Monolithic CAD/CAM Lithium Disilicate Versus Veneered Y-TZP Crowns: Comparison of Failure Modes and Reliability After Fatigue

Purpose: The aim of this research was to evaluate the fatigue behavior and reliability of monolithic computer-aided design/computer-assisted manufacture (CAD/CAM) lithium disilicate and hand-layer-veneered zirconia all-ceramic crowns. Materials and Methods: A CAD-based mandibular molar crown preparation, fabricated using rapid prototyping, served as the master die. Fully anatomically shaped monolithic lithium disilicate crowns (IPS e.max CAD, n = 19) and hand-layer-veneered zirconia-based crowns (IPS e.max ZirCAD/Ceram, n = 21) were designed and milled using a CAD/CAM system. Crowns were cemented on aged dentinlike composite dies with resin cement. Crowns were exposed to mouth-motion fatigue by sliding a WC-indenter (r = 3.18 mm) 0.7 mm lingually down the distobuccal cusp using three different step-stress profiles until failure occurred. Failure was designated as a large chip or fracture through the crown. If no failures occurred at high loads (> 900 N), the test method was changed to staircase r ratio fatigue. Stress level probability curves and reliability were calculated. Results: Hand-layer-veneered zirconia crowns revealed veneer chipping and had a reliability of < 0.01 (0.03 to 0.00, two-sided 90% confidence bounds) for a mission of 100,000 cycles and a 200-N load. None of the fully anatomically shaped CAD/CAM-fabricated monolithic lithium disilicate crowns failed during step-stress mouth-motion fatigue (180,000 cycles, 900 N). CAD/CAM lithium disilicate crowns also survived r ratio fatigue (1,000,000 cycles, 100 to 1,000 N). There appears to be a threshold for damage/bulk fracture for the lithium disilicate ceramic in the range of 1,100 to 1,200 N. Conclusion: Based on present fatigue findings, the application of CAD/CAM lithium disilicate ceramic in a monolithic/fully anatomical configuration resulted in fatigue-resistant crowns, whereas hand-layer-veneered zirconia crowns revealed a high susceptibility to mouth-motion cyclic loading with early veneer failures. Int J Prosthodont 2010; 23: 434-442.

The Influence of Certain Processing Factors on the Durability of Yttrium Stabilized Zirconia Used As Dental Biomaterial

In dentistry, yttrium partially stabilized zirconia (ZrO2) has become one of the most attractive ceramic materials for prosthetic applications. The aim of this series of studies was to evaluate whether certain treatments used in the manufacturing process, such as sintering time, color shading or heat treatment of zirconia affect the material properties. Another aim was to evaluate the load-bearing capacity and marginal fit of manually copy-milled custom-made versus prefabricated commercially available zirconia implant abutments. Mechanical properties such as flexural strength and surface microhardness were determined for green-stage milled and sintered yttrium partially stabilized zirconia after different sintering time, coloring process and heat treatments. Scanning electron microscope (SEM) was used for analyzing the possible changes in surface structure of zirconia material after reduced sintering time, coloring and heat treatments. Possible phase change from the tetragonal to the monoclinic phase was evaluated by X-ray diffraction analysis (XRD). The load-bearing capacity of different implant abutments was measured and the fit between abutment and implant replica was examined with SEM. The results of these studies showed that the shorter sintering time or the thermocycling did not affect the strength or surface microhardness of zirconia. Coloring of zirconia decreased strength compared to un-colored control zirconia, and some of the colored zirconia specimens also showed a decrease in surface microhardness. Coloring also affected the dimensions of zirconia. Significantly decreased shrinkage was found for colored zirconia specimens during sintering. Heat treatment of zirconia did not seem to affect materials’ mechanical properties but when a thin coating of wash and glaze porcelain was fired on the tensile side of the disc the flexural strength decreased significantly. Furthermore, it was found that thermocycling increased the monoclinic phase on the surface of the zirconia. Color shading or heat treatment did not seem to affect phase transformation but small monoclinic peaks were detected on the surface of the heat treated specimens with a thin coating of wash and glaze porcelain on the opposite side. Custom-made zirconia abutments showed comparable load-bearing capacity to the prefabricated commercially available zirconia abutments. However, the fit of the custom-made abutments was less satisfactory than that of the commercially available abutments. These studies suggest that zirconia is a durable material and other treatments than color shading used in the manufacturing process of zirconia bulk material does not affect the material’s strength. The decrease in strength and dimensional changes after color shading needs to be taken into account when fabricating zirconia substructures for fixed dental prostheses. Manually copy-milled custom-made abutments have acceptable load-bearing capacity but the marginal accuracy has to be evaluated carefully.

Comparaison de la force d'adhésion de deux types de résines de collage appliquées sur des surfaces métalliques traitées de différentes façons : une étude in vitro

L’objectif de cette étude était d’évaluer et de comparer la force d’adhésion de deux résines de collage: le ClearfilTM Esthetic Cement & DC Bond Kit (C) et le RelyXTM Unicem (R), sur trois adhérents différents : une surface d’émail, un alliage de métaux non précieux (Np) et un alliage de métaux semi-précieux (Sp). La surface des échantillons des alliages métalliques a subi différents traitements de surface. Sur l’émail (n=15) ainsi que sur les plaquettes d’alliages Np et Sp (n=15), des cylindres de résine étaient appliqués et polymérisés. Suite au processus de collage, les échantillons ont été incubés à 37°C pendant 24 heures, puis ont subi 500 cycles de thermocyclage. Des tests de cisaillement ont été effectués, suivi par l’analyse de la surface des échantillons au microscope à balayage électronique. Une comparaison de type T-test et des comparaisons multiples post hoc, ont été effectuées pour l’analyse statistique (p 0,05). Sur l’émail, les résultats ont démontré que la résine C présentait une force d'adhésion moyenne statistiquement supérieure (33,97±17,18 MPa) à la résine R (10,48±11,23 MPa) (p 0,05). Le type d’alliage utilisé n’influençait pas la force d’adhésion, et ce, peu importe le type de résine de collage (p>0,05). Pour le groupe Sp, la résine C a démontré une adhésion statistiquement supérieure à la résine R, et ce, pour tous les traitements de surface (p 0,05). En conclusion, la résine C a démontré des résultats d’adhésion significativement supérieurs à la résine R sur l’émail ainsi que sur presque toutes les surfaces traitées des alliages de métaux.

Photoelastic Stress Analysis in Screwed and Cemented Implant-Supported Dentures With External Hexagon Implants

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cementation of Prosthetic Restorations: From Conventional Cementation to Dental Bonding Concept

The cementation procedure of metal-free fixed partial dentures exhibits special characteristics about the porcelains and cementation agents, which turns the correct association between these materials necessary. Our purpose in this literature review was to point the main groups of cements associated to metal-free restoration and discuss about the advantages, disadvantages, and recommendations of each one. Our search was confined to the electronic databases PubMed and SciELO and to books about this matter. There are essentially 3 types of hard cement: conventional, resin, or a hybrid of the two. The metal-free restorations can be fixed with conventional or resin cements. The right choice of luting material is of vital importance to the longevity of dental restorative materials. Conventional cements are advantageous when good compressive straight, good film thickness, and water dissolution resistance are necessary. However, they need an ideal preparation, and they are not acid dissolution resistant. Conventional cements are indicated to porcelains that cannot be acid etched. Resin cements represent the choice to metal-free restoration cementation because they present better physical properties and aesthetic than conventional agents.

All-Ceramic Crowns Over Single Implant Zircon Abutment. Influence of Young's Modulus on Mechanics

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of metal conditioners on the adhesive bonding of resin cements to cast titanium

Objective: To assess the effect of metal conditioners on the bond strength between resin cements and cast titanium. Method and Materials: Commercially pure titanium (99.56%) was cast using an arc casting machine. Surfaces were finished with 400-grit silicon carbide paper followed by air abrasion with 50-mu m aluminum oxide. A piece of double-coated tape with a 4-mm circular hole was then positioned on the metal surface to control the area of the bond. The prepared surfaces were then divided into 4 groups (n=10): G1, unprimed Panavia F; G2, Alloy Primer-Panavia F; G3, unprimed Bistite DC; G4, Metaltite-Bistite DC. Forty minutes after insertion of the resin cements, the specimens were detached from the mold and stored in water at 37 C for 24 hours. Shear bond strength was performed in a testing machine (MTS 810) at a crosshead speed of 0.5 mm/min. Data were analyzed using ANOVA and Tukey's test with a .05 significance level. The fractured surfaces were observed through an optical microscope at 10x magnification. Results: the G1 group demonstrated significantly higher shear bond strength (17.95 MPa) than the other groups. G3 (13.79 MPa) and G4 (12.98 MPa) showed similar mean values to each other and were statistically superior to G2 (9.31 MPa). Debonded surfaces generally presented adhesive failure between metal surfaces and resin cements. Conclusion: While the Metaltite conditioner did not influence the bond strength of the Bistite DC cement, the Alloy Primer conditioner significantly decreased the mean bond strength of the Panavia F cement.

Evaluation of mechanical properties of dental feldsphatic porcelains for metal and zirconia core

Studies has been reported a significant incidence of chipping of the feldspathic porcelain veneer in zirconia-based restorations. The purpose of this study was to compare the three-point flexural strength (MPa), Weibull parameters, Vickers hardness (VHN) and Vickers indentation fracture toughness (MPa/mm(1/2)) in feldspatic porcelains for metal and for zirconia frameworks. Bar specimens were made with the porcelains e.MaxCeram (EM) and VitaVM9 (V9) for zirconia core, and Duceragold (DG) and VitaVMK95 (VK) for metal core (n = 15). Kruskal-Wallis and Dun test were used for statistical analysis. There was no significant difference (p=0.31) among the porcelains in the flexural strength (Median = 73.2; 74.6; 74.5; 74.4). Weibull calculation presented highest reliability for VK (10.8) followed by em (7.1), V9 (5.7) and DG (5.6). Vickers hardness test showed that em (536.3), V9 (579.9) and VK (522.1) had no difference and DG (489.6) had the lowest value (p<.001). The highest fracture toughness was to VK (1.77), DG (1.58) had an intermediate value while V9 (1.33) and em (1.18) had the lowest values (p<.001). Despite of the suitable flexural strength, reliability and high hardness, the porcelains used to zirconia-based fixed dental prostheses showed lower fracture toughness values.

Effect of Static and Cyclic Loading on Ceramic Laminate Veneers Adhered to Teeth with and Without Aged Composite Restorations

Purpose: Existing composite restorations on teeth are often remade prior to the cementation of fixed dental prostheses. The aim of this study was to evaluate the effect of static and cyclic loading on ceramic laminate veneers adhered to aged resin composite restorations.Materials and Methods: Eighty sound maxillary incisors were collected and randomly divided into four groups: group 1: control group, no restorations; group 2: two Class III restorations; group 3: two Class IV restorations; group 4: complete composite substrate. Standard composite restorations were made using a microhybrid resin composite (Anterior Shine). Restored teeth were subjected to thermocycling (6000 cycles). Window preparations were made on the labial surface of the teeth for ceramic laminate fabrication (Empress II). Teeth were conditioned using an etch-and-rinse system. Existing composite restorations representing the aged composites were silica coated (CoJet) and silanized (ESPE-Sil). Ceramic laminates were cemented using a bis-GMA-based cement (Variolink Veneer). The specimens were randomly divided into two groups and were subjected to either static (groups 1a, 2a, 3a, 4a) or cyclic loading (groups 1b, 2b, 3b, 4b). Failure type and location after loading were classified. Data were analyzed using one-way ANOVA and Tukey's test.Results: Significantly higher fracture strength was obtained in group 4 (330 +/- 81 N) compared to the controls in group 1 (179 +/- 120 N) (one-way ANOVA, p < 0.05). Group lb survived a lower mean number of cyclic loads (672,820 cycles) than teeth of groups 2b to 4b (846x10(3) to 873x10(3) cycles). Failure type evaluation after the fracture test showed predominantly adhesive failures between dentin and cement, but after cyclic loading, more cohesive fractures in the ceramic were seen.Conclusion: Ceramic laminate veneers bonded to conditioned aged composite restorations provided favorable results. Surface conditioning of existing restorations may eliminate the necessity of removing aged composite restorations.

External Hexagon and Internal Hexagon in Straight and Offset Implant Placement: Strain Gauge Analysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estética en prótesis removibles

Nowadays, aesthetics is very appreciated in the social context and a attractive smile is the object of desire in most of patients requiring prosthesis treatment. In case of removable prosthesis, total or partial, this feature is more significant since some or all teeth may be absents. Implants leading to a significant improvement in relation to function and comfort of removable prosthesis users, but the aesthetics of these prostheses had little attention in the current scientific literature. Thus, the aim of present article was to make a review of the literature on the aesthetic features related to rehabilitation with removable prostheses. In present study we found as significant factors for the aesthetics in removable partial and total prostheses: Selection of artificial teeth and their arrangement, characterization of acrylic resin basis and also the types and location of retainers for the removable partial prostheses. We conclude that the involvement and the aesthetic knowledge during the appropriate planning of this process is responsibility of the professional.

Composite pontics for orthodontic patients with extraction spaces.

Esthetic orthodontic appliances continue to appeal to more patients, which results in objections to extraction spaces that remain for several months during orthodontic therapy. This has led orthodontists to design temporary pontics that fill extraction sites and that can be reduced as the spaces close. This report describes a simple, efficient, and expeditious technique for making such pontics. © 2010 Quintessence Publishing Co, Inc.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Caracterização microestrutural e resistência à corrosão de ligas Ni-Cr-Mo refundidas utilizadas em próteses dentárias

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise extensométrica de cargas estáticas axiais e não axiais em próteses implantossuportadas de três elementos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)