Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study.

Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.

The effect of SiO2 crystallization in enhancing the luminescence of Dy3+-Sm3+ co-doped glass ceramics for cool white light application.

The present work investigates the structural and luminescence behaviour of Dy3+-Sm3+ co-doped glass ceramics obtained through heat treatment of precursor glasses. The growth of SiO2 polycrystalline particles and evolution of these crystallites in the glass domain are witnessed via XRD and FESEM study. The presence of network vibrational bands, hydroxyl groups and the increased quantity of bridging oxygens (BOs) in glass ceramics are analysed through FTIR spectroscopy study. The absorption study (UV-Visible-NIR) showed the possible electronic transitions of Dy3+ and Sm3+ ions. The red shift in the absorption band edges and the lower bandgap values are obtained as a result of improved heat treatment in glass ceramics. Emission studies show the enhanced luminescence intensity of glass ceramics under 350 and 402 nm excitations. Decay measurement of glass ceramics showed the improved lifetimes of Dy3+ and Sm3+ ions to have appeared in microseconds (×10-6 s). The colour characteristics of glass ceramics analysed using CIE colour chromaticity diagram and correlated colour temperature (CCT) values suggest the neutral to cool white light emissions. Therefore, prepared glass ceramics with SiO2 polycrystalline phase are considered to be suitable materials in cool white LEDs applications.

Zirconia toughened fluorosilicate glass-ceramics for dental prosthetic restorations.

Background: Dental glass-ceramics have limited strength and are unsuitable for high-stress-bearing areas. Zirconia stands out as a popular choice for reinforcing dental glass-ceramics due to its biocompatibility and high fracture toughness. Objectives: The objective of the study is to investigate the effect of an increase in zirconia (25, 30, 35 and 50 wt%) on microstructure, chemical solubility, hardness, fracture toughness, and brittleness index of fluorosilicate glass systems for dental restorative applications. Material and methods: The fluorosilicate glass frit was obtained through the melt-quench technique. The glass frit was ball-milled with 25, 30, 35 and 50 wt % of 3 mol% yttria-stabilized zirconia (G-25Z, G-30Z, G-35Z, and G-50Z). The composites were sintered to 1000 °C for 48h at a heating rate of 5 °C/min. The glass frit was subject to differential scanning calorimetry. Phase analysis and microstructural characterization were carried out. The crystallite size of zirconia and glass-ceramics, micro-hardness, indentation fracture toughness, brittleness index, and chemical solubility were evaluated. Results: Phase analysis reveals tetragonal and monoclinic zirconia with minor peaks of forsterite, fluorphlogopite, norbergite, and spinel. Their microstructures reveal the characteristic house-of-cards arrangement of fluorophlogopite crystals with dispersed zirconia. The results of hardness and fracture toughness show a statistically significant improvement with an increase in zirconia content. The crystallite size of zirconia and fluorophlogopite crystals with aspect ratio, brittleness index, and chemical solubility declined as the zirconia content increased. Conclusions: Increase in zirconia content from 25 wt % to 50 wt % in heat-treated fluorosilicate glass systems reveals non-reactive zirconia with a stable glass matrix and limits the growth of fluorphlogopite crystals with a house-of-cards microstructure. This results in a range of properties suitable for dental restorations of enhanced hardness, and improved fracture toughness. Despite these improvements, the material maintains its machinability with reduced chemical solubility.

Exploring the Effect of V2O5 and Nb2O5 Content on the Structural, Thermal, and Electrical Characteristics of Sodium Phosphate Glasses and Glass-Ceramics.

Na-V-P-Nb-based materials have gained substantial recognition as cathode materials in high-rate sodium-ion batteries due to their unique properties and compositions, comprising both alkali and transition metal ions, which allow them to exhibit a mixed ionic-polaronic conduction mechanism. In this study, the impact of introducing two transition metal oxides, V2O5 and Nb2O5, on the thermal, (micro)structural, and electrical properties of the 35Na2O-25V2O5-(40 - x)P2O5 - xNb2O5 system is examined. The starting glass shows the highest values of DC conductivity, σDC, reaching 1.45 × 10-8 Ω-1 cm-1 at 303 K, along with a glass transition temperature, Tg, of 371 °C. The incorporation of Nb2O5 influences both σDC and Tg, resulting in non-linear trends, with the lowest values observed for the glass with x = 20 mol%. Electron paramagnetic resonance measurements and vibrational spectroscopy results suggest that the observed non-monotonic trend in σDC arises from a diminishing contribution of polaronic conductivity due to the decrease in the relative number of V4+ ions and the introduction of Nb2O5, which disrupts the predominantly mixed vanadate-phosphate network within the starting glasses, consequently impeding polaronic transport. The mechanism of electrical transport is investigated using the model-free Summerfield scaling procedure, revealing the presence of mixed ionic-polaronic conductivity in glasses where x < 10 mol%, whereas for x ≥ 10 mol%, the ionic conductivity mechanism becomes prominent. To assess the impact of the V2O5 content on the electrical transport mechanism, a comparative analysis of two analogue series with varying V2O5 content (10 and 25 mol%) is conducted to evaluate the extent of its polaronic contribution.

Glass-Ceramic Materials with Luminescent Properties in the System ZnO-B2O3-Nb2O5-Eu2O3.

In this paper, the crystallization behavior of 50ZnO:47B2O3:3Nb2O3:0.5Eu2O3 (G-0 h) glass has been investigated in detail by DSC, XRD and TEM analysis. The luminescent properties of the resulting glass-ceramics were also investigated. By XRD and TEM analysis, crystallization of several crystalline phases has been proved (α-Zn3B2O6, ß-Zn3B2O6 and ZnNb2O6). By calculating crystal parameters, it was found that europium ions are successfully incorporated in the ß-Zn3B2O6. Photo-luminescent spectra showed increased emission in the resulting glass-ceramic samples compared to the parent glass sample due to higher asymmetry of Eu3+ ions in the obtained crystalline phases. It was established that the optimum emission intensity is registered for glass-ceramic samples obtained after 25 h heat treatment of the parent glass.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study.

BACKGROUND: Self-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass-ceramic veneers made by either pressing (PG) or milling (MG) process. METHODS: Fifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups. RESULTS: A total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05). CONCLUSION: SZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Effect of Er,Cr: YSGG laser debonding treatment on the optical properties and surface roughness of ceramic laminate veneers: An in vitro study.

PURPOSE: The objective of this study was to evaluate the effect of (Er,Cr: YSGG) laser debonding treatment on optical properties and surface roughness of veneers made of different ceramic materials. MATERIALS AND METHODS: Thirty bovine incisors were prepared to receive laminate veneers and divided into three groups (n = 10) according to ceramic material where group (E): IPS e.max CAD, group (S): Vita Suprinity, and group (C): Celtra Duo. Blocks were sectioned into 0.5 mm thickness plates and cemented on the labial surface of incisors using resin cement. The Er,Cr: YSGG laser was applied to each specimen at 4.5 W and 25 Hz for group E and at 6 W and 25 Hz for groups S and C. Color change (△E00), translucency parameter (TP) and surface roughness in µm (Ra) values were measured and calculated before and after laser treatment. Data were analyzed using two-way mixed model ANOVA at a significance level of p < 0.05. RESULTS: The highest mean △E00 value was recorded in group E (1.35 ± 0.09) followed by group S (1.08 ± 0.16) and then group C (0.93 ± 0.10) with a significant difference between them (p < 0.001). All groups exceeded the perceptibility threshold but remained below the acceptability threshold. No statistically significant difference was found in TP except for group E (p = 0.019). Ra values after laser debonding showed significantly higher values than before laser treatment in all three groups (p < 0.001). CONCLUSION: Er,Cr: YSGG laser can be safely used for debonding ceramic veneers without altering the optical properties but it does increase the roughness of debonded ceramic restorations.

Does glaze firing affect the strength of advanced lithium disilicate after simulated defects?

OBJECTIVE: To study the influence of glazing on strength repair of lithium disilicate glass-ceramics after defect incorporation in different production processing phases. MATERIALS AND METHODS: Bar-shaped specimens (1 × 1 × 12 mm, n = 280; 20/group) made from different lithium disilicate ceramics (IPS e.max CAD, Ivoclar, "LD" or advanced lithium disilicate CEREC Tessera, Dentsply Sirona, "ALD") were exposed to 7 different protocols: crystallized without (c) and with glaze layer (cg), with a defect incorporated before crystallization without (ic) and with glaze layer (icg), with a defect after crystallization without (ci) or with glaze layer (cig), and defect incorporated after the glaze layer (cgi). The flexural strength was determined using the three-point bending test. Analysis of indented areas and fractured specimens was performed by scanning electron microscopy. Flexural strength data were evaluated by two-way ANOVA followed by Tukey tests (α = 5%). RESULTS: Two-way ANOVA revealed a significant influence of ceramic (p < 0.001; F = 55.45), protocol (p < 0.001; F = 56.94), and the interaction protocol*ceramic (p < 0.001; F = 13.86). Regardless of ceramics, defect incorporation as final step resulted in the worst strength, while defects introduced before crystallization did not reduce strength. Glaze firing after defect incorporation led to strength repair for ALD, whereas such an effect was not evident for LD. CONCLUSIONS: The advanced lithium disilicate must receive a glaze layer to achieve its highest strength. Defects incorporated in the pre-crystallized stage can be healed during crystallization. Defects should not be incorporated after glazing. CLINICAL RELEVANCE: Clinical adjustments should be performed on pre-crystallized or crystalized restorations that receive a glazer layer afterwards.

Effect of resin cement elastic modulus on the biaxial flexural strength and structural reliability of an ultra-thin lithium disilicate glass-ceramic material.

OBJECTIVES: Photo- and dual-polymerized resin-based luting agent was evaluated for elastic moduli effects on ultra-thin lithium disilicate (LD) glass-ceramic strengthening, structural reliability, and stress distribution. MATERIALS AND METHODS: One hundred-sixty LD discs (IPS e.max CAD, Ivoclar/Vivadent) were produced in ultra-thin thicknesses (half with 0.3 mm and the other half with 0.5 mm). The ultra-thin ceramic disks were coated with two different cement types (Variolink Veneer - V and Panavia F 2.0 - P). Two positive control groups were tested following hydrofluoric (HF) acid etching (LDt3, LDt5) and two negative control groups were tested for untreated ceramic (LD 3, LD 5). Biaxial flexural strength (BFS), characteristic strength (σ0) and Weibull modulus (m) were the response variables (n = 20) at the ceramic/resin cement interface (z = 0). Finite element analysis (FEA) was used to calculate maximum principal stress. Data were analyzed using two-way ANOVA, and Tukey's test. Scanning electron microscopy (SEM) was used to analyze the failed specimens using fractography and surface morphology. RESULTS: The BFS of LD at either thickness was not affected by cement types, as also demonstrated by FEA. Structural reliability significantly improved in the positive control group (LDt5). CONCLUSION: The cementation of ultra-thin LD with a resin-cement of varying elastic moduli did not influence BFS. LD surface modification by HF acid-etching increased the reliability. CLINICAL RELEVANCE: Ultra-thin anterior veneer designs made from lithium disilicate have been widely proposed and the apparent success of LD ultra-thin veneers was not influenced by the cement choice in the current studies albeit the elastic moduli luting agents used were of similar values.

Effect of tooth brushing simulation on the surface properties of various resin-matrix computer-aided design/computer-aided manufacturing ceramics.

PURPOSE: The purpose was to investigate the alterations in surface properties of different resin-matrix CAD/CAM ceramics following tooth brushing simulation (TBS) and compare them with a direct resin composite and a glass ceramic CAD/CAM material. MATERIALS AND METHODS: Four resin-based CAD/CAM restoratives (Brilliant Crios-BR, Lava™ Ultimate-LV, Grandio Blocs-GR and Shofu Block HC-SH), a leucite-reinforced glass ceramic (IPS Empress® CAD-EC) and a resin composite (Filtek™ Z250-FZ) for direct restorations were tested. In particular, surface loss, hardness, roughness and morphology were investigated utilizing confocal microscopy, scanning electron microscopy and nanoindentation tester. TBS was conducted for 4 × 15 min on the surface of the samples and then the changes in their surface properties were evaluated. RESULTS: After TBS, all the experimental groups exhibited surface loss to different extent. FZ and BR presented the highest surface loss, while EC and GR the lowest (p < 0.05). Regarding surface roughness, all the tested materials exhibited increase after TBS (p < 0.05), except LV (p = 0.099). EC presented the lowest Sa values, while FZ and BR the highest (p < 0.05). Changes in surface morphology were in compliance with the results of surface roughness and also surface hardness was correlated with surface loss. CONCLUSIONS: The tested resin-matrix CAD/CAM ceramic restorative materials showed a competent behavior against abrasive forces applied during TBS. Surface loss and roughness changes were material dependent and superior compared to a resin composite for direct restorations, while in comparison with a leucite-reinforced glass ceramic exhibited inferior properties. CLINICAL SIGNIFICANCE: Tooth brushing affected differently the surface of the tested restorative materials. However, the abrasive wear that was induced was negligible. Clinical studies are necessary to ascertain if there is clinical significance of these surface alterations that may demand repair of such restorations.

Evaluation of the marginal fit of lithium disilicate single crowns fabricated with the conventional (Emax press) and the CAD/CAM (Emax CAD) method: A systematic review and meta-analysis.

AIM: The purpose of this systematic review and meta-analysis is to evaluate the marginal adaptation of single unit full coverage lithium disilicate fixed dental restorations fabricated with the conventional heat pressed technique and the digital CAD/CAM workflow. MATERIALS AND METHODS: This study is according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. study research was conducted in MEDLINE via PubMed and Cochrane Library databases together with a hand search of studies published until June 2022. The search terms were combining suitable Medical Subject Headings (MeSH terms) together with free text words in single or multiple conjunctions. A modified methodological index was used to assess the risk of bias of the included studies. A random effect model was applied to pool the effect estimates, and further assessment of the heterogeneity across studies using the Q test and the I2 metric was conducted. All statistical analyses were performed using Rstudio software, version 4.1.2, using the "meta" package. RESULTS: The electronic search and hand search identified 51 articles. Eighteen met the inclusion criteria and were included in the systematic review, 17 of which were in vitro and only one was an in vivo study. However, 17 of the initial 18 could be included in the meta-analysis, due to lack of statistical data in one of the in vitro studies. Statistical analyses were conducted by using the Rstudio software program. Meta-analysis was performed with the random effects model (α=.05). No statistical difference was found between the two fabrication methods (p-value=0.49). CONCLUSIONS: Although the mean marginal adaptation of lithium disilicate single crowns was found to be better with the heat-pressed technique, there was no statistical significance with the CAD/CAM fabricated restorations and both resulted in a clinically acceptable result. Nonetheless, more clinical studies are needed for safer conclusions.

Nonlinear Optical Glass-Ceramic From a New Polar Phase-Transition Organic-Inorganic Hybrid Crystal.

Melt-quenched glasses of organic-inorganic hybrid crystals, i.e., hybrid glasses, have attracted increasing attention as an emerging class of hybrid materials with beneficial processability and formability in the past years. Herein, we present a new hybrid crystal, (Ph3 PEt)3 [Ni(NCS)5 ] (1, Ph3 PEt+ =ethyl(triphenyl)phosphonium), crystallizing in a polar space group P1 and exhibiting thermal-induced reversible crystal-liquid-glass-crystal transitions with relatively low melting temperature of 132 °C, glass-transition temperature of 40 °C, and recrystallization on-set temperature of 78 °C, respectively. Taking advantage of such mild conditions, we fabricated an unprecedented hybrid glass-ceramic thin film, i.e., a thin glass uniformly embedding inner polar micro-crystals, which exhibits a much enhanced intrinsic second-order nonlinear optical effect, being ca. 25.6 and 3.1 times those of poly-crystalline 1 and KH2 PO4 , respectively, without any poling treatments.

Effect of the thickness of CAD-CAM materials on the shear bond strength of light-polymerized resin cement.

This study aimed to investigate the effect of the thickness of computer aided design-computer aided manufacturing (CAD-CAM) restorative materials on the bond strength of light-polymerized resin cement. Ninety specimens were prepared from three different CAD-CAM materials (a leucite-based glass-ceramic [Empress CAD], a polymer-infiltrated ceramic network [Vita Enamic], and a zirconia-reinforced lithium silicate glass-ceramic [Vita Suprinity]) in different thicknesses (1, 2, and 3 mm). One surface of each specimen was treated by using a single-step self-etching ceramic primer (Monobond Etch & Prime). Light-polymerized resin cement was bonded to treated surfaces by exposure to a light-emitting diode curing unit from the untreated side of the samples. Shear bond strength (SBS) between the ceramic and the resin cement was measured by using a universal testing machine. The leucite-based glass-ceramic had higher SBS values than the other materials at each thickness. For each material, 1 mm-thick specimens had the highest SBS values. The difference between the SBS values of 2 mm- and 3 mm-thick polymer-infiltrated ceramic network was nonsignificant, whereas the SBS values of 2 mm-thick leucite-based glass-ceramic and the zirconia-reinforced lithium silicate glass-ceramic were significantly higher than those of the corresponding 3 mm-thick specimens. The choice of the material and its thickness may be highly important for clinical success when light-polymerized resin cements are used for cementation.

Influence of nanosized defects on photoluminescence efficiency of Er3+ ions co-doped with Au2 O3 in a lead boroselenate glass ceramic system: a novel approach using positron annihilation lifetime spectroscopy.

This study consists of the results of an investigation into the influence of the free-volume space (fv ) defects on luminescence efficiency (LE) of erbium ions in Au2 O3 -doped PbO-B2 O3 -SeO2 (PBS) glass ceramics. Glass ceramics containing fixed concentrations of Er3+ ions and varied concentrations of Au2 O3 were synthesized. X-ray diffraction studies indicated that the samples contained Au2 (SeO3 )3 crystalline phase and nano gold metallic particles. The concentration of defects entrenched in the glass ceramics estimated in terms of Au2 O3 content using positron annihilation lifetime spectroscopy measurement indicated the highest content in the glass ceramic containing 0.075 mol% of Au2 O3 . Optical absorption and the photoluminescence (PL) spectra of the glass ceramics were studied in the visible region. The observed increase of PL efficiency was attributed to the enhanced concentration of free-volume imperfections in the samples. A perfect correlation could be achieved between the free-volume fraction and the PL efficiency of erbium ions in these glass ceramics.

Biaxial flexure strength and physicochemical characterization of a CAD/CAM lithium disilicate ceramic: effect of etching time, silane, and adhesive applications.

OBJECTIVE: To evaluate the effect of different acid etching time and bonding agent (silane and/or adhesive system) on biaxial flexural strength and physico-chemical properties of a lithium disilicate ceramic. MATERIAL AND METHODS: One hundred twenty ceramic discs were made and divided into 8 groups (n = 15) according to factors "etching time" (20 and 120 s) with hydrofluoric acid (HF) and "bonding agent" (C, no bonding agent; S, silane, A, adhesive; and SA, silane + adhesive). After surface treatment, a resin cement layer was applied to the surface and all specimens were subjected to biaxial flexural strength (BFS) test with treated surfaces loaded in tension (1 mm/min). The Weibull analyses and complementary analyses were also performed. Statistical analysis was done with 2-way ANOVA and the Tukey test (α = 0.05). RESULTS: ANOVA revealed that the factors "etching time" (p = 0.0003) and "bonding agent" (p = 0.007) were statistically significant. In the overall analysis, the HF120S group (272.02 ± 35.30A MPa) presented significantly higher BFS than that of HF120C (218.45 ± 17.15CD MPa) and HF20S (228.40 ± 37.83BCDMPa). On the other hand, the HF20A group (208.92 ± 31.16D MPa) had significantly lower BFS than HF120S (272.02 ± 35.30A), HF120A (254.42 ± 26.87ABC) and HF120SA (259.30 ± 36.55AB) groups (Tukey). The Weibull modulus (m) of all groups was significantly different from each other (p = 0.000). CONCLUSIONS: Regardless of etching time, the application of silane alone is sufficient to increase the flexural strength of glass ceramic, eliminating the need for the application of adhesive systems. Moreover, if only silane or adhesive is applied, 120-s HF application should increase the flexural resistance of the lithium disilicate ceramic. CLINICAL SIGNIFICANCE: Applications of adhesive systems after silanization can be suppressed from the surface treatment protocol of glass ceramics, since it does not improve their mechanical strength.

Prospective clinical evaluation of chairside-fabricated zirconia-reinforced lithium silicate ceramic partial crowns-5-year results.

OBJECTIVES: A university-based randomized clinical study evaluated the 5-year performance of chairside-fabricated zirconia-reinforced lithium silicate (ZLS)-ceramic partial crowns. MATERIAL AND METHODS: Forty-five patients were restored with 61 chairside-fabricated ZLS-restorations (Cerec SW 4.2, Dentsply Sirona, Germany; Vita Suprinity, Vita Zahnfabrik, Germany). Deviating from the manufacturers' recommendations, restorations with reduced minimum material thicknesses (MMT) were fabricated: group 1, MMT = 0.5-0.74 mm (n = 31); group 2, MMT = 0.75-1.0 mm (n = 30). For luting, a self-adhesive cement (SAC) or a total-etch technique with a composite cement (TEC) was applied. Statistical evaluation was performed by time-to-event analysis (Kaplan-Meier). Possible covariates of the survival (SVR) and success rates (SCR), evaluated in a Cox regression model, were MMT, restoration position (premolar/molar), and cementation technique (SAC vs. TEC). RESULTS: Forty patients (54 restorations, premolars, n = 23; molars, n = 31) participated in the 5-year follow-up. Five losses due to ceramic fractures occurred in group 1 (n = 28) (SVR: 83.0% [95% confidence interval (CI): 0.71-0.96]). Group 2 (n = 26) showed no losses (SVR: 100%). The success rate for partial crowns placed on premolars was 100% and 69% (95% CI: 0.54-0.84) for molar restorations. Recementation was required in 4 restorations with SAC (SCR: 86% [95% CI: 0.73-0.99]; SCR-DC: 100%). Restorations in group 2 showed a significantly reduced risk of material fracture hazard ratio (HR) = 0.09, p = 0.0292) compared with the restorations in group 1. Molar partial crowns showed an increased risk for a clinical intervention (HR = 5.26, p = 0.0222) compared to premolar restorations. CONCLUSIONS: Material thickness and position of the restoration are risk factors influencing the survival and success rate of ZLS-ceramic partial crowns. CLINICAL RELEVANCE: Observation of an MMT of at least 0.75-1.0 mm for ZLS-ceramics is essential to avoid material-related fractures. CLINICAL TRIAL REGISTRATION: German Clinical Trails Register (trial number: DRKS00005611).

Therapeutic effect of a novel bioactive glass-ceramics on early caries lesions: a single-center, randomized controlled clinical trial.

OBJECTIVES: To investigate the therapeutic effect of a novel bioactive glass-ceramics (BGC) called Huaxi BGC (HX-BGC) on early caries lesions. MATERIALS AND METHODS: A total of 195 patients who meeting inclusion criteria were recruited and randomized to three groups in a 1:1:1 ratio. The patients in the treatment group received fluoride varnish which contained 5% sodium fluoride (NaF) or distilled water which contained 7.5% HX-BGC once a month for 3 months, and the control group received placebos. Quantitative light-induced fluorescence (QLF) images were taken at baseline and at the 1-month and 3-month follow-ups. RESULTS: The three groups had similar baseline characteristics, including age, gender, and QLF parameters (ΔF, area, and ΔQ). Compared with baseline, the ΔQ values were significantly decreased in the HX-BGC and NaF groups at 1 and 3 months (p<0.005), while no statistically significant changes were found in that of the control group. After adjusting for baseline measurements, both of the 5% NaF and 7.5% HX-BGC showed a significant therapeutic effect in the treatment of initial enamel lesions at 1 month and 3 months, when compared to those receiving placebos (ΔQ, p<0.05). Moreover, the ΔQ value of the HX-BGC group decreased by a slightly more amount than that of the NaF group at 1 month (p=0.048). Similar trends were also found for the values of ΔF and area. CONCLUSION: Our results suggest that HX-BGC may serve as a promising bioactive material for the treatment of early caries lesions. CLINICAL RELEVANCE: HX-BGC holds a great promise to be used as a novel bioactive material for the treatment of early caries lesions.

Cyclic contact fatigue behavior of baria-silicate glass-ceramics as a function of crystal aspect ratio.

Ceramic materials are potentially useful for dental applications because of their esthetic potential and biocompatibility. However, evidence of contact fatigue damage in ceramics raises considerable concern regarding its effect on the survival probability predicted for dental prostheses. To simulate intraoral conditions, Hertzian indentation loading with steel indenters was applied in this study to characterize the fatigue failure mechanisms of ceramic materials. Baria silicate glasses and glass-ceramics with different aspect ratios of crystals were selected because the glass and crystal phases have similar density, elastic modulus, and thermal expansion coefficients. Therefore, this system is a model ceramic for studying the effect of crystal geometry on contact cyclic fatigue failure. The subsequent flexural strength results show that the failure of materials with a low fracture toughness such as baria-silicate glass (0.7 MPa m1/2) and glass-ceramic with an aspect ratio of 3.6/1 (1.3 MPa m1/2) initiated from cone cracks developed during cyclic loading for 103 to 105 cycles. The mean strengths of baria-silicate glass and glass-ceramics with an aspect ratio of 3.6/1 decreased significantly as a result of the presence of a cone crack. Failures of baria-silicate glass-ceramics with an aspect ratio of 8.1/1 (Kc = 2.1 MPa m1/2) were initiated from surface flaws caused by either grinding or cyclic loading. The gradual decrease of fracture stress was observed in specimens with an aspect ratio of 8.1/1 after loading in air for 103 to 105 cycles. A reduction of approximately 50 % in fracture stress levels was found for specimens with an aspect ratio of 8.1/1 after loading for 105 cycles in deionized water. Thus, even though this glass-ceramic with an 8.1/1 crystal aspect ratio material is tougher than that with a 3.6/1 crystal aspect ratio, the fatigue damage induced by a large number of cycles is comparable. The mechanisms for cyclic fatigue crack propagation in baria-silicate glass-ceramics are similar to those observed under quasi-static loading conditions. An intergranular fracture path was observed in glass-ceramics with an aspect ratio of 3.6/1. For an aspect ratio of 8.1/1, a transgranular fracture mode was dominant.

Microstructural considerations for novel lithium disilicate glass ceramics: A review.

OBJECTIVE: To review the ultrastructural characteristics of novel lithium disilicate based glass ceramics (LDC), how their manufacturing process influences their structure and their clinical use. OVERVIEW: Lithium disilicate based glass ceramic has been successfully used for indirect restorations ranging from partial tooth coverage up to tooth replacement for over 20 years. It combines esthetic and mechanical properties, unlike any other indirect material which makes it an indispensable part of esthetic and restorative dentistry. Recently, novel LDCs have been introduced to the market. Parameters for their use and their microstructure are still not been widely known. This article will review these materials and highlight with high-resolution scanning electron microscopic images their structural aspects and their resulting clinical relevance. CONCLUSION: Restorations made from LDCs are reliable and can be predictably used only when proper guidelines and protocols during manufacturing and clinical use are followed. For novel LDCs manufacturing and long-term bonding protocols still must be established. Moreover, novel LDCs machinable blocks should be crystallized or heat-treated after milling for superior performance. CLINICAL SIGNIFICANCE: With more and newer etchable LDC materials entering the market, clinicians and technicians need to be aware of the differences in manufacturing and the resulting microstructure to ensure a successful treatment outcome that will last.

Effect of aqueous environment on wear resistance of dental glass-ceramics.

BACKGROUND: Wear resistance affects dental ceramics longevity and the functions of the opposing teeth. However, data for the effect of aqueous environment on wear resistance of dental ceramics are lacking. This study evaluated the effect of aqueous environment on wear resistance of typical dental glass-ceramics. METHODS: Disk specimens were prepared from lithium disilicate glass-ceramics (LD) and leucite reinforced glass-ceramics (LEU). The disk specimens paired with steatite antagonists were tested in a pin-on-disk tribometer under both wet and dry conditions with 10 N up to 500,000 wear cycles. The wear analysis of glass-ceramics was performed using a 3D profilometer after 100,000, 300,000 and 500,000 wear cycles. Wear morphologies were analyzed by employing scanning electron microscopy (SEM). The crystalline compositions of specimens stored in a dry environment and subsequently immersed in distilled water for 40 h were separately determined using X-ray diffraction (XRD). The chemical states of the wear surfaces for LD were analyzed by X-ray photoelectron spectroscopy (XPS). The data analysis and multiple pair-wise comparisons of means were performed by using one-way analysis of variance (ANOVA) and Tukey's post-hoc test. RESULTS: LEU in a wet environment exhibited less wear volume loss than that in a dry environment (p < 0.05). The volume loss of LD in a wet environment was higher than that in a dry environment (p < 0.05). The wear volumes of steatite antagonists paired with two glass-ceramics under dry conditions were higher than under wet conditions. CONCLUSIONS: XPS spectra of LD under wet conditions indicated that high wear loss might result from the effect of stress corrosion by water and reaction of water with the ionic-covalent bonds at the crack tip. XPS spectra and SEM images of LD under dry conditions showed a possible formation of tribofilm. Within the limitations of this in vitro study, water was wear-friendly to LEU and all opposing steatites but aggravated wear for LD.