Is there a potential for durable adhesion to zirconia restorations? A systematic review.

STATEMENT OF PROBLEM: With a number of zirconia ceramic materials currently available for clinical use, an overview of the scientific literature on the adhesion methods and their potential influence is indicated. PURPOSE: The purpose of this systematic review was to classify and analyze the existing methods and materials proposed to improve adhesion to zirconia surfaces. MATERIAL AND METHODS: The current literature of in vitro studies examining the bond strength on zirconia ceramics, including clinical studies from 1998 until 2014, was analyzed. A search of the English language literature was undertaken using MEDLINE and PubMed, and a hand search was made for any relevant research paper from the library of a dental school. Papers evaluating only alumina restoration bond or ceramic-zirconia bond were excluded. RESULTS: A total of 134 publications were identified for analysis. Different adhesive techniques with different testing methods were reviewed. Results were difficult to compare in that the parameters varied in each research protocol. CONCLUSIONS: Airborne-particle abrasion and tribochemical silica coating are reference pretreatment methods. Adhesive monomers are necessary for chemical bonding. Surface contamination and aging have negative effects on adhesion to zirconia. Many factors influence each combination of zirconia material, such as surface treatment, adhesive medium, and aging conditions. Laboratory studies should be confirmed by clinical trials.

Microstructural characterization and comparative evaluation of physical, mechanical and biological properties of three ceramics for metal-ceramic restorations.

OBJECTIVES: A wide variety of dental ceramics compositions have been introduced in dental clinical practice in order to combine desired aesthetics with superior mechanical performance. The aim of the present study was to investigate the microstructural changes in three dental ceramics after their sintering according to manufacturers' instructions and to comparatively evaluate some of their physical, mechanical and biological properties. METHODS: The analysis of the phases present in each material before and after sintering was performed with scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction analysis (XRD). The thermal properties of ceramic specimens were evaluated with differential thermal and thermogravimetric analysis (TG-DTA). The mechanical properties evaluated were fracture toughness, Young's modulus and microhardness with the Vickers indentation method. MTT assay was used for cell proliferation assessment. One-way analysis of variance (ANOVA) with Bonferroni multiple comparisons tests was used to determine statistically significant differences (significance level of p<0.05). RESULTS: Results showed a remarkable variation among the three ceramic compositions of leucite content in the starting unheated ceramic powders ranging between 14 and 32 wt.% and in the respective sintered powders ranging between 15 and 41 wt.% The low fusing glass-ceramic and the high fusing leucite-based ceramic presented significantly higher fracture toughness (p<0.001) and microhardness and lower modulus of elasticity (p<0.05) compared to the low fusing feldspathic ceramic. The three ceramics were almost equivalent concerning their in vitro biological behavior. SIGNIFICANCE: Variations in crystal structure, distribution and composition are related to differences concerning mechanical properties of dental ceramics.

Computer methods for automating preoperative dental implant planning: implant positioning and size assignment.

The paper presents computer-aided methods that allocate a dental implant and suggest its size, during the pre-operative planning stage, in conformance with introduced optimization criteria and established clinical requirements. Based on computed tomography data of the jaw and prosthesis anatomy, single tooth cases are planned for the best-suited implant insertion at a user-defined region. An optimum implantation axis line is produced and cylindrical implants of various candidate sizes are then automatically positioned, while their occlusal end is leveled to bone ridge, and evaluated. Radial safety margins are used for the assessment of the implant safety distance from neighboring anatomical structures and bone quantity and quality are estimated and taken into consideration. A case study demonstrates the concept and allows for its discussion.

Sol-Gel Derived Mg-Based Ceramic Scaffolds Doped with Zinc or Copper Ions: Preliminary Results on Their Synthesis, Characterization, and Biocompatibility.

Glass-ceramic scaffolds containing Mg have shown recently the potential to enhance the proliferation, differentiation, and biomineralization of stem cells in vitro, property that makes them promising candidates for dental tissue regeneration. An additional property of a scaffold aimed at dental tissue regeneration is to protect the regeneration process against oral bacteria penetration. In this respect, novel bioactive scaffolds containing Mg(2+) and Cu(2+) or Zn(2+), ions known for their antimicrobial properties, were synthesized by the foam replica technique and tested regarding their bioactive response in SBF, mechanical properties, degradation, and porosity. Finally their ability to support the attachment and long-term proliferation of Dental Pulp Stem Cells (DPSCs) was also evaluated. The results showed that conversely to their bioactive response in SBF solution, Zn-doped scaffolds proved to respond adequately regarding their mechanical strength and to be efficient regarding their biological response, in comparison to Cu-doped scaffolds, which makes them promising candidates for targeted dental stem cell odontogenic differentiation and calcified dental tissue engineering.

Ankylosing spondylitis associated with craniomandibular disorder--a combined orthodontic and prosthodontic therapeutic approach.

Ankylosing spondylitis is a disease that causes inflammatory changes of the involved joints. Although the initial clinical signs are pain and discomfort, synovial changes progressively involve all the axial joints, including the temporomandibular joint (TMJ). Eventually, bony alterations develop (condylar erosions, flattening, sclerosis) that affect the position of the condyle, the superior joint space, and the range of movements. These symptoms correlate with the severity of the disease. Besides physiotherapy and surgery, no dental rehabilitation has been reported for these patients. This report of a female patient with ankylosing spondylitis and a TMJ disorder emphasizes dental rehabilitation. The aim of the splint, orthodontic, and prosthodontic treatment was to relieve the subjective symptoms through establishing a stable optimum occlusion. Anamnestic, laboratory, and clinical findings including pre- and postradiographic examination records are presented.

Observations on an in-vivo failure of a titanium dental implant/abutment screw system: a case report.

Titanium and its alloys are widely used in prosthetic dentistry, due to their biocompatibility, excellent mechanical and anti-corrosion behavior. However, delayed fracture of dental prosthetics is frequently encountered. Mechanisms leading to fracture are not generic but are strongly related to the particular environmental (quality of biological fluids) and mechanical loading conditions (mastication habits, presence of prosthetic metallic/ceramic components) in the patients' oral cavity. In this study, a commercially pure titanium implant-screw system has failed after 15 years of operation in the oral cavity of an old female. The system was retrieved in three pieces: the upper part of the implant, part of the abutment screw, and the apical part of the implant to which a part of the screw was embedded. This is considered as a rare case, where the whole dental assembly was retrieved after fracture allowing the extensive fractographic analysis of the conjugate pieces and the establishment of a thorough in-vivo failure scenario. Scanning electron microscopy observations performed on all three retrieved parts indicated a synergistic effect of distinct mechanisms, which led to total failure under extrinsic common fatigue loading. The principal mechanism was the propagation of a main crack, which was previously initiated in the body of the implant and affected by a wedging mechanism due to Ca/P aggregates developed within the crack. Because of the strong fixation between the implant and the abutment screw, this main crack was transferred to the latter causing eventually total failure of the assembly.

Bonding indirect resin composites to metal: Part 1. Comparison of shear bond strengths between different metal-resin bonding systems and a metal-ceramic system.

PURPOSE: This laboratory study compared the shear bond strength between three indirect resin composites and a noble alloy using their respective bonding systems. MATERIALS AND METHODS: One hundred twenty disks cast in a medium-gold, high-noble metal-ceramic alloy (V-Deltaloy) were divided equally into four groups and received different treatments for veneering: Conventional feldspathic porcelain (Omega) was applied on one set of specimens to be used as a control, and three indirect resin composites (Artglass, Sculpture, Targis) with their respective bonding systems were used for the other groups. The specimens were tested in a parallel shear test, half of them after 24-hour dry storage at room temperature and the rest after 10-day storage in normal saline solution at 37 degrees C and thermocycling. The fractured specimens were evaluated to determine the nature of the failure. RESULTS: The mean shear bond strength values (in MPa), before and after wet storage and thermocycling, were 30 and 23 for the metal-ceramic group, 29 and 23 for the Artglass group, 20 and 19 for the Sculpture group, and 17 and 14 for the Targis group, respectively. The metal-ceramic and Artglass groups exhibited significantly higher bond strengths than the other two groups. All specimens, with the exception of the Sculpture group, showed a significant decrease in bond strength after wet storage and thermocycling. CONCLUSION: No group exceeded the shear bond strength of the metal-ceramic group, but the Artglass group with its respective metal-resin bonding system exhibited similar bond strengths. The Sculpture group showed a stable bond after water storage and thermocycling.

Bonding indirect resin composites to metal: part 2. Effect of alloy surface treatment on elemental composition of alloy and bond strength.

PURPOSE: This laboratory study compared the effect of different surface treatments of a medium-gold, high-noble alloy on the shear bond strength of an indirect, highly filled resin composite to the alloy and on the elemental composition of the alloy surface. MATERIALS AND METHODS: Ninety disks, cast in a medium-gold, high-noble porcelain-fused-to-metal alloy (V-Deltaloy), received three different surface treatments: sandblasting with 50-microm Al2O3 (group 1) or 250-microm Al2O3 (group 2) and chemical agents, or with 250-microm Al2O3 without chemical agents (group 3) prior to bonding of an indirect resin composite (Artglass, and chemical agents Siloc-pre and Siloc-bond). The specimens were tested in shear, half of them after 24-hour dry storage at room temperature and the rest after 10-day storage in normal saline solution at 37 degrees C and thermocycling (2,500 cycles between 5 and 55 degrees C). Morphologic and qualitative changes on the alloy surface after sandblasting with 50- or 250-microm Al2O3 were examined by SEM using EDS analysis and compared with polished specimens. Statistical analysis was performed using two-factor ANOVA. RESULTS: The mean shear bond strengths (in MPa) after dry or wet storage and thermocycling were 29 and 24 for group 1, 21 and 18 for group 2, and 17 and 12 for group 3, respectively; there was a statistically significant difference among the groups. Sandblasting of the alloy surface led to statistically significant changes in elemental composition. These changes were of greater magnitude when 50-microm Al2O3 particles were used. CONCLUSION: The particle size used for sandblasting influences the shear bond strength between a high-noble alloy and a highly filled indirect resin composite, as well as the elemental composition of the alloy surface.