Fracture strength of direct versus indirect laminates with and without fiber application at the cementation interface

Load-bearing capacity of 3D-printed incisor partial-coverage crowns made from zirconia and composite

PURPOSE

This study investigated the fracture resistance of 0.5-mm-thick restorations for minimally invasive therapy. Anterior partial-coverage crowns composed of three-dimensional (3D)-printed 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP; Lithacon 3Y210, Lithoz) and 3D-printed composite (Varseo Smile Crown plus, Bego) were compared with a control group made from milled 3Y-TZP (Cercon ht, DentsplySirona).

METHODS

Three groups each with 27 restorations were produced. For milled 3Y-TZP partial-coverage crowns, drill compensation was needed so the milling bur could access the inner surface at the incisal edge. Restoration fit was verified by cross-sectioning 12 specimens in each group. The remaining 15 restorations were sandblasted (Al2O3, 0.1 MPa) and adhesively cemented (Panavia SA, Kuraray) onto CoCr teeth. Static load-to-failure tests were performed. The load was induced on the incisal edge. The forces needed to fracture the specimens were analyzed using the Welch analysis of variance and post hoc Dunnet-T3 tests. The Weibull parameters were also calculated.

RESULTS

Drill compensation increased cement thickness at the loading area by 200 µm in milled 3Y-TZP restorations compared with the 3D-printed partial-coverage crowns. Fracture resistance was the highest in 3D-printed 3Y-TZP restorations (1570±661N) followed by milled 3Y-TZP (886±164N) and 3D-printed composite partial-coverage crowns (570±233 N). Milled 3Y-TZP was associated with a substantially higher Weibull modulus (m=6) than the 3D-printed materials (m=2), suggesting greater reliability.

CONCLUSIONS

Fracture resistance increased with tighter fit, demonstrating the benefit of the geometric freedom associated with 3D-printing. Future research should focus on making 3D-printed 3Y-TZP more reliable to increase its safety in clinical use.

Stress Distribution, Tooth Remaining Strain, and Fracture Resistance of Endodontically Treated Molars Restored Without or With One or Two Fiberglass Posts And Direct Composite Resin

Objectives:

To evaluate the effects of direct composite resin without a post or with one or two fiberglass posts on the restoration of severely compromised endodontically treated molars.

Methods and Materials:

Forty-five molars with 2 mm of “remaining tooth structure” were divided into three groups: Wfgp, restored with Filtek Z350XT without a fiberglass post; 1fgp, restored with Z350XT with one fiberglass post in the distal root canal; and 2fgp, restored with Z350XT with two fiberglass posts, one in the distal root canal and the other in the mesial-buccal root canal. The teeth were load cycled. Tooth remaining strain was measured using strain gauges (n=10) at two moments: TrSt-100 N, during 100 N occlusal loading, and TrSt-Fr, at fracture load. Fracture resistance was calculated, and fracture mode was classified. The elastic modulus and Vickers hardness were calculated using dynamic indentation (n=5). Stress distribution was analyzed by three-dimensional finite element analysis.

Results:

The use of two fiberglass posts resulted in lower fracture resistance than was noted in the groups with one fiberglass post and without fiberglass posts. The lingual surface of the remaining tooth had higher strain values than the buccal surface, regardless of the restorative technique and moment of evaluation. The absence of a fiberglass post resulted in significantly higher strain values and more irreparable fracture modes than were noted in the other groups. The use of one fiberglass post had a better strain/fracture resistance ratio. Stresses were concentrated in the occlusal portion of the post and in the furcation region. The presence of one fiberglass post resulted in better stress distribution in the entire distal root dentin, reducing stress on the critical areas.

Conclusions:

The use of one fiberglass post for restoring molars with direct composite resin resulted in higher fracture resistance than did the use of two fiberglass posts; it also resulted in better tooth remaining strain and stress distribution and more reparable fracture modes than were seen in the group without a fiberglass post.

Comparing the shear bond strength of direct and indirect composite inlays in relation to different surface conditioning and curing techniques

Objective:

The aim of this study was to test the null hypothesis that different surface conditioning (etch and rinse and self-etch) and curing techniques (light cure/dual cure) had no effect on the shear bond strength of direct and indirect composite inlays.

Materials and Methods:

A total of 112 extracted human molar teeth were horizontally sectioned and randomly divided into two groups according to restoration technique (direct and indirect restorations). Each group was further subdivided into seven subgroups (n = 8) according to bonding agent (etch and rinse adhesives Scotchbond multi-purpose plus, All-Bond 3, Adper Single Bond and Prime Bond NT; and self-etch adhesives Clearfil Liner Bond, Futurabond DC and G bond). Indirect composites were cemented to dentin surfaces using dual-curing luting cement. Shear bond strength of specimens was tested using a Universal Testing Machine. Two samples from each subgroup were evaluated under Scanning electron microscopy to see the failing modes. Data was analyzed using independent sample t-tests and Tukey's tests.

Results:

Surface conditioning and curing of bonding agents were all found to have significant effects on shear bond strength (P < 0.05) of both direct and indirect composite inlays. With direct restoration, etch and rinse systems and dual-cured bonding agents yielded higher bond strengths than indirect restoration, self-etch systems and light-cured bonding agents.

Conclusions:

The results of the present study indicated that direct restoration to be a more reliable method than indirect restoration. Although etch and rinse bonding systems showed higher shear bond strength to dentin than self-etch systems, both systems can be safely used for the adhesion of direct as well as indirect restorations.

The effect of fiber post presence and restorative technique on the biomechanical behavior of endodontically treated maxillary incisors: an in vitro study

STATEMENT OF PROBLEM

Unresolved controversy exists concerning the best technique for restoring endodontically treated teeth. Prefabricated posts have been recommended with some debate as a method of restoring pulpless teeth before placement of the final restoration.

PURPOSE

The purpose of this in vitro study was to evaluate the effect on the strain, fracture resistance, and fracture mode of endodontically treated human incisors of 4 types of restorations with or without glass fiber posts after thermal cycling.

MATERIAL AND METHODS

Ninety human maxillary central incisors were selected and divided into 1 control group and 8 treatment groups (n=10). The teeth were endodontically treated and received 2 large Class III preparations simulating coronal destruction. The teeth were then restored with or without glass fiber posts and by using 4 restorative techniques: direct composite resin, direct composite veneer, feldspathic ceramic veneer, or a feldspathic ceramic crown. After artificial aging by thermal cycling, the incisors were loaded at a 135-degree angle, and the strain was measured by using strain gauges placed on the facial and proximal root surfaces. Specimens were subsequently loaded to the point of fracture. Strain and fracture resistance results were analyzed by a 1-way and 2-way ANOVA, followed by the Tukey HSD and Dunnett tests (α=.05).

RESULTS

One-way analyses showed that the control group and the direct composite resin restoration with and without post groups presented significantly higher fracture resistance values (P<.001). Two-way analyses showed no significant differences for the post system. Proximal strain values were higher in the control and composite resin groups and lower in the feldspathic ceramic groups.

CONCLUSIONS

The presence of glass fiber posts did not increase the fracture resistance of endodontically treated incisors. Conservative composite resin restorations showed higher fracture resistance values.

Detection of artificial demineralization bordering different types of laminate veneers using visual inspection and storage phosphor radiography

OBJECTIVE

The objective of this study is to compare the diagnostic accuracy of visual inspection (VI) and storage phosphor plate (SPP) radiography for the detection of artificial demineralization bordering different laminate veneers.

MATERIALS AND METHODS

Twenty human maxillary canine teeth were prepared. All-ceramic (A) and hybrid ceramic (H) laminate veneers were fabricated and luted. Veneered teeth were covered except for a circular window on the proximal surface bordering restorations. Teeth were kept in acetic acid buffer to create demineralization and imaged with a SPP system. Ten observers evaluated all teeth first visually then with SPP images for the presence/absence of demineralization. Teeth were examined using scanning electron microscopy (SEM) as well. The accuracy was expressed as the area under the ROC curves (A(z)). Pair-wise comparisons were performed using two-way ANOVA and post hoc t test (p = 0.05). Fleiss kappa (κ) was used for agreement.

RESULTS

SPP radiography was better than the VI for both veneers (p = 0.004). The A(z)s of two veneers were different for both VI (p < 0.005) and SPP (p < 0.005). SEM evaluation revealed lesions confined to enamel. κ was fair for H, and fair to moderate for A. Agreement was higher for the radiographic evaluation for both veneers.

CONCLUSION

Enamel demineralizations bordering hybrid and ceramic laminate veneers can be detected better with SPP radiography than VI and detectability was better for all-ceramic veneers than the hybrid ceramic ones.

CLINICAL RELEVANCE

Early detection of enamel demineralizations bordering laminate veneers would result in time-saving and less-invasive treatment methods; therefore, SPP radiography may be recommended in clinically suspicious cases since it provides better diagnostic accuracy.

Effect of fiber-reinforced composites on the failure load and failure mode of composite veneers

This study compared the initial and final failure loads and failure modes of indirect resin composite laminate veneers with and without fiber reinforcement. Forty intact lower canines received standard laminate preparations and were randomly assigned into four test groups (n=10). In Group 1, indirect resin composite veneers were repaired with two layers of preimpregnated bidirectional glass fiber weave and a restorative composite; in Group 2, with a layer of preimpregnated unidirectional glass fibers and a restorative composite; and in Group 3, with an experimental semi-IPN matrix composed of multidirectional short glass fibers. Indirect resin composite veneers without any fiber reinforcement were used as control (Group 4). All specimens were thermocycled and tested with a universal testing machine. On the final failure load, there were no statistically significant differences (p>0.05) among the test groups. Within each group, pairwise comparison of initial and final failure loads revealed statistically significant differences (p<0.05), except for Group 4 (p>0.05). On failure mode, unreinforced specimens showed instantaneous failure, whereas reinforced specimens mostly demonstrated elongated failure.

Effect of Ultrasonic Versus Manual Cementation on the Fracture Strength of Resin Composite Laminates

Indirect composite laminates, when cemented ultrasonically, resulted in repairable failures as opposed to indirect composite laminates cemented under hand pressure.

Esthetic rehabilitation of crowded maxillary anterior teeth utilizing ceramic veneers: a case report

Introduction

In attempting to provide a solution for cases that have been compromised by malpositioned anterior teeth, clinicians traditionally decide orthodontic approach. Nevertheless, in some cases changes in tooth morphology, tooth size, and shape is compulsory for optimal aesthetics. The advent in contemporary aesthetic materials and preparation techniques empowered the clinicians to deliver a promising result with minimal biologic cost. This article presents the clinical considerations that must be addressed when providing a prosthetic restoration for crowded teeth.

Case presentation

A 23 years old Turkish female patient who had malaligned anterior teeth was rehabilitated with ceramic veneers due to her rejection of orthodontic treatment. The paper describes ceramic veneers can be an alternative treatment to orthodontic therapy under variety of preparation forms when patient has anterior malalignment and rejects the orthodontic treatment.

Conclusion

The new smile line was satisfactory for the patient and the esthetics was considered as excellent.

Numerical investigation of macro- and micro-mechanics of a ceramic veneer bonded with various cement thicknesses using the typical and submodeling finite element approaches

OBJECTIVES

This study investigates the influence of cement thickness on the macro- and micro-mechanical responses in a ceramic veneer adjacent to an incisal overlapped incisor.

METHODS

Seven finite element (FE) ceramic veneer macro-models with different cement thicknesses (10-180mum) were generated. A 10N load was applied with an angulation of 60 degrees to the longitudinal tooth axis. Seven FE micro-models corresponding to the macro-models were constructed at an enamel-adhesive interface where the stress concentration was found. Based on an interfacial scanning electron microscope (SEM) micrograph, morphology of resin tags in the micro-models was generated. The micro-model boundary conditions were determined from the macro-model results. The principal stress on each node in the macro- and micro-models was calculated to investigate interfacial mechanics. A tensile test was performed to obtain an ultimate cement tensile strength to determine the material failure parameters.

RESULTS

The highest stress concentration within the cement was found at the resin tag base of the enamel-adhesive interface in lingual side. Maximum stress values from 10.6 to 14.7MPa for the micro-models were higher (44-48%) than that from 7.2 to 10.0MPa for the macro-models when the cement layers increased. Based on the ultimate tensile strength (11.8MPa), bonding failure could found when the micro-models with the cement layers presented more than about 50mum. This seems to correspond with data from previous studies.

CONCLUSIONS

Higher stresses develop in the adhesive as the cement thickness increases. Cement thicknesses less than 50mum might reduce the adhesive bonding failure.

Effect of intermediate fiber layer on the fracture load and failure mode of maxillary incisors restored with laminate veneers

This study evaluated the fracture load and failure mode of various veneer materials cemented with or without the addition of a fiber-reinforced composite (FRC) layer at the adhesive interface. Sixty intact incisors were randomly divided into three groups. Group 1 was fabricated with the heat-press technique (IPS Empress 2); Group 2 with the copy milling technique (ZirkonZahn); and Group 3 with the direct or indirect composite technique (Z250)--and specimens were cemented either with or without FRC at the adhesive interface. The specimens were thermocycled and tested with a universal testing machine. No significant differences in fracture load (p>0.05) were found among the various veneer materials. The addition of FRC at the adhesive layer did not lead to significant differences in the fracture load (p>0.05) but resulted in differences in the failure mode. Laminate veneers made of composite, zirconia, and Empress 2 showed comparable mean fracture loads. However, the use of FRC at the interface changed their failure modes.