Clinical performance comparison between lithium disilicate and hybrid resin nano-ceramic CAD/CAM onlay restorations: a two-year randomized clinical split-mouth study.

A total of 20 lithium disilicate glass-ceramics (IPS e.max CAD, Ivoclar Vivadent) and 20 resin nano-ceramic (Voco Grandio Blocks) onlay restorations were performed in 20 patients using a split-mouth design to compare the two-year clinical performance of lithium disilicate and resin nano-ceramic onlay restorations. Both restorations were evaluated at baseline, one-year, and two-year clinical follow-ups based on the modified United States Public Health Service (USPHS) criteria. Chi-square and Fisher's exact tests showed no statistically significant difference between Voco Grandio and IPS e.max ceramic restorations for all evaluated parameters during the different follow-up periods (p > 0.05). Cochrane's and MC-Nemar's tests indicated statistically significant differences regarding color match within the Voco Grandio group. They also indicated statistically significant differences in marginal discoloration, marginal adaptation, surface texture, and postoperative hypersensitivity within both ceramic material groups (p < 0.05). Kaplan-Meier curve indicated that the survival rate of both ceramic materials was 90%. After two years of clinical service, IPS e.max CAD and Voco Grandio onlay restorations exhibited similar clinical performance.

The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth.

INTRODUCTION: Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS: Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS: Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION: No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

The effect of sandblasting versus acid etching on the surface roughness and biaxial flexural strength of CAD/CAM resin-matrix ceramics (In vitro study).

BACKGROUND: CAD/CAM resin matrix ceramics are one of the materials used in dental offices. The long-term success of the restoration depends on the bond strength of the restoration to the tooth and other materials; thus, surface treatment of the restoration is necessary to achieve this. But such treatment may affect the restoration strength. The purpose of this study is to assess the impact of various surface treatments on the surface roughness (Ra) and the biaxial flexural strength of two CAD-CAM resin-matrix ceramics. METHODS: Thirty-six-disc-shaped specimens, each measuring 1.2 mm in thickness and 12 mm in diameter, were machined from two resin-matrix ceramic blocks (Lava Ultimate and Cerasmart) (n = 18). Based on the surface treatments, each material was divided into 3 groups: control (no treatment), 50-µm Al2O3 sandblasting, or 9% hydrofluoric acid etching (n = 6). The surface roughness (Ra) was evaluated by the 3D laser scanning microscope. Then, specimens were aged by thermal cycling (5000 cycles) and tested for biaxial flexural strength using a universal testing machine at a crosshead speed of 1.0 mm/min. RESULTS: No significant differences in flexural strength or Ra were found for Lava Ultimate among the surface treatment groups. For Cerasmart, only the sandblasting group showed significantly higher Ra values than the control group. Also, the Ra values for the sandblasting group were significantly higher than those for the acid etching group. The flexural strengths of the sandblasting and acid etching groups for Cerasmart were statistically similar, and both were significantly lower than the control group. CONCLUSIONS: Although all of the applied surface conditioning techniques improved Ra, they had a negative impact on the flexural strength of resin-matrix ceramics. Thus, clinicians should utilize the appropriate surface treatment techniques, taking into account their effects on the surface roughness and mechanical properties of resin-matrix ceramics.

[Effects of the resin base and retention depth on fracture resistance of molars restored with nano-ceramic endocrowns].

OBJECTIVE: To compare the effects of resin base and different retention depth on the fracture resistance of mandibular molars restored with nano-ceramic endocrowns. METHODS: Forty mandibular molars selected and randomly divided into 5 groups: ① The control group which was consisted of intact teeth, ② the non-resin base group, ③ the 2 mm retention depth group, ④ the 3 mm retention depth group, ⑤ the 4 mm retention depth group, respectively. After tooth preparation, in vitro root canal therapy was conducted, which was followed by endocrown design, production and adhesive of groups ②-⑤. All the samples were under load (N) of the universal mechanical testing machine after embedding. The fracture pattern of each sample was observed under stereomicroscope. Then the microstructure of the fracture surface was observed by scanning electron microscopy. RESULTS: The fracture loads of each group were respectively: the control group fracture load was (3 069.34±939.50) N; experimental groups: fracture load of (2 438.04±774.40) N for the group without resin base; fracture load of (3 537.18±763.65) N for the group with 2 mm retention depth. The fracture load of the retention depth 3 mm group was (2 331.55±766.39) N; the fracture load of the retention depth 4 mm group was (2 786.98±709.24) N. There was statistical significance in the effect of resin base and different retention depth on the fracture loads of molars restored with nano-ceramic endocrown (P < 0.05). Repairable fractures in each group were as follows: control group 2/8, non-resin base group 1/8, retention depth of 2 mm group 1/8, retention depth of 3 mm group 2/8, and retention depth of 4 mm group 0/8. The effects of the retention depth and the presence of resin base on the fracture resistance of the resin nano-ceramic endocrowns were statistically significant (P < 0.05). Scanning electron microscopy showed more arrest lines and small twist hackles on the fracture surface of the restorations with resin base (retention depths of 2 mm, 3 mm, and 4 mm), with cracks extending towards the root. In addition to the characteristics above, more transverse cracks parallel to the occlusal surface, pointing outwards from the center of the pulp cavity retention, were also observed on the fracture surface of the non-resin base restorations. CONCLUSION: When molar teeth with nano-ceramic endocrowns are restored, resin base and the retention depth of 2 mm help the teeth to obtain optimal fracture strength.

Effect of various polymerization protocols on the cytotoxicity of conventional and self-adhesive resin-based luting cements.

OBJECTIVES: This study evaluated the cytotoxicity of resin-based luting cements on fibroblast cells using different polymerization protocols. MATERIALS AND METHODS: Two conventional dual-polymerized (RelyX ARC, VariolinkN) and two self-adhesive resin cements (RelyX Unicem, Multilink Speed) specimens were polymerized using four different polymerization protocols: (a) photo-polymerization with direct light application, (b) photo-polymerization over ceramic and (c) resin nano-ceramic discs and (d) auto-polymerization. The specimens were then assigned to four groups to test cytotoxicity at 0, 1, 2 and 7 preincubation days (n = 5). MTT test was performed using NIH/3T3 fibroblast cells. Data were analysed using three- and one-way ANOVA. Multiple comparisons were made using Bonferroni post hoc test (p < 0.05). RESULTS: The highest cytotoxic values were recorded at day 2 for conventional resin cements and at day 0 for self-adhesive resin cements. Self-adhesive resin cements showed the most cytotoxic effect at the second day, while conventional resin cements presented immediate cytotoxicity. Auto-polymerized resin specimens and especially Multilink Speed demonstrated the most cytotoxic effect regardless of the preincubation time. Cytotoxicity of cements tested reached the lowest level at day 7. Interposition of ceramic or nano-ceramic restorative material did not significantly affect the cytotoxicity of tested luting cements (p > 0.05). CONCLUSIONS: Cytotoxicity of dual-polymerized resin cements was material-dependent and decreased gradually up to 7 days. Photo-polymerization plays an important role in reducing the cytotoxic effects. CLINICAL RELEVANCE: When luting ceramic or resin nano-ceramic restorations of which thickness does not exceed 2 mm, the level of cytotoxicity with the tested materials is not significant. Luting of restorative materials that do not allow for light transmission such as metal-fused porcelain, clinicians should be cautious in the use of dual-polymerized conventional resin cements as only auto-polymerization of resin cements takes place under such materials.

Fracture load of CAD/CAM-fabricated and 3D-printed composite crowns as a function of material thickness.

OBJECTIVES: Indirect CAD/CAM restorations can be fabricated using both subtractive and additive CAD/CAM technology. This study investigated the fracture load of crowns fabricated from three particle-filled composite CAD/CAM materials and one 3D-printed composite material. MATERIALS AND METHODS: Lava Ultimate, Cerasmart and Brilliant Crios were used as particle-filled composite CAD/CAM material and els-3D Harz as 3D-printed composite material. For each group, crowns with three different material thicknesses (0.5/1.0/1.5 mm) were fabricated. Control group was composed of ceramic-based CAD/CAM materials e.max CAD and Enamic. Totally, n = 180 crowns were fabricated and adhesively seated on SLA fabricated dies. Thermomechanical loading and fracture testing were performed. The data for fracture loading force were statistically analyzed by two-way ANOVA followed with multiple comparisons by post hoc Tukey's test (α = 0.05). RESULTS: In contrast to ceramics, all particle-filled composite crowns with 0.5-mm thickness survived fatigue testing. Forces varied statistically significantly. Brilliant Crios showed highest maximum loading force with 1580.4 ± 521.0 N (1.5 mm). Two-way ANOVA indicated that both the material and the thickness affected the fracture load (p < 0.05). CONCLUSIONS: Particle-filled composite resin CAD/CAM materials may have advantageous material characteristics compared to ceramic CAD/CAM materials for minimal restoration thicknesses. CLINICAL RELEVANCE: Composite-based CAD/CAM materials may offer new possibilities in minimally invasive restorative treatment concepts.

Fracture resistance and failure modes of endocrowns manufactured with different CAD/CAM materials under axial and lateral loading.

OBJECTIVES: The purpose of this in vitro study was to evaluate the fracture resistance and failure modes of endocrowns made of three computer-aided design/computer-aided manufacturing (CAD/CAM) materials subjected to thermo-mechanical cycling loading. MATERIALS AND METHODS: Eighty mandibular molars were divided into four groups (n = 20): one (C E) was restored with lithium disilicate glass-ceramic conventional crowns, three were restored with endocrowns made of three different CAD/CAM materials; (E E) lithium disilicate glass-ceramic, (E V) zirconia-reinforced lithium silicate glass-ceramic, and (E C) resin nano-ceramic. After cycling loading, half of the samples from each group were loaded axially and the other half was loaded laterally. Fracture resistance was recorded in Newton (N) and failure modes were classified. Two-way ANOVA, Bonferroni post hoc (α = .05), Chi-square, and multiple logistic regression tests were used to analyze data. RESULTS: Statistically significant interaction were recorded between fracture resistance (N) and loading (P < .001), and groups (conventuional crown and endocrowns; P < .001). Endocrowns presented higher fracture strength than conventional crowns. Fracture resistance was significantly larger under axial loading. The numbers of irreparable failures were extremely important in the endocrowns groups (Groups E E, E V, E C), and only conventional crowns (Group C E) showed almost no irreparable failures under axial loading. CONCLUSION: Lithium disilicate glass-ceramic recorded the highest fracture resistance under axial and lateral loading. CLINICAL SIGNIFICANCE: The number of irreparable failures with all endocrown materials tested do not suggest yet the use of this type of restorations in posterior teeth.

The Effect of Surface Treatments on the Mechanical and Optical Behaviors of CAD/CAM Restorative Materials.

PURPOSE: To evaluate the effect of different surface treatments on mechanical and optical properties of lithium disilicate ceramic (IPS e.max CAD), 2 resin nanoceramics (Lava Ultimate, GC Cerasmart), and polymer-infiltrated ceramic network material (Vita Enamic). MATERIALS AND METHODS: CAD/CAM blocks were sectioned into 4 × 1 × 14 mm3 bars for three-point bending test and 1 × 8 × 8 mm3 square specimens were obtained for color and translucency measurements. Bar-shaped and square specimens were divided into five groups according to the surface treatment method as: control (no treatment), hydrofluoric acid etching, airborne-particle abrasion, 2 W and 3 W Er,Cr:YSGG laser irradiation (n = 10). Three-point bending test was carried out on a universal test machine with a 1 mm/min crosshead speed. Color and translucency measurements were performed with a spectrophotometer and repeated after surface treatments. Flexural strength, translucency parameter, and ΔE values were calculated and data were statistically analyzed using one-way ANOVA and Bonferroni post hoc tests. ΔE values >1.2 and >2.7 were considered as perceptible and unacceptable, respectively. RESULTS: All surface treatment methods decreased the flexural strength of all tested materials (P < 0.05) except for 2 W laser-irradiated and airborne-particle abraded Vita Enamic and 2 W laser irradiated Lava Ultimate (P > 0.05). Color changes of lithium disilicate specimens were not perceptible except for airborne-particle abraded specimens. All ΔE values of resin-based materials were above the perceptibility threshold. Acid-etched and 3 W laser-irradiated GC Vita Enamic specimens revealed unacceptable color changes. The translucencies of resin-based materials significantly decreased after all surface treatment applications. CONCLUSIONS: Surface treatments affected the flexural strength and optical properties of CAD/CAM restorative materials. Er,Cr:YSGG laser irradiation with 2 W energy level may be an alternative surface treatment method for CAD/CAM materials.

Shade Stability of Polymer Infiltrated and Resin Nano Ceramic Crowns after Dynamic Chewing Simulation.

OBJECTIVE: Investigation of the shade stability of polymer-infiltrated and resin nano ceramic crowns before and after artificial aging. METHOD: 40 identical crowns of each of the materials VITA Enamic (VE) and Lava Ultimate (LU) were manufactured. Half of the crowns went through a dynamic chewing simulation (CS) with thermocycling. Material subgroups: 1. VE, 2. VE/CS, 3. LU, 4. LU/CS (each n=20). These were divided into 4 groups (n=5) and distributed in usual stain solutions. The shade of each crown was measured occlusally and vestibularly before and after insertion using a spectrophotometer (n=5). The data were analyzed using ANOVA and Tukey's test (p≤0.05). RESULTS: Sum scores (SSC) of the occlusal ΔE values: LU/CS: 7.99, VE: 5.75 VE/CS: 5.44, LU: 5.17. The total sum of the SSC yielded, for the materials: SSCtotal(VE): 20.0 and SSCtotal(LU): 24.0. SIGNIFICANCE: Occlusally, there were significant shade differences for VE/CS (p=0.025) and LU/CS (p=0.014) between red wine and distilled water. LU/CS is significantly more clearly stained occlusally by coffee in comparison to the other three material subgroups (VE: p=0.007, LU: p=0.026, VE/CS: p=0.013). CONCLUSIONS: The shade stability of VITA Enamic crowns is superior to that of Lava Ultimate crowns. Only Lava Ultimate is affected by chewing simulation.

Fracture Resistance of Molar Crowns Fabricated with Monolithic All-Ceramic CAD/CAM Materials Cemented on Titanium Abutments: An In Vitro Study.

PURPOSE: To assess the fracture resistance of single-tooth implant-supported crown restorations made with different CAD/CAM blocks. MATERIALS AND METHODS: Thirty-six titanium abutments were put on dental implant analogs (Mis Implant). For each of three test groups (n = 12/group), implant-supported, cement-retained mandibular molar single crowns were produced. Crowns were made of lithium disilicate glass (LD) IPS e.max CAD, feldspathic glass ceramic (FEL) Vita Mark II, and resin nano-ceramic (RNC) Lava Ultimate. The crowns were cemented with self-adhesive resin cement RelyX Unicem 2. After chewing cycling, crowns were tested to failure in a universal testing machine. Fracture values were calculated as initial (F-initial) and maximum fracture (F-max). RESULTS: The study groups were ranked, in order of having highest value, (LD > FEL) > RNC for F-initial load value and (LD > RNC) > FEL for F-max load value. This demonstrated that there was no parallel change in the F-initial and F-max values presenting the fracture resistance of specimens. CONCLUSIONS: There was no accordance between the F-initial and F-max values of the LD, RNC, and FEL after chewing simulation with thermocycling resembling 5 years of clinical functional use. LD had the highest fracture resistance during the fracture test. RNC had low fracture resistance; however, it had considerably high fracture resistance during the fracture test. FEL had considerably low fracture resistance values.

Complete digital workflow for the production of implant-supported single-unit monolithic crowns.

OBJECTIVES: The aim of this case series was to introduce a complete digital workflow for the production of monolithic implant crowns. MATERIAL AND METHODS: Six patients were treated with implant-supported crowns made of resin nano ceramic (RNC). Starting with an intraoral optical scan (IOS), and following a CAD/CAM process, the monolithic crowns were bonded either to a novel prefabricated titanium abutment base (group A) or to a CAD/CAM-generated individualized titanium abutment (group B) in premolar or molar sites on a soft tissue level dental implant. Economic analyses included clinical and laboratory steps. An esthetic evaluation was performed to compare the two abutment-crown combinations. RESULTS: None of the digitally constructed RNC crowns required any clinical adaptation. Overall mean work time calculations revealed obvious differences for group A (65.3 min) compared with group B (86.5 min). Esthetic analysis demonstrated a more favorable outcome for the prefabricated bonding bases. CONCLUSIONS: Prefabricated or individualized abutments on monolithic RNC crowns using CAD/CAM technology in a model-free workflow seem to provide a feasible and streamlined treatment approach for single-edentulous space rehabilitation in the posterior region. However, RNC as full-contour material has to be considered experimental, and further large-scale clinical investigations with long-term follow-up observation are necessary.

Effect of the application of a hydrogen peroxide home bleaching agent on the cytotoxicity of different CAD-CAM restorative materials.

BACKGROUND: The information regarding the cytotoxicity of ceramic and resin-matrix ceramic materials subjected to over-the-counter bleaching agents is limited in the literature. OBJECTIVES: The aim of the present study was to investigate the cytotoxic effects of lithium disilicate ceramic (LDC), resin nano-ceramic (RNC) and nano-hybrid composite (NHC) computer-aided design/ computer-aided manufacturing (CAD-CAM) block materials subjected to a home bleaching agent and artificial saliva. MATERIAL AND METHODS: A total of 432 specimens were prepared from 3 different CAD-CAM materials. Each material group was divided into 4 groups according to the storage medium (phosphate-buffered saline (PBS) or artificial saliva), and whether the specimens were subjected to a bleaching agent or not. For the bleached groups, hydrogen peroxide (10%) was applied to the specimens for 30 min/day for 15 days, and the specimens were immersed in PBS or saliva after bleaching. The viability of epithelial cells was detected using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay at the end of the 5th, 10th and 15th day of the study. The data was statistically analyzed. RESULTS: Regardless of the storage medium and the time period, all restorative materials decreased the viability of cells. The highest cytotoxicity levels were determined on the 15th day of the study. The application of a bleaching agent increased the cytotoxicity of the LDC specimens stored in artificial saliva. The RNC material stored in PBS demonstrated significantly higher cell viability than the LDC and NHC groups. The LDC and RNC specimens stored in artificial saliva did not show any significant difference in cytotoxicity. When the materials were subjected to bleaching, NHC demonstrated the highest cytotoxicity during all periods. No significant difference was found between the LDC and RNC specimens subjected to both artificial saliva and bleaching in terms of cytotoxicity. CONCLUSIONS: The type of restorative material, the immersion medium, the application of a bleaching agent, and the application period affected the cytotoxicity of the materials. Over-the-counter home bleaching agents may induce cellular cytotoxicity due to the existing restorations, and patients should be informed about this potential biological response.

Physical and mechanical properties of four 3D-printed resins at two different thick layers: An in vitro comparative study.

OBJECTIVES: This in vitro comparative study aimed to evaluate the physical and mechanical properties of four 3D-printed resins with two different thickness layers. METHODS: Four printed resins (VarseoSmile Crown Plus, VSC; NexDent C&B MFH, MFH; Nanolab 3D, NNL; and Resilab 3D Temp, RSL) were printed with 50 µm and 100 µm layer thickness, resulting in 80 bars measuring 25 × 2×2 mm. The specimens underwent a Raman spectroscopy for degree of conversion, confocal laser scanning microscopy for surface roughness (Sa), three-point bending test for flexural strength and elastic modulus, and a Vickers hardness test (VHN). Data was tested for normality using the Shapiro-Wilk, two-way ANOVA, and Tukey test (α = 0.05) for statistical analysis. RESULTS: The layer thickness affected all performed tests, but the elastic modulus (p < 0.001). Specimens with 100 µm showed, in general, worse results outcomes than those with 50 µm (p < 0.001). However, within the limitations of this comparative in vitro study, it could be concluded that the tested resins and layer thicknesses directly influenced physical and mechanical properties. SIGNIFICANCE: The physical and mechanical properties of three-dimensional printed restorations can be affected by the layer thickness, which can interfere with the choice of the 3D printing resin for a desired clinical outcome.

Color Stability of Polymer-Based Composite CAD/CAM Blocks: A Systematic Review.

BACKGROUND: This systematic review aims to evaluate the color stability of resin composite CAD/CAM blocks (CCB) when submitted to staining solutions. METHODS: A systematic search was performed on different databases (Embase, Medline, Scopus, Web of Science). Search terms were: 'polymer infiltrated', 'polymer-based', 'resin nanoceramic', 'resin ceramic', 'hybrid composite', 'hybrid ceramic', 'composite ceramic', 'resin infiltrated', 'CAD-CAM', 'CAD/CAM', 'color stability', 'staining', 'staining susceptibility', 'color change', 'color difference'. INCLUSION CRITERIA: in vitro articles published in the English language until 18 September 2022 without initial time restriction evaluating the color stability of CCB when submitted to staining solutions. EXCLUSION CRITERIA: studies investigating color change induced by smoke or whitening treatments; studies not including a clinical evaluation of the results using the thresholds for color perceptibility and acceptability. Risk of bias assessment using the QUIN tool. FINDINGS: Out of the 378 initially retrieved articles, 19 were included in this review. They investigated 17 different CCBs and different artificial staining by liquid protocols, including coffee, red wine, tea, and cola. CCBs exceeded clinical acceptability thresholds for color shift in 18 out of 19 studies, with a significantly higher color stability than conventional hybrid resin-based composites (RBCs), and a significantly lower color stability than ceramic materials. The identified differences in CCBs in color stability can be attributed to the material's composition, but also to the heterogeneity of staining procedures. Interpretation and clinical implication: Clinicians should be aware that, although to a lower degree when compared to RBCs used in direct or indirect procedures, CCBs undergo color changes to a higher degree in comparison to ceramic materials.

Influence of Pre-Treatment and Artificial Aging on the Retention of 3D-Printed Permanent Composite Crowns.

The aim of this in vitro study is to investigate the bonding properties of a 3D-printable permanent composite material in comparison to milled composite materials. The tested materials are 3D-printed BEGO VarseoSmile Crown plus (VA1_ab, VA1_nt, VA2_ab, VA2_nt), Vita Enamic (EN1, EN2), and 3M Lava Ultimate (UL1, UL2) (N = 64; n = 8). For this purpose, all crowns are luted to polymer tooth stumps #46 (FDI) using dual-curing luting composite, strictly according to the manufacturer's instructions. VA1_ab and VA2_ab are additionally airborne-particle abraded. 4 groups (VA2_ab, VA2_nt, EN2, UL2) are artificially aged (1,200,000 cycles, 50 N, 10,000 thermocycles), whereby no specimen has failed. All 64 specimens undergo pull-off testing until retention loss. The mean forces of retention-loss is 786.6 ± 137.6 N (VA1_nt, *), 988.6 ± 212.1 N (VA2_nt, *, Ɨ), 1223.8 ± 119.2 N (VA1_ab, Ɨ, ǂ), 1051.9 ± 107.2 N (VA2_ab, *, Ɨ), 1185.9 ± 211.8 N (EN1, Ɨ, ǂ), 1485.0 ± 198.2 N EN2, ǂ), 1533.8 ± 42.4 N (UL1, ǂ), and 1521.8 ± 343.4 N (UL2, ǂ) (one-way ANOVA (Scheffé method); p < 0.05; *, Ɨ, ǂ: group distribution). No characteristic failure modes can be detected. In conclusion, all of the pull-off forces reflect retention values that seem to be sufficiently high for clinical use. Additional airborne-particle abrasion of VA does not result in significantly better retention but can be recommended.

Colour stability of sectional laminate veneers: A laboratory study.

BACKGROUND: This study aimed to evaluate the colour stability of sectional laminate veneers (SLVs) fabricated with four and cemented with two different materials. METHODS: Eighty SLVs were prepared with a thickness of 0.2-0.4 mm from IPS e.max CAD, Lava Ultimate, CEREC Blocs and IPS InLine and were cemented with Variolink Veneer and Variolink N to form eight groups (n:10). After cementation, specimens underwent 5000 thermocyles prior to immersion in a coffee solution. RESULTS: Colour change before and after thermal cycling did not reveal significant differences (P > 0.05). After coffee immersion, significant colour change was observed in all groups (P > 0.05). Only IPS InLine cemented with Variolink Veneer was considered clinically acceptable (∆E < 3.3). According to observer scorings, marginal discolouration was higher in Lava Ultimate, while no discolouration was observed in IPS InLine. Dual or light-curing resin cements showed insignificant differences. CONCLUSIONS: SLVs fabricated with different aesthetic materials underwent perceptible (∆E > 3.3) discolouration except for the IPS InLine cemented with light-curing resin cement. Cementation with either dual-curing or light-curing resin cements does not by itself affect colour stability. The highest marginal discolouration was in the Lava Ultimate group while no discolouration was detected in the IPS InLine group.

[Influence of different surface treatments on resin nano ceramic-resin cement bond strength].

OBJECTIVE: This work aimed to evaluate the effect of different surface treatments on the shear bond strength of resin nano ceramic to resin cement, thereby providing a theoretical basis for the improvement of clinical application. METHODS: A total of 150 specimens (10 mm×10 mm×3 mm) were milled from resin nano ceramic blocks (Lava Ultimate) using computer-aided design/computer aided manufacturing(CAD/CAM) technology. The specimens were randomly divided into five groups according to the surface treatment performed, as follows: control, sandblasted, sandblasted+silane, hydrofluoric acid, and hydrofluoric acid+silane groups. After the corresponding surface treatment, the specimens were cemented using Single Bond Universal Adhesive and RelyXTM Ultimate ClickerTM adhesive resin cement. All cemented specimens were placed in distilled water for 24 h and 30 days and subjected to a shear bond strength test in a universal testing machine. RESULTS: The surface treatment and water storage periods showed significant effects on bond strength. Surface treatment with sandblasted+silane showed the highest shear strength values among all tested groups, and the difference was statistically significant (P<0.05). A difference was observed between the control and hydrofluoric acid groups, and both had significantly difference compared with other groups (P<0.05). Sandblasted and hydrofluoric acid+silane groups were not statistically different, and both had significantly difference compared with other groups (P<0.05). CONCLUSIONS: The surface of resin nanoceramic treated by sand-blasted, sandblasted+silane, and hydrofluoric acid+silane can improve the bond strength. The sandblasted+silane group had the best the shear bond strength among the groups.

Effects of hydrothermal aging, thermal cycling, and water storage on the mechanical properties of a machinable resin-based composite containing nano-zirconia fillers.

OBJECTIVES: This study aimed to investigate the effects of hydrothermal aging, thermal cycling, and water storage on the mechanical properties of a machinable resin-based composite containing nano-zirconia fillers. MATERIALS AND METHODS: A machinable resin-based composite containing nano-zirconia fillers (Lava Ultimate, LU) and a resin-based composite with a similar resin matrix-to-filler ratio but without zirconia fillers (Tetric N-Ceram, TNC) were prepared into bars and assigned into four groups based on the type of aging treatment (hydrothermal aging, thermal cycling, water storage, or no aging). The phase transformations of the zirconia fillers in LU after aging were evaluated by X-ray diffraction. The flexural strength, Weibull modulus, flexural modulus, and Vickers hardness of each group were investigated. The fracture surface morphologies of both resin-based composites before and after aging were observed by a scanning electron microscopy (SEM). RESULTS: Only Tetragonal zirconia was detected in the LU samples. Both before and after aging, the flexural strength, flexural modulus, and Vickers hardness values of LU were significantly higher than those of TNC (p < 0.05) with the exception of the flexural modulus of LU, which showed no difference with that of TNC after water storage (p = 0.68). Hydrothermal aging, thermal cycling, and water storage had no significant effects on the surface Vickers hardnesses of LU or TNC (p > 0.05). Hydrothermal aging significantly improved the flexural strength of LU (p = 0.00). Thermal cycling (p = 0.00) and water storage (p = 0.00) significantly decreased the flexural strength of LU. The flexural strength of TNC was not decreased by hydrothermal aging (p = 0.82) or water storage (p = 0.36), while it was decreased by thermal cycling (p = 0.00). The hydrothermal aging group of LU exhibited the highest Weibull modulus. CONCLUSIONS: The machinable resin-based composite containing nano-zirconia fillers provides superior flexural strength, flexural modulus, and Vickers hardness compared to the direct-filling resin-based composite with a similar resin matrix-to-filler ratio, although it fails to provide better aging resistance.

Microtensile bond strengths of adhesively bonded polymer-based CAD/CAM materials to dentin.

This in vitro study aimed to evaluate the effect of two different polymer-based CAD/CAM materials; resin-nano ceramic (Lava Ultimate [LVU]) and composite (CERASMART [CS]), their different surface pre-treatments, and use of different resin cements on the µTBS of adhesively bonded CAD/CAM onlays to dentin. CAD/CAM materials were cut into slabs and divided into five groups according to the surface pre-treatments applied: Silane Primer, OptiBond XTR adhesive, Silane Primer+OptiBond XTR adhesive, Single Bond Universal (SBU), and RelyX Ceramic Primer+SBU. The LVU and CS specimens were bonded to the mid-coronal dentin of 50 non-carious human molars using NX3 resin cement with OptiBond XTR or RelyX Ultimate with SBU. µTBS was evaluated after 5,000 thermocycling and analysed with three-way-ANOVA and post-hoc Tukey's tests (p<0.05). The µTBS was significantly influenced by the type of CAD/CAM material (p<0.0001) surface pre-treatments (p<0.05) and resin cements (p<0.05). Regardless of the pre-treatments and resin cements, bonding of the composite CAD/CAM material to dentin was higher than the resin nano-ceramic material.

Shade Stability of Polymer-Infiltrated and Resin Nano Ceramics.

BACKGROUND: The esthetics plays an increasingly significant role in today's dentistry. OBJECTIVE: The objective was to investigate the shade stability of a polymer-infiltrated and a resin nano ceramic in comparison to a conventional feldspar ceramic and an acrylate polymer. METHODS: 20 specimens of each of the materials, CAD-Temp (CT), Mark II (M), VITA Enamic (VE) and Lava Ultimate (LU), were prepared using the standard method. These were divided into groups (n=5) and placed in the following stain solutions: Distilled water, coffee, Coca-Cola and red wine for 14 days. The shade of each specimen was measured before and after using a spectrophotometer (n=5). The data were analyzed using ANOVA and Tukey's test (p ≤ 0.05). RESULTS: The largest ΔE mean values were observed in CT by Coca-Cola (4.38 ± 0.41), in M by coffee (5.95 ± 0.62), in VE (6.02 ± 0.78) and LU (8.61 ± 0.30) by red wine. LU had the largest and strongest overall shade differences (total score: SSC=16.95) and CT the least (SSC=8.74). Overall shade differences of VE (SSC=12.03) and M (SSC=12.48) were statistically indistinguishable. After 14 days, only Coca-Cola caused clinically relevant shade differences in CT (ΔE > 2.7); this was also caused by coffee, Coca-Cola and red wine in M and coffee and red wine in VE and LU. CONCLUSION: On average, VE showed fewer shade differences than LU. After 14 days of immersion, shade differences which exceeded the clinical acceptance threshold of ΔE=2.7 were shown by CT in Coca-Cola, by M in coffee, Coca-Cola and red wine, and by VE and LU in coffee and red wine.