Validación de test de flexión-relajación para definir un déficit lumbar con electrodos tetrapolares / Validation of the flexion-relaxation test to define a lumbar deficit with tetrapolar electrodes

Introducción y objetivo: Obtener un nuevo punto de corte (PC) para un test de flexión-relajación (FR) lumbar efectuado con electrodos (e.) tetrapolares, desde valores ya definidos con dispositivos bipolares.Materiales y métodosLa muestra del estudio consta de 47 pacientes en situación de incapacidad temporal por dolor lumbar (DL). Fueron evaluados mediante un test de dinamometría isométrica, una prueba cinemática y una valoración del fenómeno FR.Se plantean dos experimentos con curvas ROC. El primero, con 47 pacientes que efectuaron de modo consecutivo el test FR con ambos tipos de electrodos, utilizándose como variable de clasificación el punto de corte conocido para los e. bipolares (2,49uV). En el segundo, con los datos de la EMGs registrados con e. tetrapolares en 17 pacientes, se efectúa un test de DeLong que compara las 2 curvas ROC que construimos, por un lado, al clasificar la muestra desde pruebas de dinamometría y cinemática, y por el otro, al clasificarlos con los valores de la EMGs bipolar.ResultadosUn total de 34 pacientes completaron adecuadamente las valoraciones del primer experimento y 17 pacientes el segundo. El primer estudio arroja un punto de corte de 1,2uV, con un AUC del 87,7%; sensibilidad 84,2% y especificidad 80%. El segundo muestra un PC para los e. bipolares de 1,21uV (AUC 87,5%) y para los e. tetrapolares de 1,43 (AUC 82,5%) con un test de DeLong sin diferencias significativas entre ambas curvas (p>0,4065).ConclusionesLa metodología de validación con curvas ROC ha permitido obtener un nuevo PC para la prueba FR de modo práctico, simplemente simultaneando ambos test sobre el mismo grupo de pacientes hasta obtener una muestra significativa. (AU)

Introduction and objective: To obtain a new cut-off point (CP) for a lumbar flexion-relaxation (RF) test established with tetrapolar (e.) electrodes, from values already defined with bipolar devices.Materials and methodsThe study sample consists of 47 patients in a situation of temporary disability due to low back pain (DL). They were evaluated by means of an isometric dynamometry test, a kinematic test and an assessment of the FR phenomenon.Two experiments with ROC curves are proposed. The first, with 47 patients who consecutively performed the RF test with both types of electrodes, using the cut-off point (CP) known for the e. bipolar (2.49μV). In the second, with the EMG data recorded with e. tetrapolar in 17 patients, a DeLong test was performed that compares the 2 ROC curves that were constructed on the one hand, by classifying the sample from dynamometry and kinematic tests, and on the other, by classifying them with the bipolar EMG values.ResultsA total of 34 patients adequately completed the evaluations of the first experiment and 17 patients the second. The first study shows a cut-off point of 1.2μV, with an AUC of 87.7%; Sensitivity 84.2% and Specificity 80%. The second shows a PC for e. bipolars of 1.21μV (AUC 87.5%) and for e. tetrapolar values of 1.43 (AUC 82.5%) with a DeLong test without significant differences between both curves (p>0.4065).ConclusionsThe validation methodology with ROC curves has made it possible to obtain a new PC for the RF test in a practical way, simply by simultaneously performing both tests on the same group of patients until a significant sample is obtained. (AU)

[Effect of printing orientation on physical and mechanical properties of 3D printing prosthodontic base resin materials].

OBJECTIVE: To analyze the influence of forming direction on the surface characteristics, elastic modulus, bending strength and fracture toughness of printed parts and the relationship between forming direction and force direction, and to provide scientific basis and guidance for the clinical application of oral denture base resin materials. METHODS: The 3D printing technology was used to print denture base resin samples. The shape and size of the samples referred to the current standard for testing conventional denture base materials. The samples used for physical performance testing were cylindrical (with a diameter of 15 mm and a thickness of 1 mm) and printed at different angles along the Z axis (0°, 45°, 90°). Scanning electron microscope was used to observe the microscopic topography of the different samples. The color stability of different samples was observed by color stabilizer. The surface roughness of the samples was analyzed by using surface roughness tester. The Vickers hardness was measured to analyze the hardness of the samples. The samples used for mechanical performance testing were rectangular (elastic modulus and bending strength: A length of 64 mm, a width of 10 mm, and a height of 3.3 mm; fracture toughness: A length of 39 mm, a width of 8 mm, and a height of 4 mm), divided into two groups: W group and H group. The W group was printed from the bottom up along the Z axis with the length × width as the bottom surface parallel to the X, Y axis plane, while the H group printed from the bottom up along the Z axis with the length × height as the bottom surface parallel to the X, Y axis plane. The forming angles of both groups were equally divided into 0°, 45°, and 90°. The elastic modulus, bending strength and fracture toughness of different samples were studied through universal mechanical testing machine. SPSS 22.0 software was used for statistical analysis. RESULTS: The microscopic topography and roughness of different samples were closely related to the printing direction, with significant differences between the 0°, 45°, and 90° specimens. The 0° specimens had the smoothest surface (roughness < 1 µm). The surface of the 45° specimen was the roughest (roughness>3 µm). The microhardness of the 0° sample was the best [(196.13±0.20) MPa], with a significant difference compared with the 90° sample [(186.62±4.81) MPa, P < 0.05]. The mechanical properties of different samples were also closely related to the printing direction. The elastic modulus, bending strength, and fracture toughness of the 45° samples in the W group were the highest compared with the other groups. The results of elastic modulus showed that in the H group, the 45° specimens had the highest elastic mo-dulus, which was significantly different from the 0° and 90° specimens (P < 0.05). The elastic modulus of 0° and 45° specimens in the W group were higher than those in 90° specimens (P < 0.05). The bending strength results showed that there was no significant difference between the specimens from dif-ferent angles in the H group. The bending strength of the 90° specimens in the W group was the smallest, and there was a significant difference between 90° and the 0° and 45° specimens (P < 0.05); And the bendind strength of the 0° and 45° specimens in the W group was significantly higher than that of the 0° and 45° specimens in the H group (P < 0.05). The fracture toughness results showed that the fracture toughness of the H group specimens was lower than 1.9 MPa m1/2, which was specified in the denture base standard. The 45° samples in the W group were the highest, with significant differences compared with the 0° and 90° samples (P < 0.05). And the 90° samples of the W group specimens were lower than 1.9 MPa m1/2. And the fracture toughness of the 45° specimen in the W group was significantly higher than that of all the specimens in the H group (P < 0.05). CONCLUSION: The 0° samples had relatively better physical properties. The 45° samples had the best mechanical properties. But the fracture toughness of specimens (H group and 90° samples of W group) did not yet meet clinical requirements. That indicated that the characteristics of the 3D printing denture base resin were affected by the printing direction. Only when the performance of the printed samples in all directions met the minimum requirements of the standard, they could be used in clinical practice.

Effect of thermal cycling on the flexural strength of 3-D printed, CAD/CAM milled and heat-polymerized denture base materials.

BACKGROUND: This study compared the impact of thermal cycling on the flexural strength of denture-base materials produced through conventional and digital methods, using both subtractive and additive approaches. METHODS: In total, 60 rectangular specimens were fabricated with specific dimensions for flexural strength tests. The dimensions were set according to the International Organization for Standardization (ISO) guideline 20795-1:2013 as 64 × 10 × 3.3 ± 0.2 mm. Specimens from each material group were divided into two subgroups (thermal cycled or nonthermal cycled, n = 10/group). We used distinct methods to produce three different denture-base materials: Ivobase (IB), which is a computer-aided-design/computer-aided-manufacturing-type milled pre-polymerized polymethyl methacrylate resin disc; Formlabs (FL), a 3D-printed denture-base resin; and Meliodent (MD), a conventional heat-polymerized acrylic. Flexural strength tests were performed on half of the samples without a thermal-cycle procedure, and the other half were tested after a thermal cycle. The data were analyzed using a two-way analysis of variance and a post hoc Tukey test (α = 0.05). RESULTS: Based on the results of flexural-strength testing, the ranking was as follows: FL > IB > MD. The effect of thermal aging was statistically significant for the FL and IB bases, but not for the MD base. CONCLUSIONS: Digitally produced denture bases exhibited superior flexural strength compared with conventionally manufactured bases. Although thermal cycling reduced flexural strength in all groups, the decrease was not statistically significant in the heat-polymerized acrylic group.

Effect of Hydrothermal Aging on the Flexural Strength and Microhardness of Materials Used for Additive or Subtractive Manufacturing of Definitive Restorations.

PURPOSE: To evaluate the flexural strength (FS) and microhardness of various CAD/CAM restorative materials intended for definitive use. The effect of hydrothermal aging on the mechanical properties of these materials was also investigated. MATERIALS AND METHODS: A total of 210 bar-shaped specimens (17 × 4 × 1.5 mm ± 0.02 mm) were fabricated via either subtractive manufacturing (SM) methods-reinforced composite resin (SM-CR), polymer-infiltrated ceramic network (SM-PICN), fine-structured feldspathic ceramic (SMFC), nanographene-reinforced polymethyl methacrylate (PMMA; SM-GPMMA), PMMAbased resin (SM-PMMA)-or additive manufacturing (AM) methods with urethane acrylate-based resins (AM-UA1 and AM-UA2). Specimens were then divided into two subgroups (nonaged or hydrothermal aging; n = 15). A three-point flexural strength test was performed, and five specimens from the nonaged group were submitted to microhardness testing. Specimens were subjected to 10,000 thermal cycles, and the measurements were repeated. RESULTS: Regardless of aging, SM-CR had the highest FS (P < .001), followed by SM-GPMMA (P ≤ .042). In nonaged groups, AM-UA2 had a lower FS than all other materials except SM-FC (P = 1.000). In hydrothermal aging groups, AM specimens had lower FS values than other materials, except SM-PMMA. With regard to microhardness, there was no significant difference found between any of the tested materials (P ≥ .945) in the nonaged and hydrothermal aging groups. CONCLUSIONS: The effect of hydrothermal aging on FS varied depending on the type of restorative material. Regardless of aging condition, SM-CR showed the highest FS values, whereas SM-FC had the highest microhardness. Hydrothermal aging had no significant influence on the microhardness of the tested materials.

Comparative study of physical-chemical properties of bioactive glass ionomer cement.

This study analyzed the physical-chemical properties of bioactive ionomer materials. Cention N bioactive materials were evaluated chemically activated (CN) and light-cured (CN-LC), Equia Forte Fill (EQUI); conventional resin composite Filtek Z350 XT (Z350); resin glass ionomer cement Riva light Cure (RIVA) and flowable resin composite Filtek Bulk Fill Flow (BULK-F) were evaluated. Sixty specimens (n=10) were prepared for sorption (SR), solubility (SL), flexural strength (FS), shrinkage stress (SS), conversion degree (CD), microhardness (MI), and surface roughness (SR) tests. Non-cured and light-cured materials were assessed on FTIR. 30 human molar teeth were used in the bond strength test (BS). Data were subjected to ANOVA and post-hoc Tukey's test (5% of significance). EQUI showed more sorption in SR and no statistical difference from RIVA and CN-LC. CN group showed more solubility and EQUI presented less (p<0.05). BULK-F showed higher FS (MPa), without differences from CN and Z350, whereas EQUI presented the lowest FS not differing from RIVA. BULK-F and CN-LC showed more shrinkage stress differing from EQUI. CN-LC and CN showed higher CD differing from the other which showed no differences (p>0.05) between them. EQUI showed the highest hardness (p<0.05) in MI. There were no differences (p>0.05) in SR (µm). Z350 and BULK-F presented higher BS, whereas CN-LC showed the lowest, although not differing from EQUI and RIVA. Equia Forte's solubility and microhardness make it a good alternative as a restorative material. Cention N degree of conversion and flexural strength making it an esthetic option to amalgam.

Effects of multiple firings on the translucency, crystalline phase, and mechanical strength of highly translucent zirconia.

This study aimed to clarify the effects of multiple firings on the translucency, crystal structure, and mechanical strength of highly translucent zirconia. Four types of highly translucent zirconia (LAVA Esthetic, LAVA Plus, KATANA Zirconia STML, and KATANA Zirconia HTML) were fired three times at three different temperatures, and the translucency, crystal structure, and flexural strength were evaluated before and after firing. The translucency was statistically compared using repeated-measures analysis of variance; the zirconia phase composition was assessed using X-ray diffraction followed by Rietveld analysis; and the biaxial flexural strength was assessed using Weibull analysis. The translucency of LAVA Esthetic and KATANA Zirconia HTML decreased significantly after firing, and the crystal composition of LAVA Plus and KATANA Zirconia HTML changed after multiple firings, whereas multiple firings did not affect the biaxial flexural strength of any samples. Thus, multiple firings may affect the optical properties of highly translucent zirconia.

Flexural strength of repaired denture base materials manufactured for the CAD-CAM technique.

PURPOSE: To evaluate the flexural properties of repaired poly(methylmethacrylate) (PMMA) denture base materials for computer-aided design/computer-aided manufacturing (CAD-CAM) and to compare them with heat-activated polymerized PMMA. METHODS: A total of 288 specimens (65 × 10 × 2.5 mm) were prepared using both CAD-CAM and conventional blocks and repaired using autopolymerizing and visible-light polymerizing (VLC) materials. Microwave energy, water storage and hydroflask polymerization were applied as additional post-polymerization cycles after the repair process. The flexural strength (FS) of the specimens was evaluated using the three-point bending test. Data were evaluated statistically using 2-way ANOVA followed by Bonferroni's correction to determine the significance of differences between the groups (P ≤ 0.05). RESULTS: The FS of the denture base materials for CAD-CAM was significantly higher than that for the heat-activated group (P ≤ 0.05). The FS was significantly highest when microwave energy was used for the post-polymerization cycle. The FS values for all groups repaired with VLC resin were significantly lower than for the autopolymerization group (P ≤ 0.05). CONCLUSION: The flexural properties of denture base materials for CAD-CAM repaired using autopolymerizing acrylic resins can recover by 50-70%. Additional post-polymerization cycles for autopolymerizing repair resin can be suggested to improve the clinical service properties of repaired dentures.

Influence of printing orientation on mechanical properties of aged 3D-printed restorative resins.

OBJECTIVE: To evaluate the influence of printing orientation on flexural strength (σf) and elastic modulus (E) of different 3D printing dental restorative resins. METHODS: Bar-shaped specimens (n = 20) were fabricated from two SLA-printed resins (FT- Formlabs Temporary, and FP- Formlabs Permanent) and two DLP-printed resins (DFT- Detax Freeprint Temp, and GCT- GC Temporary) using two building orientations (0º and 90º). The 3D-printed structures were aged (14 d) before submitted to three-point bending in 37ºC distilled water at a crosshead speed of 1.0 ± 0.3 mm/min until fracture to calculate the σf and the E values. The fractured surfaces were evaluated using stereomicroscopy and scanning electron microscopy (SEM) following fractography principles. Data were statistically analyzed using two-way ANOVA and Tukey post-hoc (α = 0.001). RESULTS: FP and FT showed significantly higher E values than DFT and GCT, irrespectively of printing orientation (p < 0.001). There was no statistical difference between the building orientations (0º and 90º) for the mean σf and E values for the resin materials evaluated. Fractographic characteristics were similar for the surface fracture from all the materials evaluated, showing typical brittle fracture behavior. SIGNIFICANCE: Printing orientation did not influence of flexural strength and elastic modulus values for the 3D-printed resin structures evaluated. Surface topography was mostly governed by the 3D printer type.

Fracture Strength of Six-Unit Anterior Fixed Provisional Restorations Fabricated Using Various Dental CAD/CAM Systems.

PURPOSE: This study compares the fracture strengths of long-span fixed provisional restorations fabricated via digital additive and subtractive methods to those fabricated via conventional heat-processing techniques. MATERIALS AND METHODS: A six-unit anterior partial restoration was designed as an anatomical and morphologic structure using a dental CAD/CAM system. The provisional restorations (N = 40) of four different fabrication methods (n = 10 per group) were used for the failure loading test: stereolithography apparatus (SLA), liquid crystal display (LCD), milling (MIL), and heat-processed temporary (HPT). The specimens were subjected to a maximum load-to-fracture test using a universal testing machine, and the representative fracture patterns were observed. Statistical analysis was performed using Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, and Bonferroni post hoc tests (P < .05). RESULTS: The four groups showed significant differences in fracture strength according to the materials and manufacturing methods used (P < .001, except between SLA and HPT groups). The fracture strengths of MIL and LCD digitally fabricated groups were significantly higher than that of the HPT group (P < .001). CONCLUSIONS: The subtractive method is ideal for fabricating long-span fixed provisional restorations for long-term use. Additionally, LCD additive manufacturing technology could soon be a good alternative for restorations.

Fabrication of green anti-microbial and anti-static cement building bricks.

The design cement mix of grade 350 was created in accordance with Egyptian Standards by partially substituting the fine aggregate with WPVC waste in various weight percentages (10, 20, 30, 40, 50, 75, and 100%). A control mix with 0% replacement was also prepared. The W/C ratio was about 0.5 for all mixes. Compressive, flexure strength, bulk density, and absorption tests were studied. For WPVC replacement, until 30%, compressive strength and flexure strength are acceptable with respect to standerds. Thermal treatment at 200 °C improves the compressive strength, flexure strength and water absorption for 20% WPVC only. The dielectric properties of all cement paste mixes before and after heat treatment, over a frequency range (0.1-106 Hz), were measured as a function of frequency. For dielectric properties and conductivity, an improvement was obtained until 30% WPVC. After this percentage, the dielectric properties and the conductivity got worse. So, cement paste with 30% WPVC as replacement of sand is the optimum ratio with conductivity in range of 10-12 S/cm, which is a good choice for antistatic cement paste applications (10-10-10-12 S/cm). The antimicrobial efficacy of the prepared cement samples of WPVC concentrations (0, 20 and 30) % were studied, the number of grown microbial colonies decreased for all the samples compared to control tap water and decreased by introducing WPVC into the cement paste sample. So, it is recommended to use these samples in places that should be carefully shielded from bacterial infections and static electric charge dangers.

Comparative Evaluation of Fracture Toughness and Flexural Strength of Four Different Core Build-up Materials: An In Vitro Study.

AIM: To evaluate and compare the fracture toughness and flexural strength of four different core build-up materials. MATERIALS AND METHODS: A total of 60 samples were divided into four groups (n = 15) group I: dual cure composite resin reinforced with zirconia particles (Luxacore Z), group II: light cure composite resin (Lumiglass DeepCure), group III: zirconia reinforced glass ionomer cement (GIC) (Zirconomer Improved), and group IV: chemically cure composite resin (Self Comp) respectively. All the core build-up materials were manipulated according to the manufacturer's instructions and poured into the mold. A universal testing machine applied a central load to the specimen in a 3-point bending mode. Fracture of the specimen was identified and the reading was recorded by the universal testing machine. The data were analyzed statistically using one-way analysis of variance (ANOVA) and then compared. RESULTS: Group I showed the highest flexural strength (48.65 MPa) among all the groups while group IV showed the lowest flexural strength (17.90 MPa). Group I showed the highest fracture toughness (99.12 MPa) among all the groups while group IV showed the lowest fracture toughness (36.41 MPa.cm-0.5). When mean flexural strength and fracture toughness values of all four groups were compared by using one-way ANOVA, the compared data was highly significant. CONCLUSION: Based on the findings of this study, dual cure composite resin was the material of choice in terms of flexural strength and fracture toughness for core build-up material followed by light cure composite resin. CLINICAL SIGNIFICANCE: The core buildup material serves to strengthen the tooth structure, allowing it to withstand the forces of chewing and preventing the risk of tooth fractures. This material is essential in restoring damaged or decayed teeth, as it provides a stable foundation for further dental work. By reinforcing the tooth structure, the core buildup material ensures that the tooth can function properly and remain healthy for years to come. How to cite this article: Nakade P, Thaore S, Bangar B, et al. Comparative Evaluation of Fracture Toughness and Flexural Strength of Four Different Core Build-up Materials: An In Vitro Study. J Contemp Dent Pract 2024;25(2):191-195.

Fracture strength of porcelain veneer on surface-treated zirconia.

In this study, we investigated the effects of surface treatment on the fracture strength of porcelain-veneered zirconia. Highly translucent 4 mol% yttria-stabilized zirconia disks (KATANA HT, Kuraray Noritake Dental) were divided into three surface-treatment groups: 1)as-sintered, 2) alumina sandblasted, and 3) ground. Crystallographic and surface-roughness analyses were conducted for each group. Veneering ceramics (Cerabien ZR, Kuraray Noritake Dental) were applied to the zirconia surfaces. The fracture strengths of the porcelain-veneered zirconia disks were measured using biaxial flexural-strength tests. Crystallographic analysis revealed that grinding and sandblasting increased the fractions of the monoclinic and rhombohedral zirconia phases. The ground specimens had a higher surface roughness than the sandblasted specimens. Weibull analysis showed no significant differences in biaxial flexural strength among the three groups. The results suggest that these surface treatments do not affect the fracture strength of porcelain-veneered zirconia.

Fracture strength of ceramic overlays with immediate dentin sealing and same-day delivery.

Limited research is available evaluating whether the reported in vitro benefit of immediate dentin sealing (IDS)-namely, increased bond strength to tooth structure-can be acquired in the era of same-day (SD) dentistry. The purpose of this study was to compare the fracture strengths of ceramic overlays fabricated with a delayed dentin sealing (DDS) technique or an IDS technique under 1-hour SD or 2-week multiple-day (MD) delivery conditions. Forty extracted, healthy maxillary third molars were prepared for a lithium disilicate overlay restoration and divided into 4 groups of 10 teeth each. In the SD-DDS group, the teeth were prepared and then stored for 1 hour in artificial saliva, and the adhesion protocol (bonding agent and resin cement) was applied at the time of delivery of the ceramic overlay. In the SD-IDS group, the teeth were prepared, the adhesive protocol was applied immediately, and the teeth were stored for 1 hour before delivery of the overlay. The protocols for the MD-DDS and MD-IDS groups were identical to SD-DDS and SD-IDS, respectively, except that the teeth were provisionalized and stored for 2 weeks prior to delivery of the overlay. Specimens were thermocycled and subjected to cyclic functional loading before they were loaded to failure in a universal testing machine using a rod resting on the buccal incline of the palatal cusp. Two-way analysis of variance tests revealed no statistically significant differences in fracture strength between the groups based on dentin sealing (P = 0.331) or delivery time (P = 0.314). The specimens demonstrated 2 fracture types; either a portion of the ceramic cohesively fractured, leaving the tooth intact, or the ceramic and part of the tooth fractured. There were no instances in which the restoration itself delaminated during fracture testing. A Kruskal-Wallis test indicated there were no statistically significant differences in fracture modes between the groups. In this in vitro study, IDS did not provide a significant increase in the fracture strength of overlay restorations compared with DDS, regardless of whether the restorations were delivered the same day or after 2 weeks of storage.

Wear resistance and flexural properties of low force SLA- and DLP-printed splint materials in different printing orientations: An in vitro study.

OBJECTIVES: To investigate the influence of material and printing orientation on wear resistance and flexural properties of one low force SLA- and two DLP-printed splint materials and to compare these 3D-printed splints to a subtractively manufactured splint material. METHODS: Two DLP-printed (V-Print splint, LuxaPrint Ortho Plus) and one low force SLA-printed (Dental LT Clear) material, where specimens were printed in three printing orientations (0°, 45°, 90°), were investigated. In addition, one milled splint material (Zirlux Splint Transparent) was examined. A total of 160 specimens were produced for both test series. The two-body wear test was performed in a chewing simulator (80'000 cycles at 50 N with 5-55 °C thermocycling). Steatite balls were used as antagonists. The wear pattern was analyzed with a 3D digital microscope in terms of maximum vertical intrusion depth (mm) and total volume loss (mm³). The flexural properties were investigated by three-point bending in accordance with ISO 20795-1: 2013 (denture base polymers). The flexural strength (MPa) and the flexural modulus (MPa) were measured. Two-way ANOVA was performed to investigate the effects of the two independent variables material and printing orientation for the three 3D-printed materials. The comparison of the printing orientations within one material was carried out with one-way ANOVA with post-hoc Tukey tests. RESULTS: Two-way ANOVA revealed that wear and flexural properties are highly dependent on the 3D-printed material (p < 0.001). Across groups, a significant effect was observed for wear depth (p = 0.031) and wear volume (p = 0.044) with regard to printing orientation but this was not found for flexural strength (p = 0.080) and flexural modulus (p = 0.136). One-way ANOVA showed that both DLP-printed groups showed no significant differences within the printing orientations in terms of wear and flexural properties. Dental LT Clear showed that 90° oriented specimens had higher flexural strength than 0° oriented ones (p < 0.001) and 45° oriented specimens also showed higher values than 0° ones (p = 0.038). No significant differences were observed within the printing orientations for flexural modulus and wear behaviour within this group. T-tests showed that the milled splints exhibited statistically higher wear resistance and flexural properties compared to all three 3D-printed splint materials (p < 0.001) and that highly significant differences were found between the 3D-printed splint materials for both test series. CONCLUSION: Within the limitations of this in vitro study, it can be stated that wear behaviour and flexural properties are highly dependent on the 3D-printed material itself. Currently, milled splints exhibit higher wear resistance and flexural properties compared to 3D-printed splint materials. The printing orientation has a minor influence on the properties investigated. Nevertheless, two-way ANOVA also showed a significant influence of printing orientation in the wear test across groups and one-way ANOVA detected significant effects for SLA material in terms of flexural strength, with printing in 90° showing the highest flexural strength. Therefore, anisotropy was found in SLA material, but it can be limited with the employed printing parameters. Both DLP-printed materials showed no significant difference within the printing orientation.

Biaxial flexural strength of 3D-printed 3Y-TZP zirconia using a novel ceramic printer.

OBJECTIVES: To compare the strength and reliability of 3D-printed 3Y-TZP zirconia manufactured with various printing orientations and staining. MATERIALS AND METHODS: A total of one-hundred cylindrical zirconia specimens were designed and fabricated using 3D printing and processed according to ISO 6872 standards. Of these specimens, 80 were 3D printed using the new ZIPRO-D (ZD) 3D ceramic printer. In this ZD group, 60 specimens were printed in a vertical orientation and were either stained after debinding (ZD1, x-orientation, n = 20) or not stained (ZD2, x-orientation, n = 20; ZD3, y-orientation, n = 20) and the remaining 20 specimens out of n = 80 were printed in a horizontal orientation (ZD4). Further 20 specimens out of the entire sample N = 100 were printed vertically with the CeraFab7500 3D ceramic printer (LC). All completed specimens were loaded until fracture using a universal testing machine. Biaxial flexural strengths and Weibull parameters were computed for the ZD groups and for the LC group. Group and sub-group effects were evaluated using Welch ANOVA (alpha = 0.05). RESULTS: The mean (standard deviation, SD) biaxial flexural strengths of vertically oriented ZD samples with (ZD1) and without (ZD2/ZD3) staining were 811 (197) and 850 (152) MPa, respectively (p > 0.05). The ZD4 (horizontally printed), 1107 (144) MPa, and LC (1238 (327)) MPa samples had higher mean (SD) flexural strengths than the ZD1-3 specimens. No difference was observed between the ZD4 and LC group (p > 0.05). Weibull moduli were between m = 4.6 (ZD1) and 9.1 (ZD4) in the ZD group and m = 3.5 in the LC group. CONCLUSIONS: All tested 3D-printed zirconia specimens exceeded the flexural strengths required for class 5 restorations according to ISO 6872 standards. While the flexural strengths of zirconia printed using the novel ZD device in the vertical orientation are lower than those of zirconia printed using the LC printer, the ZD printer shows at least comparable reliability. CLINICAL RELEVANCE: 3D-printing of zirconia is a new technology in dental application. Based on the presented strengths values, clinical application of 3D-printed zirconia for fixed dental protheses can be recommended.

Comparison of subcritical growth parameters of a Y-TZP obtained via cyclic or dynamic fatigue tests.

OBJECTIVE: The objective of this study was to 1) compare the stress corrosion coefficient (n) of a Y-TZP obtained by two fatigue tests: cyclic and dynamic and 2) evaluate the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and slow crack growth. METHODS: A total of 145 Y-TZP specimens were produced in accordance with the manufacturer's instructions. These specimens, measuring 4.0 × 3.0 × 25.0 mm, were used for dynamic (n = 70) and cyclic fatigue tests (n = 75). The specimens were obtained from CAD/CAM blocks, sectioned, and sintered in a furnace at 1530 °C with a heating rate of 25 °C/min. They were tested in their "as-sintered" form without any additional surface treatment. The fatigue tests were conducted using a four-point bending to obtain the slow crack growth parameters (n). The cyclic fatigue test was also conducted in two frequencies (2 and 10 Hz), using stress levels between 350 and 600 MPa. Data from these tests were analyzed using ASTM C 1368-00 formulas and Weibull statistics. Scanning electron microscope (SEM) was used for fracture surface analysis to identify the origin of the fracture. Critical defect size was measured and used, along with flexural strength values, to estimate fracture toughness. Dynamic fatigue test data were used to obtain subcritical crack growth (SCG) parameters and perform Weibull statistical analysis. The cyclic fatigue data were used in the General Log-linear Model equation using the ALTA PRO software. Data were analyzed using one-way ANOVA followed by Tukey post-hoc tests and Student's t-test at a significance level of p ≤ 0.05. RESULTS: In the dynamic fatigue test, the values obtained for σfo and n were 667 and 54, respectively. This parameter indicates how the strength of the material diminishes over time due to internal cracks. The Weibull parameters obtained from the same test results were m = 7.9, σ0 = 968, 9 and σ5% = 767, which indicates the reliability of the material. The Weibull parameters obtained by cyclic fatigue were statistically similar for the two frequencies used, the m* was 0.17 (2 Hz) and 0.21 (10 Hz); characteristic lifetimes (η) were 1.93 × 106 and 40,768, respectively. The n values obtained by cyclic fatigue were 48 and 40 at frequencies of 2 and 10 Hz, respectively. There was no effect of the frequency, the stress level or the interaction of the two in the Y-TZP lifetime, when analysed by General Log Linear Model. SIGNIFICANCE: the n values obtained by cyclic and dynamic fatigue tests showed no statistically significant difference and the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and subcritical growth were not observed in the tested specimens.

Anti-Microbial Effect of AgBr-NP@CTMAB on Streptococcus Mutans and Assessment of Surface Roughness Hardness and Flexural Strength of PMMA.

Purpose: To investigate the inhibition of Streptococcus mutans (S.mutans) and its biofilm by AgBr-nanoparticles (NP) @CTMAB (cetyltrimethyl-ammonium bromide) and evaluate the changes in Polymethyl methacrylate (PMMA)'s surface roughness (Ra), microhardness, and flexural strength during prolonged immersion in AgBr-NP@CTMAB for application in the denture cleaning industry. Patients and Methods: The antibacterial activity of AgBr-NP@CTMAB against S.mutans was measured colony formation assay, OD600 and laser confocal microscopy. Changes in the specimens' values for surface roughness, microhardness, and flexural strength (MPa) were measured after immersion solutions for 180 or 360 days. Results: The AgBr-NP@CTMAB solution exhibited a robust antibacterial effect on planktonic S. mutans, with a minimum bactericidal concentration of 5 µg/mL. The 10 µg/mL AgBr-NP@CTMAB solution efficiently inhibited S. mutans biofilm formation. (2) No significant difference in surface roughness after immersion in AgBr-NP@CTMAB (10 µg/mL and 20 µg/mL) comparing with distilled water (P > 0.05) and Polident had significantly higher than distilled water (P < 0.05). There was a significant decrease in the surface hardness of the PMMA specimens that were immersed in the Polident compared with those in distilled water (P < 0.05). While, no significant differences in surface hardness after immersion in the AgBr-NP@CTMAB (P > 0.05). The result of flexural strength suggested that there was no statistically significant difference (P < 0.05) between AgBr-NP@CTMAB as well as Polident and water. Conclusion: AgBrNP@CTMAB can efficiently inhibit the growth of plankton S.mutans and biofilm formation, without affecting the flexural strength, microhardness, or surface roughness of PMMA. Therefore, AgBrNP@CTMAB holds promise as a new denture cleaning agent.

Fracture strength of 3-units fixed partial dentures fabricated with metal-ceramic, graphene doped PMMA and PMMA before and after ageing: An in-vitro study.

OBJECTIVES: To evaluate the fracture strength and linear elongation at break of three-units fixed partial dentures (FPDs) fabricated with traditional and new materials for fixed prosthodontics before and after ageing. METHODS: Sixty models of three-units FPDs were fabricated and cemented onto a Co-Cr model simulating the replacement of a maxillary second premolar. The samples were randomly divided into 3 groups: metal-ceramic (MCR), graphene-doped polymethylmethacrylate (PMMA-GR) and polymethylmethacrylate (PMMA). Half of the samples were directly subjected to fracture test, while the remaining half underwent an ageing process and then a fracture loading test using an electrodynamic testing machine. Fracture load and elongation at break values were taken and statistically analysed. RESULTS: Significant differences were detected between the different materials (p<0.05). All groups showed a reduction of the fracture load and elongation at break values after ageing, but not statistically significant, except for PMMA group (p = 2.012e-19) (p = 3.8e-11). CONCLUSIONS: MCR and PMMA-GR three-units FPDs showed higher fracture strength and lower elongation at break compared to PMMA. MCR and PMMA-GR had higher resistance to ageing processes compared to PMMA. CLINICAL SIGNIFICANCE: PMMA-GR could be considered a material for long-term provisional restorations as its mechanical behaviour and ageing resistance are more like MCR than PMMA.

Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation.

STATEMENT OF PROBLEM: The existing knowledge is insufficient for comprehending the fatigue survival and fracture resistance of molars that have deep approximal direct and indirect restorations, whether with or without deep margin elevation (DME). PURPOSE: The aim of this laboratory and in silico study is to investigate the fatigue survival, fracture strength, failure pattern and tooth deformation of molars restored with DME in combination with a direct or indirect restoration. MATERIAL AND METHODS: This study utilized 45 extracted sound human molars, divided into three groups (n = 15). Standardized 100% inter-cuspal inlay preparations were performed, extending 2 mm below the CEJ and immediate dentin sealing (IDS) was applied. Group 1 (Co_1) was restored with direct composite; Group 2 (Hyb_2) with a 2 mm DME of direct composite and a glass-ceramic lithium disilicate restoration; Group 3 (Cer_3) a glass-ceramic lithium disilicate restoration. All specimens were exposed to a fatigue process involving thermal-cyclic loading (50N for 1.2 × 106 cycles at 1.7 Hz, between 5 and 55 °C), if teeth survived, they were fractured using a load-to-failure test and failure types were analyzed. Finite element analysis (FEA) was conducted to assess tooth deformation and tensile stress in the restorations. Statistical evaluation of fracture strength was conducted using the Kruskal-Wallis test. Fisher's exact test was utilized to analyze the fracture types and repairability. A statistical significance level of α < 0.05 was set for all analyses. RESULTS: All specimens successfully withstood the fatigue testing procedure, and no statistically significant differences in fracture strength were observed among the three groups (P > 0.05). The Fisher's exact test indicated a significant association between the restorative material and fracture type (F2 = 18.315, df = 2, P = 0.004), but also for repairability (F2 = 13.725, df = 2, P = 0.001). Crown-root fractures were significantly more common in the Cer_3 group compared to the Co_1 group (P = 0.001) and the Co_1 group had significantly more repairable fractures (F2 = 13.197, df = 2, P = 0.001). FEA revealed comparable outcomes of deformation among models and higher maximum tensile stress on models with higher frequency of catastrophic failures. CONCLUSIONS: All tested restoration materials exhibited comparable fatigue survival and fracture strength in this laboratory and in silico study. However, it is important to recognize the potential for more severe and irreparable fractures when opting for deeply luted glass-ceramic inlay restorations in clinical practice. In such cases, it would be prudent to consider the alternative option being a direct composite approach, because of its more forgiving fracture types and repairability. CLINICAL IMPLICATIONS: Molars with deep approximal direct and indirect restorations, whether with or without DME, are comparable in their fatigue survival and fracture resistance to withstand intra-oral forces. Deep direct restorations exhibit more repairable fractures compared to deeply luted glass-ceramics.

Mechanical Properties of Zirconia Materials with Different Translucency: An In Vitro Study.

PURPOSE: To investigate the biaxial flexural strength of zirconia materials with different translucency before and after aging procedures and to evaluate the effects of aging on hardness and surface characteristics. MATERIALS AND METHODS: A total of 90 disc-shaped specimens (n = 30 each) were prepared from translucent (Upcera-ST, Upcera Dental), high translucent (Katana HT, Kuraray Noritake), and ultra high translucent (Katana UTML, Kuraray Noritake) zirconia materials to a ø.16 ±1.2 mm thickness. The different translucency discs were then divided into three subgroups; one group was subjected to aging in a chewing simulator (n = 10), one group was aged with thermocycling (n = 10), and one was a control group (n = 10). Biaxial flexural strength, Vickers hardness, and surface characteristics were examined for all discs. The data were analyzed using the Shapiro-Wilk (P = .05), Mann-Whitney U, and Kruskal-Wallis H tests. Fracture strength was determined using biaxial bending strength tests, and Weibull analysis was used to analyze the resulting data. RESULTS: A statistically significant difference was found among zirconia materials with different translucency in terms of fracture strength. On average, fracture strength was highest in the Upcera ST group (1,932.87 MPa) and lowest in the Katana UTML group (1,073.6 MPa; P = .001). The results of Weibull analysis showed a statistically similar distribution for all groups. CONCLUSIONS: Aging procedures did not cause significant differences in fracture strength and hardness. The fracture strength of the zirconia materials with different translucency was considered acceptable for intraoral use.