Fracture Resistance of Monolithic Glass-Ceramics Versus Bilayered Zirconia-Based Restorations.

PURPOSE: To compare the fracture resistance of monolithic reinforced glass-ceramic restorations with bilayer zirconia-based restorations. MATERIALS AND METHODS: Fifteen ceramic crowns were fabricated on epoxy dies duplicated from a stainless steel master die. They were divided into 3 equal groups (n = 5) according to the type of ceramic material used: group I, monolithic lithium disilicate (IPS e.max CAD), group V, monolithic zirconia-reinforced lithium silicate (Vita Suprinity), and group B (bilayered zirconia substructure with veneering ceramic). All specimens were cemented on epoxy dies with a self-adhesive resin cement (Rely X Unicem), subjected to a chewing simulator, and then loaded until fracture in a universal testing machine. The results were tabulated and statistically analyzed using one-way ANOVA to compare among the 3 materials. The Bonferroni post hoc test was used for pairwise comparisons when the ANOVA test was significant. RESULTS: Zirconia-reinforced lithium silicate (Vita Suprinity) crowns showed the highest statistically significant (p < 0.05) mean fracture resistance values (1742.9 ± 102.7 N), followed by lithium disilicate (IPS e.max CAD) (1565.2 ± 89.7 N). Bilayered zirconia-based crowns showed the lowest statistically significantly mean fracture resistance values (1267.8 ± 86.1 N). CONCLUSIONS: Monolithic reinforced glass-ceramics (lithium disilicate and zirconia-reinforced lithium silicate) have better fracture resistance than bilayered zirconia-based ceramics. CLINICAL IMPLICATIONS: The use of monolithic reinforced ceramic restorations (lithium disilicate and zirconia-reinforced lithium silicate) is preferred to bilayered zirconia-based restorations to avoid chipping of the ceramic veneer.

In vitro evaluation of marginal discrepancy of monolithic zirconia restorations fabricated with different CAD-CAM systems.

STATEMENT OF PROBLEM: Dental laboratories use different computer-aided design and computer-aided manufacturing (CAD-CAM) systems to fabricate fixed prostheses; however, limited evidence is available concerning which system provides the best marginal discrepancy. PURPOSE: The purpose of this in vitro study was to evaluate the marginal fit of 5 different monolithic zirconia restorations milled with different CAD-CAM systems. MATERIAL AND METHODS: Thirty monolithic zirconia crowns were fabricated on a custom-designed stainless steel die and were divided into 5 groups according to the type of monolithic zirconia crown and the CAD-CAM system used: group TZ, milled with an MCXL milling machine; group CZ, translucent zirconia milled with a motion milling machine; group ZZ, zirconia milled with a dental milling unit; group PZ, translucent zirconia milled with a zirconia milling unit; and group BZ, solid zirconia milled using an S1 VHF milling machine. The marginal fit was measured with a binocular microscope at an original magnification of ×100. The results were tabulated and statistically analyzed with 1-way ANOVA and post hoc surface range test, and pairwise multiple comparisons were made using Bonferroni correction (α=.05). RESULTS: The type of CAD-CAM used affected the marginal fit of the monolithic restoration. The mean (±SD) highest marginal discrepancy was recorded in group TZI at 39.3 ±2.3 µm, while the least mean marginal discrepancy was recorded in group IZ (22.8 ±8.9 µm). The Bonferroni post hoc test showed that group TZI was significantly different from all other groups tested (P<.05). CONCLUSIONS: Within the limitation of this in vitro study, all tested CAD-CAM systems produced monolithic zirconia restorations with clinically acceptable marginal discrepancies; however, the CAD-CAM system with the 5-axis milling unit produced the best marginal fit.

Flexural strength of small connector designs of zirconia-based partial fixed dental prostheses.

STATEMENT OF PROBLEM: Partial fixed dental prostheses with a small connector size are required for optimal esthetics and limited interarch space; however, final strength is endangered. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different connector designs on the flexural strength of simulated 3-unit partial fixed dental prostheses made of yttria-stabilized tetragonal zirconia polycrystalline using computer-aided design and computer-aided manufacturing technology. MATERIAL AND METHODS: To simulate a 3-unit partial fixed dental prosthesis, 20 rectangular bar-shaped specimens were fabricated with dimensions of 4 ± 0.05 mm (H) × 4 ± 0.05 mm (W) × 30 0.5 mm (L). Each bar specimen had 2 constricted parts on both sides, representing the connector and defining a central pontic of 10 ± 0.10 mm in length. The specimens were divided into 4 groups according to the connector diameter and design, as follows: SR: 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; SS: 2 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature; CR: 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; and CS: 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature. An additional 5 specimens were fabricated with no constriction and served as the control group. The specimens were subjected to a 3-point flexural strength test in a universal testing machine with a crosshead speed of 0.5 mm/min until failure. Scanning electron microscopic and photomicrograph images were used to examine the fracture surfaces. Two-way ANOVA and the Tukey-Kramer post hoc test were used to analyze the data (α = .05). RESULTS: The mean flexural strength for SR 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (583.6 ± 49.7 MPa) was significantly higher than that of SS, which was 2 mm (H)× 3 mm (W) sharp 0.1 mm radius of curvature (502.8 ± 23.3 MPa). Similarly, the mean flexural strength for CR was 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (682.9 ± 36.8), which was significantly higher than that of CC, 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature (486.7 ± 35.6 MPa). CONCLUSIONS: The flexural strength of the yttria-stabilized tetragonal zirconia polycrystalline-based ceramics was affected by the connector dimension and design. The 2-round connector design was more able to withstand occlusal forces than the sharp design. The 3-connector design with a minimum cross section of 2 × 3 mm is recommended for anterior fixed dental prostheses, provided it has a round curvature.

Effect of polyhedral silsesquioxane (POSS) on the flexural strength and color of interim materials.

STATEMENT OF PROBLEM: Polyhedral silsesquioxane (POSS) nanofillers can reinforce interim materials. However, the interaction between the POSS and the brand and its effect on color are unknown. PURPOSE: The purpose of this study was to determine the effect on the flexural strength, color, and color stability of 4 commercially available interim materials modified with 1 wt% POSS. MATERIAL AND METHODS: Four commercial interim resin materials were used in this study: Jet, Trim, Temphase, and Protemp. The flexural strength of the interim materials was measured with and without 1 wt% POSS with an Instron universal testing machine. The color of the interim material and the material with 1 wt% POSS were evaluated, followed by the evaluation of the color change after coffee staining. The data were analyzed with a 2-way analysis of variance (ANOVA) followed by the Tukey standardized range test (HSD) to determine statistical significance (α=.05). RESULTS: POSS enhanced the flexural strength of Protemp and Trim but had no effect on Temphase and Jet. POSS had a significant affect on the color (L*, a*, b*), but only 2 pairwise differences (in L* Trim versus Trim POSS and in a* Temphase versus Temphase POSS) were detected. The effect of POSS on color change after coffee staining was minimal. POSS only had a significant effect on ΔL, and only 1 pairwise difference was detected (Temphase versus Temphase POSS). The collapsed means revealed significant differences in color change among brands after coffee staining. CONCLUSIONS: The reinforcement effect of POSS on flexural strength depended on the brand, suggesting that the chemistry of the resin affects the ability of POSS to modify mechanical properties. POSS affected the initial color of the interim materials but had little effect on the color change after coffee staining.

Accuracy of ceramic restorations made with two CAD/CAM systems.

STATEMENT OF PROBLEM: Different types of CAD/CAM systems are currently available, but information regarding which system produces the best marginal fit is lacking. PURPOSE: The purpose of this study was to evaluate the effect of 2 different CAD/CAM systems (Cerec inLab, Kavo Everest) on the marginal fit of 2 types of zirconia-based and lithium disilicate crowns. MATERIAL AND METHODS: Forty zirconia-based and lithium disilicate crowns, 20 each, were fabricated with the Cerec inLab and Everest CAD/CAM systems on a specially designed stainless steel die to ensure the standardization of specimen shape and dimensions. The vertical marginal fit for all tested crowns was evaluated by using a digital microscope at ×100 magnification, and the data were tabulated and statistically analyzed with 2-way ANOVA, followed by the Tukey honestly significant difference (HSD) test with a confidence level of .05 to determine the mean differences. RESULTS: The results showed that the CAD/CAM technique, ceramic type, and their interaction had a statistically significant effect on the mean marginal fit of both ceramic types tested. CONCLUSIONS: Better marginal fit values were exhibited by the Everest CAD/CAM technique for both ceramic types tested.

Validation of two clinical color measuring instruments for use in dental research.

OBJECTIVE: There are several shade matching instruments developed for clinical use, but the validity of their use in dental research has not been thoroughly investigated. The objective of this study is to evaluate the accuracy of using two clinical color measuring instruments, VitaEasyshade and Spectroshade, against a referent laboratory color measuring instrument (Spectroradiometer PR670). METHODS AND MATERIALS: The validity and repeatability of the referent laboratory color measuring instrument was assessed using standard color patches with certified CIE L*a*b* values. 10% of the 240 color patches were randomly selected and measured ten times in a random order to test for repeatability. 16 metal ceramic specimens, fabricated from base metal alloy veneered with porcelain of different Vita Classic shades, were measured for L*a*b* values using the PR670, Vita EasyShade and the Spectroshade. The CIE L*a*b* values obtained from the three color measuring instruments were compared using repeated measures ANOVA and post hoc using the Bonferroni test. The color difference, CIEDE2000 (∆E00), between the gold standard (PR670) and the two color measuring instruments were also determined and compared against the known perceptible color difference. RESULTS: L*a*b* values varied significantly between the three instruments. When comparing the mean ΔE00, the differences in values between PR670 and Spectroshade were not clinically significantly. However, the mean ΔE00 values between PR670 and Vita Easyshade were both clinically and statistically significant. CONCLUSION: The lack of clinical significance in values obtained from the SpectroShade when compared to those obtained by the PR670 suggests that the SpectroShade may be recommended for use in dental color research. CLINICAL SIGNIFICANCE: The SpectroShade instrument and PR670 spectroradiometer provided values that lacked clinical significance, suggesting that its use may be highly beneficial for clinical shade matching as well as color research.

Effect of Finish Line Design and Cement Space Thickness on the Marginal Accuracy of Monolithic Zirconia Crowns / Efeito do desenho da linha de término e da espessura do espaço de cimento na precisão marginal de coroas monolíticas de zircônia

Objective: The purpose of this study was to evaluate the effect of finish line design and cement space thickness on the marginal accuracy of monolithic zirconia crowns. Materials and methods: Thirty crowns were fabricated from translucent zirconia (inCoris TZI) using Cerec in-Lab system and divided into three main groups (10 each) according to the finish line type of the die (knife-edge, chamfer, and shoulder). Every group was divided into two subgroups (5 each) according to cement space thickness (20 and50µm). Optical impressions were taken for the dies using the Cerec scanner and cement space was set twice for every finish line design; 20 and 50 µm. The completed crowns were cemented to the dies and the marginal gap was evaluated. The collected data was statistically analyzed using Mann-Whitney U test and Kruskal-Wallis test and the significance level was set at P ≤ 0.05. Results: Regarding the marginal gap; there was no statistically significant difference between different finish line designs or between different cement space thicknesses. Conclusion: Neither finish line design nor cement space thickness has an effect on the marginal gap of inCoris TZI crowns. (AU)

Declaração do problema: A necessidade de um método minimamente invasivo de preparação de coroa única é inevitável, principalmente com dentes enfraquecidos e com alta probabilidade de irritação pulpar. Portanto, é necessária uma restauração durável e adaptada, com preparação menos invasiva da linha de término. Objetivo: O objetivo deste estudo foi avaliar o efeito do design da linha de término e da espessura do espaço de cimento na precisão marginal das coroas monolíticas de zircônia. Material e Métodos: Trinta coroas foram fabricadas a partir de zircônia translúcida (inCoris TZI) usando o sistema Cerec em laboratório, e divididas em três grupos principais (n = 10), de acordo com o tipo de linha de término da matriz (lâmina, chanfro e ombro). Cada grupo foi dividido em dois subgrupos (5 cada), de acordo com a espessura do espaço do cimento (20 e 50 µm). Impressões ópticas foram obtidas para as matrizes usando o scanner Cerec e o espaço de cimento foi definido duas vezes para cada projeto de linha de chegada: 20 e 50 µm. As coroas confeccionadas foram cimentadas nos moldes e a diferença marginal foi avaliada. Os dados coletados foram analisados estatisticamente pelo teste U de Mann-Whitney e Kruskal-Wallis e o nível de significância foi estabelecido em P ≤ 0,05. Resultados: Em relação ao gap marginal não houve diferença estatisticamente significante entre diferentes projetos de linha de acabamento ou entre diferentes espessuras de espaço de cimento. Conclusão: nem o design da linha de término, nem a espessura do espaço de cimento afetam a folga marginal das coroas inCoris TZI. (AU)

Effect of diode laser irradiation of bonding agents before curing versus standard bonding protocol on the shear bond strength between resin cement and dentin / Efeito da irradiação com laser de diodo sobre sistemas adesivos antes da cura versus protocolo de adesão padrão na resistência ao cisalhamento entre o cimento resinoso e a dentina

Objective: This study aimed to evaluate the effect of diode laser irradiation (970 nm) of a one-step self-etch adhesive (Clearfil S3 Bond/CS3B) and of the bonding agent of a two-step self-etch adhesive (Clearfil Liner Bond F/CLBF) placed on dentin before polymerization on the shear bond strength. Material and methods: Forty sound premolars were sectioned buccally to obtain flat dentin surfaces. The specimens were divided into 4 groups (n = 10): Group (OS) ­ CS3B + polymerization. Group (OS-L) ­ CS3B + laser + polymerization. Group (TS) ­ CLBF (bonding agent only) + polymerization. Group (TS-L) ­ CLBF (bonding agent only) + laser + polymerization. The diode laser was irradiated through an 8 mm bleaching tip for 10 seconds, (0.4 W, 10 Hz, 4 J). All samples were cemented to composite blocks and submitted to 4000 thermal cycles. The samples were tested for shear bond strength in a universal testing machine. Data obtained was analyzed using Twoway (ANOVA) (p < 0.05) and the Bonferroni posthoc test. Representative samples from each group were analyzed using scanning electron microscopy (SEM). Results: Group TS-L ­ (7.43 MPa) displayed statistically significant higher shear bond strength in comparison to that of group TS ­ (5.13 MPa). No statistically significant difference was found between group OS-L ­ (6.49 MPa) and group OS ­ (7.28 MPa). Group TS-L exhibited the highest resin penetration beyond the hybrid layer under SEM. Conclusions: Diode laser irradiation of a bonding agent placed on dentin without prior priming increased the bond strength to dentin and is promising as a new dentin adhesion protocol. (AU)

Objetivo: Este estudo teve como objetivo avaliar o efeito da irradiação com laser de diodo (970 nm) sobre um adesivo autocondicionante de um passo (Clearfil S3 Bond / CS3B) e de um outro adesivo autocondicionante de dois passos (Clearfil Liner Bond F / CLBF) aplicado na dentina, antes de sua polimerização, na resistência ao cisalhamento. Material e métodos: Quarenta pré-molares hígidos foram seccionados vestibularmente para obtenção de superfícies dentinárias planas. Os espécimes foram divididos em 4 grupos (n = 10): Grupo (OS) - polimerização de CS3B +. Grupo (OS-L) - laser + CS3 + polimerização. Grupo (TS) - CLBF (apenas agente de adesão) + polimerização. Grupo (TS-L) - CLBF (somente agente de adesão) + laser + polimerização. O laser de diodo foi irradiado através de uma ponta de branqueamento de 8 mm durante 10 segundos (0,4 W, 10 Hz, 4 J). Todas as amostras foram cimentadas a blocos de compósitos, submetidos a 4.000 ciclos térmicos. As amostras foram testadas quanto à resistência ao cisalhamento em uma máquina universal de ensaios. Os dados obtidos foram analisados utilizandose Two-way (ANOVA) (p < 0,05) e o teste post-hoc de Bonferroni. Amostras representativas de cada grupo foram analisadas por microscopia eletrônica de varredura (MEV). Resultados: O grupo TS-L - (7,43 MPa) apresentou resistência ao cisalhamento estatisticamente significativa maior em relação ao grupo TS (5,13 MPa). Não houve diferença estatisticamente significativa entre o grupo OS-L - (6,49 MPa) e grupo OS - (7,28 MPa). O grupo TS-L exibiu a maior penetração de resina além da camada híbrida em MEV. Conclusões: A irradiação com laser de diodo de um agente adesivo colocado sobre a dentina sem o uso prévio de primers aumentou a força de adesão à dentina e é promissora como um novo protocolo de adesão dentinária. (AU)

Fracture resistance of fiber-reinforced PMMA interim fixed partial dentures.

PURPOSE: To compare different fiber reinforcements on fracture toughness of interim polymethyl methacrylate materials and then use the best combination to determine the optimal position for fiber placement in an interim 3-unit fixed partial denture (FPD). MATERIALS AND METHODS: In the first stage of the study, five groups of notched fracture toughness specimens were fabricated and loaded to failure (Instron): (1) unreinforced (control); (2) reinforced with pre-impregnated silanized E-glass fibers (Fibrestick); (3) cold plasma-treated woven polyethylene fibers (Ribbond triaxial); (4) pre-impregnated silanized plasma-treated woven polyethylene fibers (Construct); and (5) 1.0-mm-diameter stainless steel wire. In the second stage, the optimal position (occlusal, middle, or cervical third of pontic) for reinforcement with glass fibers (regimen 2) was tested by loading a 3-unit FPD to failure. All groups were compared with analysis of variance (alpha < 0.05). RESULTS: The fracture toughness (in MPam(1/2)) for each reinforced group (Fibrestick 2.74 +/- 0.12, Construct fibers 2.59 +/- 0.28, Ribbond triaxial 2.13 +/- 0.20, and orthodontic wire 1.66 +/- 0.09) was statistically greater (p< 0.05) than for the unreinforced group (control = 1.25 +/- 0.006). Fracture loads for FPDs were greatest when the fiber reinforcements were placed in the cervical third (cervical = 1165 N). CONCLUSIONS: The use of fiber and, to a lesser extent, orthodontic wire is an effective method to reinforce interim restoration resins.

The effect of fiber reinforcement on the fracture toughness and flexural strength of provisional restorative resins.

STATEMENT OF PROBLEM: Fracture of provisional restorations is of concern, especially with long-span fixed partial dentures or areas of heavy occlusal stress. A number of different techniques for reinforcement of provisional restorations have been suggested; however, the effect of these techniques is largely unclear. PURPOSE: The aim of this study was to determine the fracture toughness and flexural strength of different types of provisional restoration resins reinforced with different commercially available fibers. MATERIAL AND METHODS: A total of 105 specimens were prepared in this study for each test; compact tensile specimens for the fracture toughness test and rectangular specimens for the flexural strength test. The specimens were divided into 3 groups according to the type of resin used, Jet, Trim, or Temphase (n=35), and then each group was divided into 7 subgroups (n=5) according to the type of fiber reinforcement, Construct, Fibrestick, Ribbond normal, Ribbond THM, Ribbond triaxial, or Fibrenet. Unreinforced specimens served as the control. Specimens were loaded in a universal testing machine until fracture. The mean fracture toughness (MPa.m(1/2)) and mean flexural strength (MPa) were compared by 1-way analysis of variance, followed by the Tukey standardized range test (alpha=.05). RESULTS: Fibrestick and Construct reinforcements showed a significant increase (P<.0001) in mean fracture toughness over unreinforced controls for all resins tested. Fibrestick increased the polymethyl methacrylate from 1.25+/-0.06 MPa.m(1/2) to 2.74+/-0.12 MPa.m(1/2); polyethyl methacrylate from 0.67+/-0.07 MPa.m(1/2) to 1.64+/-0.13 MPa.m(1/2); and bis-acryl from 0.87+/-0.05 MPa.m(1/2) to 1.39+/-0.11 MPa.m(1/2). Construct increased polymethyl methacrylate to 2.59+/-0.28 MPa.m(1/2); polyethyl methacrylate to 1.53+/-0.22 MPa.m(1/2); and bis-acryl to 1.30+/-0.13 MPa.m(1/2); however, there was no significant difference between Fibrestick and Construct reinforcements in the degree of reinforcement. Similarly the mean flexural strength values were significantly increased by different combinations of fiber and resin (P<.0001). CONCLUSION: The addition of fibers to provisional resin increased both fracture toughness and flexural strength.