U100) e o terço cervical radicular apresentaram resultados significativamente superiores no teste de push-out (p < 0,05). As fotomicrografias mostraram que houve fendas maiores nas regiões médias e apicais do que nas regiões cervicais. Conclusão: Os resultados deste estudo mostraram que os cimentos autoadesivos apresentaram resultados superiores quando comparados aos cimentos adesivos. A região radicular cervical apresentou os melhores resultados no teste de cisalhamento.