Influence of cusp inclination and curvature on the in vitro failure and fracture resistance of veneered zirconia crowns

Edge chipping patterns in posterior teeth of hominins and apes

Chip scars in fossil teeth are a lasting evidence that bears on human evolution. Chip dimensions in posterior teeth of hominins, apes and white-lipped peccary (Tayassu pecari) are measured from published occlusal images. The results are plotted as D/Dm vs. h/Dm, where h, D and Dm denote indent distance, chip width and mean tooth crown diameter. The hominin species follow a similar pattern where D/Dm monotonically increases up to h/Dm ≈ 0.3. The behavior for the apes is characterized by two phases. In the first, h/Dm monotonically increases up to h/Dm ≈ 0.26 while in the second (h/Dm ≈ 0.26 to 0.42), D/Dm experiences a drastic change in behavior. The interpretation of chip morphology is assisted by results from controlled spherical indentation tests on extracted human molars. This study shows that in addition to the commonly recognized chipping due to cusp loading, a chip may also initiate from the inner wall of the tooth's central fossa. Accordingly, it is suggested that the chipping in hominins generally initiates from a (worn) cusp while that in apes involves cusp loading up to h/Dm ≈ 0.26 and fossa loading thereafter. The behavior for T. pecari is much similar to that of the apes. The fossa chipping is facilitated by a consumption of hard, large-size diet (e.g., plants, roots, barks and nuts) and presence of broad central fossa, conditions that are met in apes. Finally, a simple expression for the critical chipping force Pch due to fossa loading is developed.

Generative deep learning approaches for the design of dental restorations: A narrative review

OBJECTIVES

This study aims to explore and discuss recent advancements in tooth reconstruction utilizing deep learning (DL) techniques. A review on new DL methodologies in partial and full tooth reconstruction is conducted.

DATA/SOURCES

PubMed, Google Scholar, and IEEE Xplore databases were searched for articles from 2003 to 2023.

STUDY SELECTION

The review includes 9 articles published from 2018 to 2023. The selected articles showcase novel DL approaches for tooth reconstruction, while those concentrating solely on the application or review of DL methods are excluded. The review shows that data is acquired via intraoral scans or laboratory scans of dental plaster models. Common data representations are depth maps, point clouds, and voxelized point clouds. Reconstructions focus on single teeth, using data from adjacent teeth or the entire jaw. Some articles include antagonist teeth data and features like occlusal grooves and gap distance. Primary network architectures include Generative Adversarial Networks (GANs) and Transformers. Compared to conventional digital methods, DL-based tooth reconstruction reports error rates approximately two times lower.

CONCLUSIONS

Generative DL models analyze dental datasets to reconstruct missing teeth by extracting insights into patterns and structures. Through specialized application, these models reconstruct morphologically and functionally sound dental structures, leveraging information from the existing teeth. The reported advancements facilitate the feasibility of DL-based dental crown reconstruction. Beyond GANs and Transformers with point clouds or voxels, recent studies indicate promising outcomes with diffusion-based architectures and innovative data representations like wavelets for 3D shape completion and inference problems.

CLINICAL SIGNIFICANCE

Generative network architectures employed in the analysis and reconstruction of dental structures demonstrate notable proficiency. The enhanced accuracy and efficiency of DL-based frameworks hold the potential to enhance clinical outcomes and increase patient satisfaction. The reduced reconstruction times and diminished requirement for manual intervention may lead to cost savings and improved accessibility of dental services.

A data-driven approach for the partial reconstruction of individual human molar teeth using generative deep learning

Background and objective

Due to the high prevalence of dental caries, fixed dental restorations are regularly required to restore compromised teeth or replace missing teeth while retaining function and aesthetic appearance. The fabrication of dental restorations, however, remains challenging due to the complexity of the human masticatory system as well as the unique morphology of each individual dentition. Adaptation and reworking are frequently required during the insertion of fixed dental prostheses (FDPs), which increase cost and treatment time. This article proposes a data-driven approach for the partial reconstruction of occlusal surfaces based on a data set that comprises 92 3D mesh files of full dental crown restorations.

Methods

A Generative Adversarial Network (GAN) is considered for the given task in view of its ability to represent extensive data sets in an unsupervised manner with a wide variety of applications. Having demonstrated good capabilities in terms of image quality and training stability, StyleGAN-2 has been chosen as the main network for generating the occlusal surfaces. A 2D projection method is proposed in order to generate 2D representations of the provided 3D tooth data set for integration with the StyleGAN architecture. The reconstruction capabilities of the trained network are demonstrated by means of 4 common inlay types using a Bayesian Image Reconstruction method. This involves pre-processing the data in order to extract the necessary information of the tooth preparations required for the used method as well as the modification of the initial reconstruction loss.

Results

The reconstruction process yields satisfactory visual and quantitative results for all preparations with a root mean square error (RMSE) ranging from 0.02 mm to 0.18 mm. When compared against a clinical procedure for CAD inlay fabrication, the group of dentists preferred the GAN-based restorations for 3 of the total 4 inlay geometries.

Conclusions

This article shows the effectiveness of the StyleGAN architecture with a downstream optimization process for the reconstruction of 4 different inlay geometries. The independence of the reconstruction process and the initial training of the GAN enables the application of the method for arbitrary inlay geometries without time-consuming retraining of the GAN.

Influence of ceramic thickness and dental substrate on the survival rate and failure load of non-retentive occlusal veneers after fatigue

OBJECTIVE

To investigate the effect of ceramic thickness and dental substrate (enamel vs. dentin/enamel) on the survival rate and failure load of non-retentive occlusal veneers.

MATERIALS AND METHODS

Human maxillary molars (n = 60) were divided into five test-groups (n = 12). The groups (named DE-1.5, DE-1.0, DE-0.5, E-1.0, E-0.5) differed in their dental substrate (E = enamel, DE = dentin/enamel) and restoration thickness (standard: 1.5 mm, thin: 1.0 mm, ultrathin: 0.5 mm). All teeth were prepared for non-retentive monolithic lithium-disilicate occlusal veneers (IPS e.max Press, Ivoclar). Restorations were adhesively cemented (Syntac Classic/Variolink II, Ivoclar) and exposed to thermomechanical fatigue (1.2 million cycles, 1.6 Hz, 49 N/ 5-55°C). Single load to failure was performed using a universal testing-machine. A linear-regression model was applied, pairwise comparisons used the Student-Newman-Keuls method (p < 0.05).

RESULTS

Three dentin-based occlusal veneers (one DE-1.0, two DE-0.5) revealed cracks after fatigue exposure, which corresponds to an overall-survival rate of 95%. Load to failure resulted in the following ranking: 2142 N(DE-0.5) > 2105 N(E-1.0) > 2075 N(E-0.5) > 1440 N(DE-1.5) > 1430 N(DE-1.0). Thin (E-1.0) and ultrathin enamel-based occlusal veneers (E-0.5) revealed high failure loads and surpassed the standard thickness dentin-based veneers (DE-1.5) significantly (p = 0.044, p = 0.022).

CONCLUSION

All tested monolithic lithium disilicate occlusal veneers obtained failure loads above physiological chewing forces. Thin and ultrathin enamel-based occlusal veneers outperformed the standard thick dentin-based occlusal veneers.

CLINICAL SIGNIFICANCE

Minimally invasive enamel-based occlusal veneer restorations with non-retentive preparation design may serve as a conservative treatment option.

On edge chipping in molar teeth from blunt occlusal contact

Edge chipping is a leading failure mode in dental teeth. Virtually all chipping studies are limited to Vickers indentation on polished cusps of molar teeth. Such works are here extended to spherical contact. Occlusal loads are applied on the tooth's central fossa or a polished cusp using ball radii ranging from 0.4 to 5.16 mm. The chip dimensions are characterized by h/Dm and D/Dm, where h, D and Dm denote indent distance, chip size and tooth crown diameter. For the fossa loading, h/Dm, D/Dm and the least chipping force Pch are virtually independent of ball radius r for r < ≈ 4 mm. In this range, h/Dm and D/Dm lie between ≈0.30 to 0.36 and 0.51 to 0.69, respectively, while Pch equals ≈1330 N. For r > ≈ 4 mm, the failure occurs by debonding of enamel sectors from the dentin core. In the case of cusp loading, h/Dm < ≈ 0.3 while D/Dm and Pch vary with r. For relatively small h or large r, the failure occurs as soon as radial cracks initiate under the loading point. For a load applied near a cusp tip, the failure occurs by enamel debonding. Finally, the present work is easily extendable to fossil teeth of hominins and apes as well as prosthetic teeth. The morphological features obtained in such studies should provide quantitative means to assess the relationships between chip dimensions, chipping force and diet characteristics.

Microstructure, composition, and flexural strength of different layers within zirconia materials with strength gradient

OBJECTIVES

The aim of this study was to compare composition, microstructure, and mechanical strength of current multilayer zirconia blanks.

METHODS

Bar shaped specimens were made from several layers of multilayer zirconia blanks (Cercon ht ML, Dentsply Sirona, US; Katana Zirconia YML, Kuraray, J;SHOFU Disk ZR Lucent Supra, Shofu, J; priti multidisc ZrO₂ Multi Translucent, Pritidenta, D; IPS e.max ZirCAD Prime, Ivoclar Vivadent, FL). Flexural strength was determined in a three-point bending test on extra-thin bars. X-ray diffraction (XRD) with Rietveld refinement was used to assess crystal structure and scanning electron microscopy (SEM) imaging to visualize the microstructure of each material and layer.

RESULTS

Mean flexural strength varied between 467.5 ± 97.5 MPa (top layer, IPS e.max ZirCAD Prime) and 898.0 ± 188.5 MPa (bottom layer, Cercon ht ML) with significant (p ≤ 0.055) differences between the individual layers. XRD indicated 5Y-TZP for enamel-layers, 3Y-TZP for dentine-layers, individual mixtures of 3Y-TZP, 4Y-TZP, or 5 Y-TZP for intermediate layers. SEM analysis showed grain sizes between approx. 0.15 and 4 µm. Grain size tended to decrease from top to bottom layers.

SIGNIFICANCE

The investigated blanks differ predominantly in the intermediate layers. In addition to dimensioning of restorations, the milling position in the blanks must also be taken into account when using multilayer zirconia as restorative material.

On the behaviour of zirconia-based dental materials: A review

Zirconia-based dental materials are extensively used in clinical practice due to their tooth-like appearance, biofunctionality, biocompatibility, and affordability. However, premature clinical failures of veneering porcelains raise a concern about their integrity. Extensive studies have been performed over a decade to resolve this issue, but it is challenging to reference all information effectively. A single source identifying the significance of potential parameters on material performance has not previously been available. An evidence-based meta-narrative review technique was used to review the characteristic parameters that can affect the overall behaviour of zirconia-based materials. Keywords were chosen to assess manuscripts based on scientific coherence with this paper's research objective. Online keyword searches were carried out on ScienceDirect, PubMed, and SAGE databases for relevant published manuscripts from year 1985-2020.261 out of 3170 identified manuscripts were included. A total of 10 parameters were identified and classified into the material, manufacturing, and geometric aspects. The effect of every parameter was reviewed on the performance of the material. A discrepancy in findings was observed and is attributed to the fact that there is no standard methodology. This review acts as a single source that summarizes various parameters' contribution to zirconia-based dental materials' performance. This review facilitates manufacturing improvements by accounting for every parameter's effect on overall performance.

[Reliability study in the measurement of the cusp inclination angle of a chairside digital model]

OBJECTIVE

This study aims to evaluate the reliability of the software Picpick in the measurement of the cusp inclination angle of a digital model.

METHODS

Twenty-one trimmed models were used as experimental objects. The chairside digital impression was then used for the acquisition of 3D digital models, and the software Picpick was employed for the measurement of the cusp inclination of these models. The measurements were repeated three times, and the results were compared with a gold standard, which was a manually measured experimental model cusp angle. The intraclass correlation coefficient (ICC) was calculated.

RESULTS

The paired t test value of the two measurement methods was 0.91. The ICCs between the two measurement methods and three repeated measurements were greater than 0.9. The digital model achieved a smaller coefficient of variation (9.9%).

CONCLUSIONS

The software Picpick is reliable in measuring the cusp inclination of a digital model.

Influence of Cusp Inclination and Type of Retention on Fracture Load of Implant-Supported Crowns

There are few informations about the influence of cusp inclination on the fracture strength of implant-supported crowns. The study aimed to evaluate the influence of cusp inclination and retention type on fracture load in implant-supported metal-ceramic single crowns. Sixty crowns were made, classified as cemented and screw-retained with screw access hole (SAH) sealed or not. Standard (33°) and reduced (20°) cusp inclinations were tested for each group (n=10). To support crowns of a mandibular second molar, analogs of external hexagon implants 5.0 were used. The fracture load was measured in a universal testing machine EMIC DL2000 (10 kN load cell; 0.5 mm/min). Two-way ANOVA (retention and cusp inclination) followed by post hoc Tukey's honest significant difference test was used for the statistical analyses (a=0.05). Crowns with reduced cusp inclination exhibited significantly higher fracture load (p<0.01) than crowns with standard cusp inclination. Cemented crowns showed significantly higher fracture load (p<0.01) than screw-retained crowns. The interaction among these factors was not significant (p>0.05) for the fracture load. The sealing of SAH did not influence the fracture load of screw-retained crowns (p>0.05). In conclusion, fracture load of implant-supported metal-ceramic crowns was influenced by retention and cusp inclination, and there was no influence of the sealing of SAH.

Effect of contact stress on the cycle-dependent wear behavior of ceramic restoration

AIM

Ceramic restoration experiences the non-linear wear process during the chewing simulation, which contains running-in, steady and severe wear stages. However since various levels of contact stress may be applied on the occlusal surface during chewing, the cycle-dependent wear behaviors of ceramic crowns may differ. The aim of this study was to investigate the effect of contact stress on the development of wear behavior, as tested in a chewing simulator.

MATERIALS AND METHODS

Thirty-six anatomical metal-ceramic crowns using Ceramco III as the veneering porcelain were randomly assigned to two groups based on the contact stress applied in the wear testing. Stainless steel balls served as antagonists. The specimens were dynamically loaded in a chewing simulator up to 2.4×10⁶ loading cycles, with additional thermal cycling between 5 and 55℃. For each group, several checkpoints were employed to measure the substance loss of the crowns' occlusal surfaces and to evaluate the microstructure of the worn areas.

RESULTS

After 2.4×10⁶ cycles, the ceramic restorations with lower contact stress demonstrated a long steady wear stage following the running-in, but without the severe wear stage. And a slowly microstructural degradation was observed that the subsurface defect could not be seen until final. With higher contact stress, however, the ceramic restorations experienced a faster transition from running-in to severe wear stage that the steady wear stage nearly disappeared. And an early formation of subsurface defects and the deterioration of microstructure were observed.

CONCLUSIONS

Contact stress is a key factor affecting the wear development of ceramic restoration. The higher contact stress promotes the veneering porcelain to evolve into severe wear stage. In contrast, lower contact stress is prone to keep the veneering porcelain operating in steady wear stage, which delays the arrival of severe wear region.