Effect of Endocrown Pulp Chamber Extension Depth on Molar Fracture Resistance.

PURPOSE: The purpose of this study was to evaluate the effect of endocrown pulp chamber extension on mandibular molar fracture resistance. METHODS AND MATERIALS: A total of 36 recently extracted mandibular third molars of approximate equal size were sectioned at the facial lingual height of contour followed by endodontic access into the pulp chamber. The specimens were then randomly divided into three groups (n=12) and pulpal and root canal contents removed. Pulp chamber floors were established at 2, 3, and 4 mm from the occlusal table using a three-step etch-and-rinse adhesive and a flowable resin composite. The prepared specimens were then embedded in auto-polymerizing denture base resin with surface area available for adhesive bonding determined using a digital recording microscope. Specimens were restored using a standardized template with a chairside computer-aided design/computer-aided manufacturing unit with the endocrown milled from a lithium disilicate glass-ceramic material. Restoration parameters of occlusal table anatomy and thickness were standardized with the only parameter difference being the pulp chamber extension depth. The endocrown restorations were luted with a self-adhesive resin luting agent and tested to failure after 24 hours on a universal testing machine, with force applied to the facial cusps at a 45° angle to the long axis of the tooth. The failure load was converted into stress for each specimen using the available surface area for bonding. Mean failure load and stress among the three groups was first subjected to the Shapiro-Wilk and Bartlett tests and then analyzed with an analysis of variance with the Tukey post hoc test at a 95% confidence level (p=0.05). RESULTS: The 2- and 4-mm chamber extension groups demonstrated the highest fracture resistance stress, with the 3-mm group similar to the 2-mm group. The 3- and 4-mm chamber extension group specimens demonstrated nearly universal catastrophic tooth fracture, whereas half the 2-mm chamber extension group displayed nonrestorable root fractures. CONCLUSIONS: Under the conditions of this study, mandibular molars restored with the endocrown technique with 2- and 4-mm pulp chamber extensions displayed greater tooth fracture resistance force as well as stress. All groups demonstrated a high number of catastrophic fractures, but these results may not be clinically significant because the fracture force results are higher than normal reported values of masticatory function.

Premolar Axial Wall Height Effect on CAD/CAM Crown Retention.

OBJECTIVE: To evaluate the significance of reduced axial wall height on retention of adhesively luted, all-ceramic, lithium disilicate premolar computer-aided design/computer-aided manufacturing (CAD/CAM) crowns based on preparations with a near ideal total occlusal convergence of 10°. METHODS: Forty-eight recently extracted premolars were randomly divided into four groups (n=12). Each group received all-ceramic CAD/CAM crown preparations featuring axial wall heights of 0, 1, 2, and 3 mm, respectively, all with a 10° total occlusal convergence. Scanned preparations were fitted with lithium disilicate all-ceramic crowns that were luted with a self-etching resin cement. Specimens were tested to failure at a 45° angle to the tooth long axis with failure load converted to megapascals (MPa) based on the measured bonding surface area. Mean data were analyzed using analysis of variance/Tukey's post hoc test (α=0.05). RESULTS: Lithium disilicate crowns adhesively luted on preparations with 0 axial wall height demonstrated significantly less failure resistance compared with the crowns luted on preparations with axial wall heights of 1 to 3 mm. There was no failure stress difference between preparations with 1 to 3 mm axial wall height. CONCLUSIONS: Under conditions of this study, adhesively luted lithium disilicate bicuspid crowns with a total occlusal convergence of 10° demonstrated similar failure resistance independent of axial wall height of 1 to 3 mm. This study provides some evidence that adhesion combined with an ideal total occlusal convergence may compensate for reduced axial wall height.

Effect of Selective Etch on the Bond Strength of Composite to Enamel Using a Silorane Adhesive.

An improvement in bond strength to enamel has been demonstrated with the use of phosphoric acid prior to bonding with self-etch methacrylate-based adhesive agents. No research has evaluated the effect of phosphoric-acid etching of enamel with a newer self-etch silorane adhesive. The purpose of this study was to evaluate the shear-bond strength of composite to enamel using the self-etch silorane adhesive compared to other self-etching methacrylate-based adhesives, with or without a separate application of phosphoric acid. Bovine incisors were sectioned using a diamond saw and mounted in plastic pipe. The bonding agents were applied to flattened enamel surfaces with or without the application of 35% phosphoric acid. The bonded tooth specimens were inserted beneath a mold, and composite was placed incrementally and light cured. The specimens were stored for 24 hours and six months in water and tested in shear. Data were analyzed with a three-way analysis of variance (ANOVA) to evaluate the effects of surface treatment, adhesive agent, or time on the bond strength of composite to bovine enamel (α=0.05). Significant differences were found between the groups based on surface treatment (p<0.01) or adhesive agent (p<0.01), but not on time (p=0.19), with no significant interactions (p>0.14). Phosphoric-acid etching of bovine enamel significantly increased the bond strength of the self-etch methacrylate and the silorane adhesives. The methacrylate-based adhesives had significantly greater bond strength to enamel than the silorane adhesive.

The effect of simplified adhesives on the bond strength to dentin of dual-cure resin cements.

The purpose of this study was to compare the shear bond strengths to dentin of two dual-cure resin cements, one with a unique initiator, NX3 (Kerr Corp), and the other with a traditional redox-initiator system, Calibra (Dentsply), when used in combination with simplified or nonsimplified adhesive agents. The two dual-cure resin cements, in either self- or dual-cure activation modes, were bonded to human dentin with four dental adhesives to create 16 subgroups of 10 specimens each. After 24 hours of storage in distilled water at 37°C, the specimens were tested in shear in a universal testing machine. With both NX3 and Calibra, bond strengths significantly increased when the specimens were dual cured. In addition, with either cement in either mode, the nonsimplified adhesives performed significantly better than did the simplified adhesive bonding agents. When used specifically with simplified adhesives in either cure mode, NX3 did not produce significantly higher bond strengths than did Calibra. In general, lower dentin bond strengths were found with simplified adhesives or self-cure activation with either resin cement.