Reliability and Failure Modes of a Hybrid Ceramic Abutment Prototype.

PURPOSE: A ceramic and metal abutment prototype was fatigue tested to determine the probability of survival at various loads. MATERIALS AND METHODS: Lithium disilicate CAD-milled abutments (n = 24) were cemented to titanium sleeve inserts and then screw attached to titanium fixtures. The assembly was then embedded at a 30° angle in polymethylmethacrylate. Each (n = 24) was restored with a resin-cemented machined lithium disilicate all-ceramic central incisor crown. Single load (lingual-incisal contact) to failure was determined for three specimens. Fatigue testing (n = 21) was conducted employing the step-stress method with lingual mouth motion loading. Failures were recorded, and reliability calculations were performed using proprietary software. Probability Weibull curves were calculated with 90% confidence bounds. Fracture modes were classified with a stereomicroscope, and representative samples imaged with scanning electron microscopy. RESULTS: Fatigue results indicated that the limiting factor in the current design is the fatigue strength of the abutment screw, where screw fracture often leads to failure of the abutment metal sleeve and/or cracking in the implant fixture. Reliability for completion of a mission at 200 N load for 50K cycles was 0.38 (0.52% to 0.25 90% CI) and for 100K cycles was only 0.12 (0.26 to 0.05)-only 12% predicted to survive. These results are similar to those from previous studies on metal to metal abutment/fixture systems where screw failure is a limitation. No ceramic crown or ceramic abutment initiated fractures occurred, supporting the research hypothesis. The limiting factor in performance was the screw failure in the metal-to-metal connection between the prototyped abutment and the fixture, indicating that this configuration should function clinically with no abutment ceramic complications. CONCLUSION: The combined ceramic with titanium sleeve abutment prototype performance was limited by the fatigue degradation of the abutment screw. In fatigue, no ceramic crown or ceramic abutment components failed, supporting the research hypothesis with a reliability similar to that of all-metal abutment fixture systems. A lithium disilcate abutment with a Ti alloy sleeve in combination with an all-ceramic crown should be expected to function clinically in a satisfactory manner.

Whence the Maryland Bridge? The evolution of the adhesive bridge.

The evolution of the adhesive bridge technique from perforated retainers in the anterior to its application in the posterior and how this led to development of methods to bond directly to metal are detailed below. The parallel nature of bonded bridges evolution in the US and Japan are noted.

Short- and Long-term Evaluation of Dentin-Resin Interfaces Formed by Etch-and-Rinse Adhesives on Plasma-treated Dentin.

PURPOSE: To investigate the influence of atmospheric pressure plasma (APP) treatment on the microtensile dentin bond strength of two etch-and-rinse adhesive systems, after one week and one year of water storage, and additionally to observe the micromorphology of resin/dentin interfaces under scanning electronic microscopy (SEM). MATERIALS AND METHODS: The occlusal enamel was removed from third human molars to expose a flat dentin surface. The teeth were then randomly divided into six groups (n = 7), according to two adhesives (Optibond FL and XP-Bond) and three APP treatments (untreated dentin [control], APP application before or after acid etching). After performing the composite resin buildup on bonded dentin, the teeth were sectioned perpendicularly to the bonded interface to obtain beam-shaped specimens (cross-sectional area of ~0.9 mm2). The specimens were tested in tension until failure after one week and one year of water storage (1.0 mm/min rate). Bond strength data were analyzed by three-way ANOVA and Tukey's post-hoc test (α = 0.05%). Bonded beam specimens from each tooth were also prepared for interfacial SEM investigation. RESULTS: At one week, APP treatment applied after acid etching increased the dentin bond strength for XP Bond, while no effect was observed for Optibond FL. After one year, the bond strength of XP Bond decreased in groups where APP was applied after etching. The evaluation time did not influence the bond strength for Optibond FL. CONCLUSION: One-year evaluation did not show any sign of degradation of interfacial structures in any group. Application of APP to etched dentin combined with a two-step etch-and-rinse adhesive significantly increased bond strength at one week, but the effect was not stable after one year and was adhesive dependent.

A pilot study of dentists' assessment of caries detection and staging systems applied to early caries: PEARL Network findings.

The International Caries Detection and Assessment System (ICDAS II) and the Caries Classification System (CCS) are caries stage description systems proposed for adoption into clinical practice. This pilot study investigated clinicians' training in and use of these systems for detection of early caries and recommendations for individual tooth treatment. Patient participants (N = 8) with a range of noncavitated lesions (CCS ranks 2 and 4 and ICDAS II ranks 2-4) identified by a team of calibrated examiners were recruited from the New York University College of Dentistry clinic. Eighteen dentists-8 from the Practitioners Engaged in Applied Research and Learning (PEARL) Network and 10 recruited from the Academy of General Dentistry-were randomly assigned to 1 of 3 groups: 5 dentists used only visual-tactile (VT) examination, 7 were trained in the ICDAS II, and 6 were trained in the CCS. Lesion stage for each tooth was determined by the ICDAS II and CCS groups, and recommended treatment was decided by all groups. Teeth were assessed both with and without radiographs. Caries was detected in 92.7% (95% CI, 88%-96%) of the teeth by dentists with CCS training, 88.8% (95% CI, 84%-92%) of the teeth by those with ICDAS II training, and 62.3% (95% CI, 55%-69%) of teeth by the VT group. Web-based training was acceptable to all dentists in the CCS group (6 of 6) but fewer of the dentists in the ICDAS II group (5 of 7). The modified CCS translated clinically to more accurate caries detection, particularly compared to detection by untrained dentists (VT group). Moreover, the CCS was more accepted than was the ICDAS II, but dentists in both groups were open to the application of these systems. Agreement on caries staging requires additional training prior to a larger validation study.

Long-term Adhesion Study of Self-etching Systems to Plasma-treated Dentin.

PURPOSE: To determine the influence of atmospheric pressure plasma (APP) treatment on the microtensile dentin bond strength of two self-etching adhesive systems after one year of water storage as well as observe the contact angle changes of dentin treated with plasma and the micromorphology of resin/dentin interfaces using SEM. MATERIALS AND METHODS: For contact angle measurements, 6 human molars were sectioned to remove the occlusal enamel surface, embedded in PMMA resin, and ground to expose a flat dentin surface. Teeth were divided into two groups: 1) argon APP treatment for 30 s, and 2) blown air (control). For the microtensile test, 28 human third molars were used and prepared similarly to contact angle measurements. Teeth were randomly divided into 4 groups (n = 7) according to two self-etching adhesives and APP treatment (with/without). After making the composite resin buildup, teeth were sectioned perpendicular to the bonded interface to obtain beam specimens. The specimens were tested after 24 h and one year of water storage until failure. Bond strength data were analyzed by three-way ANOVA and Tukey's post-hoc test (α = 0.05%). Three beam specimens per group that were not used in the bond strength test were prepared for interfacial SEM analysis. RESULTS: APP application decreased the contact angle, but increased the bond strength only for one adhesive tested. SEM evaluation found signs of degradation within interfacial structures following 1-year aging in water. APP increased the dentin surface energy, but the effects of APP and 1-year water storage on dentin bond strength were product dependent. CONCLUSION: APP increased the dentin surface energy. It also increased the bond strength for Scotchbond Universal, but storage for one year negated the positive effect of APP treatment.

Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR Dental PBRN.

Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with 3 dental practice-based research networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95% CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased 4-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment >2 years; suppuration and dental extractions were independent risk factors for ONJ.

Abutment design for implant-supported indirect composite molar crowns: reliability and fractography.

PURPOSE: To investigate the reliability of titanium abutments veneered with indirect composites for implant-supported crowns and the possibility to trace back the fracture origin by qualitative fractographic analysis. MATERIALS AND METHODS: Large base (LB) (6.4-mm diameter base, with a 4-mm high cone in the center for composite retention), small base (SB-4) (5.2-mm base, 4-mm high cone), and small base with cone shortened to 2 mm (SB-2) Ti abutments were used. Each abutment received incremental layers of indirect resin composite until completing the anatomy of a maxillary molar crown. Step-stress accelerated-life fatigue testing (n = 18 each) was performed in water. Weibull curves with use stress of 200 N for 50,000 and 100,000 cycles were calculated. Probability Weibull plots examined the differences between groups. Specimens were inspected in light-polarized and scanning electron microscopes for fractographic analysis. RESULTS: Use level probability Weibull plots showed Beta values of 0.27 for LB, 0.32 for SB-4, and 0.26 for SB-2, indicating that failures were not influenced by fatigue and damage accumulation. The data replotted as Weibull distribution showed no significant difference in the characteristic strengths between LB (794 N) and SB-4 abutments (836 N), which were both significantly higher than SB-2 (601 N). Failure mode was cohesive within the composite for all groups. Fractographic markings showed that failures initiated at the indentation area and propagated toward the margins of cohesively failed composite. CONCLUSIONS: Reliability was not influenced by abutment design. Qualitative fractographic analysis of the failed indirect composite was feasible.

Residual thermal stress simulation in three-dimensional molar crown systems: a finite element analysis.

PURPOSE: To simulate coefficient of thermal expansion (CTE)-generated stress fields in monolithic metal and ceramic crowns, and CTE mismatch stresses between metal, alumina, or zirconia cores and veneer layered crowns when cooled from high temperature processing. MATERIALS AND METHODS: A 3D computer-aided design model of a mandibular first molar crown was generated. Tooth preparation comprised reduction of proximal walls by 1.5 mm and of occlusal surfaces by 2.0 mm. Crown systems were monolithic (all-porcelain, alumina, metal, or zirconia) or subdivided into a core (metallic, zirconia, or alumina) and a porcelain veneer layer. The model was thermally loaded from 900°C to 25°C. A finite element mesh of three nodes per edge and a first/last node interval ratio of 1 was used, resulting in approximately 60,000 elements for both solids. Regions and values of maximum principal stress at the core and veneer layers were determined through 3D graphs and software output. RESULTS: The metal-porcelain and zirconia-porcelain systems showed compressive fields within the veneer cusp bulk, whereas alumina-porcelain presented tensile fields. At the core/veneer interface, compressive fields were observed for the metal-porcelain system, slightly tensile for the zirconia-porcelain, and higher tensile stress magnitudes for the alumina-porcelain. Increasingly compressive stresses were observed for the metal, alumina, zirconia, and all-porcelain monolithic systems. CONCLUSIONS: Variations in residual thermal stress levels were observed between bilayered and single-material systems due to the interaction between crown configuration and material properties.

Conventional and modified veneered zirconia vs. metalloceramic: fatigue and finite element analysis.

PURPOSE: The purpose of this study was to test the hypothesis that all-ceramic crown core-veneer system reliability is improved by modifying the core design and as a result is comparable in reliability to metal-ceramic retainers (MCR). Finite element analysis (FEA) was performed to verify maximum principal stress distribution in the systems. MATERIALS AND METHODS: A first lower molar full crown preparation was modeled by reducing the height of proximal walls by 1.5 mm and occlusal surface by 2.0 mm. The CAD-based preparation was replicated and positioned in a dental articulator for specimen fabrication. Conventional (0.5 mm uniform thickness) and modified (2.5 mm height, 1 mm thickness at the lingual extending to proximals) zirconia (Y-TZP) core designs were produced with 1.5 mm veneer porcelain. MCR controls were fabricated following conventional design. All crowns were resin cemented to 30-day aged composite dies, aged 14 days in water and either single-loaded to failure or step-stress fatigue tested. The loads were positioned either on the mesiobuccal or mesiolingual cusp (n = 21 for each ceramic system and cusp). Probability Weibull and use level probability curves were calculated. Crack evolution was followed, and postmortem specimens were analyzed and compared to clinical failures. RESULTS: Compared to conventional and MCRs, increased levels of stress were observed in the core region for the modified Y-TZP core design. The reliability was higher in the Y-TZP-lingual-modified group at 100,000 cycles and 200 N, but not significantly different from the MCR-mesiolingual group. The MCR-distobuccal group showed the highest reliability. Fracture modes for Y-TZP groups were veneer chipping not exposing the core for the conventional design groups, and exposing the veneer-core interface for the modified group. MCR fractures were mostly chipping combined with metal coping exposure. CONCLUSIONS: FEA showed higher levels of stress for both Y-TZP core designs and veneer layers compared to MCR. Core design modification resulted in fatigue reliability response of Y-TZP comparable to MCR at 100,000 cycles and 200 N. Fracture modes observed matched with clinical scenarios.

Effect of metal primers on microtensile bond strength between zirconia and resin cements.

STATEMENT OF PROBLEM: There are no established clinical procedures for bonding zirconia to tooth structure using resin cements. PURPOSE: The purpose of this study was to evaluate the influence of metal primers, resin cements, and aging on bonding to zirconia. MATERIAL AND METHODS: Zirconia was treated with commercial primers developed for bonding to metal alloys (Metaltite, Metal Primer II, Alloy Primer or Totalbond). Non-primed specimens were considered as controls. One-hundred disk-shaped specimens (19 × 4 mm) were cemented to composite resin substrates using Panavia or RelyX Unicem (n=5). Microtensile bond strength specimens were tested after 48 hours and 5 months (150 days), and failure modes were classified as type 1 (between ceramic/cement), 2 (between composite resin/cement) or 3 (mixed). Data were analyzed by 3-way ANOVA and Multiple Comparison Tukey test (α=.05). RESULTS: The interactions primer/luting system (P=.016) and luting system/storage time (P=.004) were statistically significant. The use of Alloy Primer significantly improved the bond strength of RelyX Unicem (P<.001), while for Panavia, none of the primers increased the bond strength compared to the control group. At 48 hours, Panavia had statistically higher bond strength (P=.004) than Unicem (13.9 ± 4.4 MPa and 10.2 ± 6.6 MPa, respectively). However, both luting systems presented decreasing, statistically similar, values after aging (Panavia: 3.6 ± 2.2 MPa; Unicem: 6.1 ± 5.3 MPa). At 48 hours, Alloy Primer/Unicem had the lowest incidence of type 1 failure (8%). After aging, all the groups showed a predominance of type 1 failures. CONCLUSIONS: The use of Alloy Primer improved bond strength between RelyX Unicem and zirconia. Though the initial values obtained with Panavia were significantly higher than RelyX Unicem, after aging, both luting agents presented statistically similar performances.

Additive CAD/CAM process for dental prostheses.

This article describes the evolution of a computer-aided design/computer-aided manufacturing (CAD/CAM) process where ceramic paste is deposited in a layer-by-layer sequence using a computer numerical control machine to build up core and fixed partial denture (FPD) structures (robocasting). Al(2)O(3) (alumina) or ZrO(2) (Y-TZP) are blended into a 0.8% aqueous solution of ammonium polyacrylate in a ratio of approximately 1:1 solid:liquid. A viscosifying agent, hydroxypropyl methylcellulose, is added to a concentration of 1% in the liquid phase, and then a counter polyelectrolyte is added to gel the slurry. There are two methods for robocasting crown structures (cores or FPD framework). One is for the core to be printed using zirconia ink without support materials, in which the stereolithography (STL) file is inverted (occlusal surface resting on a flat substrate) and built. The second method uses a fugitive material composed of carbon black codeposited with the ceramic material. During the sintering process, the carbon black is removed. There are two key challenges to successful printing of ceramic crowns by the robocasting technique. First is the development of suitable materials for printing, and second is the design of printing patterns for assembly of the complex geometry required for a dental restoration. Robocasting has room for improvement. Current development involves enhancing the automation of nozzle alignment for accurate support material deposition and better fidelity of the occlusal surface. An accompanying effort involves calculation of optimal support structures to yield the best geometric results and minimal material usage.

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.

Thermal/mechanical simulation and laboratory fatigue testing of an alternative yttria tetragonal zirconia polycrystal core-veneer all-ceramic layered crown design.

This study evaluated the stress levels at the core layer and the veneer layer of zirconia crowns (comprising an alternative core design vs. a standard core design) under mechanical/thermal simulation, and subjected simulated models to laboratory mouth-motion fatigue. The dimensions of a mandibular first molar were imported into computer-aided design (CAD) software and a tooth preparation was modeled. A crown was designed using the space between the original tooth and the prepared tooth. The alternative core presented an additional lingual shoulder that lowered the veneer bulk of the cusps. Finite element analyses evaluated the residual maximum principal stresses fields at the core and veneer of both designs under loading and when cooled from 900 degrees C to 25 degrees C. Crowns were fabricated and mouth-motion fatigued, generating master Weibull curves and reliability data. Thermal modeling showed low residual stress fields throughout the bulk of the cusps for both groups. Mechanical simulation depicted a shift in stress levels to the core of the alternative design compared with the standard design. Significantly higher reliability was found for the alternative core. Regardless of the alternative configuration, thermal and mechanical computer simulations showed stress in the alternative core design comparable and higher to that of the standard configuration, respectively. Such a mechanical scenario probably led to the higher reliability of the alternative design under fatigue.

Biomechanical evaluation of an anatomically correct all-ceramic tooth-crown system configuration: core layer multivariate analysis incorporating clinically relevant variables.

In a crown system, core fracture requires replacement of the restoration. Understanding maximum principal stress concentration in the veneered core of a tooth-crown system as a function of variations in clinically relevant parameters is crucial in the rational design of crown systems. This study evaluated the main and interacting effects of a set of clinical variables on the maximum principal stress (MPS) in the core of an anatomically correct veneer-core-cement-tooth model. A 3D CAD model of a mandibular first molar crown was generated; tooth preparation was modeled by reducing the proximal walls by 1.5 mm and the occlusal surface by 2.0 mm. A cemented veneered core crown was modeled on the preparation. This "crown system" permitted finite element model investigation of the main and interacting effects of proximal wall height reduction, core material, core thickness, cement modulus, cement thickness, and load position on the maximum stress distribution in a factorial design. Analysis of variance was used to identify the main and interacting influences on the level of MPS in the crown core. Statistical significance was set at p<0.05. MPS levels varied as a function of two-way interactions between the following: core thickness and load position; cement thickness and load position; cement modulus and load position; cement thickness and core thickness; and cement thickness and cement modulus; and also three-way interactions among the load position, core material, and proximal wall height reduction, and among the core thickness, cement thickness, and cement modulus. MPS in the crown-tooth system is influenced by the design parameters and also by the interaction among them. Hence, while the geometry of molar crowns is complex, these analyses identify the factors that influence MPS and suggest levels that will minimize the core MPS in future studies of crown design.

The tooth: An analogue for biomimetic materials design and processing.

OBJECTIVE: Overview the development of human tooth; enamel, dentoenamel junction and dentin in regard to hierarchical structure property relationships and how these component structures can serve as templates for the design of tough materials. METHODS: The dental, engineering and ceramic literature (PubMed, Science Direct, Google Scholar) covering the last 20years was over viewed regarding enamel and dentin characterization, structure-property studies, as well as, publications related to bioinspired materials with relationship to tooth structure. Relevant publications were selected for inclusion. RESULTS: Enamel has been studied and modelled at 3 hierarchical levels, prism structure, parallel prism interactions and enamel decussation effects. Missing is a 4th level where the previous three hierarchies are combined with the 3D arrangement of these levels in enamel areas. Aspects of the enamel prism infrastructure and prism decussation have been used in 3D printing of Bouligand ceramic structures. The dento-enamel junction serves to arrest cracks and reduce the stress in enamel as a graded elastic modulus layer, leading to development of dental ceramics with increased strength and fatigue resistance. Dentin is a compliant structure that supports enamel mechanically and may, through providing interstitial fluid at the DEJ, allow repair of microcracks in enamel. Adequate models of dentin properties remain to be developed as it remains highly variable in tubule lumen size and the degree of mineral density around and between tubules. SIGNIFICANCE: The structure of teeth, particularly the 4 hierarchical levels of enamel, creates a vital, hard, tough damage tolerant system for inspiring new materials.

Resistance of bonded premolars to four artificial ageing models post enamel conditioning with a novel calcium-phosphate paste.

BACKGROUND: This in vitro study compares a novel calcium-phosphate etchant paste to conventional 37% phosphoric acid gel for bonding metal and ceramic brackets by evaluating the shear bond strength, remnant adhesive and enamel damage following water storage, acid challenge and fatigue loading. MATERIAL AND METHODS: Metal and ceramic brackets were bonded to 240 extracted human premolars using two enamel conditioning protocols: conventional 37% phosphoric acid (PA) gel (control), and an acidic calcium-phosphate (CaP) paste. The CaP paste was prepared from ß-tricalcium phosphate and monocalcium phosphate monohydrate powders mixed with 37% phosphoric acid solution, and the resulting phase was confirmed using FTIR. The bonded premolars were exposed to four artificial ageing models to examine the shear bond strength (SBS), adhesive remnant index (ARI score), with stereomicroscopic evaluation of enamel damage. RESULTS: Metal and ceramic control subgroups yielded significantly higher (p < 0.05) SBS (17.1-31.8 MPa) than the CaP subgroups (11.4-23.8 MPa) post all artificial ageing protocols, coupled with higher ARI scores and evidence of enamel damage. In contrast, the CaP subgroups survived all artificial ageing tests by maintaining adequate SBS for clinical performance, with the advantages of leaving unblemished enamel surface and bracket failures at the enamel-adhesive interface. CONCLUSIONS: Enamel conditioning with acidic CaP pastes attained adequate bond strengths with no or minimal adhesive residue and enamel damage, suggesting a suitable alternative to the conventional PA gel for orthodontic bonding. Key words:Enamel etching, calcium phosphate, bracket bond strength, adhesive residue, enamel damage.

In vitro bond strengths post thermal and fatigue load cycling of sapphire brackets bonded with self-etch primer and evaluation of enamel damage.

BACKGROUND: This in vitro study compares a self-etch primer (SEP) to an etch-and-rinse (EaR) for bonding sapphire brackets by evaluation of the enamel etch-pattern, shear bond strength, amount of remnant adhesive and enamel surface damage following thermal and fatigue cyclic loading. MATERIAL AND METHODS: Ceramic (sapphire) brackets were bonded to 80 extracted human premolars using two enamel etching protocols: conventional EaR using 37% phosphoric acid (PA) gel (control), and a SEP (Transbond Plus). Each group was subdivided into two subgroups (n=20 teeth) according to the time of bracket debonding: after 24 h water storage or following 5000 thermo-cycles plus 5000 cycles fatigue loading, to determine the shear bond strength (SBS), adhesive remnant index (ARI score), with scanning electron microscopy (SEM) evaluation of enamel condition. RESULTS: The control subgroups consistently exhibited significantly higher (p<0.05) SBS mean values (23.4-29.8 MPa) than the SEP subgroups (15.1-22.4 MPa) at both bracket debonding time points. However, the SEP subgroups yielded milder etch-patterns and attained SBS values above the minimum requirement range for clinical performance. In addition, the higher SBS of control subgroups was accompanied with higher ARI scores and enamel damage grades than SEP subgroups as confirmed by SEM. Thermocycling and fatigue significantly reduced the SBS of all subgroups, with a non-significant drop in the amount of adhesive residue or enamel damage. CONCLUSIONS: The use of SEP can be a suitable alternative to the conventional PA gel for sapphire bracket bonding as it maintains suitable bond strength and has the potential to produce both less remnant adhesive and enamel damage. Key words:Enamel etching, ceramic brackets, orthodontic bonding, adhesive remnants, enamel damage.

Effect of indenter material on reliability of all-ceramic crowns.

OBJECTIVES: Controversy exists about whether the elastic modulus (E) mismatch between the loading indenter and ceramic materials influences fatigue testing results. The research hypotheses were that for porcelain veneered Y-TZP crowns 1) A low modulus Steatite indenter (SB) leads to higher fatigue reliability compared to a high modulus tungsten carbide indenter (WC); 2) Different surface damage patterns are expected between low and high modulus indenters after sliding contact fatigue testing. All ceramic crowns will exhibit similar step-stress accelerated life testing (SSALT) contact fatigue reliability (hypothesis 1) and failure characteristics (hypothesis 2) when using high stiffness tungsten carbide (WC, E = 600 GPa) vs. enamel like steatite (SB, E = 90 GPa) indenters. METHODS: Manufacturer (3M Oral Care) prepared Y-TZP-veneered all-ceramic molar crowns were bonded to aged resin composite reproductions of a standard tooth preparation and subjected to mouth-motion SSALT fatigue (n = 18 per indenter type). Failure was defined either as initial inner cone crack (IC), or final fracture (FF) when porcelain fractured (chipping). Selected IC specimens that did not progress to FF were embedded in epoxy resin and sectioned for fractographic analysis. RESULTS: The distribution of failures across the load and cycle profiles lead to similar calculated Weibull Use Level Probability Plots with overlap of the 2-sided 90% confidence bounds. The calculated reliability for IC and FF was equivalent at a mission of 300 N or 700 N load and 50,000 cycles, although the WC indenter had a trend for lower reliability for IC at 700 N. Both indenters produced similar patterns of wear and cracking on crown surfaces. Fractographic landmarks showed competing failure modes, but sliding contact partial inner cone cracks were the most dominant for both groups. SIGNIFICANCE: The more compliant Steatite indenter had similar veneered crown fatigue reliability and failure modes to those found with use of a high stiffness tungsten carbide indenter (hypotheses 1 and 2 rejected).

Effect of framework design on crown failure.

This study evaluated the effect of core-design modification on the characteristic strength and failure modes of glass-infiltrated alumina (In-Ceram) (ICA) compared with porcelain fused to metal (PFM). Premolar crowns of a standard design (PFMs and ICAs) or with a modified framework design (PFMm and ICAm) were fabricated, cemented on dies, and loaded until failure. The crowns were loaded at 0.5 mm min(-1) using a 6.25 mm tungsten-carbide ball at the central fossa. Fracture load values were recorded and fracture analysis of representative samples were evaluated using scanning electron microscopy. Probability Weibull curves with two-sided 90% confidence limits were calculated for each group and a contour plot of the characteristic strength was obtained. Design modification showed an increase in the characteristic strength of the PFMm and ICAm groups, with PFM groups showing higher characteristic strength than ICA groups. The PFMm group showed the highest characteristic strength among all groups. Fracture modes of PFMs and of PFMm frequently reached the core interface at the lingual cusp, whereas ICA exhibited bulk fracture through the alumina core. Core-design modification significantly improved the characteristic strength for PFM and for ICA. The PFM groups demonstrated higher characteristic strength than both ICA groups combined.

Fracture Modes in Curved Brittle Layers Subject to Concentrated Cyclic Loading in Liquid Environments.

Damage response of brittle curved structures subject to cyclic Hertzian indentation was investigated. Specimens were fabricated by bisecting cylindrical quartz glass hollow tubes. The resulting hemi-cylindrical glass shells were bonded internally and at the edges to polymeric supporting structures and loaded axially in water on the outer circumference with a spherical tungsten carbide indenter. Critical loads and number of cycles to initiate and propagate near-contact cone cracks and far-field flexure radial cracks to failure were recorded. Flat quartz glass plates on polymer substrates were tested as a control group. Our findings showed that cone cracks form at lower loads, and can propagate through the quartz layer to the quartz/polymer interface at lower number of cycles, in the curved specimens relative to their flat counterparts. Flexural radial cracks require a higher load to initiate in the curved specimens relative to flat structures. These radial cracks can propagate rapidly to the margins, the flat edges of the bisecting plane, under cyclic loading at relatively low loads, owing to mechanical fatigue and a greater spatial range of tensile stresses in curved structures.