Clinical outcome of single porcelain-fused-to-zirconium dioxide crowns: a systematic review

STATEMENT OF PROBLEM The increasing demand by patients for esthetic and metal-free restorations has driven the development of ceramic restorations with good esthetic and mechanical stability. Recent clinical studies have investigated the use of zirconium dioxide as a core material for complete crowns and computer-aided-design/computer-aided-manufacturing fabricated restorations. PURPOSE The aim of this systematic review was to evaluate the clinical survival rates of porcelain-fused-to-zirconia (PFZ) single crowns on anterior and posterior teeth and to compare them with metal ceramic (MC) crowns. MATERIAL AND METHODS A systematic search was conducted with PubMed and manual research to identify literature written in English that refers to in vivo studies published from January 1, 1950 through July 1, 2011. Clinical trials that evaluated PFZ and MC single crowns on natural teeth were selected for further analysis. Titles and/or abstracts of articles identified through the electronic searches were reviewed and evaluated for appropriateness. In addition, a hand search of relevant dental journals was peformed, and reference lists of culled articles were screened to identify publications. RESULTS The search resulted in a total of 488 initial matches. Nineteen studies with a total of 3621 crowns met the inclusion criteria. The survival rates of PFZ crowns (total 300) ranged from 92.7% to 100% for a follow-up time of 24 to 39 months, whereas those of MC crowns (total 3321) ranged from 70% to 100% for a follow-up time of 12 to 298 months. Studies that reported long-term results were found only for the MC crown group. CONCLUSIONS The scientific clinical data available to compare PFZ and MC crowns are limited. The survival rates may well be influenced by the selection and appropriate use of the veneering ceramic, and, therefore, additional prospective long-term clinical trials are necessary to draw reliable conclusions.

Single crowns versus conventional fillings for the restoration of root-filled teeth.

BACKGROUND Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012. OBJECTIVES To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. SEARCH METHODS We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI). MAIN RESULTS We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Developing a high density platinum/alumina hermetic feedthrough

Typically, hermetic feedthroughs for implantable devices, such as pacemakers, use a alumina ceramic insulator brazed to a platinum wire pin. This combination of material has a long history in implantable devices and has been approved by the FDA for implantable hermetic feedthroughs. The growing demand for increased input/output (I/O) hermetic feedthroughs for implantable neural stimulator applications could be addressed by developing a new, cofired platinum/alumina multilayer ceramic technology in a configuration that supports 300 plus I/Os, which is not commercially available. Seven platinum powders with different particle sizes were used to develop different conductive cofire inks to control the densification mismatch between platinum and alumina. Firing profile (ramp rate, burn- out and holding times) and firing atmosphere and concentrations (hydrogen (wet/dry), air, neutral, vacuum) were also optimized. Platinum and alumina exhibit the alloy formation reaction in a reduced atmosphere. Formation of any compound can increase the bonding of the metal/ceramic interface, resulting in enhanced hermeticity. The feedthrough fabricated in a reduced atmosphere demonstrated significantly superior performance than that of other atmospheres. A composite structure of tungsten/platinum ratios graded thru the via structure (pure W, 50/50 W/Pt, 80/20 Pt/W and pure Pt) exhibited the best performance in comparison to the performance of other materials used for ink metallization. Studies on the high temperature reaction of platinum and alumina, previously unreported, showed that, at low temperatures in reduced atmosphere, Pt 3Al or Pt8Al21 with a tetragonal structure would be formed. Cubic Pt3Al is formed upon heating the sample to temperatures above 1350 °C. This cubic structure is the equilibrium state of Pt-Al alloy at high temperatures. The alumina dissolves into the platinum ink and is redeposited as a surface coating. This was observed on both cofired samples and pure platinum thin films coated on a 99.6 Wt% alumina and fired at 1550 °C. Different mechanisms are proposed to describe this behavior based on the size of the platinum particle

Study of porcelain-zirconia composites for dental applications

Materiais compósitos restauradores representam um dos mais bem sucedidos biomateriais na pesquisa moderna, na substituição do tecido biológico em aparência e função. Nesta linha, a porcelana feldspática tem sido largamente usada em odontologia devido suas interessantes qualidades como estabilidade de cor, propriedades estéticas, elevada durabilidade mecânica, biocompatibilidade, baixa condutividade térmica e elevada resistência ao desgaste. Entretanto, este material é frágil e pode falhar em ambiente oral devido ao micro-vazamento, baixa resistência à tração, descolagem ou fratura. Assim, para melhorar as propriedades mecânicas da porcelana, a zircônia parcialmente estabilizada com Ítria (Y-TZP) pode ser uma boa alternativa para fortalecer e produzir infraestruturas totalmente cerâmicas (coroas e próteses parciais fixas). Portanto, este estudo tem por objetivo avaliar as propriedades mecânicas e características microestruturais da porcelana reforçada com zircônia (3Y-TZP) em diferentes conteúdos e as variáveis que afetam as propriedades mecânicas destes materiais. O estudo de caracterização revelou que a zircônia comercial apresenta melhores resultados quando comparada com a zircônia sintetizada pelo CPM. Assim, os estudos seguintes utilizaram a zircônia comercial para todos os testes requeridos. As partículas de zircônia apresentam elevadas propriedades mecânicas quando comparadas a zircônia aglomerada. Os diferentes conteúdos revelam que as propriedades mecânicas dos compósitos aumentam com o aumento do conteúdo volumétrico até 30% vol.% (198,5Mpa), ou seja, maior resistência à flexão quando comparada com os outros compósitos. Do mesmo modo, a resistência ao desgaste para os compósitos com (30%, vol.% de zircônia) apresenta valores superiores quando comparado aos demais compósitos. Na adesão cerâmico-cerâmico a porcelana exibe elevada adesão para a superfície de zircônia porosa quando comparada a superfície rugosa. Os furos superficiais (PZ) e aplicação de compósitos com camada intermediária (RZI) na zircônia causam separadamente uma melhoria da resistência ao cisalhamento da zircônia-porcelana quando comparados as amostras convencionais de zircônia-porcelana (RZ), embora não sejam estatisticamente significativas (p>0.05). A presença de uma camada intermediaria produz um aumento significativo na força de ligação (~55%) em relação as amostras convencionais (RZ). Portanto, a correta a correta configuração e tratamento superficial podem produzir subestruturas com qualidade e força de ligação adequadas aos requisitos odontológicos.

Propriedades óticas dos sistemas cerâmicos atuais e suas aplicações em dentes naturais

A estética representa uma qualidade cada vez mais requisitada pela sociedade na atualidade. A busca pela aparência ideal expandiu-se também na medicina dentária, aumentando as exigências por resultados perfeitos. A medicina dentária tem desenvolvido novas técnicas e novos materiais com a ambição de reproduzir as propriedades estéticas e funcionais dos dentes naturais. Os sistemas totalmente cerâmicos têm sido alvo de grande entusiasmo dado as suas características inerentes. O seu potencial na reabilitação oral estética tem derrotado as suas antecessoras metalocerâmicas. À semelhança do esmalte e da dentina, os sistemas totalmente cerâmicos exibem boas propriedades óticas de translucidez, opacidade, fluorescência e opalescência, resultado da interação com a luz. Ainda que não seja possível dissociar as propriedades óticas das propriedades mecânicas de um dente natural para o sucesso de uma restauração, a heterogeneidade das cerâmicas têm sido exitosas enquanto sistema que combina diferentes propriedades para diferentes indicações clínicas. Esta variabilidade deve-se a diferentes composições químicas e a diferentes processos de fabricação, entre outros, que acentuam ou atenuam qualidades em cada sistema totalmente cerâmico. Este trabalho pretende abordar e comparar os sistemas cerâmicos atuais (cerâmicas com base em sílica, cerâmicas com base de alumina, cerâmicas com base em zircónia) de acordo com as suas propriedades óticas e a consequente aplicação clínica tendo em conta as características dos dentes naturais.

Caracterização Microestrutural e Tribocorrosiva de Sistemas Metalocerâmicos Odontológicos do Tipo Ni-Cr/Porcelana E Ni-Cr/Ti/Porcelana

The partial fixed prosthodontics restoration is used to rehabilitate form and function of partial or total compromised teeth, having to remain permanently joined to remainder tooth. The most useful material on prosthodontics is the feldspar porcelain, commercialized as aluminosilicate powders. Dental porcelains are presented with limited mechanical properties to rehabilitate extensive spaces. The association with Ni-Cr metallic systems (metal-ceramic system) allows that the metallic substructure compensates the fragile porcelain nature, preserving the thermal insulation and aesthetics desirable, as well as reducing the possibility of cracking during matication efforts. Cohesive flaws by low mechanical strength connect the metallic substructure to the oral environment, characterized by a electrolytic solution (saliva), by aggressive temperature, pH cyclic changes and mechanical requests. This process results on ionic liberation that could promote allergic or inflammatory responses, and/or clinical degradation of ceramometal system. The aim of this study was to evaluate the presence of an intermediate titanium layer on the microscopic fracture behavior of porcelains on ceramometal systems. Plasma deposition of titanium films result in regular passivating oxide layers which act as barriers to protect the metallic substrate against the hazardous effects of corrosive saliva. Tribocorrosion tests were performed to simulate the oral environment and mechanical stress, making it possible the early detection of crack formation and growth on metal-ceramic systems, which estimate the adherence between the compounds of this system. Plain samples consisting of dental feldspar porcelain deposited either onto metallic substrates or titanium films were fired and characterized by scanning electron microscopy. The result showed that the titanium film improved the adherence of the system compared to conventional metal-ceramic interfaces, thus holding crack propagation

Revestimentos a base de Ta/Al2O3 produzidos por aspersão térmica sobre substrato metálico

Metal substrates were coated by thermal spraying plasma torch, they were positioned at a distance of 4 and 5 cm from the nozzle exit of the plasma jet. The starting materials were used for deposition of tantalum oxide powder and aluminium. These two materials were mixed and ground into high-energy mill, then immersed in the torch for the production of alumina coating infused with particles of tantalum with nano and micrometric size. The spraying equipment used is a plasma torch arc not transferred, which operating in the range of 250 A and 80 V, was able to produce enough heat to ignite aluminothermic between Ta2O5 and aluminum. Upon reaching the plasma jet, the mixing powders react with the heat of the blaze, which provides sufficient energy for melting aluminum particles. This energy is transferred through mechanisms of self-propagating to the oxide, beginning a reduction reaction, which then hits on the surface of the substrate and forms a coating on which a composite is formed by a junction metal - ceramic (Ta +Al2O3). The phases and quantification of each were obtained respectively by X-ray diffraction and the Rietveld method. Morphology by scanning electron microscopy and chemical analysis by energy dispersive spectroscopy EDS. It was also performed measurements of the substrate roughness, Vickers microhardness measurements in sprays and determination of the electron temperature of the plasma jet by optical emission spectroscopy EEO. The results confirmed the expectation generated around the end product of spraying the mixture Ta2O5 + Al, both in the formation of nano-sized particles and in their final form. The electron excitation temperature was consistent with the purpose of work, in addition, the thermodynamic temperature was efficient for the reduction process of Ta2O5. The electron excitation temperature showed values of 3000, 4500 and 8000 K for flows10, 20 and 30 l / min respectively, these values were taken at the nozzle exit of the plasma jet. The thermodynamic temperature around 1200 ° C, was effective in the reduction process of Ta2O5

Estudo da influência da temperatura de brasagem nas uniões zircônia/aço inox 304 utilizando metalização mecânica

Metal-Ceramic (M/C) Zirconia-stainless steel interfaces have been processed through brazing techniques due to the excellent combination of properties such as high temperature stability, high corrosion resistance and good mechanical properties. However, some M/C interfaces show some defects, like porosity and cracks results in the degradation of the interfaces, leading even to its total rupture. Most of time, those defects are associated with an improper brazing parameters selection to the M/C system. In this work, ZrO2 Y-TZP and ZrO2 Mg - PSZ were joint with the stainless steel grade 304 by brazing using a eutectic silver-copper (Ag28Cu) interlayer alloy with different thermal cycles. Ceramic surfaces were previous mechanically metallized with titanium to improve adhesion of the system. The effect of temperature on the M/C interface was studied. SEM-EDS and 3 point flexural bend test were performed to evaluate morphology, chemical composition and mechanical resistance of the M/C interfaces. Lower thermal cycle temperatures produced better results of mechanical resistance, and more regular/ homogeneous reaction layers between braze alloy and metal-ceramic surfaces. Also was proved the AgCu braze alloy activation in situ by titanium

Shear bond strength of a ceramic to Co-Cr alloys

Statement of problem. Different combinations of Co-Cr alloys bonded to ceramic have been used in dentistry; however, the bond strength of ceramic to metal can vary because of different compositions of these alloys.Purpose. The purpose of this study was to evaluate the shear bond strength of a dental ceramic to 5 commercially available Co-Cr alloys.Material and methods. Five Co-Cr alloys (IPS d.SIGN 20, IPS d.SIGN 30, Remanium 2000, Heranium P, and Wirobond C) were tested and compared to a control group of an Au-Pd alloy (Olympia). Specimen disks, 5 mm high and 4 mm in diameter, were fabricated with the lost-wax technique. Sixty specimens were prepared using opaque and dentin ceramics (VITA Omega 900), veneered, 4 mm high and 4 mm in diameter, over the metal specimens (n = 10). The shear bond strength test was performed in a universal testing machine with a crosshead speed of 0.5 mm/min. After shear bond testing, fracture surfaces were evaluated in a stereomicroscope under x25 magnification. Ultimate shear bond strength (MPa) data were analyzed with 1-way ANOVA and the Tukey HSD test (alpha = .05).Results. The mean (SID) bond strengths (MPa) were: 61.4 (7.8) for Olympia; 94.0 (18.9) for IPS 20; 96.8 (10.2) for I PS 30; 75.1 (12.4) for Remanium; 71.2 (14.3) for Heranium P; and 63.2 (10.9) for Wirobond C. Mean bond strengths for IPS 20 and IPS 30 were not significantly different, but were significantly (P<.001) higher than mean bond strengths for the other 4 alloys, which were not significantly different from each other.Conclusions. Bond strength of a dental ceramic to a Co-Cr alloy is dependent on the alloy composition.

An Investigation of the Properties of some of the White Metal Alloys

Although there is no standardized list of alloys, most investigators have, to avoid confusion, concurred in at least grouping the metals under several general heads. Precious metals: gold, silver and the platinum group; the light metals: aluminum and magnesium; the non-ferrous metals (excluding all steels and iron-base alloys); and the antifriction metals.

High-performance ceramic membranes with a separation layer of metal oxide nanofibers

In conventional fabrication of ceramic separation membranes, the particulate sols are applied onto porous supports. Major structural deficiencies under this approach are pin-holes and cracks, and the dramatic losses of flux when pore sizes are reduced to enhance selectivity. We have overcome these structural deficiencies by constructing hierarchically structured separation layer on a porous substrate using lager titanate nanofibers and smaller boehmite nanofibers. This yields a radical change in membrane texture. The resulting membranes effectively filter out species larger than 60 nm at flow rates orders of magnitude greater than conventional membranes. This reveals a new direction in membrane fabrication.

Ceramic membranes for separation of proteins and DNA by in situ growth of alumina nanofibres with a nanomesh of metal oxide nanofibres

Ceramic membranes were fabricated by in situ synthesis of alumina nanofibres in the pores of an alumina support as a separation layer, and exhibited a high permeation selectivity for bovine serum albumin relative to bovine hemoglobin (over 60 times) and can effectively retain DNA molecules at high fluxes.

High-flux ceramic membranes with a nanomesh of metal oxide nanofibers

Traditional ceramic separation membranes, which are fabricated by applying colloidal suspensions of metal hydroxides to porous supports, tend to suffer from pinholes and cracks that seriously affect their quality. Other intrinsic problems for these membranes include dramatic losses of flux when the pore sizes are reduced to enhance selectivity and dead-end pores that make no contribution to filtration. In this work, we propose a new strategy for addressing these problems by constructing a hierarchically structured separation layer on a porous substrate using large titanate nanofibers and smaller boehmite nanofibers. The nanofibers are able to divide large voids into smaller ones without forming dead-end pores and with the minimum reduction of the total void volume. The separation layer of nanofibers has a porosity of over 70% of its volume, whereas the separation layer in conventional ceramic membranes has a porosity below 36% and inevitably includes dead-end pores that make no contribution to the flux. This radical change in membrane texture greatly enhances membrane performance. The resulting membranes were able to filter out 95.3% of 60-nm particles from a 0.01 wt % latex while maintaining a relatively high flux of between 800 and 1000 L/m2·h, under a low driving pressure (20 kPa). Such flow rates are orders of magnitude greater than those of conventional membranes with equal selectivity. Moreover, the flux was stable at approximately 800 L/m2·h with a selectivity of more than 95%, even after six repeated runs of filtration and calcination. Use of different supports, either porous glass or porous alumina, had no substantial effect on the performance of the membranes; thus, it is possible to construct the membranes from a variety of supports without compromising functionality. The Darcy equation satisfactorily describes the correlation between the filtration flux and the structural parameters of the new membranes. The assembly of nanofiber meshes to combine high flux with excellent selectivity is an exciting new direction in membrane fabrication.

Nucleation and growth of Al2O3/metal composites by oxidation of aluminum alloys

The nucleation and growth mechanisms during high temperature oxidation of liquid Al-3% Mg and Al-3% Mg-3% Si alloys were studied with the aim of enhancing our understanding of a new composite fabrication process. The typical oxidation sequence consists of an initial event of rapid but brief oxidation, followed by an incubation period of limited oxide growth after which bulk Al2O3/Al composite forms. A duplex oxide layer, MgO (upper) and MgAl2O4 (lower), forms on the alloy surface during initial oxidation and incubation. The spinel layer remains next to the liquid alloy during bulk oxide growth and is the eventual repository for most of the magnesium in the original alloy. Metal microchannels developed during incubation continuously supply alloy through the composite to the reaction interface. During the growth process, a layered structure exists at the upper extremity of the composite, consisting of MgO at the top surface, MgAl2O4 (probably discontinuous), Al alloy, and finally the bulk Al2O3 composite containing microchannels of the alloy. The bulk oxide growth mechanism appears to involve continuous formation and dissolution of the Mg-rich oxides at the surface, diffusion of oxygen through the underlying liquid metal, and epitaxial growth of Al2O3 on the existing composite body. The roles of Mg and Si in the composite growth process are discussed.

Large negative magnetoresistance and metal-insulator transition observed in MnO/C composite coatings grown on ceramic alumina by metalorganic chemical vapor deposition

MnO/C composite coatings were grown by the metalorganic chemical vapor deposition process on ceramic alumina in argon ambient. Characterization by various techniques confirms that these coatings are homogeneous composites comprising nanometer-sized MnO particles embedded in a matrix of nanometer-sized graphite. Components of the MnO/C composite coating crystalline disordered, but are electrically quite conductive. Resistance vs. temperature measurements show that coating resistance increases exponentially from a few hundred ohms at room temperature to a few megaohms at 30 K. Logarithmic plots of reduced activation energy vs. temperature show that the coating material undergoes a metal-insulator transition. The reduced activation energy exponent for the film under zero magnetic field was 2.1, which is unusually high, implying that conduction is suppressed at much faster rate than the Mott or the Efros-Shklovskii hopping mechanism. Magnetoconductance us. magnetic field plots obtained at various temperatures show a high magnetoconductance (similar to 28.8%) at 100 K, which is unusually large for a disordered system, wherein magnetoresistance is attributed typically to weak localization. A plausible explanation for the unusual behavior observed in the carbonaceous disordered composite material is proposed. (C) 2010 Elsevier Ltd. All rights reserved.