Survival and complications of monolithic ceramic for tooth-supported fixed dental prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Although recent studies have reported the success of implant-supported monolithic restorations, consensus on the use of monolithic ceramic restorations is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the survival and biological and technical complication rates of monolithic single crowns and fixed partial dentures (FPDs). MATERIAL AND METHODS: An electronic search was conducted by 2 independent authors on the PubMed/MEDLINE, Scopus, and Cochrane Library databases. The Newcastle-Ottawa scale and Cochrane risk of bias tool were used to assess the quality and risk of bias of the included studies. Meta-analysis was performed by using the R software program. RESULTS: The search identified 763 articles, 18 of which met the eligibility criteria. A total of 15 studies evaluated monolithic ceramic single crowns, and 4 studies evaluated FPDs. The studies included 1061 monolithic single crowns (524 lithium disilicate, 461 zirconia, and 76 polymer-infiltrated ceramic network [PICN]) and 104 FPDs (36 lithium disilicate and 68 zirconia). Meta-analysis of single-arm studies indicated the proportion of survival, biological, and technical complication rates of 1% (95% confidence interval [CI]: 0% to 3%), 1% (CI: 0% to 4%), and 2% (CI: 1% to 4%), respectively, for single crowns, independent of ceramic material, and 3% (CI: 0% to 34%), 5% (CI: 1% to 21%), and 5% (CI: 1% to 21%) for FPDs, respectively. Only 5 studies performed a direct comparison between monolithic and veneered ceramic restorations, and no significant difference was observed in terms of survival (risk ratio [RR]: 0.68; CI: 0.25-1.91; P=.96), biological (RR: 0.69; CI: 0.31-1.53; P=.35), and technical complication rates (RR: 0.87; CI: 0.40-1.88; P=.29). CONCLUSIONS: The use of monolithic ceramic can be considered a favorable treatment for tooth-supported single crowns and FPDs, with high survival and low complication rates. However, further randomized controlled trials are needed to reassess these clinical performances, mainly by comparing them with the performance of veneered restorations.

Effect of laser irradiation on bond strength between zirconia and resin cement or veneer ceramic: A systematic review and meta-analysis.

Aim: This systematic review with meta-analysis aimed to evaluate the effect of the laser treatment on bond strength between Y-TZP and the resin cement or with the veneering ceramic, and the effect on the alteration of the Y-TZP surface roughness. Settings and Design: Systematic review and meta analysis following PROSPERO guidelines. Materials and Methods: A comprehensive review was performed up to September 2020 on four databases (PubMed/MEDLINE, Embase, Scopus, and Cochrane Library), using the combination of keywords: "laser AND zirconia AND surface treatment AND bond strength". Statistical Analysis Used: The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. The continuous outcome was evaluated by mean difference and the corresponding 95% confidence intervals. Results: A total of 37 studies were identified for the inclusion of data, with only in vitro studies. The types of laser reported in the studies were: Er:YAG, Nd:YAG, Er,Cr:YSGG, CO2, Femtosecond, and Yb lasers. A random-effect model found statistically significant differences between lasers and control groups of Y-TZP (P < 0.00001; MD: 3.08; 95% CI: 2.58 to 3.58). Only the bond strength with the Er:YAG laser did not present statistical difference (P = 0.51; MD: 0.22; 95% CI: -0.44-0.88). In another analysis, a random-effect model found a statistically significant difference between the laser and control groups on surface roughness (P < 0.00001; MD: 0.96; 95% CI: 0.86 to 1.06). Conclusions: Laser irradiation is capable to improve the Y-TZP surface roughness and the bond strength of zirconia with resin cement and veneering ceramics. However, there is a lack of laser protocol for the zirconia surface, a fact that makes a simple and direct comparison difficult.

Effect of handling material on mechanical and optical properties of feldspathic porcelain.

OBJECTIVE: To evaluate the optical, chemical, and mechanical properties of feldspathic porcelain after handling with different instrument materials. MATERIAL AND METHODS: Feldspathic porcelain was manipulated with different spatula compositions: metal spatula (MS), plastic spatula (PS), and glass spatula (GS) for the fabrication of 30 (n = 10) disks. Contrast ratio (CR), translucency parameter (TP), and surface Knoop microhardness (KHN) were measured. The color change (ΔE00 ) was evaluated using the CIEDE2000 system. Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were used for surface analysis. Data were analyzed using one-way ANOVA and Tukey test (P < 0.05). RESULTS: All groups presented different morphological surfaces with higher presence of Al on the MS. PS group presented lower Al, Si, K than MS, and GS. Higher CR was observed for PS (0.734; P < 0.043), followed by MS (0.696; P < 0.043) and GS (0.65; P < 0.011). The highest TP (13.06) and KHN (386.27) were presented by GS (P < 0.001). MS and PS presented similar KHN results. The higher ΔE00 were found for plastic/metal comparison. Also, the L* values for the MS group (67.49) were lower than the other groups. CONCLUSION: The use of metal spatula promoted higher color alteration during feldspathic porcelain manipulation than did the other materials. Handling with glass instrument promoted higher microhardness than other spatula materials. CLINICAL SIGNIFICANCE: The effect of the material used for ceramic handling on feldspathic porcelain properties is often ignored. This study shows that the handling spatula material must be carefully chosen to avoid inadvertent changes to the feldspathic porcelain restoration.

Cytotoxicity and inflammatory response of different types of provisional restorative materials.

AIM: To evaluate the cytotoxicity and inflammatory response of different types of provisional restorative materials to mice gingival fibroblasts. METHODS: Cytotoxicity of provisional material discs (thermal-polymerized acrylic resin; auto-polymerized acrylic resin; bisacrylic resin; nano-ceramic resin for CAD/CAM and prefabricated polymer block for CAD/CAM) to Mice (Balb/c) gingival cell were investigated under direct and indirect contact (extracts) at 24, 48 and 72 h, using the MTT and Alamar blue assays. Materials extracts (24 h) were applied to the cell culture (indirect contact) or cells were seeded on discs of provisional materials, and the cytotoxicity and production of IL-6, IL-1ß and TNF-α after 24, 48 and 72 h were analyzed through MTT, Alamar Blue® and ELISA. Culture medium was used as control for indirect contact assay (extract) and the surfaces of the wells without discs of provisional materials were used as control for direct contact assay. Results were analysed statistically by ANOVA followed by the Bonferroni-Test correction. Statistically significant differences were considered if P was < .05. RESULTS: Auto-polymerized and bisacrylic resins (direct contact) reduced cell viability after 24, 48 and 72 h compared to control (P < .05). Indirect contact (extract) was not cytotoxic to cells at all periods compared to control (P > .05). Auto-polymerized and bisacrylic resins increased IL-6, IL-1ß and TNF-α levels mainly at 24 h when compared to the other materials (P < .001). CONCLUSION: Auto-polymerized and bisacrylic were more cytotoxic to mice gingival fibroblasts. CAD/CAM nano ceramic resin and prefabricated polymer blocks are more predictable materials to preserve the periodontal soft tissues.

O desafio do restabelecimento de um sorriso antiestético por meio de prótese fixa metal-free / The challenge of restoring an unsightly smile by means of a fixed metal-free prosthesis / El desafío del restablecimiento de una sonrisa antiestética por medio de prótesis fija metal-free

Para alcançar a estética em dentes anteriores deve-se ter conhecimento de diversas técnicas e principalmente fazer a escolha correta dos materiais. As cerâmicas odontológicas estão cada vez mais presentes nas restaurações, visto que possuem ótimas propriedades ópticas e mecânicas. Assim, o objetivo deste estudo foi proporcionar a estética em dentes anteriores com diferentes subtratos através de uma prótese fixa metal-free. Paciente do gênero masculino, 38 anos, procurou atendimento queixando-se da estética do seu sorriso. No exame clínico foi observada uma coroa total metalocerâmica no elemento 21 e facetas de resina composta nos elementos 11,12 e 22, todas com estética insatisfatória. O dente 21 apresentava um núcleo metálico fundido adequado e os dentes 12 e 22 com tratamentos endodônticos. Foi proposta a instalação de pinos de fibra de vidro nos dentes 12 e 22. Além, da confecção de coroas totais metais-free em dissilicato de lítio nos quatro incisivos superiores com o sistema e-max ceram. O resultado final estético e funcional foi aprovado pelo paciente e pelos profissionais envolvidos(AU)

To achieve aesthetics in anterior teeth one must be aware of several techniques and especially make the correct choice of materials. Dental ceramics are increasingly present in restorations, since they have excellent optical and mechanical properties. Thus, the objective of this study was to achieve esthetics in anterior teeth with different substrate through a fixed prosthesis metal-free. A male patient, 38 years old, sought care complaining about the aesthetics of his smile. In the clinical examination a total metaloceramic crown was observed in element 21 and composite resin facets in elements 11,12 and 22, all with unsatisfactory aesthetics. Tooth 21 had a suitable molten metal core and teeth 12 and 22 with endodontic treatments. It was proposed to install fiberglass pins on the teeth 12 and 22. In addition, from the manufacture of total metal-free crowns in lithium disilicate in the four upper incisors with the e-max system ceram. The final aesthetic and functional result was approved by the patient and the professionals involved(AU)

Para alcanzar la estética en dientes anteriores se debe tener conocimiento de diversas técnicas y principalmente hacer la elección correcta de los materiales. Las cerámicas dentales están cada vez más presentes en las restauraciones, ya que poseen óptimas propiedades ópticas y mecánicas. Así, el objetivo de este estudio fue proporcionar la estética en dientes anteriores con diferentes sustratos a través de una prótesis fija metal-free. Paciente del género masculino, 38 años, buscó atención quejándose de la estética de su sonrisa. En el examen clínico se observó una corona total metalocerámica en el elemento 21 y facetas de resina compuesta en los elementos 11,12 y 22, todas con estética insatisfactoria. El diente 21 presentaba un núcleo metálico fundido adecuado y los dientes 12 y 22 con tratamientos endodónticos. Se propuso la instalación de pines de fibra de vidrio en los dientes 12 y 22. Además, de la confección de coronas totales metales libres en disilicato de litio en los cuatro incisivos superiores con el sistema e-max ceram. El resultado final estético y funcional fue aprobado por el paciente y los profesionales involucrados(AU)

Reabilitação estética anterior associando prótese metalocerâmica e prótese fixa metal-free: relato de caso / Previous aesthetic rehabilitation associated with metaloceramic prosthesis and fixed metal-free prosthesis: case report / Rehabilitación estética anterior asociando prótesis metalocerámica y prótesis fixa metal-free: reporte de caso

Devido a evolução dos sistemas cerâmicos, atualmente, são permitidas inúmeras associações de materiais restauradores. Entretanto, mimetizar as características visuais das próteses livres de metal com próteses metalocerâmica permanece um desafio. Assim, o objetivo deste trabalho foi relatar o caso clínico de substituição de próteses desadaptadas, homogeneizando próteses parciais fixas livres de metal e metalocerâmicas dento e implantossuportadas, após cirurgia periodontal. O paciente de 55 anos, gênero masculino, compareceu à Clínica de Prótese Parcial Fixa, da Faculdade de Odontologia de Araçatuba ­ FOA/UNESP em 2017 queixando-se dos seus dentes anteriores estarem "feios" e com a "raiz aparecendo". No exame clínico foi constatada recessão gengival nos elementos 11 e 13, os quais continham uma prótese parcial fixa de três elementos metalocerâmicas desadaptada, prótese sobre implante nos elementos 21 e 22, que apresentavam-se desadaptadas e com estética desfavorável. No exame radiográfico pôde-se observar a presença de um núcleo metálico fundido nos elementos 11 e 13. Foi proposto, então, a confecção de coroas totais livres de metal nos elementos anteriores superiores (13, 12, 11, 21 e 23) e coroa metalocerâmica para o elemento 22. Para isso, foi realizado enceramento diagnóstico inicial e, após o consentimento do paciente, foi efetuada a remoção das próteses antigas. Com a remoção, visualizamos uma . depressão na vestibular do rebordo na área do 12 (ausente), solucionado com um enxerto gengival subepitelialApós a realização dos preparos dentários e moldagem com silicone de adição as peças foram confeccionadas com sistema e.max Ceram (Ivoclar Vivadent). Após a prova estética e ajustes oclusais iniciais, as peças foram preparadas para cimentação resinosa com o sistema Variolink® N (Ivoclar Vivadent). O cimento transparente Conclui-se que, apesar da disparidade dos materiais, é possível mimetizá-los e foi selecionado previamente por meio de provas com o kit Try-In.oferecer resultados reabilitadores suficientemente estéticos e satisfatórios(AU)

Due to the evolution of ceramic systems, numerous associations of restorative materials are now permitted. However, mimicking the visual characteristics of metal-free prostheses with metal-ceramic dentures remains a challenge. Thus, the objective of this study was to report the clinical case of replacement of maladaptive dentures, homogenizing denture free and fixed metal partial dentures and implants supported after periodontal surgery. The patient, 55 years old, male, attended the Fixed Partial Prosthesis Clinic of the Faculty of Dentistry of Araçatuba - FOA / UNESP in 2017 complaining that his anterior teeth were "ugly" and with the "root appearing". In the clinical examination, gingival recession was observed in elements 11 and 13, which contained a fixed partial prosthesis of three maladaptive metal-ceramic elements, a prosthesis on implants in elements 21 and 22, the prostheses were maladapted and unfavorable esthetics. In the radiographic examination it is possible to observe the presence of a molten metal nucleus in elements 11 and 13. It was proposed, then, the manufacture of free metal crowns in the upper anterior elements (13, 12, 11, 21 and 23) and crown PFM for the element 22. For this, it performed waxing initial diagnosis and after the patient's consent, the removal of the old prosthesis were performed. Upon removal, a depression visualize the buccal flange in the area 12 (absent), solved with a subepithelial gum graft. After the dental preparations and molding with silicone of addition the pieces were made with e.max Ceram system (Ivoclar Vivadent). After the initial test and aesthetic occlusal adjustments, the pieces were prepared for cementing with resin Variolink® N system (Ivoclar Vivadent). The clear cement was previously selected by the test realized with Try-In kit. We conclude that, despite the disparity of materials, it is possible to mimic them and offer rehabilitative results sufficiently aesthetic and satisfactory(AU)

Debido a la evolución de los sistemas cerámicos, actualmente, se permiten numerosas asociaciones de materiales restauradores. Sin embargo, mimetizar las características visuales de las prótesis libres de metal con prótesis metalocerámicas sigue siendo un desafío. Así, el objetivo de este trabajo fue relatar el caso clínico de sustitución de prótesis desadaptadas, homogeneizando prótesis parciales fijas libres de metal y metalocerámicas dento e implantosuportadas, después de cirugía periodontal. El paciente de 55 años, género masculino, asistió a la Clínica de Prótesis Parcial Fija, de la Facultad de Odontología de Araçatuba - FOA / UNESP en 2017 quejándose de sus dientes anteriores estar "feos" y con la "raíz apareciendo". En el examen clínico se constató recesión gingival en los elementos 11 y 13, los cuales contenían una prótesis parcial fija de tres elementos metalocerámicos desadaptados, prótesis sobre implante en los elementos 21 y 22, las prótesis se presentaban desadaptadas y con estética desfavorable. En el examen radiográfico se puede observar la presencia de un núcleo metálico fundido en los elementos 11 y 13. Se propuso entonces la confección de coronas totales de metal en los elementos anteriores superiores (13, 12, 11, 21 y 23) y corona metalocerámica para el elemento 22. Para ello, se realizó el encerado diagnóstico inicial y, tras el consentimiento del paciente, se efectuó la remoción de las prótesis antiguas. Con la remoción, visualizamos una depresión en la vestibular del borde en el área del 12 (ausente), solucionado con un injerto gingival subepitelial. Después de la realización de los preparados dentales y moldeo con silicona de adición las piezas fueron confeccionadas con sistema e.max Ceram (Ivoclar Vivadent). Después de la prueba estética y ajustes oclusales iniciales, las piezas fueron preparadas para cementación resinosa con el sistema Variolink® N (Ivoclar Vivadent). El cemento transparente fue seleccionado previamente por medio de pruebas con el kit Try-In. Se concluye que, a pesar de la disparidad de los materiales, es posible mimetizarlos y ofrecer resultados rehabilitadores suficientemente estéticos y satisfactorios(AU)

Efeito de diferentes protocolos de polimento e repolimento de consultório (intraoral) nas propriedades físicas, químicas e mecânicas de cerâmica para o sistema CAD/CAM após simulação in vitro de 3 e 6 anos de uso clínico / Effect of different polishing and repolishing protocols (intraoral) on the physical, chemical and mechanical properties of ceramics for the CAD / CAM system after in vitro simulation of 3 and 6 years of clinical use

O melhor método para atingir uma superfície lisa das cerâmicas odontológicas é uma questão de controvérsia, devido à falta de um protocolo estabelecido na literatura. Atualmente, há o questionamento se os kits de polimento para consultório resultam em um acabamento e polimento superior ou semelhante ao obtido com o glaze, sendo esta questão de suma importância. Dessa forma, o presente estudo teve como objetivo avaliar as características físicas, químicas e mecânicas da cerâmica de dissilicato de lítio para o sistema CAD/CAM, submetida a diferentes protocolos de polimento e após diferentes ciclos de envelhecimento térmico, com e sem repolimento. Foram confeccionados 204 espécimes (14x4x1,2 mm) divididos em 07 grupos, de acordo com os polimentos realizados em suas superfícies e ciclos de ciclagem térmica (CT). Três sistemas de polimento foram avaliados: Glaze, Kit de polimento Ceramisté (Shofu) e Kit de polimento OptraFine (Ivoclar). O envelhecimento ocorreu por meio de diferentes testes: T1 - armazenamento em água destilada por 24 horas (controle); T2 ­ após 21.900 ciclos de 5 e 55o C por 30 segundos de CT (CT1); T3 - após 43.800 ciclos de CT (CT2); e após 21.900 ciclos de CT + repolimento dos espécimes + 21.900 ciclos de CT. Foram consideradas 5 variáveis de resposta: (1) rugosidade superficial (Ra), (2) energia de superfície (ES), (3) microscopia eletrônica de varredura (MEV) associada a espectroscopia de energia dispersiva (EED), (4) resistência à flexão (RF) e (5) módulo de elasticidade (ME). Os dados quantitativos foram submetidos à análise estatística ANOVA (2 fatores) e teste de Tukey, com nível de significância de 5%. Os resultados de Ra mostraram diferença estatística entre todos os grupos, sendo que o Grupo Glaze, apresentou menores valores. Para ES, houve diminuição dos valores após 43.800 ciclos de ciclagem térmica em todos os grupos. As imagens de MEV mostraram uma superfície mais lisa e homogênea nos espécimes do Grupo Glaze e mais rugosas e com depressões nos espécimes do Grupo Desgaste com ponta diamantada. Na RF, após 43.800 ciclos de ciclagem térmica, o Grupo Glaze apresentou maiores valores, sendo diferente estatisticamente de todos os outros grupos (p<0,001). Não houve diferença estatística entre os grupos que receberam polimento e repolimento com os Kits de polimento intraorais. No ME os grupos que receberam o glaze apresentaram maiores valores do que os demais grupos. O repolimento favoreceu na caracterização de superfície dos espécimes, porém, não influenciou na resistência à flexão e no módulo de elasticidade, exceto o grupo que recebeu polimento com o kit OptraFine. Em todas as análises quantitativas, o envelhecimento através da ciclagem térmica influenciou negativamente nas propriedades avaliadas, exceto para a análise de ES que, em geral, após o envelhecimento, houve uma diminuição dos valores(AU)

The best method to achieve a smooth surface of dental ceramics is a controversy, due to the lack of a protocol established in the literature. Nowadays, the question is whether office polishing kits result in superior finishing and polishing or similar to that obtained with glaze, being this issue of utmost importance. In this way, the present study aimed to evaluate the physical, chemical and mechanical of lithium disilicate ceramics for the CAD / CAM system, submitted to different clinical polishing protocols and after cycles of thermal fatigue with and without repolishing. A total of 204 specimens of 14x4x1.2mm dimensions was prepared and divided into 07 groups according to the polishes performed on their surfaces and thermal cycling cycles (TC). Three polishing systems will be evaluated: Glaze, Ceramisté Polishing Kit (Shofu) and OptraFine Polishing Kit (Ivoclar). The aging was perfomed by different tests: T1- storage in distilled water for 24 hours (Control); T2 - after 21,900 cycles of 5 and 55oC for 30 seconds of TC (TC1); T3 - after 43.800 cycles of TC (TC2) and after 21.900 cycles of TC + repolishing of the specimens + 21.900 cycles of TC. Five response variables were considered: (1) surface roughness (Ra), (2) surface energy (SE), (3) scanning electron microscopy (SEM) associated with energy dispersive spectroscopy (EDS), (4) flexural strength (FS), and (5) modulus of elasticity (ME). The quantitative data were submitted to ANOVA (two way) and Tukey test with significance level of 5%. The results of Ra showed statistical difference among all groups, and the Glaze Group showed lower values. For SE, there was a decrease in values after 43,800 cycles of thermal cycling in all groups. The SEM images showed a smoother and homogeneous surface in Glaze Group specimens and were more rough and with depressions in the Group Diamond wear specimens. In FS, after 43,800 cycles of thermal cycling, the Glaze Group presented higher values, being statistically different from all other groups (p <0.001). There was no statistical difference between the groups that received polishing and repolishing with the intraoral polishing Kits. In ME, the groups that received glaze had higher values than the other groups. The repolishing protocol favored the surface characterization of the specimens, but did not influence flexural strength and modulus of elasticity, except the group that was polished with the OptraFine kit. In all quantitative analyzes, aging through thermal cycling had a negative influence on the evaluated properties, except for ES analysis, which, in general, after aging, decreased values(AU)