Fracture toughness of yttria-stabilized zirconia sintered in conventional and microwave ovens.

STATEMENT OF PROBLEM: The fabrication of zirconium dioxide (ZrO2) dental prosthetic substructures requires an extended sintering process (8 to 10 hours) in a conventional oven. Microwave sintering is a shorter process (2 hours) than conventional sintering. PURPOSE: The purpose of this study was to compare the fracture toughness of 3 mol % Y2O3-stabilized ZrO2 sintered in a conventional or microwave oven. MATERIAL AND METHODS: Partially sintered ZrO2 specimens from 3 manufacturers, KaVo, Lava 3M, and Crystal HS were milled (KaVo Everest engine) and randomly divided into 2 groups: conventional sintering and microwave sintering (n=16 per group). The specimens were sintered according to the manufacturers' recommendations and stored in artificial saliva for 10 days. Fracture toughness was determined by using a 4-point bend test, and load to fracture was recorded. Mean fracture toughness for each material was calculated. A 2-way ANOVA followed by the Tukey HDS post hoc test was used to assess the significance of sintering and material effects on fracture toughness, including an interaction between the 2 factors (α=.05). RESULTS: The 2-way ANOVA suggested a significant main effect for ZrO2 manufacturer (P<.001). The post hoc Tukey HSD test indicated that mean fracture toughness for the KaVo ZrO2 (5.85 MPa·m(1/2) ±1.29) was significantly higher than for Lava 3M (5.19 MPa·m(1/2) ±0.47) and Crystal HS (4.94 MPa·m(1/2) ±0.66) (P<.05) and no significant difference was observed between Lava 3M and Crystal HS (P>.05). The main effect of the sintering process (Conventional [5.30 MPa·m(1/2) ±1.00] or Microwave [5.36 MPa·m(1/2) ±0.92]) was not significant (P=.76), and there was no interaction between sintering and ZrO2 manufacturer (P=.91). CONCLUSIONS: Based on the results of this study, no statistically significant difference was observed in the fracture toughness of ZrO2 sintered in microwave or conventional ovens.

Human perception of dental porcelain translucency correlated to spectrophotometric measurements.

PURPOSE: This study evaluated the relationship between instrumental measurements and subjective visual assessment of differences in dental porcelain translucency. MATERIALS AND METHODS: Unshaded feldspathic porcelain was used with controlled amounts of tin oxide to create two groups of 12-mm diameter disks with incremental changes in opacity. Contrast ratio (CR = Yb/Yw) was determined with a spectrophotometer, and used as a measure of porcelain translucency (Group A = 0.20 to 0.40; Group B = 0.6-0.8). Within each group, there were 14 specimens with 11 CRs. Three observer groups (first year dental students, residents, faculty with >10 years of shade matching experience) were recruited to assess the translucency between porcelain disks under two lighting conditions (reflected light, transmitted light). Each subject's ability to distinguish between specimens of differing translucency was determined. Descriptive statistics and three-way ANOVA followed by a post-hoc Tukey-Kramer test were used to evaluate the translucency perception threshold (TPT) of subjects (alpha= 0.05). RESULTS: The overall mean TPT (DeltaC) was 0.07, while 50% of the subjects could perceive a 0.06 CR difference between porcelain specimens. Three-way ANOVA revealed a significant difference in translucency perception among the observer groups (p < 0.0001), whereas the main effects for porcelain opacity (p= 0.3038) and lighting condition (p= 0.0645) were not significant, and no significant interactions were found. Post-hoc Tukey-Kramer test indicated that the mean TPT observed in the faculty group (DeltaC = 0.04) was significantly lower than those observed in student (DeltaC = 0.09) and resident groups (DeltaC = 0.08), while there was no significant difference between students and residents. CONCLUSIONS: The overall mean TPT of all subjects was 0.07, and 50% of the study population perceived a 0.06 CR difference in translucency. Increased shade matching experience (> or =10 years) significantly improved the ability to perceive differences in translucency; however, neither the viewing condition nor porcelain opacity affected the perceived translucency threshold.

Flexural and fatigue strengths of denture base resin.

STATEMENT OF PROBLEM: Mechanical properties of denture acrylic resins are important for the clinical success of multiple types of prostheses. Acrylic resins must be strong and resilient so as to withstand impact. Few studies utilize cyclic loads to characterize material response to repeated stress. PURPOSE: The purpose of this study was to evaluate static and dynamic flexure properties of a variety of acrylic resins utilized in the fabrication of prostheses: (1) heat-polymerized polymethyl methacrylate (PMMA), powder-liquid type, and (2) a newly introduced, visible light-polymerized urethane dimethacrylate dough type. MATERIAL AND METHODS: Twenty rectangular bars each of 4 PMMA acrylic resin materials (Diamond D, Fricke HI-I, Lucitone 199, Nature-Cryl Hi-Plus) and 1 urethane dimethacrylate (Eclipse) were fabricated and stored in 100% humidity for 30 days. Half of the specimens for each group were submitted to a static 3-point flexure test. The other half was submitted to cycling loading at 5 Hz for 10(4) cycles. Data were analyzed using 1-way ANOVA and 2-way ANOVA, followed by Tukey HSD or Bonferroni post hoc tests when necessary (alpha=.05). RESULTS: Mean static flexure strength (SDs) in MPa were: Eclipse, 127.11 (5.83); Diamond D, 84.92 (5.10); Lucitone 199, 83.96 (11.96); HI-I, 79.54 (5.84); and Nature-Cryl Hi-Plus, 75.82 (6.96). Mean flexural strengths (SDs) in MPa postcycling were: Eclipse, 113.36 (31.29); Diamond D, 88.26 (5.46); Nature-Cryl Hi-Plus, 81.86 (4.93); HI-I, 79.18 (6.60); and Lucitone 199, 74.34 (4.95). CONCLUSIONS: The visible light-polymerized urethane dimethacrylate resin (Eclipse) showed greater flexure strength than all PMMA heat-polymerized resins for both static and cycled groups (P<.001). Yet the Eclipse material had lower load limits, and demonstrated brittle-type behavior and greater standard deviations. The heat-polymerized PMMA materials did not significantly differ from each other after static or cyclic testing.

An in vitro comparison of vertical marginal gaps of CAD/CAM titanium and conventional cast restorations.

PURPOSE: To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations. MATERIALS AND METHODS: Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences. RESULTS: The vertical margin openings were CAD/CAM: 79.43 +/- 25.46 microm; WAX/CAM: 73.12 +/- 24.15 microm; WAX/CAST: 23.91 +/- 9.80 microm. There was a statistically significant difference between the WAX/CAST group and the remaining groups. CONCLUSIONS: There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.

Cementing all-ceramic restorations: recommendations for success.

BACKGROUND: Several all-ceramic restorative systems of various compositions, properties and indications are available to the dental practitioner. Because of the large number of systems, the dental team faces questions and decisions when choosing the appropriate system and the appropriate means of cementation. OVERVIEW: The authors present a brief overview of the cementation options for various types of all-ceramic restorations. In this article, they discuss the cementation of current all-ceramic restorations and make clinical recommendations tailored to each type of ceramic. CONCLUSION AND CLINICAL IMPLICATIONS: The clinician must have a good understanding of the ceramic type to determine whether a restoration should be cemented adhesively or nonadhesively. Other variables, such as isolation and preparation design, also influence the cementation choice. Various ceramic types demand different surface treatments before cementation. Choosing and applying the appropriate surface treatment and cementation procedure will contribute to long-lasting restorations. The literature is lacking in clinical trial results that validate current in vitro data regarding cementation of all-ceramic restorations.

Color stability of provisional crown and fixed partial denture resins.

STATEMENT OF PROBLEM: Provisional resins are used extensively during fixed prosthodontic treatment and exhibit varying degrees of color change/discoloration over time. Data are needed to help predict color stability of provisional resins. PURPOSE: The purpose of this in vitro study was to measure the color change of 12 provisional prosthodontic materials after immersion in artificial saliva and artificial saliva-coffee solutions for 1, 2, and 4 weeks. MATERIAL AND METHODS: Twelve provisional materials were studied. Methacrylates consisted of Alike, Jet, Temporary Bridge Resin, Unifast, and Zeta CC. Bis-acryl resins included Instatemp, Integrity, Luxatemp, Protemp Garant, Provipont, Provitec, and Temphase. Ten specimens (25.4 mm x 25.4 mm x 2.4 mm) of each material were fabricated. Five specimens were stored at 37 degrees C in artificial saliva and 5 were stored in a solution of artificial saliva (400 cc) and coffee (800 cc). Baseline color was measured using a colorimeter. Further color measurements were made after 1, 2, and 4 weeks of immersion. CIE L *a *b * values were recorded and color differences (DeltaE) between baseline and each storage interval were calculated using a 2-way ANOVA with Bonferroni adjustment for multiple comparisons in conjunction with an overall alpha=.05. RESULTS: Results indicated the presence of strong interaction between material and storage solution regardless of the aspect of color considered (P<.0001 for DeltaE, DeltaL *, Deltaa *, and Deltab *). Coffee solution relative to saliva solution had the most significant impact on color change for Luxatemp, Protemp, and Temphase materials at 4 weeks, but the greatest overall color change for both coffee and saliva solutions was found for Provipont (DeltaE=9.40 coffee; 8.51 saliva) and the least overall color change for both solutions was found for Zeta CC (DeltaE=0.31 coffee; 0.23 saliva). CONCLUSIONS: Under the conditions of this study, 12 provisional crown and fixed partial denture resins demonstrated varying tendency to discolor over a range of time periods when immersed in artificial saliva and artificial saliva-coffee solutions.

The impact of saliva on patient care: A literature review.

Decreased salivary flow results in a clinically significant oral imbalance that may manifest as increased caries, susceptibility to oral candidosis, altered taste sensation, or a host of other problems. This article reviews the role of saliva in oral health, highlights the causes and consequences of xerostomia, and outlines treatment modalities for patients with xerostomia. Journal articles were investigated through Medline, and relevant textbooks and handbooks were consulted. A summary of the literature pertinent to clinical prosthodontics is presented.

Flexural strength of provisional crown and fixed partial denture resins.

STATEMENT OF PROBLEM: Provisional prostheses are subject to flexure under function. Selection of the appropriate material for their fabrication is difficult given the limited evidence-based information on the flexural strength of provisional resins. PURPOSE: This study compared the flexural strength of 5 methacrylate-based resins and 8 bis-acryl resins used to fabricate provisional crowns and fixed partial dentures. MATERIAL AND METHODS: Bar-type specimens were fabricated according to American National Standards Institute/American Dental Association specification 27. After being immersed in artificial saliva at 37 degrees C for 10 days, the specimens were fractured under 3-point loading in a universal testing machine at a crosshead speed of 0.75 mm/min. Maximal loads to fracture in Newtons were recorded. Mean flexural strengths were calculated in MPa (n = 10 per group). Comparisons were made with analysis of variance and Duncan's multiple range test (P<.05). RESULTS: Mean flexural strengths ranged from 56.2 to 123.6 MPa. There were 4 statistically similar groups. The group with the highest strengths consisted of 4 bis-acryl materials (Provipont, Integrity, Protemp 3 Garant, and Luxatemp). CONCLUSION: Within the limitations of this study, flexural strengths were material- rather than category-specific. Some, but not all, bis-acryl resins demonstrated significantly superior flexural strength over traditional methacrylate resins.

Effect of storage solution on surface roughness of provisional crown and fixed partial denture materials.

PURPOSE: This study evaluated the surface roughness of polished provisional materials at baseline and after storage in artificial saliva and artificial saliva-coffee solutions. MATERIALS AND METHODS: Ten specimens (25 mm x 25 mm x 2 mm) of 12 commercially available provisional crown materials (5 methacrylate and 7 bis-acryl resins) were fabricated and polished. Baseline surface roughness measurements (Ra) were made using a surface roughness tester. Specimens were divided into 2 groups and stored in artificial saliva or artificial saliva-coffee solution at 37 degrees C for 2 weeks. Baseline surface roughness data were analyzed using the analysis of variance; multiple comparisons adjustment was made using the Tukey method. Multiple linear regression methods were used to analyze change in roughness relative to baseline and to assess the impact of storage medium, material, and baseline roughness on this change, including potential interactions among these 3 factors; descriptors of poststorage surface roughness were obtained. RESULTS: Alike demonstrated the greatest surface roughness, both at baseline and after storage (p <0.05 after adjustment for all Pairwise comparison by Tukey method). Temphase, Temporary Bridge Resin, Instatemp, Unifast, Jet, and Zeta had the lowest baseline surface roughness measurements. The lowest poststorage roughness scores were associated with Protemp Garant, Jet, and Integrity. Five materials (Protemp Garant, Instatemp, Unifast, Jet, and Zeta), formed the group having the lowest rough poststorage outcomes. The data provided strong evidence of a material effect (p <0.0001) at baseline. Evaluation of change in Ra following storage indicated that surface roughness increased for the majority of materials after storage in a moist environment, and that provisional crown materials that exhibit less initial surface roughness tend to undergo greater surface roughness change in a moist environment. Strong indications were found that the effect of the type of storage solution used differed among the materials. CONCLUSIONS: There were significant differences in surface roughness of provisional crown materials when polished under the same conditions. Methacrylate resins in general exhibited smoother surfaces after initial polishing. Surface roughness increased for nearly all materials after storage in either moist environment.

Relative translucency of six all-ceramic systems. Part I: core materials.

STATEMENT OF PROBLEM: All-ceramic restorations have been advocated for superior esthetics. Various materials have been used to improve ceramic core strength, but it is unclear whether they affect the opacity of all-ceramic systems. PURPOSE: This study compared the translucency of 6 all-ceramic system core materials at clinically appropriate thicknesses. MATERIALS AND METHODS: Disc specimens 13 mm in diameter and 0.49 +/- 0.01 mm in thickness were fabricated from the following materials (n = 5 per group): IPS Empress dentin, IPS Empress 2 dentin, In-Ceram Alumina core, In-Ceram Spinell core, In-Ceram Zirconia core, and Procera AllCeram core. Empress and Empress 2 dentin specimens also were fabricated and tested at a thickness of 0.77 +/- 0.02 mm (the manufacturer's recommended core thickness is 0.8 mm). A high-noble metal-ceramic alloy (Porc. 52 SF) served as the control, and Vitadur Alpha opaque dentin was used as a standard. Sample reflectance (ratio of the intensity of reflected light to that of the incident light) was measured with an integrating sphere attached to a spectrophotometer across the visible spectrum (380 to 700 nm); 0-degree illumination and diffuse viewing geometry were used. Contrast ratios were calculated from the luminous reflectance (Y) of the specimens with a black (Yb) and a white (Yw) backing to give Yb/Yw with CIE illuminant D65 and a 2-degree observer function (0.0 = transparent, 1.0 = opaque). One-way analysis of variance and Tukey's multiple-comparison test were used to analyze the data (P<.05). RESULTS: Contrast ratios in order of most translucent to most opaque were as follows: Vitadur Alpha 0.60 +/- 0.03, Empress (0.5 mm) 0.64 +/- 0.01, In-Ceram Spinell 0.67 +/- 0.02, Empress 2 (0.5 mm) 0.68 +/- 0.02, Empress (0.8 mm) 0.72 +/- 0.01, Procera 0.72 +/- 0.01, Empress 2 (0.8 mm) 0.74 +/- 0.01, In-Ceram Alumina 0.87 +/- 0.01, In-Ceram Zirconia 1.00 +/- 0.01, and 52 SF alloy 1.00 +/- 0.00. CONCLUSION: Within the limitations of this study, there was a range of ceramic core translucency at clinically relevant core thicknesses. In order of decreasing translucency, the ranges were Vitadur Alpha dentin (standard) > In-Ceram Spinell > Empress, Procera, Empress 2 > In-Ceram Alumina > In-Ceram Zirconia, 52 SF alloy.

Relative translucency of six all-ceramic systems. Part II: core and veneer materials.

UNLABELLED: STATEMENT OF PROBLEM All-ceramic core materials with various strengthening compositions have a range of translucencies. It is unknown whether translucency differs when all-ceramic materials are fabricated similarly to the clinical restoration with a veneered core material. PURPOSE: This study compared the translucency of 6 all-ceramic materials veneered and glazed at clinically appropriate thicknesses. MATERIALS AND METHODS: Core specimens (n = 5 per group) of Empress dentin, Empress 2 dentin, In-Ceram Alumina, In-Ceram Spinell, In-Ceram Zirconia, and Procera AllCeram were fabricated as described in Part I of this study and veneered with their corresponding dentin porcelain to a final thickness of 1.47 +/- 0.01 mm. These specimens were compared with veneered Vitadur Alpha opaque dentin (as a standard), a clear glass disc (positive control), and a high-noble metal-ceramic alloy (Porc. 52 SF) veneered with Vitadur Omega dentin (negative control). Specimen reflectance was measured with an integrating sphere attached to a spectrophotometer across the visible spectrum (380 to 700 nm); 0-degree illumination and diffuse viewing geometry were used. Measurements were repeated after a glazing cycle. Contrast ratios were calculated from the luminous reflectance (Y) of the specimens with a black (Yb) and a white backing (Yw) to give Yb/Yw with CIE illuminant D65 and a 2-degree observer function (0.0 = transparent, 1.0 = opaque). One-way analysis of variance and Tukey's multiple-comparison test were used to analyze the data (P<.05). RESULTS: Significant differences in contrast ratios were found among the ceramic systems tested when they were veneered (P<.0001) and after the glazing cycle (P<.0001). Significant changes in contrast ratios (P<.0001) also were identified when the veneered specimens were glazed. CONCLUSION: Within the limitations of this study, a range of translucency was identified in the veneered all-ceramic systems tested. Such variability may affect their ability to match natural teeth. The glazing cycle resulted in decreased opacity for all test materials except the completely opaque In-Ceram Zirconia and metal-ceramic specimens.