Dental zirconia microwave-sintering followed by rapid cooling protocol.

OBJECTIVES: This study aimed to evaluate the effect of microwave sintering temperature and cooling rate (MS) on 3Y-TZP ceramics and its influence on the ceramic microstructure and mechanical properties. Specifically, to optimize the sintering process, reducing the total sintering time compared to conventional sintering. MATERIALS AND METHODS: Eighty-four pre-sintered Y-TZP discs (Vipi block Zirconn, VIPI) (ISO 6872) were divided into seven groups (n = 12) according to the sintering conditions: conventional sintering (CS) at 1530 °C for 120 min and microwave sintering at 1400 °C (MS1400) and 1450 °C (MS1450) for 15 min followed by different cooling conditions: rapid cooling (RC), cooling at 400 °C (C400) and 25 °C (C25). The specimens were submitted to apparent density measurements, X-ray diffraction analysis (XRD), scanning electron microscopy, and biaxial flexural strength test. Data was statistically analyzed through two-way ANOVA, Tukey, Sidak, Dunnett and Weibull (α = 0.05). RESULTS: All MS1400 groups presented lower density values than the CS and MS1450 groups. Two-way ANOVA revealed that the MS temperature and cooling rate affected the biaxial flexural strength of the Y-TZP (p < 0.01). Group MS1400RC presented lower biaxial flexural strength values (681.9 MPa) than MS1450RC (824.7 MPa). The cooling rate did not statistically decrease the biaxial strength among the groups submitted to microwave sintering at 1450 °C. XRD analysis showed that the sintering and cooling temperature did not induce tetragonal to monoclinic phase transformation. CONCLUSIONS: Microwave sintering at 1450 °C for 15 min followed by rapid cooling can be a viable fast alternative protocol for Y-TZP sintering, compared with the conventional sintering, reducing the total sintering time by 75% and reducing the energy used for the sintering process without affecting the Y-TZP biaxial flexural strength and relative density compared to the conventional sintering. Moreover, the microwave technique promoted smaller grains and did not induce monoclinic phase formation.

New adhesive protocol improves shear bond strength of Polyetherketoneketone (PEKK).

OBJECTIVE: Inert surface of Polyetherketoneketone (PEKK) jeopardizes resin bonding. This study aimed to present a new adhesive protocol to improve PEKK bonding. METHODS: A total of 360 PEKK blocks were milled, polished (maximum roughness of 0.20 µm), and randomly assigned to groups. The new protocol was applied (n = 36) and compared to conventional treatments (no treatment; sandblasting (110-µm Al2O3 and silica); no adhesive; Visiolink (Bredent); and PEKKbond (AnaxDent)) (n = 36). For the new protocol, the surface was blasted (110 µm Al2O3 and 96% isopropyl alcohol at 60 psi), followed by 96% isopropyl alcohol washing, and air drying. PEKKbond was applied (dried for 3 min at 77 °C), followed by Visiolink (dried for 3 min at 60 °C); both light-cured for 3 min (800 mW/cm2). Preopaque (GC Europe) and Opaque (AnaxDent) were applied and light-cured (5 min). Morphological topography was analyzed, and flowable gingiva-colored composite (AnaxGum, AnaxDent) was bonded. All specimens were aged for 24 h and thermocycled (5000 cycles, 5-55 °C). Shear bond strength (SBS) was measured (MPa) and data were analyzed by two-way ANOVA, Tukey, and Weibull moduli estimation (α = 0.05). RESULTS: The highest SBS values were found in the new protocol (p < 0.05), regardless of aging. Thermocycling reduced SBS (p < 0.05), while Al2O3 and PEKKbond produced higher SBS values than silica and Visiolink, respectively (p < 0.05). SIGNIFICANCE: The new protocol strongly improves PEKK adhesiveness, and this can reflect in the longevity of prostheses.

Is scanning under rubber dam isolation a feasible approach for the execution of indirect restorations? / O escaneamento sob isolamento absoluto é uma técnica viável para execução de restaurações indiretas?

Objective: The aim of the study was to report the aplicability of intraoral scanning while rubber dam isolation is in place. Material and Methods: Female patient, 50 years old, required restorative procedures on teeth 35 and 37. An intraoral scan was initially performed on both arches. Isolation was carried out from 33 to 37, tooth preparation and immediate dentin sealing were carried out. A new scan with the rubber dam in place was performed and a CAD/CAM lithium disilicate hybrid block was digitally designed, milled, crystallized and cemented under the tooth surface with the rubber dam still in position. After completing this stage, the rubber dam was removed, the occlusion was verified, presenting excellent aesthetic and functional results. Results: The absolute isolation process used in the present study works as an excellent device for gingival retraction. Conclusion: The absolute isolation can be recommended in clinical activities of intraoral scanning favoring the quality of the final result of treatments (AU)

Objetivo: O objetivo do estudo foi relatar a aplicabilidade do escaneamento intraoral sob isolamento absoluto. Material e Métodos: Paciente do sexo feminino, 50 anos, necessitou de procedimentos restauradores nos dentes 35 e 37. Uma varredura intraoral foi inicialmente realizada em ambos os arcos. O isolamento absoluto foi feito de 33 a 37, permitindo a realização do preparo dentário e selamento imediato da dentina. Um novo escaneamento com o dique de borracha colocado foi realizado e um bloco híbrido de dissilicato de lítio CAD/CAM foi projetado digitalmente, fresado, cristalizado e cimentado sob a superfície dentária ainda com o dique de borracha em posição. Após a finalização dessa etapa, o dique de borracha foi removido, a oclusão foi verificada apresentando ótimos resultados estéticos e funcionais. Resultados: O isolamento absoluto utilizado no presente estudo funciona como um excelente dispositivo para retração gengival. Conclusão: O isolamento absoluto pode ser recomendado em atividades clínicas de escaneamento intraoral favorecendo a qualidade do resultado final dos tratamentos (AU)

Are Tooth and Ceramic Fractures Different Sides of the Same Coin? A Report of Two Clinical Cases.

Two clinical cases involving the fracture of a natural tooth and one of a ceramic crown are presented and discussed based on fractography principles. In the first case, a patient reported intense pain in a sound third molar where a longitudinal fracture was identified, and the tooth was extracted. In the second case, a posterior rehabilitation using a lithium silicate ceramic crown was carried out, and the patient returned after 1 year with a fractured piece of the crown. Both were analyzed under microscopy to identify the origins of fractures and their causes. The fractures were critically analyzed so that relevant information could be generated from the laboratory to the clinic.

Are tooth and ceramic fractures different sides of the same coin? Report of two clinical cases.

Two clinical cases involving the fracture of a natural tooth and of a ceramic crown were presented and discussed based on fractography principles. In the first case, a patient reported intense pain in a sound third molar, where a longitudinal fracture was identified, and the tooth was extracted. In the second case, a posterior rehabilitation using a LS (lithium-silicate) ceramic crown was carried out and after one year, the patient returned with a fractured piece of the crown. Both were analyzed under microscopy, to identify the origins of fractures and their causes. The fractures were critically analyzed so that relevant information could be generated from the laboratory to clinic.

Polishing the bonding surface, before or after crystallization, does not alter the fatigue behavior of bonded CAD-CAM lithium disilicate.

The aim of this study was to assess if the finishing/polishing of the bonding surface of lithium disilicate ceramic, prior to or after crystallization, would affect the fatigue behavior of a bonded restorations. For this, lithium disilicate ceramic (IPS e.max CAD) discs (n = 15) were milled and randomly divided into 3 groups: CAD-CAM group which remained untouched; PRE group which received a finishing/polishing protocol (OptraFine system) prior to its crystallization; and POST group, which received the treatment after its crystallization. After surface treatments, ceramic and glass-fiber reinforced epoxy resin discs were paired and bonded using a resin cement (Multilink N). A cyclical fatigue test was conducted (frequency 20 Hz, initial load 200 N for 5000 cycles, step-size of 100 N for 10,000 cycles/step) until failure occurrence. Surface roughness and topography were analyzed. An initial descriptive analysis of surface roughness, FFL and CFF was performed to obtain the mean, standard deviation and confidence interval values (SPSS v. 21, SPSS Inc.) for statistical analysis. Roughness data was using one-way ANOVA with Tukey's post hoc test (α = 0.05), while the fatigue data was submitted to survival analysis with Kaplan-Meier test (α = 0.05) and Weibull modulus (Weibull++, Reliasoft). Neither the finishing/polishing procedure of the bonding surface, nor the moment (prior to or after crystallization), affected the fatigue behavior of bonded milled lithium disilicate. There were also no differences for mechanical reliability among conditions. Despite this, finishing/polishing reduced surface roughness and led to smoother topography. Finishing/polishing the bonding surface of milled lithium disilicate, before or after crystallization, does not alter the fatigue behavior of the bonded restorative set, although there is some influence on roughness and topography.

Effect of Resin Cement at Different Thicknesses on the Fatigue Shear Bond Strength to Leucite Ceramic.

OBJECTIVES: This in vitro study was performed to evaluate fatigue survival by shear test in the union of leucite-reinforced feldspathic ceramic using different cement thicknesses. MATERIALS AND METHODS: Leucite-reinforced glass ceramics blocks were sectioned in 2-mm thick slices where resin cylinders were cemented. The samples were distributed in two experimental groups (n = 20) according to the cement thickness (60 and 300 µm). The specimens of each group were submitted to the stepwise fatigue test in the mechanical cycling machine under shear stress state, with a frequency of 2 Hz, a step-size of 0.16 bar, starting with a load of 31 N (1.0 bar) and a lifetime of 20,000 cycles at each load step. RESULTS: The samples were analyzed in a stereomicroscope and scanning electron microscopy to determine the failure type. There is no significant difference between the mean values of shear bond strength according to both groups. Log-rank (p = 0.925) and Wilcoxon (p = 0.520) tests revealed a similar survival probability in both cement layer thicknesses according to the confidence interval (95%). The fracture analysis showed that the mixed failure was the most common failure type in the 300-µm thickness group (80%), while adhesive failure was predominant in the 60-µm thickness group (67%). The different cement thicknesses did not influence the leucite ceramic bonding in fatigue shear testing; however, the thicker cement layer increased the predominance of the ceramic material failure. CONCLUSION: The resin cement thicknesses bonded to leucite ceramic did not influence the long-term interfacial shear bond strength, although thicker cement layer increased the ceramic material cohesive failure. Regardless the cement layer thickness, the shear bond strength lifetime decreases under fatigue.

Impact of different complete coverage onlay preparation designs and the intraoral scanner on the accuracy of digital scans.

STATEMENT OF PROBLEM: The trueness and precision of intraoral scanners (IOSs) and the effect of intracoronal restorations have been reported. However, studies addressing the accuracy of IOSs in reproducing different complete coverage onlay preparation designs are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the influence of complete coverage onlay preparation design and intraoral scanning devices on the accuracy of digital scans in terms of trueness and precision. MATERIAL AND METHODS: Three preparation designs on the mandibular first molar were considered: a traditional preparation design with isthmus reduction (IST), a traditional preparation design without isthmus reduction (wIST), and simplified nonretentive preparation (nRET). Digital scans of epoxy resin mandibular arch reference models of the preparations (containing second premolar, first molar, and second molar) were obtained by using 3 IOSs (iTero Element 2 [ELE], Trios 3 [TRI], and Primescan [PRI]) (n=10). Trueness (µm) and precision (µm) were analyzed by superimposing the digital scan on the digital reference models obtained with a high-accuracy industrial scanner (ATOS Core 80) in a tridimensional metrology software program. Accuracy was quantified by the absolute deviation (µm). Local and overall mean positive and negative deviations for trueness were also obtained. Data were analyzed by using the Kruskal-Wallis and Dunn tests with a statistical software program (α=.05). RESULTS: The nonretentive preparation groups obtained higher trueness (3.8 µm) and precision (2.7 µm) than the IST and wIST groups (trueness=7.5 to 6.3 µm, precision=5.5 to 4.6 µm). Trueness values were lower with ELE×IST (16 µm), followed by ELE×wIST (13 µm), and PRI×IST (7.8 µm). In general, no difference was found between PRI and TRI scanners (6.3 to 5.9 µm), with lower performance for ELE (13 µm). Positive deviations were higher on the proximal box of the IST and wIST preparation and on the occlusal box of the IST group. Negative deviation was higher on the ELE×IST occlusal box. CONCLUSIONS: Different intraoral scanners and preparation designs influenced the accuracy of digital scans. A more complex preparation such as IST and wIST showed higher deviation. The iTero Element 2 scanner exhibited higher deviation for both trueness and precision.

Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation.

OBJECTIVES: This study evaluated the effect of deep margin elevation (DME) and restorative materials (leucite-reinforced glass-ceramics [C] vs. indirect resin composite [R]) on the fatigue behavior and stress distribution of maxillary molars with 2-mm deep proximal margins restored with MOD inlay. METHODS: Fifty-two extracted human third molars were randomly assigned into four groups (n = 13): C; DME + C; R; and DME + R. Inlays were fabricated in CAD-CAM and bonded to all teeth. The fatigue behavior was assessed with the stepwise stress test (10,000 cycles/step; step = 50 N; 20 Hz; initial load = 200 N). Fatigue failure loads and the number of cycles were analyzed with 2-way ANOVA and Tukey's test (p < 0.05) and Kaplan-Meier survival plots. The stress distribution was assessed with finite element analysis. The models were considered isotropic, linear, and homogeneous, and presented bonded contacts. A tripod axial load (400 N) was applied to the occlusal surface. The stress distribution was analyzed with the maximum principal stress criterion. RESULTS: For fatigue, there was no difference for DME factor (p > 0.05). For the material factor, the load and number of cycles for failure were statistically higher in the R groups (p < 0.05). The finite element analysis showed that resin composite inlays concentrated more stress in the tooth structure, while ceramic inlays concentrated more stress in the restoration. Non-reparable failures were more frequent in the resin composite inlays groups. CONCLUSIONS: DME was not negative for fatigue and biomechanical behaviors. Resin composite inlays were more resistant to the fatigue test, although the failure mode was more aggressive. CLINICAL SIGNIFICANCE: DME does not impair mechanical behavior. Resin composite inlays failed at higher loads but with a more aggressive failure mode.

Biomechanical, operative and biological aspects of the cervical margin relocation: a case report / Aspectos biomecânicos, operatórios e biológicos da recolocação da margem cervical com resina composta em cavidades classe II com margens profundas: um relato de caso

The clinical success of tooth-colored indirect restorations has been confirmed in several studies. However, inlays and onlays restorations in Class II cavities with deep gingival margins can still be considered a clinical challenge. With the purpose of facilitating the execution of the operative procedures in intrasulcular margins and reducing the risk of restorative failures, the technique of cervical margin relocation has been explored as a noninvasive alternative to surgical crown lengthening. This work aims at discussing through a case report the biomechanical, operative and biological aspects in the treatment of teeth with deep gingival margins. Therefore, given the therapy applied in the clinical case presented, it is concluded that the cervical margin relocation with composite resin is advantageous since it eliminates the need for surgery, allowing the implementation of indirect restorations in fewer clinical sessions, not causing damage to periodontal tissues once it provided good finishing and polishing with the establishment of a correct emergence profile, allowing flawless maintenance of gingival health after one year. (AU)

Sucesso clínico das restaurações indiretas livres de metal tem sido confirmado em diversos estudos. No entanto, restaurações parciais indiretas em cavidades do tipo classe II com margens profundas ainda podem ser consideradas um desafio clínico. Com a proposta de facilitar a execução dos procedimentos operatórios em margens intra-sulculares e reduzir a ocorrência de falhas, a técnica de elevação da margem gengival em resina composta tem sido explorada como alternativa não invasiva à cirurgia de aumento de coroa clínica. Este trabalho tem a intenção de discutir através de um relato de caso clínico os aspectos biomecânicos, operatórios e biológicos no tratamento de dentes com margens cervicais profundas. Sendo assim, conclui-se que a técnica de elevação da margem gengival com resina composta é vantajosa, pois elimina a necessidade de cirurgia permitindo a execução de restaurações indiretas em menos sessões clínicas, não gerando danos aos tecidos periodontais, desde que haja um bom acabamento e polimento, com estabelecimento de um correto perfil de emergência. (AU)

Guided endodontic access of severe calcified tooth without incisal edge ­ case report / Acesso endodôntico guiado de dente calcificado severamente sem borda incisal ­ relato de caso

Pulp tissue may suffer calcification because of trauma, operative procedures or carious lesions. This paper aimed to report and discuss the guided endodontic access as an alternative treatment. A 52 years old female patient had severe root canal calcification of tooth #11 associated with a radiolucent periapical lesion. Firstly, the crown and metal post and core were removed. A digital impression and cone-beam computed tomography "CBCT" scans were performed and imported to implant planning software (SimPlant Version 11; Materialise Dental, Leuven, Belgium).The guided endodontic access template was designed to allow the drill to reach a distance of 2 mm short of the apical foramen, once printed, it was tested in the mouth to evaluate its insertion and stability in the dental arch. The calcified root canal was penetrated using the access drill rotating by a low-speed hand-piece (10,000 rpm) under saline solution irrigation through advancing movements. Then, the apical foramen was negotiated with C-Pilot files #10 and #15. The working length was measured using the iPex-II apex locator. The instrumentation was carried out with Reciproc R50 and 2.5% sodium hypochlorite. One week later, a full-ceramic crown preparation was performed, and polyvinyl siloxane impression was carried out. A total of three follow-up sessions were performed after one week, one and twelve months. Bone neoformation was observed in the site of the periapical lesion and the patient had no signs or symptoms of any discomfort. Therefore, guided endodontics is indicated for severe calcified root canals.(AU)

O tecido pulpar pode sofrer calcificação por trauma, procedimentos cirúrgicos ou como resposta a lesões cariosas. Este trabalho teve como objetivo relatar e discutir o acesso endodôntico guiado como opção de tratamento. Paciente do sexo feminino, 52 anos, com calcificação severa do canal radicular do dente 11 associada a lesão periapical radiolucida. Na primeira intervenção clínica, a coroa e o pino de metal foram removidos. Uma impressão digital e imagens de CBCT foram realizadas e importadas para o software de planejamento de implante (SimPlant Versão 11; Materialize Dental, Leuven, Bélgica) tentando projetar um modelo de acesso endodôntico guiado para permitir que a broca alcance uma distância de 2 mm antes do forame apical, uma vez impresso, foi testado na boca para avaliar sua inserção e estabilidade na arcada dentária. O canal radicular calcificado foi penetrado com broca de acesso girando por peça de mão de baixa velocidade (10.000 rpm) sob irrigação com solução salina por meio de movimentos de avanço. Em seguida, o forame apical foi negociado com as limas C-Pilot nº 10 e nº 15. O comprimento de trabalho foi determinado usando o localizador de ápice iPex-II. A instrumentação foi realizada com Reciproc R50 e hipoclorito de sódio 2,5%. Uma semana depois, foi realizado o preparo da coroa total em cerâmica e a moldagem com polivinilsiloxano. Um total de três sessões de acompanhamento foram realizadas após uma semana, um e doze meses. A neoformação óssea foi observada no local da lesão periapical e a paciente não apresentava sinais ou sintomas de qualquer desconforto. Portanto, o acesso endodôntico guiado é indicado para canais radiculares calcificados severamente.(AU)

Effect of active application of self-etching ceramic primer on the long-term bond strength of different dental CAD/CAM materials.

BACKGROUND: The objective of this in vitro study was to evaluate the effect of the active application of self-etching ceramic primer (ME&P) on the bond strength of different dental CAD/CAM materials (Lithium Disilicate ceramic (LD), Leucite ceramic (LE), Zirconia reinforced lithium silicate ceramic (ZLS), and Hybrid ceramic (HC)) with thermocycling aging. MATERIAL AND METHODS: The samples were randomly divided into 16 groups (n = 20). Dual resin cement cylinders were made and light cured for 10 s (1.200 mW/cm2) for the shear bond strength test. 3-way ANOVA revealed that the factors were statistically significant (P< 0.05). RESULTS: The aging process had a negative impact on the bond strength for all groups except for Lithium Disilicate, with active application. ZLS and LE showed promising results with high bond strength values for the ME&P active application; however, after aging the bond strength value was significantly reduced. HC showed reduced bond strength values regardless the ME&P application. CONCLUSIONS: In order to obtain a durable bond strength, the recommended protocol of 20 s of active application followed by 40 s of sitting time in the self-etching ceramic primer should be followed when using reinforced-glass ceramics as restorative materials. Key words:Dentistry, dental materials, silane, shear strength, computer-aided design.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial.

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Mechanical Behavior of Different Restorative Materials and Onlay Preparation Designs in Endodontically Treated Molars.

This study evaluated the effect of the combination of three different onlay preparation designs and two restorative materials on the stress distribution, using 3D-finite element analysis. Six models of first lower molars were created according to three preparation designs: non-retentive (nRET), traditional with occlusal isthmus reduction (IST), and traditional without occlusal isthmus reduction (wIST); and according to two restorative materials: lithium-disilicate (LD) and nanoceramic resin (NR). A 600 N axial load was applied at the central fossa. All solids were considered isotropic, homogeneous, and linearly elastic. A static linear analysis was performed, and the Maximum Principal Stress (MPS) criteria were used to evaluate the results and compare the stress in MPa on the restoration, cement layer, and tooth structure (enamel and dentin). A novel statistical approach was used for quantitative analysis of the finite element analysis results. On restoration and cement layer, nRET showed a more homogeneous stress distribution, while the highest stress peaks were calculated for LD onlays (restoration: 69-110; cement layer: 10.2-13.3). On the tooth structure, the material had more influence, with better results for LD (27-38). It can be concluded that nRET design showed the best mechanical behavior compared to IST and wIST, with LD being more advantageous for tooth structure and NR for the restoration and cement layer.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial

Abstract The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Resumo O presente estudo é um estudo clínico prospectivo, controlado, randomizado e de longo curto prazo, com o objetivo de avaliar o desempenho clínico de restauraç ões adesivas cerâmica vítrea reforçada com dissilicato de lítio e cerâmica feldspática por um período de até 2 anos. Um total de 11 pacientes (7 mulheres, 4 homens; faixa etária: 18-60 anos, idade média: 39 anos) foram inseridas para este estudo. Cada paciente recebeu duas restaurações por grupo em um delineamento de boca dividida. LD: Onze onlays, realizados com cerâmica à base de dissilicato de lítio (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein); e FP: Onze onlays, realizados com cerâmica feldspática (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Os retornos foram realizados em 2 semanas (linha de base = R1), 1 ano (R2) e 2 anos (R3) após a cimentação, por três investigadores independentes, cegos e calibrados, usando espelhos, óculos de aumento, sondas e radiografias interproximais. Foram avaliadas a sensibilidade pós-operatória, cárie secundária, integridade marginal, descoloração marginal, correspondência de cores, rugosidade da superfície, integridade dentária e integridade da restauração. O teste de Friedman (95%) foi utilizado para determinar se havia uma diferença estatisticamente significante na comparação periódica dos parâmetros nas restaurações cerâmicas. Um total de 95,4% das restaurações estava clinicamente aceitável no retorno de 2 anos, sem diferença para qualquer parâmetro de avaliação para ambos os materiais cerâmicos. Com base nos dados de 2 anos, as restaurações CAD-CAM fabricados com cerâmica feldspática e à base de dissilicato de lítio apresentaram desempenho clínico semelhante.

Novel speed sintered zirconia by microwave technology.

OBJECTIVE: Continuous efforts have been made to hasten the zirconia densification process without compromising properties. This study evaluated the long-term structural durability of microwave speed-sintered zirconia (MWZ) relative to a conventionally sintered zirconia (CZ). METHODS: As-machined dental 3Y-TZP discs (Ø12 × 1.2 mm) were speed sintered at 1450 °C for 15 min using an industrial microwave oven, while conventional sintering was conducted in a standard dental furnace at 1530 °C for 2 h. Both were followed by natural cooling. The total sintering time was 105 min for MWZ and 600 min for CZ. Groups were compared regarding density, grain size, phase composition, and fracture resistance. Structural durability was investigated employing two fatigue protocols, step-stress and dynamic fatigue. RESULTS: Compared to CZ, MWZ exhibited a slightly lower density (MWZ = 5.98 g/cm3, CZ = 6.03 g/cm3), but significantly smaller grain sizes (MWZ = 0.53 ± 0.09 µm, CZ = 0.89 ± 0.10 µm), lower cubic-zirconia contents (MWZ = 15.3%, CZ = 22.7%), and poorer translucency properties (TP) (MWZ = 13 ± 1, CZ = 29 ± 0.8). However, the two materials showed similar flexural strength (MWZ = 978 ± 112 MPa, CZ = 1044 ± 161 MPa). Additionally, step-stress testing failed to capture the fatigue effect in 3Y-TZP, whereas dynamic fatigue revealed structural degradation due to moisture-assisted slow-crack-growth (SCG). Finally, MWZ possessed a slightly higher Weibull modulus (MWZ = 7.9, CZ = 6.7) but similar resistance to SCG (MWZ = 27.5, CZ = 24.1) relative to CZ. SIGNIFICANCE: Dental 3Y-TZP with similar structural durability can be fabricated six-times faster by microwave than conventional sintering.

Impact of simulated toothbrushing on surface properties of chairside CAD-CAM materials: An in vitro study.

STATEMENT OF PROBLEM: Chairside computer-aided design and computer-aided manufacturing (CAD-CAM) materials that do not require any firing steps are a promising option to expedite restoration production; however, little information is available to determine the most suitable material for each clinical situation. PURPOSE: The purpose of this in vitro study was to evaluate the effect of simulated toothbrushing on surface gloss, roughness, and wear of chairside CAD-CAM materials. MATERIAL AND METHODS: Disk-shaped specimens (n=15) were prepared of the following materials: ENA-VITA Enamic; LAV-Lava Ultimate; EMP-IPS Empress CAD; CER-Cerasmart; GRA-Grandio blocs. Gloss (Gloss Unit-GU) and surface roughness (Ra-µm) were evaluated before and after simulated toothbrushing (100 000 strokes). Wear (µm) was assessed by contact profilometry. Additional analyses of microhardness by scanning electron microscopy were also performed. Data were analyzed with 2-way repeated measures ANOVA test for roughness and gloss, and 1-way ANOVA for wear (α=.05). To estimate the correlation between Ra and GU, the Pearson correlation was calculated. RESULTS: Before brushing, CER showed the lowest Ra (P<.001), and GRA the lowest GU values. After brushing, the feldspathic ceramic-based materials (ENA and EMP) presented the highest gloss, whereas the ceramic group (EMP) showed the lowest Ra. Before and after brushing, GRA showed the lowest GU values. Higher wear values were found for the composite resin groups (CER>GRA), with the exception of LAVA, which was similar to ENA, and EMP showing improved wear resistance. A strong negative correlation (-0.925) between GU and Ra values was detected (P<.001). CONCLUSIONS: The materials containing a glass phase (ENA and EMP) presented higher wear resistance, higher gloss, and lower roughness after brushing than the other materials tested. The correlation test showed that the higher the surface roughness, the lower the gloss.

Influence of the background, substrate and thickness in light behaviour and colour of zirconia-reinforced lithium silicate (ZLS) glass-ceramic / Influência do fundo, substrato e espessura no comportamento da luz e cor das cerâmicas de dissilicato de lítio reforçadas com zircónia (ZLS)

Objective: To evaluate the influence of background, substrates and thickness on the color and light behaviour of two ZLS glass ceramics. Material and Methods: Standardized disc-shape specimens (12 x 1.2 mm), color A1 HT, of Celtra Duo and Vita Suprinity (n=30), were tested over a white/black background, and divided in five groups (n=6) to be tested over five substrates (polished gold alloy, white zirconia and composite, dentine and enamel A1 colour). The L*, C*, h*, a*, b* and Δ E values, were recorded in two thicknesses (1.2 and 2.4 mm). Translucency parameter (TP), contrast ratio (CR) and opalescence parameter (OP) were calculated. Data was analysed with non­parametric tests: Mann Whitney between ceramic materials for thickness, Wilcoxon for thicknesses in substrates and ceramic material and Kruskal­Wallis with Bonferroni corrections tests (p<0,01) for substrates. Results: For 2.4 mm, the Δ E values were always higher independently of ceramic material or substrates. Vita Suprinity registered lower values than Celtra Duo. Zirconia substrate registered the lower values. For 1.2 mm, dentine registered the lower values. Gold alloy and composite substrates registered the lower Δ E values for 1.2 mm Celtra Duo and 2.4 mm Vita Suprinity specimens. CT and OP higher values and TP lower values were registered for 2.4 mm Vita Suprinity. It was impossible to calculate for Celtra Duo specimens. Conclusions: Background, substrate and thickness had significant influence in light behaviour and final color of ZLS glass ceramics. Substrates Gold alloy and dentine exhibited clinical acceptable Δ E values for 1.2 mm Celtra Duo specimens. (AU)

Objetivo: Avaliar a influência do fundo, do substrato e da espessura no comportamento da luz e na cor de duas cerâmicas ZLS. Material e métodos: Discos de cerâmica (12 x 1.2 mm) de cor A1 HT, de Celtra Duo e Suprinity (n=30), foram testados sobre fundo branco/preto e cinco substratos (liga Ag-Au-Pt polida; zircónia branca; compósito, dentina e esmalte de cor A1). Os valores L*, C*, h*, a*, b* e Δ E foram registados em duas espessuras (1.2 mm e 2.4 mm). O parâmetro de translucidez (TP), o parâmetro de opalescência (OP) e o índice de contraste (CR) foram determinados. Foram realizados testes não paramétricos: Mann Whitney entre cerâmicas por espessura, Wilcoxon entre categoria de espessura por substrato e cerâmica; Kruskal­Wallis com correção de Bonferroni para substratos (p <0,01). Resultados: Para 2,4 mm, o Δ E foi sempre superior independentemente do material ou substrato. Os valores de Suprinity foram inferiores aos de Celtra Duo. O substrato zirconia obteve o Δ E mais baixo. Para 1,2 mm, a dentina obteve o Δ E mais baixo. A liga dourada e o compósito obtiveram Δ E mais baixo para Celtra Duo 1,2 mm e Suprinity 2,4 mm. Para Suprinity, CT e OP foram maiores para 2,4 mm e menores para TP. Não foi possível calcular para Celtra Duo. Conclusão: O fundo, substrato e espessura tiveram influência significativa no comportamento da luz e cor das restaurações de cerâmica ZLS. Apenas os substratos metal e dentina apresentaram valores clinicamente aceitáveis, para Celtra Duo na espessura de 1.2 mm.(AU)

Trueness and precision of the reproduction of dental casts by the conventional, milling and 3D printing techniques / Fidelidade e precisão de modelos de trabalho reproduzidos pelas técnicas convencional, de fresagem e de impressão 3D

Objective: To compare the reproduction trueness and precision of dental casts made by the conventional, milling and 3D printing techniques. Material and Methods: From an upper right side half-arch reference model (RM), 72 models were obtained and divided into three groups: conventional (CM), milled (MM) and printed (PM). All models were scanned and converted into standard tessellation language (.STL) files. The files were superimposed using 3D analysis software, and statistical analysis was performed using the root mean square (RMS) values obtained. The Shapiro-Wilk test was used to assess normality, and the Kruskal-Wallis test was used to compare groups (ρ < ⍺; ⍺ = 0.05). The Mann-Whitney U test was used for multiple comparisons among groups (ρ < ਕ; ਕ = 0.017). Results: There were significant differences in trueness (ρ = 0.000; ρ <0.001) and precision (ρ = 0.000; ρ < 0.001) among the three dental cast groups. Regarding trueness, CM presented better results, followed by MM and PM. Regarding precision, MM showed better results, followed by PM and CM, which did not show significant differences. Conclusions: For dental cast reproduction the conventional technique has the best trueness and the milling technique has the best precision.(AU)

Objetivo: Comparar a fidelidade e precisão de reprodução de modelos de trabalho pelas técnicas convencional, de fresagem e de impressão 3D. Material e Métodos: A partir de um modelo de referência (MR) de uma hemi-arcada superior direita, foram obtidos 72 modelos divididos em três grupos: convencionais (MC), fresados (MF) e impressos (MI). Todos foram digitalizados e convertidos sob a forma de ficheiros .STL (standard tesselation language). Os ficheiros foram sobrepostos utilizando um software de análise 3D, e através dos valores RMS (raiz do valor quadrático médio) obtidos foi realizada a análise estatística. Para avaliação da normalidade foi utilizado o teste Shapiro Wilk e para a comparação entre grupos foi utilizado o teste Kruskal-Wallis (ρ < ⍺; ⍺ = 0.05). Para as comparações múltiplas entre grupos, foi utilizado o teste U de Mann-Whitney (ρ < ਕ; ਕ = 0.017). Resultados:Existem diferenças significativas de fidelidade (ρ = 0.000; ρ <0.001) e precisão (ρ = 0.000; ρ < 0.001) entre os três grupos. Em relação à fidelidade, MC apresentou melhores resultados, seguido por MF e MI. Em relação à precisão, MF apresentou melhores resultados, seguido por MI e MC, que não apresentaram diferenças significativas entre si. Conclusão: Para reprodução de modelos de trabalho, a técnica convencional é a que apresenta maior fidelidade e a técnica de fresagem a que apresenta maior precisão.(AU)

Evaluation of the influence of the impression technique, scanning direction and type of scanner on the accuracy of the final model / Avaliação da influência da técnica de impressão, direção de digitalização e tipo de scanner na precisão do modelo final

Objective: The purpose of this study is to evaluate the influence of the type of scanner and scanning direction on the accuracy of the final cast. Material and Methods: A partial master cast was used as a reference. A total of 128 scans were obtained and divided into two groups: the conventional method and the digital method. The digital group was divided into three groups: TRIOS 3, Omnicam and CS 3600. Each of these groups was subdivided according to the scanning direction, and each scan was overlaid on the digital reference cast to measure the trueness and precision of the procedures. Results: The overall precision values for the type of impression were 59.89 ± 13.08 µm for conventional and 13.42 ± 4.28 µm for digital; the values for trueness were 49.37 ± 19.13 µm for conventional and 53.53 ± 4.97 µm for digital; the scanning direction trueness values were 53.05 ± 4.36 µm for continuous and 54.03 ± 5.52 µm for segmented; and the precision values were 14.18 ± 4.67 µm for continuous and 12.67 ± 3.75 µm for segmented (p> 0.05). For the scanner type, the trueness values were 50.06 ± 2.65 µm for Trios 3, 57.45 ± 4.63 µm for Omnicam, and 52.57 ± 4.65 µm for Carestream; and those for precision were 11.7 ± 2.07 µm for Trios 3, 10.09 ± 2.24 µm for Omnicam, and 18.49 ± 2.42 µm for Carestream (p <0.05). Conclusions: The digital impression method is the most favorable method regarding precision; in terms of trueness, there are no differences between the types of impressions. (AU)

Objetivo: O objetivo deste estudo é avaliar a influência do tipo de técnica de moldagem, tipo de escâner intraoral e direção do escaneamento na precisão do modelo final. Material e Métodos: Um modelo parcial mestre foi usado como referência. Um total de 128 escaneamentos foi obtido e dividido em dois grupos: o método convencional (n = 32) e o método digital (n = 96). O grupo digital foi dividido em três grupos: TRIOS 3 (n = 32), Omnicam (n = 32) e CS 3600 (n = 32). Cada um desses grupos foi subdividido de acordo com a direção do escaneamento (n = 16), e cada escaneamento foi sobreposto ao modelo de referência digital para medir a veracidade e precisão dos procedimentos. Resultados: Os valores gerais de precisão para o tipo de impressão foram 59,89 ± 13,08 µm para convencional e 13,42 ± 4,28 µm para digital; os valores de veracidade foram 49,37 ± 19,13 µm para convencional e 53,53 ± 4,97 µm para digital; os valores de veracidade para a direção de digitalização foram 53,05 ± 4,36 µm para contínua e 54,03 ± 5,52 µm para segmentada; e os valores de precisão foram 14,18 ± 4,67 µm para contínua e 12,67 ± 3,75 µm para segmentada (p> 0,05). Para o tipo de scanner, os valores de veracidade foram 50,06 ± 2,65 µm para Trios 3, 57,45 ± 4,63 µm para Omnicam e 52,57 ± 4,65 µm para Carestream; e os de precisão foram 11,7 ± 2,07 µm para Trios 3, 10,09 ± 2,24 µm para Omnicam e 18,49 ± 2,42 µm para Carestream (p <0,05). Conclusões: O método de moldagem digital é o método mais favorável em relação à precisão; em termos de veracidade, não há diferenças entre os tipos de impressão (AU)