Structural stability of posterior retainer design for resin-bonded prostheses: a 3D finite element study

Posterior two-unit cantilevered zirconia resin-bonded fixed partial dentures: A 3-year prospective single-arm clinical trial

OBJECTIVES

To evaluate the longevity of cantilevered zirconia-based resin-bonded fixed partial dentures (RBFPDs) in replacing missing posterior teeth, as well as the quality of life and patient satisfaction experienced by those receiving zirconia RBFPDs.

METHODS

A prospective single-arm uncontrolled clinical trial was conducted to replace one or more missing premolars or molars with a span of 5 to 8 mm using cantilevered zirconia RBFPDs. Thirty-six participants with 40 prostheses were recruited and underwent a 3-year clinical evaluation. The retainer designs included a minimum thickness of 0.8 mm, a minimum of 200° circumferential wraparound with an occlusal bar, and a connector dimension of 3 × 3 mm. Patient-reported outcomes, including patient satisfaction and Oral Health Impact Profile (OHIP), were assessed.

RESULTS

The average age of participants was 45.8 years, and 72.5 % were women. The success rate of the posterior zirconia RBFPDs was 76.2 %, with an estimated mean success duration of 46.1 months. The survival rate was 88.1 %, with an estimated mean survival duration of 49.4 months. Participants were highly satisfied with the treatment, achieving an average satisfaction score of 80.8 ± 11.9. Participants' total OHIP scores decreased from 52.3 to 39.6 after 3 years, indicating a significant improvement in oral health-related quality of life (P = 0.009).

CONCLUSIONS

After 3 years, a moderately high survival rate and favourable patient-reported outcomes of posterior cantilevered zirconia RBFPDs were achieved. Therefore, it can be recommended as a conservative treatment option to replace missing posterior teeth, provided that retainer design considerations are taken into account.

CLINICAL SIGNIFICANCE

Cantilevered zirconia RBFPDs for posterior teeth can serve as a conservative treatment option that is both aesthetically pleasing and biocompatible. It offers a more cost-effective alternative compared to dental implants, which are often prohibitively expensive for the majority of patients. This approach has the potential to greatly improve patient-reported outcomes.

Marginal fit and retention force of zirconia resin-bonded fixed dental prostheses in the posterior region with different designs

Background/purpose

Retainer debonding of resin-bonded fixed dental prostheses (RBFDPs) is one of the major reasons for their lower survival rates than fixed dental prostheses (FDPs) with full-coverage crowns. Recent advances in milling technology have enabled the fabrication of RBFDPs with complex retainers (D-shaped designs). This study aimed to assess the marginal fit and retention force of zirconia RBFDPs with inlay-, L-, and D-shaped designs to clarify their clinical applications.

Materials and methods

Three abutment teeth models without maxillary second premolars were created using inlay-, L-, and D-shaped retainer designs. The zirconia RBFDPs were designed and fabricated according to the manufacturer's instructions (n = 10). The marginal gap was measured using the silicone replica technique. Zirconia frameworks were bonded to the abutment teeth using resin cement. Tensile test was conducted after thermal cycling and dynamic loading tests. The loads during debonding or fracture were recorded. The failure pattern was analyzed by observing the fracture surface using a scanning electron microscope.

Results

D-shaped RBFDPs showed a significantly larger marginal gap than inlay- and L-shaped RBFDPs (P < 0.05). However, the mean marginal values were clinically acceptable (<120 μm). The D-shaped model exhibited the highest tensile strength in the tensile tests. The inlay-shaped and most of the D-shaped RBFDPs experienced debonding with cohesive failure, whereas the L-shaped RBFDPs showed fractures near the connector.

Conclusion

The D-shaped retainer design was superior to the inlay- and L-shaped designs with respect to the inhibition of retainer debonding. However, the marginal fitness needs to be improved.

Influence of retainer design and number of inlay boxes on the biomechanical behavior of zirconia cantilever resin bonded fixed dental prosthesis

OBJECTIVES

The development of dental adhesives with enhanced bond strength has assisted minimally invasive dentistry. The aim of this study was to evaluate the fracture load and stress distribution pattern of two retainer designs for posterior cantilever resin bonded fixed dental protheses (RBFDPs).

MATERIALS AND METHODS

Forty human mandibular molars were divided into two groups according to the retainer design; lingual coverage (LC) and occlusal coverage (OC) retainers. Each main group was then divided according to the number of inlay boxes (n = 10); one inlay and two inlay boxes. High translucency (3Y) zirconia was used to manufacture all restorations, and a dual-polymerizing adhesive resin cement was used for bonding. All specimens underwent 10,000 cycles of thermocycling (5-55°C), 240,000 cycles of dynamic loading (50 N, descending speed v = 30 mm/second, frequency = 1.6 Hz), and failure load test. Both one-way and two-way ANOVA tests were used to analyze the data. The four models included in the in-vitro study are part of the finite element analysis (FEA). When the restorations failed, maximal principal stress values on restorations, enamel, dentin, and luting resin were investigated.

RESULTS

A statistically significant (p = 0.018) higher failure load was recorded for OC1 (627.00 ± 153.4 N) than the other groups; (548.0 ± 75.6 N, 521.20 ± 11.3 N, and 509.20 ± 14.9 N for LC1, LC2, and OC2, respectively). With regard to failure mode, one inlay box designs showed more favorable failure pattern than those of two inlay boxes. FEA showed higher stress magnitude transmitted to the tooth structure in models LC2 and OC2.

CONCLUSIONS

Lingual coverage and occlusal coverage retainers are promising designs capable to withstand the normal occlusal force for cantilever RBFDP in premolar area. The use of two inlay boxes decreased the fracture load of the two retainer designs and increased the stress transmitted to the tooth and resulted in high incidence of catastrophic failure.

CLINICAL SIGNIFICANCE

Monolithic high translucent zirconia RBFDP could be considered as a viable treatment option to substitute missing posterior tooth, with improved esthetics and biocompatibility.

Cantilever resin-bonded fixed dental prosthesis to substitute a single premolar: Impact of retainer design and ceramic material after dynamic loading

PURPOSE

To evaluate the influence of retainer design and ceramic materials on the durability of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging.

METHODS

One hundred caries-free human mandibular molars were prepared as abutments for all-ceramic cantilevered fixed dental prostheses using the following retainer designs: One wing (OW), Two wings (TW), Inlay ring (IR), Lingual coverage (LC), and Occlusal coverage (OC). Two ceramic materials were used: monolithic high translucent zirconia(z) and zirconia-reinforced lithium disilicate (ZLS2) (n=10). All restorations were adhesively bonded with resin cement. The thermocycling of the specimens were performed between 5°C and 55°C for 10,000 cycles and then exposed to 240.000 cycles of dynamic loading on a chewing simulator. All surviving specimens were loaded onto the pontic until failure using a universal testing machine.

RESULTS

The mean failure load ranged from 124.00 to 627.00 N for the zirconia groups and from 133.30 to 230.00 N for the ZLS2 groups. Regarding the materials, a significantly higher failure load was recorded in the zirconia groups than in the ZLS2 groups (P<0.001), except for OW (P=0.748). Regarding the retainer designs, a significant different failure load was recorded between the different designs except for IR and LC in the zirconia groups, IR and OC, OW and TW, and TW and LC in the ZLS2 groups (P<0.001).

CONCLUSIONS

Zirconia IR, LC, and OC can be used as cantilever RBFDP in the premolar region. The fracture resistance of the ZLS2 design was below the normal bite force and should not be recommended as the first option.

Biomechanical behavior of posterior metal-free cantilever fixed dental prostheses: effect of material and retainer design

OBJECTIVE

To study the fracture resistance and stress distribution pattern of translucent zirconia and fiber-reinforced composite cantilever resin-bonded fixed dental prostheses (RPFDPs) with two retainer designs.

MATERIALS AND METHODS

Forty human mandibular molars were divided into two groups according to the retainer design. The restorations included a premolar pontic and 2 retainer designs: (D1) inlay ring retainer and (D2) lingual coverage retainer. Each main group was then divided according to the material used (n = 10): zirconia (Z) or fiber-reinforced composite (FRC) (F). Restorations were cemented using dual polymerizing adhesive luting resin. All specimens were thermo-cycled (5-55 °C for 10,000 cycles), then subjected to dynamic loading (50 N, 240,000, and 1.6 Hz) and fracture resistance test. The finite element analysis includes the two models of retainer designs used in the in vitro test. Modified von Mises stress values on enamel, dentin, luting resin, and restorations were examined when the restorations failed.

RESULTS

A significantly higher failure load was recorded for zirconia groups (505.00 ± 61.50 and 548.00 ± 75.63 N for D1Z and D2Z, respectively) than for FRC groups (345.00 ± 42.33 and 375.10 ± 53.62 N for D1F and D2F, respectively) (P = 0.001). With regard to failure mode, D2 showed a more favorable failure pattern than D1. Model D2 resulted in lower stresses in tooth structure than model D1, and zirconia transmitted more stresses to the tooth structure than FRC.

CONCLUSIONS

The lingual coverage retainer (D2) enhanced the biomechanical performance of the restoration/tooth complex. Considering the failure mode and tooth stress, FRC is a promising treatment option when constructing a cantilever RPFDP.

CLINICAL RELEVANCE

Dentists should be aware of the biomechanical behavior during the selection of the material and for the replacement of a single missing mandibular premolar tooth with minimally invasive RBFDP.

Effect of different designs of minimally invasive cantilever resin-bonded fixed dental prostheses replacing mandibular premolar: Long-term fracture load and 3D finite element analysis

PURPOSE

To evaluate the fracture load and stress magnitude of different retainer designs of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging.

MATERIALS AND METHODS

Fifty caries-free human mandibular molars were prepared as abutments for cantilever fixed dental prostheses using different retainer designs: one wing (OW), two wings (TW), inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC). Computer-aided design and computer-aided manufacturing were used for milling the RBFDPs using fiber-reinforced composite (FRC), and the restorations were adhesively bonded. The specimens were then subjected to thermomechanical aging and loaded until failure. The 3D finite element analysis (FEA) was performed with five models of retainer designs similar to the in vitro test. Modified von Mises stress values on enamel, dentine, luting resin, and restorations were examined. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (p < 0.001).

RESULTS

A statistically significant difference (p < 0.001) was found between all groups except between IR and LC and between OW and TW designs, with the highest mean failure load detected for OC (534.70 N) and the lowest detected for OW (129.80 N). With regard to failure mode, OW, TW, and LC showed more incidences of favorable failure patterns than IR and OC designs. FEA showed that FRC transmitted low stresses in tooth structure and high stresses to the luting resin.

CONCLUSIONS

LC and OC designs can be used to design cantilever RBFDPs in premolar area. IR design transmitted more stresses to the tooth structure and resulted in 30% catastrophic failure. OW and TW were below the normal occlusal force and should be carefully used.

Effect of different restorative crown design and materials on stress distribution in endodontically treated molars: a finite element analysis study

Background

The purposes of this simulation study were to evaluate the stresses in the roots of endodontically treated molars with extensive coronal tissue loss which were restored by endocrowns (all-in-one core and crown) and traditional crowns with post-cores, during masticatory simulation using finite element analysis.

Methods

A mesio-distal cross-section of a lower right first molar was digitized and used to create 2-dimensional models of the teeth and supporting tissue; different crown designs, viz., endocrown with 2 mm occlusal clearance, endocrown with 4 mm occlusal clearance and post-core crown; different crown materials, viz., zirconia (Zr) and lithia-disilicate reinforced glass ceramic (LDRGC), and different post and core materials, viz., glass fiber (GF), stainless steel (SS) and metal cast (MC). An axial load of 600 N was applied to the central fossa of occlusal surface.

Results

The stress distributions were similar between Zr and LDRGC for periodontal ligament and alveolar bone. The root canal inner wall maximum principal stresses of SS post (70.8 MPa) and MC post (71.4 MPa) were higher than that of GF post (36.0 MPa) and endocrown (2.4 MPa).

Conclusion

The endocrowns reduced stress concentration for the root canal inner wall in comparison with the conventional post-core crown. Molars restored with endocrowns are less prone to root fracture than those with posts.

Fracture force for veneered materials on restorations measured by torsion testing

The torsional fracture strength at the interface between a base plate and veneering material was evaluated for three kinds of veneered restoration: porcelain fused to zirconia (PFZ), porcelain fused to metal (PFM), and composite resin veneered metal (CRVM). The metal and zirconia base plate (30×4×0.4 mm) were prepared and these plates were veneered as test specimens using each material to a total thickness of 1.2 mm. Torsional force was applied to each specimen using a rotational speed of 1.0 deg/min until the veneering material underwent fracture or exfoliation. The torsional fracture values were measured and the data were statistically analyzed using one-way ANOVA. The torsional fracture strength for PFZ, PFM, and CRVM was 3.0, 3.1, and 11.1 N•cm, respectively.

Effect of different surface treatments and retainer designs on the retention of posterior Pd-Ag porcelain-fused-to-metal resin-bonded fixed partial dentures

The aim of this study was to investigate the adhesive property of palladium-silver alloy (Pd-Ag) and the simulated clinical performance of Pd-Ag porcelain-fused-to-metal (PFM), resin-bonded, fixed partial dentures (RBFPDs). A total of 40 Pd-Ag discs (diameter=5 mm) were prepared and divided into the following four groups (n=10): a) No sandblasting, used as a control; and b, 50 µm; c, 110 µm; and d, 250 µm aluminum oxide (Al₂O₃) particles, respectively. Another 50 discs were pre-sandblasted and divided into five groups (n=10) subjected to different treatments: e) Sandblasting, used as a control; f) silane; g) alloy primer; h) silica coating + silane and i) silica coating + alloy primer. All 90 discs were bonded to enamel with Panavia F 2.0 and then subjected to shear bond strength (SBS) testing. The fracture surfaces were examined by scanning electron microscopy. Next, 40 missing maxillary second premolar models were restored with one of the four following RBFPD designs (n=10): I) A premolar occlusal bar combined with molar double rests (MDR); II) both occlusal bars with a wing (OBB); III) a premolar occlusal bar combined with a molar dental band (MDB); and IV) two single rests adjacent to the edentulous space with a wing (SRB) used as a control. All specimens were aged with thermal cycling and mechanical loading. Subsequently, they were loaded until broken. The data were analyzed by one-way analysis of variance. Al₂O₃ (250 µm) abrasion provided the highest SBS (P<0.05). The alloy primer and silica + silane exhibited increased SBS. Furthermore, fracture analysis revealed that the failure mode varied among the different treatments. Whereas MDB exhibited the highest retention (P<0.05), that of OBB was greater than that of MDR (P<0.05), and the control exhibited the lowest retention. Abrasion with Al₂O₃ (250 µm) effectively increased the adhesive property of Pd-Ag. Additionally, treatment with the alloy primer and silica coating + silane was able to increase the adhesive property of abraded Pd-Ag. Under the present conditions, all three modified retainer types provided improved outcomes for Pd-Ag PFM RBFPDs compared with the control.