Impact of the Microstructure of CAD/CAM Blocks on the Bonding Strength and the Bonded Interface.

PURPOSE: To investigate the relationship between the microstructure of CAD/CAM blocks and the quality of adhesion as function of the surface treatment and resin cement type. MATERIALS AND METHODS: Two nano-ceramic composite resin CAD/CAM blocks, Lava Ultimate (LU) and Cerasmart (CS), and two Leucite-reinforced glass ceramic CAD/CAM IPS blocks, Empress® CAD (EM) and InitialTM LRF (IR), received either Hydrofluoric acid (HF) or sandblasting (SB) surface treatments. The blocks were then luted using two dual-cure resin cements, LinkForce (LF) and Multilink Automix (ML) with their corresponding silanes, resulting in 16 study groups. The luted blocks were then thermal-cycling (TC) for 5000 cycles and subjected to a microtensile bond strength (µTBS) test. Scanning electron microscopy (SEM) micrographs of the treated surfaces were analyzed using ImageJ software and XRD analyses were performed for the two ceramic blocks. The data obtained were submitted to Games-Howell post-hoc nonparametric test to compare combinations of groups or treatments and a linear mixed-effects model for the factors surface treatment, block type, and resin cement, together with their first-degree interactions (α = 0.05). RESULTS: The lowest mean µTBS values were obtained with LU-HF, whereas the highest mean µTBS values were obtained with CS regardless of resin cement type and surface treatment method. IR-HF mean µTBS were significantly higher than IR-SB, EM-SB, and EM-HF. Analysis using ImageJ software demonstrated significant differences in the density and pore size after HF surface treatment. CONCLUSIONS: The specific microstructure of each block material within the same family group impacted the micromechanical retention and the bonded interface strength.

Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic review of in vitro studies.

STATEMENT OF PROBLEM: Different parameters can influence the adaptation of computer-assisted design and computer-assisted manufacturing (CAD-CAM) inlay/onlay restorations. However, systematic reviews to identify and discuss these parameters are lacking. PURPOSE: The purpose of this systematic review was to summarize the scientific literature investigating all parameters that can influence both the marginal and internal adaptation of CAD-CAM inlay/onlay restorations. MATERIAL AND METHODS: An electronic search was conducted by 2 independent reviewers for studies published in English between January 1, 2007 and September 20, 2017 on the PubMed/MEDLINE, Scopus, and Web of Science databases and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Factors investigated in the selected articles included the type of CAD-CAM system, virtual space parameters, version of the software, type of block, luting procedure, type of restoration, sample size and aging procedure, evaluation method, and number of measurement points per specimen. RESULTS: A total of 162 articles were identified, of which 23 articles met the inclusion criteria. Nine studies investigated adaptation with different restorative materials, 2 evaluated adaptation according to the type of preparation design, 9 compared adaptation before/after thermomechanical loading, and 2 before/after cementation, 1 study investigated marginal adaptation based on whether the optical scan was made intraorally or extraorally, 1 compared adaptation with 5 and 3 axis CAM systems, and 1 assessed adaptation with 4 different intraoral scanners. The risk of bias was high for 7, medium for 15, and low for 1 of the studies reviewed. The high level of heterogeneity across the studies excluded meta-analysis. CONCLUSIONS: Most of the studies reported clinically acceptable values for marginal adaptation. The performance of a CAD-CAM system is influenced by the type of restorative material. A nonretentive cavity preparation exhibited better adaptation than a retentive preparation. Most studies showed that thermomechanical loading affected the quality of marginal adaptation. Cementation increased marginal discrepancies. No statistically significant difference was found for marginal fit of onlays between intraoral and extraoral optical scans using a stone die. The number of milling axes, the type of digital camera, and the region measured were statistically significant in relation to marginal/internal adaptation. Values of adaptation recorded failed to reproduce the preestablished spacer parameters in the software. Clarification is needed concerning adaptation according to the type of preparation design, the type of material, the choice of intrinsic parameters for the CAD process, the type and shape of milling instruments, and the behavior of the material during milling. Adaptation of CAD-CAM inlay/onlays should be evaluated under clinical conditions.

Mechanical properties and internal fit of 4 CAD-CAM block materials.

STATEMENT OF PROBLEM: Recent polymer-based computer-assisted design and computer-assisted manufacturing (CAD-CAM) materials have been commercialized for inlay restorations, a polymer-infiltrated ceramic-network (PICN) and composite resin nanoceramics. Little independent evidence regarding their mechanical properties exists. Internal adaptation is an important factor for the clinical success and longevity of a restoration, and data concerning this parameter for inlays made with these blocks are scarce. PURPOSE: The purpose of this in vitro study was to evaluate and compare the mechanical properties (flexural strength, flexural modulus, Vickers hardness, fracture toughness) and the internal adaptation of these recent polymer-based blocks with a lithium disilicate glass-ceramic block. MATERIAL AND METHODS: The materials tested in this study were a PICN material (Vita Enamic), 2 composite resin nanoceramics (Lava Ultimate; 3M ESPE and Cerasmart; GCDental Products), and a lithium disilicate glass-ceramic (IPS e.max CAD). Mechanical properties were evaluated according to ISO norm DIS 6872:2013. Bar-shaped specimens (18×3×3 mm) were prepared and submitted to a 3-point bend test using a universal testing machine at a cross-head speed of 0.5 mm/min. In addition, identical cavities were prepared in 60 human mandibular extracted molars (n=15) and optically scanned to receive mesioocclusodistal inlays milled with the 4 materials tested in a CEREC Inlab milling machine. The replica technique and a stereomicroscope (×20) were used to measure the internal fit of the inlays at 9 preselected locations. All data were statistically analyzed using 1-way ANOVA and the post hoc Tukey multiple comparison or Games-Howell test (α=.05). RESULTS: The mean flexural strength of the tested blocks ranged from 148.7 ±9.5 MPa (Vita Enamic) to 216.5 ±28.3 MPa (Cerasmart). The mean flexural modulus ranged from 23.3 ±6.4 GPa (Vita Enamic) to 52.8 ±10.5 GPa (IPS e.max CAD). The mean Vickers hardness ranged from 0.66 ±0.02 GPa (Cerasmart) to 5.98 ±0.69 GPa (IPS e.max CAD). The mean fracture toughness ranged from 1.2 ±0.17 MPa.m1/2 (Cerasmart) to 1.8 ±0.29 MPa.m1/2 (IPS e.max CAD). The values for internal discrepancy ranged from 119 ±55 µm to 234 ±51 µm. The mean internal discrepancy was significantly higher for Lava Ultimate (P<.05) than IPS e.max CAD and Cerasmart but not for Vita Enamic. The factor ''material'' was statistically significant in relation to the mechanical properties evaluated in this study (P<.05). The Pearson correlation was negative between the flexural strength results and the internal discrepancy of the materials tested (R2=0.941; P<.05). CONCLUSIONS: The mechanical properties of the CAD-CAM block materials tested were within the acceptable range for fabrication of single restorations according to the ISO standard for ceramics (ISO 6872:2008). IPS e.max CAD and Cerasmart were observed to have superior flexural strength and better internal fit.

Intraoral Scanner Technologies: A Review to Make a Successful Impression.

To overcome difficulties associated with conventional techniques, impressions with IOS (intraoral scanner) and CAD/CAM (computer-aided design and manufacturing) technologies were developed for dental practice. The last decade has seen an increasing number of optical IOS devices, and these are based on different technologies; the choice of which may impact on clinical use. To allow informed choice before purchasing or renewing an IOS, this article summarizes first the technologies currently used (light projection, distance object determination, and reconstruction). In the second section, the clinical considerations of each strategy such as handling, learning curve, powdering, scanning paths, tracking, and mesh quality are discussed. The last section is dedicated to the accuracy of files and of the intermaxillary relationship registered with IOS as the rendering of files in the graphical user interface is often misleading. This overview leads to the conclusion that the current IOS is adapted for a common practice, although differences exist between the technologies employed. An important aspect highlighted in this review is the reduction in the volume of hardware which has led to an increase in the importance of software-based technologies.