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Bahadır HS, Bulut AC, Yılmaz B. Effect of preparation design on the fracture resistance and fracture patterns of 3D printed one-piece endodontic crowns. J Prosthet Dent 2024:S0022-3913(24)00423-2. [PMID: 38960755 DOI: 10.1016/j.prosdent.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
STATEMENT OF PROBLEM The impact of various preparation designs on the fracture resistance and fracture type of mandibular premolars restored with 3 dimensionally (3D) printed, 1-piece endodontic crowns remains unclear. PURPOSE The purpose of this study was to investigate the effect of different preparation designs on the fracture resistance and fracture patterns of mandibular premolars restored with 3D printed 1-piece endodontic crowns after thermal aging. MATERIAL AND METHODS Forty-five freshly extracted mandibular premolars received 3 different preparation designs: with at least 2 intact cuspal walls (2CW), with only 1 intact cuspal wall (1CW), and no cuspal wall present (NoCW). One-piece endodontic crowns were designed by using a computer-aided design (CAD) software program, 3D printed, cemented to the prepared teeth with self-adhesive resin cement, and thermocycled between 5 °C and 55 °C in artificial saliva. Subsequently, all specimens were subjected to a fracture test. The results were statistically analyzed using 1-way ANOVA (α=.05), and fracture types of all specimens were examined using a light microscope. RESULTS The analysis of fracture resistance values across separate designs revealed no statistically significant differences (P>.05). Mean fracture resistance values were 724.5 N in 2CW, 713 N in 1CW, and 861 N in NoCW. In 2CW and 1CW, the 1-piece endodontic crowns mostly displayed Type III fractures, whereas those in NoCW exhibited a combination of Type II and Type III fractures. CONCLUSIONS The mandibular premolar 1-piece endodontic crowns tested in this study exhibited similar fracture resistance and type of fracture with different preparation designs.
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Affiliation(s)
- Hasibe Sevilay Bahadır
- Assistant Professor, Department of Restorative Dentistry, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ali Can Bulut
- Associate Professor, Department of Prosthodontic Dentistry, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Burak Yılmaz
- Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; and Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
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M. S. Alqahtani W, A. Yousief S, Tammam R, M. Galal R, Brakat A, Mohamed El Sayed H, Kamal A, Noushad M, Nassani MZ. Biomechanics of Central Incisor Endocrowns with Different Lengths and Milled Materials after Static and Vertical Loading: A Finite Element Study. Int J Dent 2024; 2024:4670728. [PMID: 38585251 PMCID: PMC10999285 DOI: 10.1155/2024/4670728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose The aim of this study was to compare and assess the stress distribution and failure possibility of endodontically treated central incisor protected with endocrowns with different heights, with various CAD-CAM blocks such as IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia. Materials and Methods A root canal-treated central incisor (plastic model) restored with an endocrown was scanned with a laser scanner to prepare a control model with a CAD software and then transferred to an FEA software. Proposed crown heights were 2, 4, and 6 mm. The model that was duplicated and restored with CAD-CAM blocks, IPS e.max CAD, Katana Zirconia, and Zolid Fx Zirconia were tested as endocrown materials. Bone geometry was simplified to be two coaxial cylinders in all models. Stress distributions under 50 N axial and oblique (with 135° angle from the vertical plane) loading were analyzed. Each model was then subjected to two occlusal loading conditions-the lingual slope of the incisal edge and the junction between incisal and middle thirds. Eighteen runs and calculations were performed to determine the endocrown height and material effect. Results The results showed a minor or negligible effect of changing the endocrown material. Increasing endocrown height was shown to reduce stresses and deformations on most of the model components (bone, gutta-percha, periodontal ligament, and endocrown), except root and cement. Differences in deformations and stresses between the two models of 4 and 6 mm were relatively smaller (ranged between 1% and 30%) compared to those between the 2 and 4 mm models (ranged between 10% and 400%). Conclusions The material used to fabricate endocrowns did not show considerable effect on the underlying structures. However, the endocrown design (2, 4, and 6 mm height) was shown to affect all components of the studied systems. Increasing endocrown height is recommended for bone, periodontal ligaments, and endocrown body, as it reduces stresses and deformations. On the other hand, it dramatically increases stresses on the root and cement layer. Smaller endocrown sizes represent an acceptable treatment option when there is a healthy periodontal state, while using larger sizes will be more suitable when there is a periodontal compromise with bone loss.
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Affiliation(s)
- Waleed M. S. Alqahtani
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Salah A. Yousief
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia
- Department of Crown and Bridge, Faculty of Oral and Dental Medicine, Al Azhar University, Assuit Branch, Cairo 71524, Egypt
| | - Raafat Tammam
- Department of Prosthodontics, Faculty of Dentistry, Assiut University, Assiut 71515, Egypt
| | - Rami M. Galal
- Department of Fixed and Removable Prosthodontics, National Research Centre, Cairo, Egypt
| | - Ali Brakat
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia
| | - Hend Mohamed El Sayed
- Restorative Dentistry Conservative Dentistry Department, Faculty of Dentistry, Cairo University, 11 EL-Saraya Street Manial, Cairo 11553, Egypt
| | - Ala'a Kamal
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia
| | - Mohammed Noushad
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia
| | - Mohammad Zakaria Nassani
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh 13313, Saudi Arabia
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Agrawal P, Rathod A, Jaiswal P, Masurkar D, Chandak M, Patel A, Bhopatkar J. Metal Marvels: Revolutionizing Endodontic Restoration With a Novel Endocrown Approach. Cureus 2024; 16:e55319. [PMID: 38562352 PMCID: PMC10982129 DOI: 10.7759/cureus.55319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
This case report explores the innovative application of the endocrown technique for restoring a severely damaged mandibular molar (tooth #46) in a 28-year-old male patient. With a recent root canal treatment history, the patient presented with a dislodged prosthesis. Due to financial constraints, a base metal alloy was chosen for the endocrown restoration. The unique preparation process involved reducing the occlusal surface by 2 mm, creating a shoulder cervical margin, and preserving enamel walls. The endocrown, crafted from a base metal alloy, demonstrated a semi-conservative approach, providing cost-effectiveness and minimal tooth preparation. The case adheres to the 2013 CAse REport (CARE) guidelines. The discussion highlights the biomechanical benefits of the endocrown, emphasizing stress resistance, stability, and superior performance compared to traditional treatments. Materials like ceramic, resin nanoceramic, and polyetheretherketone are briefly discussed, focusing on the promising success rates of endocrowns, mainly through computer-aided designing/computer-aided manufacturing systems. The report provides valuable insights for clinicians considering this endocrown technique in reconstructing severely damaged molars and premolars.
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Affiliation(s)
- Paridhi Agrawal
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aishwarya Rathod
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Priyanka Jaiswal
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepika Masurkar
- Department of Periodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manoj Chandak
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditya Patel
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jay Bhopatkar
- Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Stoilov M, Boehmer T, Stoilov L, Stark H, Marder M, Enkling N, Kraus D. Influence of Cementation Mode and Ferrule Design on the Fatigue Resistance of Monolithic Zirconia Endocrowns. J Clin Med 2024; 13:1165. [PMID: 38398475 PMCID: PMC10889707 DOI: 10.3390/jcm13041165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Classic endocrowns made of dental ceramics are considered a promising alternative to traditional post-endodontic restorations. The use of circular ferrules in endocrowns is a topic of controversial discussion. Therefore, the present study aims to evaluate the effect of ferrule design and cementation mode on the fatigue resistance of zirconia endocrowns. Methods: Eighty human molars were divided into four groups (n = 20): NFC (no-ferrule, conventional cementation), NFA (no-ferrule, adhesive luting), FC (ferrule, conventional cementation) and FA (ferrule, adhesive luting). Both the classic and the modified endocrown preparation with a two-millimeter ferrule design were carried out. Endocrowns were fabricated from zirconia using the CEREC system. After thermocycling, specimens were loaded according to the step-stress test up to 1500 N. Results: Failure rate was low; 88.8% of total specimens passed the step-stress test. Fractures were distributed between all groups; no significant differences in fatigue resistance were detected for preparation design and cementation mode. Conclusions: Endocrowns appear to be a promising concept for endodontically treated molars. Ferrule and also cementation mode have only a minor influence on fatigue resistance of zirconia endocrowns. However, at very high forces, the marginal area of the ferrule represents a weak point.
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Affiliation(s)
- Milan Stoilov
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
| | - Tobias Boehmer
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
| | - Lea Stoilov
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
| | - Michael Marder
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
| | - Norbert Enkling
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
- Department of Reconstructive Dentistry and Gerodontology, Bern University, 3012 Bern, Switzerland
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (T.B.); (L.S.); (H.S.); (M.M.); (N.E.); (D.K.)
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Lenz U, Bacchi A, Della Bona A. Biomechanical performance of endocrown and core-crown restorations: A systematic review. J ESTHET RESTOR DENT 2024; 36:303-323. [PMID: 37571973 DOI: 10.1111/jerd.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To assess and compare, through a systematic review of the literature, the biomechanical performance of endocrowns and traditional core-crowns (with and without intracanal post) for the rehabilitation of endodontically treated teeth with severe coronal structure damage. MATERIALS AND METHODS A systematic search was performed in MEDLINE/PubMed, Scopus, and Web of Science databases. In-vitro studies comparing endocrowns with (post-)core-crown restorations were selected and screened by two independent reviewers. The included studies were submitted to the risk of bias analysis using the RoBDEMAT tool and the biomechanical outcomes were collected for qualitative analysis. The extracted data were presented based on comparative analyses among the included studies. RESULTS Thirty-one studies were included: 9 studies evaluated restorations of molars, 14 for premolars, and 8 studies evaluated anterior restorations. For the majority of the studies, endocrowns showed either similar or greater survival rates under fatigue and monotonic load than (post-)core-crown restorations, irrespectively of the tooth. The endocrowns showed more favorable failure patterns than (post-)core-crowns, irrespectively of the tooth. Endocrowns produced lower stresses in the restorative material for molars and premolars and in the luting material for premolars than (post-)core-crown restorations. The included studies presented adequate information for most items of the RoBDEMAT risk of bias tool. CONCLUSION Endocrowns showed similar or greater biomechanical performance than the traditional (post-)core-crown restorations in most of the evaluated studies. CLINICAL SIGNIFICANCE This systematic review showed that endocrowns present either similar or greater biomechanical performance than core-crown restorations for anterior and posterior endodontically treated teeth with severe structural damage.
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Affiliation(s)
- Ulysses Lenz
- Postgraduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Brazil
| | - Atais Bacchi
- Postgraduate Program in Dentistry, Paulo Picanço School of Dentistry, Fortaleza, Brazil
| | - Alvaro Della Bona
- Postgraduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Brazil
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Jalalian E, Zarbakhsh A, Khorshidi S, Golalipour S, Mohammadnasl S, Sayyari M. Comparative analysis of endocrown fracture resistance and marginal adaptation: CAD/CAM technology using lithium disilicate vs. zirconia-reinforced lithium silicate ceramics. Saudi Dent J 2024; 36:353-358. [PMID: 38420004 PMCID: PMC10897595 DOI: 10.1016/j.sdentj.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024] Open
Abstract
Aims The present study aimed to compare the fracture resistance and marginal adaptation of endocrowns fabricated using lithium disilicate (LDS) and zirconia-reinforced lithium silicate 9ZLS) ceramics by the computer-aided design and computer-aided manufacturing (CAD/CAM) technology. Materials and Methods In this in vitro experimental study, 24 extracted mandibular first molars received standard endocrown preparation and were randomly assigned to two groups (n = 12) for the fabrication of endocrowns with ZLS (Suprinity) and LDS (IPS e.max CAD) ceramics. After scanning the teeth with a CAD scanner, endocrowns were designed by inLab Software version 15 (inLab SW 15) and prepared by an imes-icore 350i milling machine. The vertical marginal gap of endocrowns was measured under a stereomicroscope at three steps before and after cementation and after thermomechanical cycles. The fracture resistance of specimens was then measured by load application at a 45° angle. Mode of failure was also determined as reparable or irreparable. Data were analyzed using Pearson's correlation test and t-test. Results The mean fracture resistance of ZLS endocrowns was significantly higher than that of LDS endocrowns (P = 0.000). The reparability of ZLS endocrowns was zero, while that of LDS endocrowns was 83.33 %. The vertical marginal gap was significantly smaller in ZLS than in LDS endocrowns at all three time points (P < 0.05). Also, the marginal gap increased by cementation and thermomechanical cycles in both groups. Conclusion ZLS and LDS endocrowns both showed acceptable vertical marginal adaptation. ZLS had superior marginal adaptation and higher fracture resistance.
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Affiliation(s)
- Ezatollah Jalalian
- Prosthodontic Dept, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Arash Zarbakhsh
- Department of Fixed Prosthodontics, Dental Branch, Azad University, Tehran, Iran
| | - Sotude Khorshidi
- Department of Prosthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
| | | | - Sara Mohammadnasl
- Graduated from Dental Branch oF Iran Azad University of Tehran, Tehran, Iran
| | - Maryam Sayyari
- Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Abduljabar AH, Iskander AW, Elfezary MT, Wakwak MAA, Bathabt WA, Souror YR. Endocrown Feasibility for Primary Molars: A Finite Element Study. Eur J Dent 2024; 18:208-213. [PMID: 37130553 PMCID: PMC10959615 DOI: 10.1055/s-0043-1764421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE To study the possibility of using pediatric endocrowns to restore the second primary molar using three-dimensional (3D) finite element analysis. DESIGN A 3D finite element model was built for a pediatric mandibular molar, starting with laser scanning a naturally extracted tooth. The access cavity had an elliptic shape with 6 mm width, 4 mm height, and 2 mm depth with a wall taper angle of 5 degrees.Two materials (Zr and E-max) were tested for the endocrown and two cementing materials (glass ionomer and resin cement) with 20 to 40 μm thickness. Twelve case studies were reported within this research as the applied load of 330 N was tested with three angulations vertical, oblique at 45 degrees, and laterally. RESULTS Twelve linear static stress analyses were performed. The resultant stresses and deformations' distribution patterns did not alter much, and values were within the threshold of physiological tolerance. Deformations were negligibly changed with changing endocrown and cement materials. In contrast, endocrown stresses indicated zirconia endocrown would have a long lifetime, while E-max one will have a relatively short lifetime. CONCLUSIONS Analysis results indicated that bone was negligibly affected by changing endocrowns and cementing materials. Both tested endocrown materials can be used safely. Zirconia endocrowns may have a much longer lifetime than E-max.
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Affiliation(s)
| | | | - Mohamed Taha Elfezary
- Pediatric Dentistry Department, Faculty of Dentistry, Al-Azhar University, Assiut, Egypt
| | | | | | - Yasser R. Souror
- Pediatric Dentistry Department, Faculty of Dentistry, Al-Azhar University, Assiut, Egypt
- Misr University for Science & Technology (MUST) 6th of October City, Giza, Egypt
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Do TT, Trinh TM, Tran TTP, Nguyen VTT, Le LN. Clinical performance of computer-aided design/computer-aided manufacture lithium disilicate ceramic endocrown restorations: A 2-year study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:51-56. [PMID: 38389749 PMCID: PMC10880470 DOI: 10.4103/jcde.jcde_99_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 02/24/2024]
Abstract
Context Optimal restoration methods for endodontically treated teeth (ETTs) have always remained an ongoing discussion among physicians in this day and age. ETTs have a tendency to fracture when chewing, compared to initial teeth. From the perspective of biology, preserving and restoring tooth structure is critical to maintaining biomechanical, functional, and esthetic harmony. Dental bonding techniques have lessened the necessity for post-and-core restorations in ETTs with severe substance loss. A minimally invasive endodontic restoration technique called "endocrown" was initially introduced by Bindl and Mörmann in 1999. Aims The aim of the study was to clinically evaluate all-ceramic mandibular molar endocrowns made using computer-aided design/computer-aided manufacturing (CAD/CAM) following 2 years of follow-up. Subjects and Methods This unblinded study contains 56 patients with 56 mandibular molars, which had severe substance loss. After teeth preparation, lithium disilicate ceramic endocrowns were manufactured with the CEREC CAD/CAM system, and cementation was performed using a composite luting agent. The endocrowns were assessed using the modified United States Public Health Service criteria at baseline, 6 months, 1 year, and 2 years following placement. Patient satisfaction was evaluated using a questionnaire. Statistical Analysis Used This study used descriptive statistics, including mean, standard deviation, and 95% confidence intervals. Data were processed using STATA version 14.0 (StataCorp LLC, USA). Results Two endocrowns (3.6%) failed throughout the period of observation. The high clinical rating criteria (96.4%, count of 54) and the increased satisfaction percentage (94.6%, count of 53) remained practically stable during the follow-up assessments at 6 months and after 1-2 years. Conclusions Endocrown offers a less invasive treatment option that may be a better method for endodontically treated mandibular molars. With contemporary CAD/CAM technology and new materials, time in the chair and esthetics optimally improved, bringing satisfaction to the patient.
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Affiliation(s)
- Thao Thi Do
- Department of Oral Pathology and Periodontology, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Tri Minh Trinh
- Department of Prosthodontics, Faculty of Odonto-Stomatology, Hong Bang International University, Ho Chi Minh City, Vietnam
| | - Thao Thi Phuong Tran
- Department of Periodontology, Faculty of Odonto-Stomatology, Hong Bang International University, Ho Chi Minh City, Vietnam
| | - Van Thi Tuong Nguyen
- Department of Oral Pathology and Periodontology, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Lam Nguyen Le
- Department of Pediatrics and Orthodontics, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
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Sun J, Jiang J, Xue Z, Ma H, Pan J, Qian K. Mechanical properties of cracked teeth with different dental materials and crown parameters: An in vitro proof-of-concept. J Mech Behav Biomed Mater 2023; 145:106045. [PMID: 37506569 DOI: 10.1016/j.jmbbm.2023.106045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE This work analyzed and compared the mechanical properties of identical cracked tooth models treated with different materials and crown parameters. Thus, to provide dentists with a more structured way to select materials and geometric parameters and determine the strongest restoration model for cracked teeth. METHODS This work used finite element analysis (FEA). We applied 25 restorative models, including five restorative materials, and three preparation parameters. Seven mechanical properties of the cracked tooth preparation were analyzed using correlation analysis. RESULTS The highest lifetime of the cracked preparation was obtained for crowns with a 5° of polymerization, width = 0.8 mm, and a length offset of 0.2 mm. The highest lifetime was obtained with ZC crown material, but the least deformation of the cracked tip was obtained with LU material. SIGNIFICANCE The results showed that the larger MOE material for the crown and a reasonable increase in the thickness and length of the crown is a favorable method to prevent further cracks to extend. This FEA study, thereby forming a novel basis for clinical guidance as to preparation of dental crowns applicable to cracked teeth.
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Affiliation(s)
- Jianpeng Sun
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China
| | - Jingang Jiang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China.
| | - Zhonghao Xue
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China
| | - Hongyuan Ma
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China
| | - Jie Pan
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081, PR China; Peking University School of Stomatology, Peking, 100081, PR China
| | - Kun Qian
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081, PR China; Peking University School of Stomatology, Peking, 100081, PR China
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Veselinova M, Diamantopoulou S, Paximada C, Papazoglou E. In-Vitro Comparison of Fracture Strength of Endocrowns and Overlays in Endodontically Treated Teeth Manufactured with Monolithic Lithium Disilicate and Zirconia. J Funct Biomater 2023; 14:422. [PMID: 37623666 PMCID: PMC10455451 DOI: 10.3390/jfb14080422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
To evaluate the fracture strength and the failure mode of endodontically treated molars restored with monolithic lithium disilicate and zirconia endocrowns and overlays. A total of 48 extracted mandibular molars were endodontically treated, decoronated 2 mm above the cementoenamel junction and divided into four 12-specimen groups. Group ELD: lithium disilicate endocrowns. Group EZ: monolithic zirconia endocrowns. Group OLD: lithium disilicate overlays. Group OZ: monolithic zirconia overlays. Overlays did not extend in the pulp chamber and endocrowns extended in the pulp chamber 2 mm. After adhesive bonding of the restorations, the specimens were subjected to thermocycling (×5000 cycles) and then to fracture resistance testing at lateral static loading (1 mm/min) at a universal testing machine. The failure mode of the specimens was qualitatively evaluated. Differences in means were compared using with t-tests for independent samples or Mann-Whitney test (p < 0.05). Weibull distribution analysis was also performed. Group ELD showed significantly higher fracture strength than all other groups (p = 0.001), and the highest Weibull modulus. Conclusions: Lithium disilicate endocrowns exhibit higher fracture strength and are more reliable compared to the other types of restorations examined. Endocrowns had more catastrophic failures compared to overlays.
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Affiliation(s)
| | | | | | - Efstratios Papazoglou
- Department of Operative Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.V.); (S.D.); (C.P.)
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Thangarasu N, Venkatesh KV. Effect of various preparation designs on pull-out bond strength of endocrown. Indian J Dent Res 2023; 34:304-307. [PMID: 38197352 DOI: 10.4103/ijdr.ijdr_517_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background The endocrown is described as monobloc ceramic component. The pull-out bond strength acts as a real-life scenario of failure that occurs in endocrown. The different preparation designs have been included to assess the type of preparation that resists the least failure. Aim To evaluate the effect of three different types of preparation designs on the pull-out bond strength (PBS) of computer-aided design/computer-aided manufacturing (CAD/CAM) monolithic endocrowns. Methods and Materials Thirty extracted mandibular first molars were used for this study. Root canal treatment was done. Samples were divided into three groups of 10 samples each. Group A consists of traditional endocrown preparation with a butt joint preparation. The group B consists of a modified preparation with 50-60 degree inward slope. The group C consists of preparation with a 50-60 degree outward slope. Endocrowns were fabricated using CAD/CAM lithium disilicate glass-ceramics. The endocrowns were adhesively bonded to the respective preparations. Pull-out bond strength was calculated using the universal testing machine at a crosshead speed of 1 mm/min. Statistical Analysis The results were statistically evaluated by one-way ANOVA and Tukey's post hoc analysis. Results Group B had higher pull-out bond strength compared to the other two types of preparation designs and showed a statistically significant value with a mean significant difference at 0.05 level (P < 0.05). Conclusion The 50-60 degree inward bevel in endocrown preparation increased the pull-out bond strength in lithium disilicate endocrowns.
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Affiliation(s)
- Naveen Thangarasu
- Department of Conservative Dentistry and Endodontics, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Chengalpattu, Tamil Nadu, India
| | - K Vijay Venkatesh
- Department of Conservative Dentistry and Endodontics, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Chengalpattu, Tamil Nadu, India
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Zhong Q, Cao X, Shen Y, Song Y, Wu Y, Qu F, Wang S, Xu C. Finite element analysis of maxillary first molar with mesial-occlusal-distal-palatal defect restored with different post-and-core strategies. Heliyon 2023; 9:e18131. [PMID: 37496905 PMCID: PMC10366429 DOI: 10.1016/j.heliyon.2023.e18131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose To explore which restoration strategy generates the most favorable stress distribution in an endodontically-treated maxillary first molar with mesial-occlusal-distal-palatal defect. Methods Models with one post in palatal canal (PP), each post in palatal and distobuccal canals (PDP), each post in palatal and mesiobuccal canals (PMP), and each post in all canals (PDMP) were established for an endodontically-treated maxillary first molar with mesial-occlusal-distal-palatal defect either with fiber-reinforced composite (FRC) post or gold alloy cast (GAC) post. A 400-N vertical force and a 225-N lateral force were respectively applied. The Mohr-Coulomb stress ratio (σMC ratio) in the residual tooth structure (RTS), the resin cement, and the crowns, the tensile stress (σt) and compressive stress (σc) in the FRC posts, the von-Mises stress ratio (σvM ratio) in the GAC post-and-cores, and the σt and shear stress (σs) at the adhesive interfaces were calculated using finite element analysis. Results FRC posts generated lower σMC ratio than GAC posts in the RTS (0.3274-0.3643 vs. 0.3399-0.4118). Among the FRC post groups, the PDMP group got the lowest σs at the dentin-post interface (14.92 MPa) and the abutment-crown interface (8.242 MPa) under vertical loading, as well as the lowest σMC ratio in the RTS (0.3381) and the lowest σs at the dentin-post interface (38.00 MPa) under lateral loading. Conclusions From the point of stress distribution, placing FRC posts in the palatal, distobuccal, and mesiobuccal canals is the optimal strategy in restoring a severely damaged maxillary first molar, provided that lateral occlusal force is reduced.
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Affiliation(s)
- Qi Zhong
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Ximeng Cao
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yingyi Shen
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yingshuang Song
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yaqin Wu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Fang Qu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shaohai Wang
- Department of Stomatology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Xu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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13
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Jiang J, Sun J, Ma H, Zhou S. In silico fatigue performance of molars restored with full crowns under alternating cyclic loadings. J Mech Behav Biomed Mater 2023; 144:105946. [PMID: 37369171 DOI: 10.1016/j.jmbbm.2023.105946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE In this study, a preclinical approach was used to analyze and directly compare the fatigue performance (fatigue life and damage percentage) and maximum principal stresses (Max. Ps) of prepared models treated with different materials and geometric parameters. METHODS Four groups of preparative parameters (crown width, crown length, degree of polymerization and material) were selected, each with five variables. An alternating cyclic occlusal load with an amplitude of 300 N was applied to the ball part along the longitudinal axis. The fatigue properties of the preparations and Max.Ps were analyzed. RESULTS A shoulder width of 0.8 mm, a shoulder height offset of 0.2 mm, a degree of polymerization of 5°, and a crown material of ZC resulted in the smallest percentage of damage. In contrast, the effect of different modulus of elasticity (MOE) on Max.Ps was not significant (p = 0.609). CONCLUSION The results suggest that the selection of larger modulus of elasticity MOE and larger Poisson's ratio material's, preparation of larger shoulder widths within safety, reasonable increase in crown length, and selection of larger degree of polymerization are favorable methods to protect the preparation.
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Affiliation(s)
- Jingang Jiang
- Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, PR China; Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China.
| | - Jianpeng Sun
- Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, PR China
| | - Hongyuan Ma
- Harbin Branch of Taili Communication Technology Limited, China Electronics Technology Group Corporation, Harbin, 150080, Heilongjiang, PR China
| | - Shan Zhou
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, PR China
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ALTAN B, FİLDİŞİ MA, ÇINAR Ş, AYDEMİR E, ÖZKAN D. Current treatment approaches of newly graduated, intern dentists and dentists in doctoral and specialty training to teeth with excessive substance loss (cross-sectional study). JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1228414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: New treatment options have been developed as alternative post-retaining restorations and crowns that preserve remaining tooth tissue in endodontically treated teeth with excessive substance loss. This study, current treatment approaches newly graduated, intern and doctoral or specialist dentists in teeth excessive coronal destruction were evaluated.
Material and Method: This cross-sectional study, online questionnaire consisting of 22 questions, 3 parts was applied. First part consists of demographic information participants, second part consists of questions measuring awareness about preferred indirect restorations, last part consists of current treatment approaches newly graduated, intern and doctoral or specialist dentists. Total 234 voluntary participants questionnaires were evaluated. Obtained data were analyzed with IBM SPSS V23.
Results: In restoration of endodontically treated buccal mesial walls (least 2 mm thick) molars, participants all 3 groups preferred posterior adhesive indirect restorations according to their titles. Considering level of awareness, participants high group preferred posterior adhesive indirect restorations more in restorations endodontically treated buccal lingual walled molar teeth. Participants all 3 groups preferred use fiber under composite strengthen teeth in the restoration of teeth with excessive substance loss.
Conclusion: According to the results, it was determined that awareness and knowledge level of dentists who received specialty or doctoral training about new current treatments was higher than other newly graduated and intern dentists. It was observed that participants group with high level awareness mostly preferred posterior region indirect adhesive restorations such as endocrown and onlay.
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Affiliation(s)
- Bike ALTAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, HAMİDİYE DİŞ HEKİMLİĞİ FAKÜLTESİ, HAMİDİYE DİŞ HEKİMLİĞİ PR
| | - Mehmet Ali FİLDİŞİ
- İSTANBUL MEDİPOL ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, DİŞ HEKİMLİĞİ PR. (ÜCRETLİ)
| | - Şevki ÇINAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, HAMİDİYE DİŞ HEKİMLİĞİ FAKÜLTESİ, HAMİDİYE DİŞ HEKİMLİĞİ PR
| | - Elifnur AYDEMİR
- İSTANBUL MEDİPOL ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, DİŞ HEKİMLİĞİ PR. (ÜCRETLİ)
| | - Davut ÖZKAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, HAMİDİYE DİŞ HEKİMLİĞİ FAKÜLTESİ, HAMİDİYE DİŞ HEKİMLİĞİ PR
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Jiang J, Sun J, Ma H, Wang J, Huang Z, Zhou S. Stress intensity factor of a cracked molar restored with different materials and designs: A 3D-FEA. J Mech Behav Biomed Mater 2023; 142:105818. [PMID: 37068432 DOI: 10.1016/j.jmbbm.2023.105818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE This work used 3D finite element analysis (FEA) to analyze and directly compare the stress intensity factor (SIF) and stress distribution at the crack tip of identical cracked tooth models restored with different materials and crown parameters. METHODS A 3D model of the cracked tooth was generated. Then, we applied 25 restorative models, including three parameters (shoulder height, width, and degree of polymerization), five restorative materials (GC, IPS, LU, ZC, VE), and two combinations of types of cement (RMGIC and GIC). An occlusal load of 800N was applied to the spherical part along the longitudinal axis. The stress distribution of the preparation and the SIF of the crack tip was analyzed. RESULTS The crack tip SIF was minimal for a shoulder height offset of 0.8 mm (P = 0.032), a shoulder width of 0.6 mm (P = 0.045), a crown material of ZC (P < 2e-16), and a cement material of RMGIC (P < 0.05), respectively. In contrast, the effect of different polymerization degrees on SIF was insignificant (P = 0.95). CONCLUSION Our results suggest that the selection of a larger modulus of elasticity (MOE) material for the crown, the preparation of a smaller shoulder width within a safe range, a reasonable increase in the crown length, and the selection of adhesive materials with high fracture toughness are favorable methods to prevent further crack extension.
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Affiliation(s)
- Jingang Jiang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China; Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, China.
| | - Jianpeng Sun
- Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, China
| | - Hongyuan Ma
- Harbin Branch of Taili Communication Technology Limited, China Electronics Technology Group Corporation, Harbin, 150080, Heilongjiang, People's Republic of China
| | - Jingchao Wang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, PR China
| | - Zhiyuan Huang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, PR China
| | - Shan Zhou
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, PR China.
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Luo B, Sun X, He L, Zhao L, Liu X, Jiang Q. Impact of different axial wall designs on the fracture strength and stress distribution of ceramic restorations in mandibular first molar. BMC Oral Health 2022; 22:549. [PMID: 36456942 PMCID: PMC9714140 DOI: 10.1186/s12903-022-02577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the fracture strength and stress distribution of four ceramic restorations. METHODS Forty human mandibular first molars were collected and randomized into four groups after establishing the distal defect: full crown group with 4 mm axial wall height (AWH) (FC4); short AWH crown group with 2 mm AWH (SC2); occlusal veneer group with 0 mm AWH (OV0); occlusal distal veneer group with only the distal surface prepared, and 4 mm AWH (OD4). The teeth were prepared according to the groups and the ceramic restorations were completed using celtra duo ceramic blocks. The ceramic thickness of the occlusal surface is about 1.5 mm and the edge is about 1 mm. The failure load values and fracture modes of each group were detected by mechanical test in vitro. According to the groups to establish three-dimensional finite element analysis (FEA) models, a 600 N loading force was applied vertically using a hemispherical indenter with a diameter of 6 mm. and compare the stress distribution under the condition of different restorations. RESULTS In vitro mechanical tests showed that the failure load values were SC2 (3232.80 ± 708.12 N) > OD4 (2886.90 ± 338.72 N) > VO0 (2133.20 ± 376.15 N) > FC4(1635.40 ± 413.05 N). The failure load values of the short AWH crown and occlusal distal veneer were significantly higher than that of occlusal veneer and full crown (P<0.05). The fracture modes of the full crown and occlusal veneer groups were mainly ceramic fractures and some were restorable tooth fractures. The short AWH crown and occlusal distal veneer groups presented with three fracture modes, the proportion of non-restorable tooth fracture was higher. The results of FEA show that under the spherical loading condition, the stress of ceramic was concentrated in the contact area of the loading head, the maximum von Mises stress values were FC4 (356.2 MPa) > VO0 (214.3 MPa) > OD4 (197.9 MPa) > SC2 (163.1 MPa). The stress of enamel was concentrated in the area where the remaining enamel was thinner, the maximum von Mises stress values was OD4 (246.2 MPa) ≈ FC4 (212.4 MPa) > VO0 (61.8 MPa) ≈ SC2 (45.81 MPa). The stress of dentin is concentrated in the root furcation and the upper third region of the root. However, stress concentration was observed at the tooth cervix in the full crown. CONCLUSION Under certain conditions, the occlusal distal veneer shows better performance than the full crown.
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Affiliation(s)
- Bin Luo
- grid.24696.3f0000 0004 0369 153XDepartment of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, 100050 Beijing, China
| | - Xiaolu Sun
- grid.479671.a0000 0004 9154 7430Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, 100010 Beijing, China
| | - Lin He
- grid.24696.3f0000 0004 0369 153XDepartment of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, 100050 Beijing, China
| | - Lidan Zhao
- grid.410737.60000 0000 8653 1072Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, 510013 Guangzhou, China
| | - Xinggang Liu
- grid.24696.3f0000 0004 0369 153XDepartment of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, 100050 Beijing, China
| | - Qingsong Jiang
- grid.24696.3f0000 0004 0369 153XDepartment of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, 100050 Beijing, China
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Cheng X, Zhang XY, Qian WH. Influence of different base materials and thicknesses on the fracture resistance of endocrown: A three-dimensional finite element analysis. BMC Oral Health 2022; 22:363. [PMID: 36008852 PMCID: PMC9414390 DOI: 10.1186/s12903-022-02350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To analyze the stress distribution of the all-ceramic endocrown with different base materials and thicknesses using three-dimensional finite element analysis. METHODS A endodontically treated maxillary premolar was scanned by micro-CT, a three-dimensional finite element model of the endocrown with fluid resin as the base material was divided into control (0 mm), 1 mm, 2 mm, and 3 mm groups according to base thickness. Three kinds of conventional base materials were used and divided into glass ion group (A), fluid resin group (B), and nanocomposite resin group (C), and a three-dimensional finite element model of the endocrown with 1.0 mm thickness of base was established. A static loading with axial and 45° direction was applied to each model, the stress distribution of each part of the endocrown was analyzed under different base materials and thicknesses. RESULTS The different thickness of the base layer has an influence on the components of the restoration and the tooth. The stress in the control group was the largest. The stress was the lowest when the thickness of the base layer was 1 mm; The maximum of the equivalent stress, the first, second, and third principal stress in the endocrown, abutment, and alveolar bone, are basically the same with the different base materials. The stress on the base layer increases with the elastic modulus of base materials increases. CONCLUSIONS The base layer played a force buffering effect on the dental body restored with endocrowns, and the effect was the best at 1 mm; The selection of base material has little influence on the whole, but in order to protect the weak tissues of the cavity bottom, the base material with lower elastic modulus can be used.
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Affiliation(s)
- Xia Cheng
- Shanghai Xuhui District Dental Center, Shanghai, 200032 China
| | - Xiu-yin Zhang
- Dept. of Prosthodontics, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200011 China
| | - Wen-hao Qian
- Shanghai Xuhui District Dental Center, Shanghai, 200032 China
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Buyukerkmen EB, Bozkurt DA, Terlemez A. Effect of surface treatment, ferrule height, and luting agent type on pull-out bond strength of monolithic zirconia endocrowns. J Oral Sci 2022; 64:279-282. [PMID: 35989297 DOI: 10.2334/josnusd.22-0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the effect of different surface treatments, ferrule heights, and luting agents on the pull-out bond strength (PBS) of computer-aided design/computer-aided manufacturing (CAD-CAM) monolithic endocrowns. METHODS After endodontic treatment and preparation for two endocrown designs (ferrule height 0 mm or 2 mm), CAD-CAM monolithic zirconia endocrowns were fabricated for 80 mandibular molars. Each endocrown design group was then divided on the basis of surface treatment into two groups: half were air-abraded and half were air-abraded/laser-irradiated. Then, all treated groups were further divided into two subgroups (n = 10) and cemented to teeth with either a 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin luting agent (Panavia SA) or a combination of MDP-containing primer and MDP-free resin luting agent (Monobond Plus/Multilink Automix). PBS was measured with a universal test machine after simulated chewing and thermocycling. Three-way ANOVA and the post-hoc Bonferroni test were used for statistical analysis. RESULTS PBS was significantly associated with type of surface treatment, type of luting agent, and ferrule height. Air-abraded/laser-irradiated endocrowns with a 2-mm ferrule that were cemented with Monobond Plus/Multilink Automix had the highest PBS (P < 0.05). CONCLUSION Surface treatment with air abrasion/laser irradiation, presence of a ferrule, and priming with an MDP-containing primer increased the PBS of monolithic zirconia endocrowns.
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Affiliation(s)
- Emine B Buyukerkmen
- Department of Prosthodontics, Faculty of Dentistry, Necmettin Erbakan University
| | - Durmuş A Bozkurt
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University
| | - Arslan Terlemez
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University
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Clinical Effect of Feldspar Glass Ceramics and Lithium Disilicate Reinforced Glass Ceramics. CONTRAST MEDIA & MOLECULAR IMAGING 2022. [DOI: 10.1155/2022/9691594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical effect of feldspar ceramics and lithium disilicate reinforced glass ceramics was studied. 57 affected teeth with complete root canal treatment and computer aided design/computer aided manufacturing (CAD/CAM) endocrown restoration were reviewed 24-36 months aftercompletion of the restoration. These dimensions including anatomical morphology, proximal contact , color matching, edge integrity, edge coloring, secondary caries, kinesthetic occlusion relationship, and periodontal health of the affected teeth by the modified clinical scoringcriteriafor United States Public Health Service (USPHS) were evaluated, and the patients’ satisfaction was recorded. The 57 affected teeth were divided into feldspar group and lithium disilicate reinforced ceramic group according to the different repair materials, and the statistical results are analyzed. The experimental results show medullary fixation crown can be used to repair a large area of dental defects after root canal treatment.
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Comparison of stress distribution between zirconia/alloy endocrown and CAD/CAM multi-piece zirconia post-crown: three-dimensional finite element analysis. Clin Oral Investig 2022; 26:5007-5017. [PMID: 35352185 DOI: 10.1007/s00784-022-04470-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to evaluate a digital multi-piece zirconia post-crown to restore a mandibular second molar with extensive coronal loss and limited restoration space, and to compare the stress distribution between endocrowns made of zirconia or alloy and CAD/CAM multi-piece zirconia post-crowns. MATERIAL AND METHODS Four three-dimensional finite element analysis models of a mandibular second molar with extensive coronal loss and limited restoration space were created as follows: (A) intact molar; (B) zirconia endocrown restored molar; (C) multi-piece post-crown restored-molar with tapered nail; (D) multi-piece post-crown restored molar with T-shaped nail. Models C and D were divided into two subgroups according to the material type: C1/D1, zirconia; C2/D2, NiCr alloy. The maximum modified von Mises failure criterion (mvM) stresses were calculated, and the stress distribution was recorded to analyze the effects of the restoration and material types on the biomechanical properties of dentin and prosthesis. RESULTS The maximum mvM stress of dentin in model B (33.80 MPa) was lower compared with models C (C1, 37.81 MPa; C2, 36.36 MPa) and D (D1, 36.34 MPa; D2, 34.97 MPa) under vertical load, but the opposite was observed under oblique load. The highest mvM stress was concentrated in the nail region located in the root canal, and the T-shaped nail values were greater than the tapered nail, whereas model D with T-shaped nail showed a lower mvM stress level in dentin compared with Model C with tapered nail. CONCLUSIONS The digital multi-piece zirconia post-crown is a potential approach to restore mandibular second molars with extensive coronal loss and limited restoration space. CLINICAL RELEVANCE The digital multi-piece zirconia post-crown has potential to restore mandibular second molars with extensive coronal loss and limited restoration space using an innovative approach.
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Abtahi S, Alikhasi M, Siadat H. Biomechanical behavior of endocrown restorations with different cavity design and CAD-CAM materials under a static and vertical load: A finite element analysis. J Prosthet Dent 2022; 127:600.e1-600.e8. [PMID: 35016795 DOI: 10.1016/j.prosdent.2021.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM The influence of different restorative materials, the divergence angle, and the preparation design of the pulp chamber floor in endocrowns on stress distribution is unclear. PURPOSE The purpose of this finite element analysis study was to evaluate the stress distribution and maximum von Mises stress values in endocrown restorations and remaining teeth. MATERIAL AND METHODS An endodontically treated first mandibular molar was prepared with 2-mm occlusal reduction, a butt-joint margin, and a mesial box with a 4-mm buccolingual extension to receive an endocrown restoration. The model was then scanned, and the exported standard tessellation language file was designed according to the anatomic references by using a computer-aided design software program. The reference model was duplicated, and 27 variations were formed: restorations made of IPS e.max, Vitablocs MarkII, and Vita Enamic, as well as different divergence angles of 6, 12, and 16 degrees prepared with 3 variations of pulp chamber floor designs, keeping the natural form, adding a 1-mm glass ionomer pulp chamber base, and adding a 2-mm extension into the distal canal. Stress distribution under axial loading and maximum von Mises stress values were analyzed and calculated by using the Ansys software program. RESULTS Endocrown restoration presented the lowest von Mises stress values when a 6-degree divergence angle was used with Vitablocs MarkII. However, in other layers such as enamel, resin cement, and pulpal floor, the lowest von Mises stress values were observed in IPS e.max restorative material when the divergence angle was increased to 16 degrees. No difference was found in the stress distribution pattern and maximum von Mises stress values in the alveolar bone or periodontal ligament. CONCLUSIONS Endocrowns fabricated with lithium disilicate ceramics without intraradicular extension exhibited lower stresses on tooth structure. An increase in the divergence angle improved the stress distribution on tooth structure; however, sound dental tissue should not be removed to achieve better stress distribution.
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Affiliation(s)
- Sara Abtahi
- Graduate student, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Alikhasi
- Professor, Department of Prosthodontics, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hakimeh Siadat
- Professor, Department of Prosthodontics, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Balaji L, Joshna B, Kuzhanchinathan M. Biomechanical stress analysis of ceramic and indirect hybrid composite endocrowns: A three-dimensional finite element analysis. ENDODONTOLOGY 2022. [DOI: 10.4103/endo.endo_156_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yildirim G, Demir C, Güven MÇ, Koç O, Dalkiliç EE. Influence of fiber insertion and different material type on stress distribution in endocrown restorations: a 3D-FEA study. Comput Methods Biomech Biomed Engin 2021; 25:1509-1519. [PMID: 34964689 DOI: 10.1080/10255842.2021.2019228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study aimed to evaluate the effects of fibers insertion and restorative material type on the stress distribution in endocrowns with finite element analysis. Five 3D models of first mandibular molars were created and restored as follows: (1) IN: intact tooth, (2) IPS-E: tooth restored with lithium disilicat ceramic endocrowns, (3) C-E: tooth restored with composite endocrowns, (4) IPS-E + F: lithium disilicate ceramic endocrowns + fiber, (5) C-E + F: composite endocrowns + fiber. Vertical masticatory load was imitated with finite element analysis. The equivalent stress of von Mises failure criterion (mvM) was calculated. The maximum mvM stress, enamel/crown, dentin and cement were compared among models and strength of the materials. Endocrowns presented a lower mvM stress level than intact tooth. In IPS-E, the mvM stress values in the crown and dentin were higher than C-E, while the mvM stress values in cement were higher in C-E group. Fibers insertion did not affect the stress level of IPS-E and C-E groups. In IPS model, fiber showed more stress absorption than C-E. The restorative material type changed the stress distribution of endocrown restorations. The fiber application did not affect the stress distribution in either endocrown group. But, more stress absorption was observed in fiber under IPS-E than C-E.
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Affiliation(s)
- Gulhan Yildirim
- Department of Prosthodontics, Beykent University, Istanbul, Turkey
| | - Cihan Demir
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | | | - Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
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Rehabilitation of severely-destructed endodontically treated premolar teeth with novel endocrown system: Biomechanical behavior assessment through 3D finite element and in vitro analyses. J Mech Behav Biomed Mater 2021; 126:105031. [PMID: 34922296 DOI: 10.1016/j.jmbbm.2021.105031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Rehabilitation of endodontically treated premolars with extensive coronal destruction through endocrown approach remains a controversial topic in reconstructive dentistry. There is no clear consensus in the literature which endocrown design with which material is the most effective restoration option for severely-destructed endodontically treated premolars. The aim of this study was to assess the biomechanical behavior of endodontically treated maxillary first premolars restored with a novel endocrown system compared to the conventional one varying the applied load type through finite element and in vitro analyses. MATERIALS AND METHODS For finite element analysis, two models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: Model C for the conventional monolithic IPS e.max CAD endocrown and Model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). Modified von Mises stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately under axial and oblique loading of 450 N. For in vitro analysis, forty sound human bifurcated maxillary first premolars were collected, endodontically-treated, and divided into 2 main groups (n = 20) according to the system used for endocrown fabrication; Group C: the conventional monolithic endocrowns and Group P: the novel bi-layered endocrowns. All specimens were subjected to an artificial thermomechanical aging protocol. Each main group was subdivided into two subgroups (n = 10) according to the loading type (axial and oblique) applied during the fracture resistance test. Qualitative analysis using Stereomicroscopy and Scanning Electron Microscopy was performed. Data were statistically analyzed at p-value ≤ 0.05. RESULTS Regarding stress distribution pattern of remaining tooth structure (enamel and dentin), both endocrown systems and cement lines under both axial and oblique load application, Model P resulted in lower stresses than Model C. The oblique stress values of all analyzed structures were higher than corresponding values resulted axially. Considering failure load, a significantly higher load was recorded for Group P when axial or oblique loading was applied (p = 0.00). A significantly higher failure load was recorded with axial loading for both main groups. With regard to failure mode, a statistically significant difference was observed between main groups (p = 0.033), with more favorable failures detected for Group P axially. CONCLUSIONS Compared to the conventional endocrown system, the studied novel system improved the biomechanical behavior within tooth/restoration complex of the restored severely-destructed endodontically treated maxillary first premolar teeth, whatever the applied load type. CLINICAL SIGNIFICANCE The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable promising option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. It can be considered as a conservative alternative option to the conventional treatment modalities not only for normal clinical conditions, but also for parafunctional cases.
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Godil AZ, Kazi AI, Wadwan SA, Gandhi KY, Dugal RJS. Comparative evaluation of marginal and internal fit of endocrowns using lithium disilicate and polyetheretherketone computer-aided design - computer-aided manufacturing (CAD-CAM) materials: An in vitro study. J Conserv Dent 2021; 24:190-194. [PMID: 34759588 PMCID: PMC8562835 DOI: 10.4103/jcd.jcd_547_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/17/2021] [Accepted: 02/19/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the marginal and internal fit of endocrowns with different computer-aided design/computer-aided manufacturing (CAD-CAM) materials by measuring them with a stereomicroscope (μm). Materials and Methods: A mandibular first molar typodont tooth was prepared to receive an endocrown. The preparation was scanned using an extra-oral scanner. Endocrowns (n = 20) were fabricated using lithium disilicate (IPS e. max CAD LT block; CEREC Ivoclar Vivadent, Liechtenstein) and polyetheretherketone (PEEK) (breCAM. BioHPP®; Bredent, UK) using CAD-CAM technique. Marginal gap was evaluated using a stereomicroscope at the midpoint of all four surfaces (mid buccal, mid lingual, mid mesial, mid distal). This was followed by sectioning of the endocrowns in a sagittal plane along with the prepared tooth to evaluate the internal fit at four different points (A, B, C, D) using a stereomicroscope. Statistical analysis was performed using one-way analysis of variance test. Results: Mean values of marginal gap of lithium disilicate and PEEK endocrowns are 56.6 ± 6.1 μm and 81.3 ± 10.1 μm, respectively. Mean value internal gaps of lithium disilicate and PEEK endocrowns are 158.2 ± 11.1 μm and 199.1 ± 13 μm, respectively. Results in the present study have shown that the marginal and internal fits of lithium disilicate endocrowns are superior to that of PEEK endocrowns. Conclusions: Based on the outcomes of this in vitro study, the marginal and internal fit of lithium disilicate endocrowns is better than PEEK endocrowns. The marginal gap clinically acceptable is <120 μm. The marginal gap values recorded in this study are within the acceptable range for both materials.
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Affiliation(s)
- Aamir Zahid Godil
- Department of Prosthodontics and Crown and Bridge, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Arshi Ilyas Kazi
- Department of Prosthodontics and Crown and Bridge, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Sanaa Akhlaq Wadwan
- Department of Prosthodontics and Crown and Bridge, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Kashif Yusuf Gandhi
- Department of Prosthodontics and Crown and Bridge, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
| | - Ramandeep J S Dugal
- Department of Prosthodontics and Crown and Bridge, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
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Biomechanical behavior of endodontically treated premolar teeth restored with novel endocrown system: 3D Finite Element and Weibull analyses. J Mech Behav Biomed Mater 2021; 124:104853. [PMID: 34600429 DOI: 10.1016/j.jmbbm.2021.104853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To date, there is no clear consensus in the literature which endocrown design with which material is the most effective treatment option to restore endodontically treated maxillary premolars with extensive loss of tooth structure. The aim of this study was to evaluate the stress distribution pattern and failure probability of maxillary first premolars restored with a novel endocrown system compared to the conventional one by means of Finite Element and Weibull analyses. MATERIALS AND METHODS Two finite element (FE) models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: model C for the conventional monolithic IPS e.max CAD endocrown and model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). A static occlusal compressive load was axially and centrally-applied. Modified von Mises and maximum principal stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately. Weibull function was incorporated with FE analysis to calculate the long term failure probability. RESULTS Regarding stresses occurred in the remaining tooth structure (enamel and dentin), model P transmitted less stresses than model C. The individual enamel of model C showed about 5% and 40% risk of failure at normal and maximum occlusal load values, respectively, while for model P, it had no failure risk at both values. For dentin, model C showed about 13% failure risk at the normal masticatory force, while model P showed only 2%. At clenching value, model C dentin showed about 44% failure risk, while only 9% was resulted for model P. CONCLUSIONS Compared to the conventional endocrown system, the positive impact of the studied novel endocrown system on the stress distribution pattern and also on the survival/failure probability of the restored severely-destructed endodontically treated maxillary first premolar teeth was reflected (more tooth-friendly), not only at normal masticatory forces but also at the maximum functional loads. CLINICAL SIGNIFICANCE The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. Despite the conventional endocrown system may benefit the durability of tooth bonding, it should not be selected for restoration of clenching cases because of the too high overall failure risk.
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Elashmawy Y, Aboushelib M, Elshahawy W. Retention of different CAD/CAM endocrowns bonded to severely damaged endodontically treated teeth: An in vitro study. J Indian Prosthodont Soc 2021; 21:269-275. [PMID: 34380814 PMCID: PMC8425367 DOI: 10.4103/jips.jips_91_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: Assess the retention of endocrowns fabricated of different CAD/CAM materials. Settings and Design: In vitro - comparative study. Material and Methods: Root canal treated mandibular first molars were prepared in a standardized method. Standardized endocrowns were manufactured using four CAD-CAM blocks: resin infiltrated ceramic (Vita Enamic), partially stabilized tetragonal zirconia (Katana), lithium disilicate ceramic (IPS e.max CAD), and polyether-ether-keton (PEEK, BioHPP). After proper surface treatment, the restorations were cemented using a resin cement (Panavia F2.0) and were connected to a special attachment unit and secured to a universal testing machine. The amount of axial load required to dislodge the restoration from the tooth structure was measured (n = 12, α = 0.05). Failures were classified as adhesive debonding from the tooth structure without damaging the supporting tooth structure and cohesive fracture of the supporting tooth structure Statistical Analysis Used: One-way analysis of variance,Tukey's post hoc test. Results: The retention of Vita Enamic (61 ± 11 N) and IPS e.max CAD (58 ± 9 N) was significantly higher (F = 123, P < 0.01) than Katana (33 ± 13) and Peek restorations (23 ± 11). Vita Enamic and IPS e.max CAD were associated with fractured tooth segments during debonding while Katana and PEEK specimens were adhesively debonded from the remaining tooth structure. Conclusions: Within the limitations of this study, using lithium disilicate ceramics and resin infiltrated ceramics as restorative materials to fabricate endocrowns to restore severely damaged endodontically treated teeth, recorded significantly higher retention values. Meanwhile, using yttrium partially stabilized zirconia and polyether ether ketones for the same purpose recorded a favorable mode failure which avoided the possibility of tooth fracture.
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Affiliation(s)
- Yasmin Elashmawy
- Department of Fixed Prosthodontics, Faculty of dentistry, University of Tanta, Tanta, Egypt
| | - Moustafa Aboushelib
- Department of Dental Materials, Faculty of dentistry, University of Alexandria, Alexandria, Egypt
| | - Waleed Elshahawy
- Department of Fixed Prosthodontics, Faculty of dentistry, University of Tanta, Tanta, Egypt
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Beji Vijayakumar J, Varadan P, Balaji L, Rajan M, Kalaiselvam R, Saeralaathan S, Ganesh A. Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? - A systematic review of in-vitro studies. Biomater Investig Dent 2021; 8:104-111. [PMID: 34368777 PMCID: PMC8312589 DOI: 10.1080/26415275.2021.1932510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives: The primary objective of this systematic review is to compare the fracture resistance of lithium disilicate (LDS)-based endocrowns and resin-based (RB) endocrowns of in-vitro studies, and the secondary objective is to compare their catastrophic failures. Materials and Methods: The review protocol was registered in the P ROSP ERO database (CRD42020166201). A comprehensive literature search was done in PubMed, Cochrane, EBSCOhost and Google Scholar using key terms. Only in-vitro studies that compared fracture resistance of LDS-based endocrowns and indirect RB endocrowns in molars were included. Data extraction, risk of bias assessment and qualitative analysis of the included studies were performed. Results: Five studies were included in this systematic review. The overall risk of bias for the included studies was moderate. Under axial loading, RB endocrowns showed similar fracture resistance when compared with LDS endocrowns. However, they showed better fracture resistance when compared with zirconia reinforced lithium silicate (ZLS) endocrowns. Furthermore, RB endocrowns showed fewer catastrophic failures than LDS-based endocrowns. Conclusions: RB endocrowns have similar or better fracture resistance and fewer catastrophic failures when compared to LDS-based endocrowns.
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Affiliation(s)
- Joshna Beji Vijayakumar
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Preethi Varadan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Lakshmi Balaji
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Mathan Rajan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Rajeswari Kalaiselvam
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Sindhu Saeralaathan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Arathi Ganesh
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
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Bhavsar B, Neilalung K, Vaz M. Why ceramic? When you can use composite. Indirect restoration of tooth in a more biomimetic way using heat treated direct resin composite. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2021. [DOI: 10.4103/jdrntruhs.jdrntruhs_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Li X, Kang T, Zhan D, Xie J, Guo L. Biomechanical behavior of endocrowns vs fiber post-core-crown vs cast post-core-crown for the restoration of maxillary central incisors with 1 mm and 2 mm ferrule height: A 3D static linear finite element analysis. Medicine (Baltimore) 2020; 99:e22648. [PMID: 33120754 PMCID: PMC7581096 DOI: 10.1097/md.0000000000022648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To analyze the stress distribution of the maxillary central incisor with oblique fracture, repaired by different methods, using 3-dimensional finite element analysis. From the biomechanical point of view, it is expected to provide a reference for clinical selection of restoration method which is more conducive to stress distribution and preservation of dental tissue as much as possible.Use cone beam CT and finite element software to establish the finite element models of the maxillary central incisor with oblique fracture, and then create models according to 5 repairing methods(A. fiber post-core-crown group; B. cast post-core-crown group; C.3 mm deep endocrown; D.4 mm deep endocrown; E.5 mm deep endocrown)after root canal treatment, and analyze the Von Mises equivalent stress and maximum principal stress distribution and peak value of each model.When the height of dentin ferrule was fixed, the value of the Von Mises equivalent stress and the maximum principal stress in residual tooth tissue: group A was the highest, and there was no significant difference in group B, C, D and E. And the stress distribution area of 5 groups were the same. In prosthodontic layer: group B was the highest, while group A was the lowest, and the stress peak slightly increased with the increase of depth in group C, D and E. And the 5 groups were with the same stress distribution area as well. In adhesive layer: group A was the highest, while group B was the lowest, and there was little difference among group C, D and E. Group A was concentrated in 1/3 of the post tip, while group B,C,D and E were concentrated in 1/3 of the post and the post tips.Complete and high enough dentin ferrule is a requirement for repairing heavily defected maxillary central incisor with fiber post-core crown and cast post-core crown. When the dentin ferrule is incomplete, the stress distribution of the endocrown is more excellent than post-core-crown. And the endocrown with a depth of 3 mm retainer may be the best repair method. As for post-core crown restoration, the cast post-core crown is more favorable for the uniform distribution of residual tooth tissue than the fiber post-core crown.
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Affiliation(s)
- Xixi Li
- Department of prosthodontics, Hospital of Stomatology Affiliated to Southwest Medical University, Luzhou
- Department of Stomatology, The First People's Hospital of Shuangliu District
| | - Ting Kang
- Chengdu Second People's Hospital, Chengdu
| | - Danting Zhan
- Department of prosthodontics, Hospital of Stomatology Affiliated to Southwest Medical University, Luzhou, China
| | - Jing Xie
- Department of prosthodontics, Hospital of Stomatology Affiliated to Southwest Medical University, Luzhou, China
| | - Ling Guo
- Department of prosthodontics, Hospital of Stomatology Affiliated to Southwest Medical University, Luzhou, China
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Silva-Sousa AC, Moris ICM, Barbosa AFS, Silva-Sousa YTC, Sousa-Neto MD, Pires CRF, Gomes EA. Effect of restorative treatment with endocrown and ferrule on the mechanical behavior of anterior endodontically treated teeth: An in vitro analysis. J Mech Behav Biomed Mater 2020; 112:104019. [PMID: 32829166 DOI: 10.1016/j.jmbbm.2020.104019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
This study evaluated the effect of endocrown and ferrule restorative treatment on the mechanical behavior of anterior endodontically treated teeth. Human canines were treated endodontically and distributed in five groups (n = 10): sound teeth (S), crown associated with glass fiber post (GFP) and ferrule (GFPf+) and that without ferrule (GFPf-), and endocrown with ferrule (Ef+) and that without ferrule (Ef-). The crowns were obtained in lithium disilicate-based glass ceramic and cemented with resin. Thermomechanical loading (TL) was performed with progressive load of 80, 120, 160, 200, 240, 280, and 320 N with 20,000 cycles each, 140,000 cycles in total, frequency of 5 Hz, and temperature variation of 5°C-55 °C, followed by fracture resistance testing with load cell of 1000 Kgf and crosshead speed of 0.5 mm/min in a universal testing machine. Failure mode has been evaluated. Data were compared by Kaplan-Meier survival analysis (p < 0.05) for TL and one-way ANOVA and Tukey's test (p < 0.05) for fracture resistance. TL showed higher number of fractures for groups without ferrule (GFPf- = 7, GFPf+ = 3, Ef- = 10, and Ef+ = 2) and lower mean fracture load probability (GFPf+ = 300 N, GFPf- = 280 N, Ef+ = 320 N, Ef- = 188 N) than those with ferrule. Regarding fracture, teeth rehabilitated with GFP were more resistant to endocrowns with ferrule (p < 0.05). A higher percentage of type III failures after fatigue and type II failures after fracture were found. In conclusion, rehabilitation using GFP with ferrule is more favorable for anterior teeth, but the use of endocrown with ferrule proved feasible.
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Affiliation(s)
- Alice Corrêa Silva-Sousa
- School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brazil; Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP-USP), Ribeirão Preto, SP, Brazil
| | - Izabela C M Moris
- School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brazil
| | | | | | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP-USP), Ribeirão Preto, SP, Brazil
| | - Cassiano Ricardo Ferreira Pires
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP-USP), Ribeirão Preto, SP, Brazil
| | - Erica Alves Gomes
- School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brazil.
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Lin J, Lin Z, Zheng Z. Effect of different restorative crown design and materials on stress distribution in endodontically treated molars: a finite element analysis study. BMC Oral Health 2020; 20:226. [PMID: 32811484 PMCID: PMC7437004 DOI: 10.1186/s12903-020-01214-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Jie Lin
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, Fujian, 350002, People's Republic of China.,Department of Crown and Bridge, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
| | - Zhenxiang Lin
- Department of Stomatology, Hospital of Fujian Provincial Authorities, 68 Guping Road, Fuzhou, Fujian, 350001, People's Republic of China
| | - Zhiqiang Zheng
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, Fujian, 350002, People's Republic of China.
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Saber SM, Hayaty DM, Nawar NN, Kim HC. The Effect of Access Cavity Designs and Sizes of Root Canal Preparations on the Biomechanical Behavior of an Endodontically Treated Mandibular First Molar: A Finite Element Analysis. J Endod 2020; 46:1675-1681. [PMID: 32640266 DOI: 10.1016/j.joen.2020.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aimed to compare the biomechanical properties of a mandibular first molar with different endodontic cavity designs and increasing sizes of root canal preparations using finite element analysis (FEA). METHODS The experimental finite element models were designed with 3 different endodontic access cavities and 2 sizes of canal preparations: traditional access cavity, conservative access cavity, and truss access cavity and #30/.04 and #40/.04 of root canal preparations. Vertical and oblique loads were applied with a 250-N static force to simulate masticatory forces. Mathematical analysis was performed to evaluate the stress distribution patterns. Maximum von Mises (VM) stresses were assessed at the occlusal surface; cervical line; and 1 , 3, 5, and 7 mm from the root apices. RESULTS Decreasing the size of the access cavity was associated with a higher magnitude of cervical stresses. The magnitude of VM stresses was maximum at the 7-mm level and was minimum at the 1-mm level from the root apex. Increasing the size of the access cavity was associated with the transmission of stresses to a further apical direction regardless of the extent of root canal enlargement. The root canal enlargement from #30 to #40 increased radicular VM stresses within all models. CONCLUSIONS Within the limitations of this study, conservative and truss access designs preserved a significant volume of tooth structure. The extent of root canal enlargement should be as small as practical without jeopardizing the biologic objectives of root canal treatment.
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Affiliation(s)
- Shehabeldin Mohamed Saber
- Department of Endodontics, The British University, Cairo, Egypt; Department of Endodontics, Ain Shams University, Cairo, Egypt.
| | | | | | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, Pusan National University School of Dentistry, Dental Research Institute, Yangsan, Korea.
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Skalskyi V, Makeev V, Stankevych O, Dubytskyi O. Acoustic properties of fracture of dental restorative materials and endocrown restorations under quasi-static loading. Dent Mater 2020; 36:617-625. [DOI: 10.1016/j.dental.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
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Al-Dabbagh RA. Survival and success of endocrowns: A systematic review and meta-analysis. J Prosthet Dent 2020; 125:415.e1-415.e9. [PMID: 32197821 DOI: 10.1016/j.prosdent.2020.01.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
Abstract
STATEMENT OF PROBLEM Endocrowns are a monoblock type of restoration that use the pulp chamber and remaining coronal tooth structure as a means of retention. However, data on their long-term survival and success rates as compared with conventional crowns are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to collate published work on endocrowns to assist clinicians in making decisions on when and whether they are an appropriate restorative option with a predictable outcome for extensively damaged endodontically treated teeth. MATERIAL AND METHODS Databases such as PubMed (MEDLINE), Scopus, EMBASE, Cochrane library, and Google Scholar were searched up to June 2019 for clinical and in vitro studies on endocrown survival and success rates. For the meta-analysis, endocrown and conventional crown survival and success rates were compared, and the pooled effects were presented as relative risks and 95% confidence intervals using a random effects model. RESULTS Ten studies fulfilled the inclusion criteria (3 clinical and 7 in vitro) and were included in the systematic review. The meta-analysis of the clinical studies showed an estimated overall 5-year survival rate of 91.4% for endocrowns and 98.3% for conventional crowns. The estimated overall 5-year success rates were 77.7% for endocrowns and 94% for conventional crowns. There were no significant differences in overall survival or success estimates between the assessed restorations (P>.05). CONCLUSIONS Additional well-designed clinical studies with long-term assessment are needed; however, endocrowns appear to be a promising conservative restorative option with acceptable long-term survival for endodontically treated posterior teeth in selected patients.
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Affiliation(s)
- Raghad A Al-Dabbagh
- Assistant Professor and Consultant in Prosthodontics, Oral and Maxillofacial Rehabilitation Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 1: The Restoration of Endodontically Treated Molars in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041364. [PMID: 32093253 PMCID: PMC7068261 DOI: 10.3390/ijerph17041364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1–2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients.
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Dartora NR, Maurício Moris IC, Poole SF, Bacchi A, Sousa-Neto MD, Silva-Sousa YT, Gomes EA. Mechanical behavior of endocrowns fabricated with different CAD-CAM ceramic systems. J Prosthet Dent 2020; 125:117-125. [PMID: 32057485 DOI: 10.1016/j.prosdent.2019.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
STATEMENT OF PROBLEM The mechanical behavior of ceramic endocrowns is unclear. PURPOSE The purpose of this in vitro and 3-dimensional finite element analysis (3D-FEA) study was to evaluate the mechanical behavior of endodontically treated teeth restored with ceramic endocrowns made by using different computer-aided design and computer-aided manufacturing (CAD-CAM) systems. MATERIAL AND METHODS Sixty mandibular human molars were endodontically treated, prepared for endocrowns, and divided into 4 groups (n=15) according to the following various ceramic systems: leucite-based glass-ceramic (LC group), lithium disilicate-based glass-ceramic (LD group), glass-ceramic based on zirconia-reinforced lithium silicate (LSZ group), and monolithic zirconia (ZR group). After adhesive bonding, the specimens were subjected to thermomechanical loading and then to fracture resistance testing in a universal testing machine. The failure mode of the specimens was qualitatively evaluated. Three-dimensional FEA was performed to evaluate the stress distribution in each group. Data were analyzed by using a 1-way ANOVA and the Tukey HSD test (α=.05). RESULTS Statistically significant differences among the groups were observed (P<.05). The outcomes of the LC, LD, and LSZ groups were similar (1178 N, 1935 N, and 1859 N) but different from those of the ZR group (6333 N). The LC and LD groups had a higher ratio of restorable failures, while LSZ and ZR had more nonrestorable failures. Fractographic analysis indicated a regular failure pattern in the ZR group and irregular failure patterns in the other groups. Three-dimensional FEA revealed similar values and stress pattern distributions among the groups. CONCLUSIONS The mechanical performance of monolithic zirconia was better than that of the other ceramic endocrowns considered in this research; however, monolithic zirconia presented a higher rate of catastrophic tooth structure failure.
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Affiliation(s)
- Nereu Roque Dartora
- Postgraduate student, School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil
| | | | - Stephanie Francoi Poole
- Postgraduate student, School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil
| | - Ataís Bacchi
- Professsor, Meridional Faculty (IMED), School of Dentistry, Passo Fundo, Brazil
| | - Manoel Damião Sousa-Neto
- Professor, Department of Restorative Dentistry, Dental School of Ribeirão Preto, University of São Paulo (FORP-USP), Ribeirão Preto, Brazil
| | | | - Erica Alves Gomes
- Professor, School of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil.
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Turkistani AA, Dimashkieh M, Rayyan M. Fracture resistance of teeth restored with endocrowns: An in vitro study. J ESTHET RESTOR DENT 2019; 32:389-394. [PMID: 31743558 DOI: 10.1111/jerd.12549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the fracture resistance and failure mode of endodontically treated teeth restored with lithium disilicate endocrowns of different crown thicknesses. MATERIALS AND METHODS A total of 30 endodontically treated permanent mandibular first molars were sectioned horizontally 2 mm above the highest point of the cemento-enamel junction. The specimens were divided into three groups, and each group was restored with lithium disilicate (IPS e-max press) endocrowns of different crown thicknesses (3, 4.5, and 6 mm, respectively). After cementation, specimens were stored in room temperature for 72 hours, followed by subjecting them to compressive strength testing until failure. The fracture loads and the failure mode were recorded. Statistically analysis was performed using one-way analysis of variance. RESULTS A statistically significant difference was found in the fracture resistance between the three groups with the highest fracture resistance in the 3 mm group, followed by the 4.5 mm group, and the least in the 6 mm group (P < .05). Most of the failures were accompanied with tooth fracture (90% in 3 mm group, 100% in 4.5 mm group, and 80% in 6 mm group). CONCLUSIONS Increasing the crown thickness of the endocrowns reduced the fracture resistance of restored teeth. Minimum fracture loads for all teeth restored with endocrowns were significantly higher than the maximum occlusal forces reported in the literature. CLINICAL SIGNIFICANCE Fracture resistance and mode of failure of lithium disilicate (IPS e-max press) endocrowns varies widely between crown thicknesses. Clinicians should be cautious with crown thickness for endocrown restorations.
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Affiliation(s)
| | | | - Mohammed Rayyan
- Prosthodontic Department, Riyadh Elm University, Riyadh, Saudi Arabia
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Tribst JPM, Dal Piva AMDO, Madruga CFL, Valera MC, Bresciani E, Bottino MA, de Melo RM. The impact of restorative material and ceramic thickness on CAD\CAM endocrowns. J Clin Exp Dent 2019; 11:e969-e977. [PMID: 31700569 PMCID: PMC6825739 DOI: 10.4317/jced.56002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022] Open
Abstract
Background Endocrown restorations as a conservative approach to restore endodontically treated teeth still need in vitro investigation under fatigue and made in different materials. This study evaluated the effect of restorative material and restoration thickness on the maximum fracture load of endocrowns subjected to cyclic loading. Material and Methods Sixty (60) third molar teeth received an endocrown preparation with three different heights of remaining dental tissue (1.5, 3.0 or 4.5 mm). A leucite-based ceramic (LEU) and a lithium disilicate (LD) based ceramic were selected to manufacture the CAD/CAM endocrown restorations, totaling 6 groups (n=10). The specimens were subjected to fatigue loading (200N, 2 x 106 cycles, water) and then to the single load to failure test (1 mm/min crosshead speed). Data were analyzed by using two-way ANOVA and Tukey tests (p< 0.05). Results All endocrowns survived the fatigue test. The thickness did not influence the restoration’s fracture load (p=0.548) instead the restorative material (p=0.003). LD showed higher mean values (1714.43 N)A than LEU (1313.47 N)B. Conclusions Endocrowns manufactured with CAD/CAM lithium disilicate blocks showed superior fracture load than the leucite-based blocks after mechanical fatigue. Nevertheless, both materials presented acceptable survival and fracture load as long as the material’s minimum thickness and the enamel adhesion are respected. Key words:Endocrown, CAD/CAM, Endodontically treated teeth, Failure load, Minimal intervention dentistry.
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Affiliation(s)
- João-Paulo-Mendes Tribst
- DDs, MSc, PhD Student in Prosthodontics, Department of Dental Materials and Proshodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos / SP, Brazil
| | - Amanda-Maria-de Oliveira Dal Piva
- DDs, MSc, PhD Student in Prosthodontics, Department of Dental Materials and Proshodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos / SP, Brazil
| | - Camila-Ferreira-Leite Madruga
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777, Jardim São Dimas, 12245-000 São José dos Campos, SP, Brazil
| | - Marcia-Carneiro Valera
- Department of Restorative Dentistry, São Paulo State University (Unesp), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777, Jardim São Dimas, 12245-000 São José dos Campos, SP, Brazil
| | - Eduardo Bresciani
- Department of Restorative Dentistry, São Paulo State University (Unesp), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777, Jardim São Dimas, 12245-000 São José dos Campos, SP, Brazil
| | - Marco-Antonio Bottino
- DDs, MSc, PhD, Professor, Department of Dental Materials and Proshodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos / SP, Brazil
| | - Renata-Marques de Melo
- DDs, MSc, PhD, Researcher III, Department of Dental Materials and Proshodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos / SP, Brazil
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Zhai XY, Zhang JY, Zhang SK, Jiang CJ, Qiu XX. [Finite-element analysis of mandibular first molar with two marginal designs of endocrown for the repair of different defects]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:480-484. [PMID: 31721493 PMCID: PMC7030409 DOI: 10.7518/hxkq.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/21/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the stress distribution of the mandibular first molar with different thicknesses and heights of the axial wall restored by the endocrown with two marginal designs and thus provide a theoretical basis for selecting clinical preparation through the finite-element method. METHODS Two marginal endocrowns of the mandibular first molar with different axial-wall thicknesses (t=1, 2, 3 mm) and heights (h=2, 3, 4 mm) were established. Group A was the butt-joint design, whereas group B was the shoulder-surrounded design. After applying vertical and oblique loads , the size and distribution of the maximum principal stress and equivalent stress of residual tooth tissue were recorded. RESULTS The maximum principal stress and equivalent stress distribution of residual tooth tissue were similar among different models. Group A showed a lower maximum principal stress and equivalent stress than group B at the same thickness and height under vertical load. Meanwhile, under oblique load, the maximum principal stress values of groups A and B decreased with increased thickness at constant height. Group A showed lower equivalent stress than group B at the same thickness and height of 2 and
3 mm. However, when the height was 4 mm, the trend was reversed. CONCLUSIONS In mastication, when bearing the vertical force, the retention of the butt-joint marginal endocrown preferred to the shoulder-surrounded one. Given the higher axial wall of the shoulder-surrounded marginal endocrown, it showed better ability to bear the oblique force than the butt-joint one.
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Affiliation(s)
- Xiao-Yang Zhai
- Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Stomatological College of Zhengzhou University, Zhengzhou 450052, China
| | - Jing-Ya Zhang
- Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Stomatological College of Zhengzhou University, Zhengzhou 450052, China
| | - San-Ke Zhang
- Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Stomatological College of Zhengzhou University, Zhengzhou 450052, China
| | - Chuan-Jing Jiang
- Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Stomatological College of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Xia Qiu
- Dept. of Prosthodontics, The First Affiliated Hospital of Zhengzhou University, Stomatological College of Zhengzhou University, Zhengzhou 450052, China
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Sun J, Ruan W, He J, Lin X, Ci B, Yin S, Yan W. Clinical efficacy of different marginal forms of endocrowns: study protocol for a randomized controlled trial. Trials 2019; 20:454. [PMID: 31340845 PMCID: PMC6657076 DOI: 10.1186/s13063-019-3530-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background After root canal treatment, most tooth defects need to be restored. Onlay restoration is widely used to restore dental defects. Endocrown is a new type of onlay; however, dentists have yet to obtain a full understanding of the clinical effects of marginal forms of endocrowns. Here, we present a multicenter protocol to compare the clinical efficacy of two marginal forms (flat and 90-degree shoulder) for tooth restoration. The efficacy will be evaluated by marginal fit, marginal discoloration, and integrity of restoration. Methods The proposed flat and 90-degree shoulder marginal endocrown assessment trial is an open-label, parallel-group, multicenter randomized controlled trial involving two hospitals. A total of 200 patients will be included in this trial, and the following patient inclusion criteria will be applied: good oral hygiene habits, no periodontal diseases, receipt of standard root canal treatment, and need for endocrown restoration. Patients will be enrolled after providing signed informed consent and will be divided into two groups (flat and 90-degree shoulder endocrown) in accordance with a random number table. Treatment allocation will be balanced (1:1). Endocrowns will be cemented by dual-cured luting composite. Clinical evaluations will be performed at baseline and at 24 months after treatment in accordance with modified US Public Health Service criteria by two independent evaluators. The primary outcome will be marginal fit; secondary outcome measures will include debonding, marginal discoloration, and integrity of restoration. All acquired data will be analyzed by an independent statistician. Wilcoxon one-sample tests will be used for intra-group comparisons, and Wilcoxon two-sample tests will be used for inter-group comparisons. The Bonferroni method will be used to correct for multiple comparisons, and hierarchical logistic regression will be applied to determine central effects. Discussion The results of this trial will provide a clinical basis for clinicians to restore teeth by endocrowns and to improve long-term restoration for patients. Trial registration ClinicalTrials.gov identifier: NCT03398395. Registered on 12 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3530-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jieli Sun
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Wenhao Ruan
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Jiahui He
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Xiaoyu Lin
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Bowen Ci
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Siye Yin
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China
| | - Wenjuan Yan
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Rd, Guangzhou, 510515, China.
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Gulabivala K, Ng YL. Value of root-filled teeth in maintaining a functional dentition for life. Br Dent J 2019; 226:769-784. [DOI: 10.1038/s41415-019-0313-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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El Ghoul W, Özcan M, Silwadi M, Salameh Z. Fracture resistance and failure modes of endocrowns manufactured with different CAD/CAM materials under axial and lateral loading. J ESTHET RESTOR DENT 2019; 31:378-387. [DOI: 10.1111/jerd.12486] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/28/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Wiam El Ghoul
- Lebanese UniversityFaculty of Dental Medicine, Department of Prosthodontics Beirut Lebanon
| | - Mutlu Özcan
- University of ZurichCenter for Dental and Oral Medicine, Division of Dental Biomaterials Zurich Switzerland
| | - Munir Silwadi
- Lebanese UniversityFaculty of Dental Medicine, Department of Prosthodontics Beirut Lebanon
| | - Ziad Salameh
- Lebanese UniversityFaculty of Dental Medicine, Department of Prosthodontics Beirut Lebanon
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Ni N, Ye J, Wang L, Shen S, Han L, Wang Y. Stress distribution in a mandibular premolar after separated nickel-titanium instrument removal and root canal preparation: a three-dimensional finite element analysis. J Int Med Res 2019; 47:1555-1564. [PMID: 30678508 PMCID: PMC6460611 DOI: 10.1177/0300060518823630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study used finite element analysis (FEA) to assess the von Mises stresses of a mandibular first premolar after removing a separated instrument with an ultrasonic technique. Methods FEA models of the original and treated mandibular first premolar were reconstructed, and three models (the original canal, size 30/taper 0.04 canal, and separated instrument removal canal) were created. Two-direction (vertical and lateral) loading patterns were simulated with a 175-N force. The maximum von Mises stresses of the models within the roots from the apex to the cervical region were collected and summarized. Results Under vertical and lateral loads, all maximal values in the three models were localized in the straight-line access region. Compared with the original model (model 1), the treated models (models 2 and 3) had greater maximum stress values from the apex to the cervical region. Greater differences in the maximum von Mises stresses between models 2 and 3 were present in the straight-line access region. Conclusions Separated instrument removal caused changes in stress distribution and increases in stress concentration in the straight-line access region of roots.
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Affiliation(s)
- Na Ni
- 1 Department of Stomatology, Tianjin Hospital, Hexi District, Tianjin, China.,2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Jing Ye
- 1 Department of Stomatology, Tianjin Hospital, Hexi District, Tianjin, China
| | - Liyuan Wang
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Simin Shen
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Lei Han
- 3 Department of Radiology, Tianjin Stomatological Hospital, Heping District, Tianjin, China
| | - Yuxia Wang
- 2 Department of Endodontics, Tianjin Stomatological Hospital, Heping District, Tianjin, China
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Askerbeyli Örs S, Aksel H, Küçükkaya Eren S, Serper A. Effect of perforation size and furcal lesion on stress distribution in mandibular molars: a finite element analysis. Int Endod J 2018; 52:377-384. [DOI: 10.1111/iej.13013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- S. Askerbeyli Örs
- Department of Endodontology Faculty of Dentistry Hacettepe University Sıhhiye Ankara Turkey
| | - H. Aksel
- Department of Endodontology Faculty of Dentistry Hacettepe University Sıhhiye Ankara Turkey
| | - S. Küçükkaya Eren
- Department of Endodontology Faculty of Dentistry Hacettepe University Sıhhiye Ankara Turkey
| | - A. Serper
- Department of Endodontology Faculty of Dentistry Hacettepe University Sıhhiye Ankara Turkey
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Endocrown: An Alternative Approach for Restoring Endodontically Treated Molars with Large Coronal Destruction. Case Rep Dent 2018; 2018:1581952. [PMID: 30228915 PMCID: PMC6136487 DOI: 10.1155/2018/1581952] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 12/03/2022] Open
Abstract
Rehabilitation of endodontically treated molar still remains a challenge. After endodontic treatment, molars lost their mechanical characteristics. In fact, they became fragile and that is in relation with the removal of pulp and surrounding dentin tissues. Endocrown which is a single partial restoration could be considered as a good alternative for restoring molars having large coronal destruction and presenting endodontic treatment difficulties. Through this work, we discuss the indication and use of endocrown to replace single crowns with intraradicular retention and to present a clinical case report of an endocrown-type restoration, fabricated from lithium disilicate ceramic (IPS e.Max CAD) in a mandibular first molar with extensive coronal destruction.
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Krance A, DuVall N, Brewster J, Roberts H. Fracture resistance of all-ceramic crowns based on different preparation designs for restoring endodontically treated molars. J ESTHET RESTOR DENT 2018; 31:72-79. [PMID: 30144367 DOI: 10.1111/jerd.12410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/27/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate endodontically treated molar fracture resistance restored with CAD/CAM lithium disilicate (LDS) crowns with different amalgam core preparation design. MATERIALS AND METHODS Eighty-four recently extracted mandibular third molars were divided into seven groups (n = 12) and embedded in autopolymerizing resin. Coronal tooth structure was removed, pulp chamber exposed, and pulpal remnants removed. One group received LDS endocrowns, while three groups received amalgam cores with 2, 1, and 0 dentin axial wall heights (AWH). Three additional groups were likewise restored using an amalgam adhesive. Scanned preparations were restored with LDS crowns luted with a self-adhesive luting cement. After 24 hours, specimens were loaded to failure with results analyzed with Welch's Test/REGW Range Test at a 95% level of confidence (α = 0.05). RESULTS The 1 mm-AWH amalgam core group had the highest failure load and was similar to the 2 mm-AWH amalgam, 2 mm-AWH bonded amalgam, and the 1 mm-AWH bonded amalgam core groups. The endocrowns had lower failure load than the 1 mm and 2 mm AWH amalgam groups but was similar to other groups. CONCLUSIONS Adhesively luted LDS crowns with amalgam core preparations overall displayed similar failure load, as endocrown restorations. However, crowns based on amalgam cores demonstrated favorable failure modes. CLINICAL SIGNIFICANCE The results of this in vitro test suggests that when suitable tooth structure and sufficient interact restorative space exists, endodontically treated molars restored with lithium disilicate complete crowns based on preparations with amalgam core foundations containing 1 mm and 2 mm of dentin axial wall height could serve as a suitable restorative option that may provide more recoverable failure modes than endocrown restorations.
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Affiliation(s)
- Aaron Krance
- Dental Flight Commander, Dover Air Force Base, Delaware
| | | | - John Brewster
- Graduate Dental Research, USAF Postgraduate Dental School, Keesler, AFB, Mississippi
| | - Howard Roberts
- Division of Restorative Dentistry, University of Kentucky College of Dentistry, Lexington, Kentucky
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Dartora NR, de Conto Ferreira MB, Moris ICM, Brazão EH, Spazin AO, Sousa-Neto MD, Silva-Sousa YT, Gomes EA. Effect of Intracoronal Depth of Teeth Restored with Endocrowns on Fracture Resistance: In Vitro and 3-dimensional Finite Element Analysis. J Endod 2018; 44:1179-1185. [DOI: 10.1016/j.joen.2018.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 03/28/2018] [Accepted: 04/08/2018] [Indexed: 11/16/2022]
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Hayes A, Duvall N, Wajdowicz M, Roberts H. Effect of Endocrown Pulp Chamber Extension Depth on Molar Fracture Resistance. Oper Dent 2018; 42:327-334. [PMID: 28467258 DOI: 10.2341/16-097-l] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of endocrown pulp chamber extension on mandibular molar fracture resistance. METHODS AND MATERIALS A total of 36 recently extracted mandibular third molars of approximate equal size were sectioned at the facial lingual height of contour followed by endodontic access into the pulp chamber. The specimens were then randomly divided into three groups (n=12) and pulpal and root canal contents removed. Pulp chamber floors were established at 2, 3, and 4 mm from the occlusal table using a three-step etch-and-rinse adhesive and a flowable resin composite. The prepared specimens were then embedded in auto-polymerizing denture base resin with surface area available for adhesive bonding determined using a digital recording microscope. Specimens were restored using a standardized template with a chairside computer-aided design/computer-aided manufacturing unit with the endocrown milled from a lithium disilicate glass-ceramic material. Restoration parameters of occlusal table anatomy and thickness were standardized with the only parameter difference being the pulp chamber extension depth. The endocrown restorations were luted with a self-adhesive resin luting agent and tested to failure after 24 hours on a universal testing machine, with force applied to the facial cusps at a 45° angle to the long axis of the tooth. The failure load was converted into stress for each specimen using the available surface area for bonding. Mean failure load and stress among the three groups was first subjected to the Shapiro-Wilk and Bartlett tests and then analyzed with an analysis of variance with the Tukey post hoc test at a 95% confidence level (p=0.05). RESULTS The 2- and 4-mm chamber extension groups demonstrated the highest fracture resistance stress, with the 3-mm group similar to the 2-mm group. The 3- and 4-mm chamber extension group specimens demonstrated nearly universal catastrophic tooth fracture, whereas half the 2-mm chamber extension group displayed nonrestorable root fractures. CONCLUSIONS Under the conditions of this study, mandibular molars restored with the endocrown technique with 2- and 4-mm pulp chamber extensions displayed greater tooth fracture resistance force as well as stress. All groups demonstrated a high number of catastrophic fractures, but these results may not be clinically significant because the fracture force results are higher than normal reported values of masticatory function.
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Kanat-Ertürk B, Saridağ S, Köseler E, Helvacioğlu-Yiğit D, Avcu E, Yildiran-Avcu Y. Fracture strengths of endocrown restorations fabricated with different preparation depths and CAD/CAM materials. Dent Mater J 2018; 37:256-265. [PMID: 29311428 DOI: 10.4012/dmj.2017-035] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objectives of this study were to compare the fracture strength of endocrown restorations fabricated with different preparation depth and various CAD/CAM ceramics, and to assess the fracture types. Endodontically treated 100 extracted human permanent maxillary centrals were divided into two preparation depth groups as short (S: 3-mm-deep) and long (L: 6-mm-deep), then five ceramic subgroups, namely: feldspathic-ceramic (Vita Mark II-VM2), lithium-disilicate glass-ceramic (IPS e.max CAD-E.max), resin-ceramic (LAVA Ultimate-LU), polymer infiltrated ceramic (Vita Enamic-VE) and monoblock zirconia (inCoris TZI-TZI) (n=10/subgroup). The endocrowns were fabricated by CAD/CAM and were cemented with resin cement (RelyX U200). The teeth were thermally cycled (5,000cycles) and fracture tests were performed at 45º angle to the teeth. The data were statistically analyzed (Kruskal-Wallis, Mann Whitney U), failure modes were evaluated with stereomicroscopy. Zirconia group provided the statistically highest fracture strength, but also exhibited non-repairable failures. Preparation depth has an effect on the fracture strength only for feldspathic ceramic.
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Affiliation(s)
| | - Serkan Saridağ
- Department of Prosthodontics, Kocaeli University, Faculty of Dentistry
| | - Ege Köseler
- Department of Prosthodontics, Kocaeli University, Faculty of Dentistry
| | | | - Egemen Avcu
- Department of Machine and Metal Technologies, Kocaeli University, Ford Otosan İhsaniye Automotive Vocational School
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