Influence of post material and ferrule thickness on the fracture resistance of endodontically treated premolars: A laboratory study.

STATEMENT OF PROBLEM: The influence of the ferrule thickness and post materials on the fracture resistance of endodontically treated teeth remains unclear. PURPOSE: The purpose of this laboratory study was to evaluate the influence of post material and ferrule thickness on the fracture resistance of endodontically treated mandibular premolars. MATERIAL AND METHODS: Sixty-four extracted and endodontically treated mandibular first premolars were used and divided into 4 test groups (n=16) depending on the ferrule thickness: F-0: without a ferrule, F-0.5: with a 0.5-mm ferrule thickness, F-1: with a 1-mm ferrule thickness, and F-1.5: with a 1.5-mm ferrule thickness. In groups with ferrules, the height ranged from 2 mm buccally/lingually to 1 mm proximally. Teeth in subgroups (n=8) were restored with either prefabricated glass fiber (FF) or titanium posts (FT) (ISO size 70 and length of 7.5 mm) and then adhesively restored with composite resin foundation materials. After foundation procedures, each specimen was restored with a cobalt chromium crown which was cemented with glass-ionomer cement. All specimens were subjected to dynamic loading in a masticatory simulator for 1 200 000 loading cycles with a nominal load of 5 Kg at 1.2 Hz and simultaneous thermocycling (5 to 55 °C). Specimens were then quasistatically loaded at 30 degrees in a universal testing machine until fracture. Fracture loads were analyzed by using 2-way ANOVA followed by the Tukey honestly significant difference test (α=.05). RESULTS: Fracture loads ranged from 610 ±45 N (no ferrule - glass fiber post) to 1216 ±169 N (1.5 mm ferrule thickness - glass fiber post). A statistically significant increase in fracture resistance was observed with increasing ferrule thickness (P<.001). However, post materials did not show a statistically significant influence (P=.977). CONCLUSIONS: Under the conditions of this laboratory study, increasing the ferrule thickness had a significant effect on the fracture resistance of endodontically treated teeth after thermomechanical fatigue, irrespective of post materials.

Influence of thermomechanical fatigue on the fracture strength of CAD-CAM-fabricated occlusal veneers.

STATEMENT OF PROBLEM: With the development of new computer-aided design and computer-aided manufacturing (CAD-CAM) restorative dental materials, limited data regarding their survival rate and fracture strength are available when they are used as occlusal veneers. Therefore, these materials should be evaluated under conditions similar to those of the oral environment before being recommended for clinical use. PURPOSE: To evaluate the influence of thermomechanical fatigue loading on the fracture strength of minimally invasive occlusal veneer restorations fabricated from different CAD-CAM materials and bonded to human maxillary premolars using self-etchnig bonding technique. MATERIAL AND METHODS: Sixty-four CAD-CAM occlusal veneer restorations were fabricated from group LD (lithium disilicate [e.max CAD]), LS (zirconia-reinforced lithium silicate [Vita Suprinity]), PI (polymer-infiltrated ceramic [Vita Enamic]), and PM (polymethylmethacrylate [Telio CAD]). The occlusal veneers were luted to enamel (n=16) using a self-etching primer (Multilink Primer A/B) and a luting composite resin (Multilink Automix). Half of the specimens of each group (n=8) were randomly selected and subjected to thermomechanical fatigue loading in a masticatory simulator (1.2 million cycles at 98 N with 5°C-55°C thermocycling). All specimens were quasistatically loaded until fracture. The statistical analysis was made using the Kruskal-Wallis and Mann-Whitney U tests (α=.05). RESULTS: According to the Kaplan-Meier analysis after the thermomechanical fatigue of the 4 groups, the cumulative survival rate was as follows: group LD, 50% group LS, 62.5% group PI, 37.5%; and group PM, 50%. Although some of the surviving specimens exhibited microcracking, their integrity or bonding to teeth was not affected. Thermomechanical fatigue significantly reduced the fracture strength of group PI (P=.047) and group PM (P=.025). Without thermomechanical fatigue, group PM showed significantly higher fracture strength than group LS (P=.015). CONCLUSIONS: In general, thermomechanical fatigue decreased the survival rate and fracture strength in all test groups.

Effect of fatigue loading on the fracture strength and failure mode of lithium disilicate and zirconia implant abutments.

OBJECTIVE: The aim of this study was to test five types of implant restorations using titanium, zirconia and lithium disilicate abutments after being subjected to long-term fatigue loading. MATERIALS AND METHODS: Forty single-tooth implant restorations were assembled on titanium implants (FairTwo; FairImplant). The restorations differed only in the type of abutment used and were divided into five groups [Ti: titanium; Zr: zirconia with no metal base; ZrT: zirconia with titanium base; LaT: lithium disilicate abutment with titanium base; and LcT: lithium disilicate hybrid-abutment-crown with titanium base]. Specimens were subjected to dynamic load of 49 N up to 1,200,000 cycles using a dual-axis chewing simulator (Kausimulator; Willytech). The surviving specimens were subjected to quasi-static loading using a universal testing machine (Z010; Zwick) until the implant-abutment connection failed. The values of force (N) at which fracture or plastic deformation of the restoration occurred were calculated and the rate of deformation was analyzed. The data was then analyzed using Mann-Whitney tests. RESULTS: Groups Ti, ZrT, LaT and LcT withstood 1,200,000 fatigue load cycles and higher forces than physiological occlusal forces without fracture or debonding of the ceramic suprastructure. In group Zr, some specimen did not survive the chewing simulation and this group showed the lowest resistance to failure with a median of 198 N. CONCLUSIONS: Within the limitations of this study, it could be concluded that lithium disilicate abutments and hybrid-abutment-crowns show promising durability and strength after long-term dynamic loading. The use of titanium base enhances the strength of the zirconia abutments.

Comparison of fracture strength and failure mode of different ceramic implant abutments.

STATEMENT OF PROBLEM: The whitish color of zirconia (ZrO2) abutments offers favorable esthetics compared with the grayish color of titanium (Ti) abutments. Nonetheless, ZrO2 has greater opacity, making it difficult to achieve natural tooth color. Therefore, lithium disilicate (LaT) abutments have been suggested to replace metal abutments. PURPOSE: The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth implant restorations using ZrO2 and LaT abutments, and to compare them with titanium (Ti) abutments. MATERIAL AND METHODS: Five different types of abutments, Ti; ZrO2 with no metal base; ZrO2 with a metal base (ZrT); LaT; and LaT combination abutment and crown (LcT) were assembled on 40 Ti implants and restored with LaT crowns. Specimens were subjected to quasistatic loading using a universal testing machine, until the implant-abutment connection failed. As bending of the metal would be considered a clinical failure, the values of force (N) at which the plastic deformation of the metal occurred were calculated, and the rate of deformation was analyzed. Statistical analysis was done using the Mann-Whitney U test (α=.05). RESULTS: Group ZrO2 revealed the lowest resistance to failure with a mean of 202 ±33 N. Groups ZrT, LaT, and LaC withstood higher forces without fracture or debonding of the ceramic suprastructure, and failure was due to deformation of metal bases, with no statistically significant differences between these groups regarding the bending behavior. CONCLUSIONS: Within the limitations of this in vitro study, it was concluded that LaT abutments have the potential to withstand the physiological occlusal forces that occur in the anterior region and that ZrO2 abutments combined with Ti inserts have much higher fracture strength than pure ZrO2 abutments.

Influence of Post Length, Post Material, and Substance Loss on the Fracture Resistance of Endodontically Treated Teeth: A Laboratory Study

PURPOSE: To evaluate the effects of post length, post material, and substance loss on the fracture resistance of endodontically treated mandibular premolars. MATERIALS AND METHODS: A total of 96 extracted human mandibular first premolars were endodontically treated and divided into 12 test groups (n = 8 each) based on the number of residual walls (one/two), post material (glass-fiber/titanium), and post length (5 mm, 7.5 mm, and 10 mm). After luting the posts, specimens received a composite resin core and a crown preparation with a 1.5-mm ferrule. Cast cobalt-chromium crowns were cemented using glass-ionomer cement. After 1,200,000 chewing cycles with a load of 49 N and simultaneous thermocycling (5°C to 55°C), specimens were quasi-statically loaded at 30 degrees to the longitudinal axis of the tooth until fracture. Fracture loads were analyzed using three-way, two-way, and one-way ANOVA (α = .05). Fracture modes were examined under a stereomicroscope (×25 magnification) and recorded. RESULTS: The mean ± SD fracture loads ranged from 642 ± 190 N (one wall, glass fiber, 5 mm) to 1,170 ± 130 N (two walls, titanium, 7.5 mm). The mean fracture load of titanium posts was significantly higher than that of glass-fiber posts (P < .001), and the 7.5-mm post length exhibited significantly higher fracture loads than groups with 5-mm and 10-mm post length (P = .008). CONCLUSIONS: Teeth restored with titanium posts revealed considerably higher fracture resistance than teeth restored with glass-fiber posts, especially if 7.5-mm-length posts were used.

Influence of Aging and Surface Treatment on the Composite Bond Strength to Translucent 3Y-TZP Zirconia.

PURPOSE: The purpose of this study was to assess the effect of aging and alumina-particle air abrasion at different pressures on the bond strength of two luting composites to a translucent 3Y-TZP zirconia. MATERIALS AND METHODS: Half of the 192 disk-shaped zirconia specimens were aged in an autoclave (group A) for 20 h (134°C, 2 bar), and the other half was not aged (group N). For each group, a different surface treatment was applied: as-sintered (group SIN), alumina-particle air abrasion either at 1 bar (group 1B) or at 2.5 bar (group 2.5B). Disks were bonded to Plexiglas tubes filled with composite resin using a phosphate monomer-based luting composite (group SA) or with a separate phosphate monomer containing primer before using a phosphate-monomer-free luting composite (group V5). All specimens were subjected to tensile bond strength testing (TBS) before and after thermocycling. RESULTS: There were no statistically significant differences caused by autoclave aging for the test groups before thermocycling, except for the A-SIN-SA group, where the TBS decreased significantly. The variation of the aluminaparticle air abrasion pressure showed no statistically significant effect, except in the N-1B-V5 group, where TBS was significantly lower than N-2.5B-V5. After thermocycling, the TBS of most groups decreased significantly. Specimens of the primer group, which were abraded at 1 bar, showed a significant decrease in TBS in comparison with alumina-particle air abrasion at 2.5 bar. CONCLUSION: Twenty hours of autoclave aging had almost no influence on the bond strength of the test groups. For the primer/resin bonding system, higher pressure during alumina-particle air abrasion might help obtain a higher and more durable bond strength to zirconia.

Influence of Post Length, Post Material, and Substance Loss on the Fracture Resistance of Endodontically Treated Teeth. A Laboratory Study.

PURPOSE: To evaluate the effects of post length, post material, and substance loss on the fracture resistance of endodontically treated mandibular premolars. MATERIALS AND METHODS: A total of 96 extracted human mandibular first premolars were endodontically treated and divided into 12 test groups (n = 8 each) based on the number of residual walls (one/two), post material (glass-fiber/titanium), and post length (5 mm, 7.5 mm, and 10 mm). After luting the posts, specimens received a composite resin core and a crown preparation with a 1.5-mm ferrule. Cast cobalt-chromium crowns were cemented using glass-ionomer cement. After 1,200,000 chewing cycles with a load of 49 N and simultaneous thermocycling (5°C to 55°C), specimens were quasi-statically loaded at 30 degrees to the longitudinal axis of the tooth until fracture. Fracture loads were analyzed using three-way, two-way, and one-way analysis of variance (α = .05). Fracture modes were examined under a stereomicroscope (×25) and recorded. RESULTS: Fracture loads ranged from 642 ± 190 N (one wall, glass fiber, 5 mm) to 1,170 ± 130 (two walls, titanium, 7.5 mm). The mean fracture load of titanium posts was significantly higher than that of glass-fiber posts (P < .001), and the 7.5-mm post length exhibited significantly higher fracture loads than groups with 5-mm and 10-mm post length (P = .008). CONCLUSION: Teeth restored with titanium posts revealed considerably higher fracture resistance than teeth restored with glass-fiber posts, especially if 7.5-mm-length posts were used.

Influence of elapsed time between airborne-particle abrasion and bonding to zirconia bond strength.

OBJECTIVE: The airborne-particle abrasion of zirconia with alumina particle (APA) has been reported to result in the durable bonding of appropriate adhesive luting systems. However, whether a delay between APA and the application of the adhesive luting material might affect the resulting bond strength and its durability is unknown. METHODS: A total of 140 disc-shaped zirconia specimens were divided according to the elapsed time between the APA of zirconia and its bonding into 5 test groups (15 min, 1 h, 4 h, 24 h, and 72 h). The specimens were airborne-particle abraded with 50-µm Al2O3, and then stored at room temperature according to the test group (n = 28/group). Surface free energy (SFE) was measured for 12 specimens per group using a goniometer. For each group 16 Plexiglas tubes filled with composite resin were bonded to the zirconia specimens with an adhesive luting resin (Panavia 21). Tensile bond strength (TBS) was tested for subgroups of 8 specimens after water storage for 3 days and for 150 days with 37,500 thermal cycles. RESULTS: SFE decreased significantly within 24 h after APA. TBS after 3 days of water storage ranged from 38.3 (1 h) to 28.4 MPa (24 h) and after 150 days with thermocycling from 38.3 (15 min) to 24.8 MPa (24 h). SIGNIFICANCE: Based on these results, the time between the APA of zirconia and the application of adhesive materials should be minimized when bonding nonretentive zirconia restorations clinically.

Influence of Cleaning Methods on Resin Bonding to Contaminated Translucent 3Y-TZP ceramic.

PURPOSE: To evaluate the influence of different cleaning methods on the resin bond strength to contaminated translucent 3Y-TZP ceramic. MATERIALS AND METHODS: A total of 133 airborne-particle abraded (0.1 MPa) zirconia specimens were divided into 7 groups. Uncontaminated zirconia specimens were either not cleaned (UN) or cleaned with cleaning paste (Ivoclean) (UP1). After contamination by saliva and blood immersion, zirconia specimens were cleaned using either distilled water rinsing (CW), 99% isopropanol in an ultrasonic bath (CI), cleaning paste according to manufacturer's instructions (CP1), cleaning paste with additional rubbing (CP2), or additional airborne-particle abrasion at 0.1 MPa (CA). Three specimens from each group were examined by x-ray photoelectron spectroscopy (XPS). For each group, sixteen Plexiglas tubes filled with composite resin (Clearfil FII, Kuraray Noritake) were bonded to the zirconia specimens using a primer (Clearfil Ceramic Primer Plus, Kuraray Noritake) and luting composite (Panavia V5, Kuraray Noritake). Before measuring tensile bond strength, specimens were stored in distilled water for 3 or 150 days plus 37,500 thermal cycles. RESULTS: After 3 days, no group showed significantly different TBS compared to the control group UN (p > 0.05). However, groups CW and CI showed significantly lower TBS than all other groups after 150 days (p ≤ 0.05). XPS analysis revealed more organic residue on zirconia surfaces of groups CW and CI than on the other groups. CONCLUSION: Cleaning with the cleaning paste and airborne-particle abrasion were effective in removing saliva and blood contamination and enhancing bond strength.

Influence of Aging on Biaxial Flexural Strength and Hardness of Translucent 3Y-TZP.

The purpose of this research was to evaluate the influence of aging and surface treatment on surface roughness, biaxial flexural strength (BFS), and Vickers hardness (VHN) of translucent dental zirconia. Half of 80 disc-shaped zirconia specimens (1.2 mm thickness and 12 mm diameter) were aged (group A) in an autoclave for 20 h (134 °C and 0.2 MPa) and the other half were not aged (group N). Specimens were subjected to: no surface treatment (SIN), particle air-abrasion with 50 µm alumina particles at 1 bar (0.1 MPa) and 2.5 bar (0.25 MPa), or polishing down to 1 µm (POL). Specimens were analyzed using X-ray diffraction, laser scanning microscope, BFS, and VHN tests. Three groups (N-SIN, N-POL, and A-POL) showed almost no monoclinic phase. While other groups showed monoclinic phase ratios ranging from 7.5 vol. % ± 2.4 vol. % (N-0.1 MPa) to 41.5 vol. % ± 0.3 vol. % (A-0.1 MPa). Aging and particle air-abrasion increased significantly the BFS, ranging from 720 ± 37 MPa (N-SIN) to 1153 ± 92 MPa (N-0.1 MPa). The hardness was not influenced significantly by aging. A certain amount of monoclinic phase at the surface strengthens the high translucent dental zirconia, while hardness and roughness are not influenced. The pressure of particle air-abrasion showed no influence on the evaluated properties.

Influence of Different Post Luting Cements on the Fracture Strength of Endodontically Treated Teeth: An In Vitro Study.

OBJECTIVE: To evaluate the fracture resistance of endodontically treated mandibular premolars restored with glass fiber posts using different luting agents. METHODS: Twenty-four extracted single-rooted mandibular premolars were endodontically treated, and post spaces were prepared to receive fiber posts. They were assigned to three test groups (n=8) according to the type of cement used for the cementation of glass fiber posts: RC group: adhesive resin cement group (etch and rinse), SC group: self-adhesive resin cement group, and GC group: glass ionomer cement group. Teeth in all groups were adhesively restored with a composite resin core material and crowned with Ni-Cr crowns. All specimens were subjected to tangential loading using a universal testing machine until fracture at 30°. Failure loads were recorded, and data were analyzed using one-way ANOVA followed by Tukey's HSD test (α=0.05). RESULTS: Specimens in the RC group were more resistant (258.3±12.7 N) to fracture than those in the SC (218.7±11.1 N) and GC (165.4±8.9 N) groups (P≤0.001). One-way ANOVA indicated that the type of cement had a significant effect on the fracture resistance of endodontically treated lower premolars (P≤0.001). CONCLUSION: The type of cement that was used to fix glass fiber posts was a determining factor of the fracture resistance of endodontically treated lower premolars.

Fracture resistance of ceramic and polymer-based occlusal veneer restorations.

OBJECTIVES: The purpose of this in vitro study was to evaluate the influence of thermodynamic loading on the durability and fracture resistance behavior of occlusal veneers fabricated from different biomedical dental CAD/CAM materials. METHODS: The occlusal surfaces of 64 extracted premolars were prepared in the enamel layer and restored with occlusal veneers with a fissure/cusp thickness of 0.5/0.8mm made from four different dental CAD/CAM materials: group LD lithium disilicate (e.max CAD), group LS zirconia-reinforced lithium silicate (Vita Suprinity), group PI polymer-infiltrated ceramic (Vita Enamic), and group PM polymethylmethacrylate PMMA (Telio CAD). The prepared teeth were etched with phosphoric acid. The occlusal veneers were then bonded using an adhesive luting system (Multilink Primer A/B and Multilink Automix luting resin). Half of the specimens were subjected to thermodynamic loading in a chewing simulator (1.2 million cycles at 98N). All specimens were quasi-statically loaded until fracture. The statistical analysis was made using the t-test and one-way ANOVA followed by the Tukey HSD test (α = 0.05). RESULTS: All aged specimens survived the thermodynamic loading. Thermodynamic loading significantly raised the fracture resistance in groups LS, PI, and PM (P < 0.03). Occlusal veneers made from lithium disilicate and zirconia-reinforced lithium silicate recorded higher fracture resistance than those made from polymer-infiltrated ceramic and PMMA resin. CONCLUSIONS: All tested dental CAD/CAM biomaterials exhibited a fracture resistance considerably exceeding the average occlusal force in the posterior dentition. Therefore, they might present a viable long-term treatment for restoring the occlusal surfaces of posterior teeth.