Fatigue resistance of CAD/CAM resin composite molar crowns

Influence of Immediate Dentin Sealing on Bond Strength of Resin-Based CAD/CAM Restoratives to Dentin: A Systematic Review of In Vitro Studies

Immediate dentin sealing (IDS) is a method of improving the bond strength of indirect dental restorative materials to dentin and belongs to the biomimetic protocols of contemporary dentistry. The purpose of this systematic review was to evaluate the effect of IDS on the bond strength of resin-based CAD/CAM materials to dentin. PubMed and MEDLINE, Scopus, and the Web of Science were searched by two individual researchers, namely for studies that have been published in English between 1 January 2005 and 31 December 2023 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The inclusion criteria encompassed articles related to in vitro studies, measuring the bond strength through microtensile bond strength (μ-TBS), micro-shear bond strength (μ-SBS), tensile bond strength (TBS) or shear bond strength (SBS) tests after the use of the IDS technique. The included restorative materials comprised resin-based CAD/CAM materials bonded to dentin. A total of 1821 studies were identified, of which 7 met the inclusion criteria. A meta-analysis was not deemed appropriate due to the high level of diversity inthe publications and techniques. The use of IDS yielded higher bond strength outcomesin various experimental conditions and resin-based CAD/CAM materials. Overall, IDS in CAD/CAM restorations may contribute to better clinical outcomesand improved restoration longevity due to this property.

The Impact of Technology Teaching in the Dental Predoctoral Curriculum on Students' Perception of Digital Dentistry

The goal was to assess dental students' perception of digital technologies after participating in a CAD/CAM exercise for scanning, designing, and manufacturing computer-aided provisional fixed dental restorations. A survey was conducted among second- (pre-D2 and post-D2), first- (D1, negative control), third-, and fourth-year dental students (D3 and D4, positive controls). Only OSU College of Dentistry students who completed the activity and completed the surveys were included. Seven questions were rated, which evaluated changes in knowledge, skill, interest, the importance of technology availability in an office, patients' perception of technology, the importance of having the technology, and the expected frequency of clinics utilizing the technology. Statistical analysis was performed with a significance level of 0.05. A total of 74 pre-D2 and 77 post-D2 questionnaires were completed. Additionally, 63 D1, 43 D3, and 39 D4 participants responded to the survey. Significant differences were found for "knowledge" and "skill" between the pre-D2 and post-D2 and pre-D2 and control groups (p < 0.001). There was a significant difference between the post-D2 participants and all the controls in terms of "interest" (p = 0.0127) and preference for in-practice technology availability (p < 0.05). There were significant results between the post-D2 participants and all the controls regarding the importance of technology availability in an office (p < 0.001) and the expected frequency of clinics utilizing the technology (p = 0.01). No significance was found for "value of technology to patients" and "the importance of having the technology". The presence of technology in practice and in educational academic environments significantly improved students' interest and perception of their knowledge and skill.

CAD-CAM resin composites: Effective components for further development

OBJECTIVE

This paper summarizes the effective components of computer-aided design and computer-aided manufacturing (CAD-CAM) resin composites that contribute to achieving greater mechanical properties and further development.

METHODS

In silico multi-scale analysis, in silico nonlinear dynamic finite element analysis (FEA), and artificial intelligence (AI) were used to explore the effective components of CAD-CAM resin composites. The effects of the filler diameter and silane coupling ratio on the mechanical properties of CAD-CAM resin composites have been clarified through multi-scale analysis. The effects of the filler contents, and filler and monomer compositions have been investigated by AI algorithms. The fracture behavior of CAD-CAM composite crown was analyzed using in silico non-linear dynamic FEA. The longevity of CAD-CAM composite crown was assessed through step-stress accelerating life testing (SSALT).

RESULTS

As the filler diameter decreases, there is an increase in elastic moduli and compressive strengths at the macroscale. At the nanoscale, a decrease in the filler diameter results in a decrease in the maximum value of the maximum principal strain. When the silane coupling ratio decreases, there is a decrease in the elastic modulus and compressive strength. According to the exhaustive search and feature importance analysis based on the AI algorithm, the combination of certain components was narrowed down to achieve a flexural strength of 269.5 MPa. The in silico non-linear FEA successfully detected the sign of the initial crack of the CAD-CAM composite molar crown. The SSALT revealed that CAD-CAM resin composite molar crowns containing nanofillers with a high fraction of resin matrix demonstrated great longevity.

SIGNIFICANCE

This paper summarized the effective components of CAD-CAM resin composites for their further development. The integration of in vitro and in silico approaches will expedite the advancement of CAD-CAM resin composites, offering benefits such as time efficiency and reduction of material waste for researchers and manufacturers.

Effect of Thermo-mechanical Cycling on Fracture Resistance of Different CAD/CAM Crowns: An In Vitro Study

AIM

To evaluate the effect of thermo-mechanical cycling (TMC) on fracture resistance of different computer-aided design/computer-aided manufacture (CAD/CAM) crowns.

MATERIALS AND METHODS

A total of 42 CAD/CAM crowns were fabricated on epoxy resin maxillary first premolar teeth and divided into three groups (n = 14) according to the material used: IPS e.max CAD (Ivoclar Vivadent) lithium disilicate (LD), Vita ENAMIC (VE) (VITA Zahnfabrik), Tetric CAD (Ivoclar Vivadent). Also, each group was subdivided into two equal subgroups according to TMC (n = 7). Subgroups (O) without TMC and subgroup (W) with TMC (5-55°C, 30 second, 75,000 cycles). All samples in each group were cemented with a universal bond (Tetric N bond universal) and adhesive resin cement (Variolink Esthetic DC) (Ivoclar Vivadent). Subsequently, the samples were loaded to failure in a universal testing machine at a crosshead speed of 1 mm/min, and the fracture pattern and the fracture resistance in each group were recorded.

RESULTS

Fracture resistance was analyzed by one-way analysis of variance (ANOVA) test, followed by Tukey's post hoc test for pairwise comparison. Fracture resistance showed a significant difference between the tested groups before and after TMC; IPS e.max CAD has the highest value (1233.35 ± 97.72, 1165.73 ± 199.54 N) followed by Tetric CAD (927.62 ± 42.5, 992.04 ± 53.46 N) and Vita ENAMIC has lowest value (506.49 ± 74.24, 354.69 ± 90.36 N).

CONCLUSION

Thermo-mechanical cycling affected the fracture resistance of both polymer-based CAD/CAM crowns.

CLINICAL SIGNIFICANCE

For dental practitioners, both IPS e.max CAD and Tetric CAD can be used clinically for posterior teeth, providing satisfactory results and resistance to fracture. How to cite this article: Elmokadem MI, Haggag KM, Mohamed HR. Effect of Thermo-mechanical Cycling on Fracture Resistance of Different CAD/CAM Crowns: An In Vitro Study. J Contemp Dent Pract 2024;25(1):29-34.

Tensile bond strength of CAD-CAM all ceramic crowns before and after thermomechanical aging

PURPOSE

The purpose of this in vitro study was to compare the tensile bond strength (TBS) of resin nanoceramics (RNC), zirconia, and lithium disilicate (LS2) restorations cemented to titanium abutments before and after thermomechanical aging.

MATERIALS AND METHODS

Twelve specimens per group were fabricated to determine the TBS between a titanium abutment and four types of crown materials (2 RNCs, LS2, and translucent zirconia crowns for the maxillary molar). After milling, the abutments and crowns were cemented with resin cement after air-particle abrasion. In addition, thermomechanical aging (200,000 cycles, 50 N, 2 Hz) was applied to half of the specimens by using a mastication simulator. TBS was measured by using a universal testing machine. The interface between the crown and the cement was observed by using scanning electron microscopy (SEM). Two-way ANOVA was performed to analyze the effects of crown materials and thermomechanical aging. Failure-mode and interface analyses were also conducted.

RESULTS

After thermomechanical aging, the TBS decreased in the LS2 specimens and increased in RNCs (p < 0.001). The ratio of mixed failure and debonding with the hole-sealing resin increased in the RNC group. SEM images showed the reduced gap between the crown and the resin cement after thermomechanical aging in the RNC group.

CONCLUSIONS

Differences in TBS were affected by the crown materials after thermomechanical aging. After thermomechanical aging, the RNC crowns showed increased TBS, whereas LS2 and zirconia crowns exhibited decreased or similar TBS.

Survival Rates of Glass versus Hybrid Ceramics in Partial Prosthetic Restorations: A Scoping Review with Emphasis on Adhesive Protocols

As dental practices and methodologies evolve, the emergence of novel materials adds complexity to clinical choices. While glass ceramics, particularly those based on lithium disilicate and leucite-reinforced variants, have been extensively researched and are well regarded for their attributes, hybrid ceramics remain relatively recent area of research that is less investigated. This review aims to evaluate the durability of glass and hybrid ceramics while assessing the role of various adhesive techniques on restoration longevity. Using a comprehensive search of PubMed and EMBASE, 84 articles from the past decade were found. Only eleven met the set criteria for analysis. The results underscore the urgent need for the extended monitoring of partial prosthetic restorations. The existing literature has significant gaps, hindering the attainment of dependable insights about these materials' long-term performance. For a clearer understanding of how different ceramic systems affect restoration survival rates, rigorous research involving more participants and uniform outcome documentation is vital.

In vitro evaluation of CAD/CAM composite materials

OBJECTIVES

The purpose of this in vitro study was to evaluate the microstructural, elemental and mechanical properties of contemporary computer-aided-design/computer-aided manufacturing (CAD/CAM) resin based composite (RBC) materials.

METHODS

Six CAD/CAM RBC materials [Brilliant CRIOS (Coltene Whaledent AG), Cerasmart (GC), Lava Ultimate (3M ESPE), Tetric CAD (Ivoclar Vivadent), Shofu Block HC (Shofu), Grandio Blocs (VOCO GmbH)] were tested. Ten rectangular blocks (14 Χ 12 Χ 18 mm) for each material, after metallographic grinding and polishing, were subjected to Instrumented Indentation Testing (ΙIT). Martens Hardness (HM), Indentation Elastic Modulus (EIT), Elastic (ηIT) and Creep indices (CIT) were determined according to formulas provided by ISO 14577. The diagonal length of each indentation was measured and HV was determined. The results of HM, EIT, ηΙΤ, HV, and CIT were statistically analyzed by one-way ANOVA and Tukey post hoc test employing the material as a discriminating variable (a = 0.05), while the possible correlations were determined by Spearman's correlation test. One specimen from each group was examined by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX).

RESULTS

Backscattered Electron images and EDX analysis demonstrated differences in size, shape and type of fillers along with elemental composition among materials tested. Statistical significant differences were identified for all mechanical properties tested. Grandio Blocs had the significantly higher HM (953±7 N/mm2), HV (136±1) and EIT (23±1 GPa) followed by Lava Ultimate (ΗM=674±25 N/mm2, HV=105±2, EIT=15±1 GPa). Elastic index ranged from 41% to 52%, with Shofu Block demonstrating the significantly highest ηIT (52 ± 1%) values. Cerasmart had significantly higher CIT value (8.4 ± 0.1%) than all other materials tested, while Grandio Blocs and Lava Ultimate had the lowest ones. Spearman's correlation revealed that all mechanical properties tested exhibited correlations with each other, apart from ηΙΤ.

CONCLUSIONS

The results showed that the CAD/CAM materials tested have differences in their microstructure, elemental composition and mechanical properties.

CLINICAL SIGNIFICANCE

The RBCs tested showed significant differences in mechanical properties and thus differences in clinical performance are anticipated. RBCs with increased filler loading had the most favorable combination of hardness, elastic modulus and creep index indicating that these materials may have better clinical performance under intraoral loading conditions.

The fracture resistance of 3D-printed versus milled provisional crowns: An in vitro study

BACKGROUND

CAD/CAM has considerably transformed the clinical practice of dentistry. In particular, advanced dental materials produced via digital technologies offer unquestionable benefits, such as ideal mechanical stability, outstanding aesthetics and reliable high precision. Additive manufacturing (AM) technology has promoted new innovations, especially in the field of biomedicine.

AIMS

The aim of this study is to analyze the fracture resistance of implant-supported 3D-printed temporary crowns relative to milled crowns by compression testing.

METHODS

The study sample included 32 specimens of temporary crowns, which were divided into 16 specimens per group. Each group consisted of eight maxillary central incisor crowns (tooth 11) and eight maxillary molar crowns (tooth 16). The first group (16 specimens) was 3D printed by a mask printer (Varseo, BEGO, Bremen, Germany) with a temporary material (VarseoSmile Temp A3, BEGO, Bremen, Germany). The second group was milled with a millable temporary material (VitaCAD Temp mono-color, Vita, Bad Säckingen, Germany). The two groups were compression tested until failure to estimate their fracture resistance. The loading forces and travel distance until failure were measured. The statistical analysis was performed using SPSS Version 24.0. We performed multiple t tests and considered a significance level of p <0.05.

RESULTS

The mean fracture force of the printed molars was 1189.50 N (±250.85) with a deformation of 1.75 mm (±0.25). The milled molars reached a mean fracture force of 1817.50 N (±258.22) with a deformation of 1.750 mm (±0.20). The printed incisors fractured at 321.63 N (±145.90) with a deformation of 1.94 mm (±0.40), while the milled incisors fractured at 443.38 N (±113.63) with a deformation of 2.26 mm (±0.40). The milled molar group revealed significantly higher mechanical fracture strength than the 3D-printed molar group (P<0.001). However, no significant differences between the 3D-printed incisors and the milled incisors were found (p = 0.084). There was no significant difference in the travel distance until fracture for both the molar group (p = 1.000) and the incisor group (p = 0.129).

CONCLUSION

Within the limits of this in vitro investigation, printed and milled temporary crowns withstood masticatory forces and were safe for clinical use.

Degree of conversion and residual monomer elution of 3D-printed, milled and self-cured resin-based composite materials for temporary dental crowns and bridges

The aim of this work was to investigate the elution of residual monomers as a function of the manufacturing process, which are CAD/CAM manufacturing, self-curing and 3D printing. The experimental materials used consisted of the base monomers TEGDMA, Bis-GMA and Bis-EMA and 50 wt.% fillers. Additionally, a 3D printing resin without fillers was tested. The elution of the base monomers into the different media (water, ethanol and ethanol/water (75/25 vol. %)) at 37 °C over a period of up to 120 d as well as the degree of conversion (DC) by FTIR were investigated. No monomer elution could be detected in water. Most residual monomers in both other media were released from the self-curing material whereas the 3D printing composite released relatively little. The CAD/CAM blanks released hardly any quantitatively detectable amounts of monomers. Relative to the base composition, TEGDMA eluted less than Bis-GMA and Bis-EMA. DC did not correlate with residual monomer release; thus, leaching was determined not only by the amount of residual monomers present but by further factors as possibly network density and structure. The CAD/CAM blanks and the 3D printing composite showed similar high DC but lower residual monomer release from the CAD/CAM blank, likewise the self-curing composite and the 3D printing resin exhibited similar DC but different monomer elution. In terms of residual monomer elution and DC, the 3D printing composite seems promising as a new material class for the use as temporary dental crowns and bridges.

Teeth Restored with Bulk–Fill Composites and Conventional Resin Composites; Investigation of Stress Distribution and Fracture Lifespan on Enamel, Dentin, and Restorative Materials via Three-Dimensional Finite Element Analysis

Objectives: the aim of this study was to examine the stress distribution of enamel, dentin, and restorative materials in sound first molar teeth with restored cavities with conventional resin composites and bulk–fill composites, as well as to determine their fracture lifetimes by using the three-dimensional finite element stress analysis method. Materials and Methods: an extracted sound number 26 tooth was scanned with a dental tomography device and recorded. Images were obtained as dicom files, and these files were transferred to the Mimics 12.00 program. In this program, different masks were created for each tooth tissue, and the density thresholds were adjusted manually to create a three-dimensional image of the tooth, and these were converted to a STL file. The obtained STL files were transferred to the Geomagic Design X program, and some necessary adjustments, such as smoothing, were made, and STP files were created. Cavity preparation and adhesive material layers were created by transferring STP files to the Solidworks program. Finally, a FE model was created in the ABAQUS program, and stress distributions were analyzed. Results: when the bulk–fill composite and conventional resin composite materials were used in the restoration of the cavity, the structures that were exposed to the most stress as a result of occlusal forces on the tooth were enamel, dentin, restorative material, and adhesive material. When the bulk–fill composite material was used in restoration, while the restorative material had the longest fracture life as a result of stresses, the enamel tissue had the shortest fracture life. When the conventional resin composite material was used as the restorative material, it had the longest fracture life, followed by dentin and enamel. Conclusion: when the bulk–fill composite material was used instead of the conventional resin composite material in the cavity, the stress values on enamel, dentin, and adhesive material increased as a result of occlusal forces, while the amount of stress on the restorative material decreased. In the fracture analysis, when the bulk–fill composite material was used instead of the conventional resin composite material, a decrease in the number of cycles required for the fracture of enamel, dentin, and restorative materials was observed as a result of the forces generated in the oral cavity.

AFM Analysis of a Three-Point Flexure Tested, 3D Printing Definitive Restoration Material for Dentistry

Background: Three-dimensional printing is a rapidly developing technology across all industries. In medicine recent developments include 3D bioprinting, personalized medication and custom prosthetics and implants. To ensure safety and long-term usability in a clinical setting, it is essential to understand material specific properties. This study aims to analyze possible surface changes of a commercially available and approved DLP 3D printed definitive restoration material for dentistry after three-point flexure testing. Furthermore, this study explores whether Atomic Force Microscopy (AFM) is a feasible method for examination of 3D printed dental materials in general. This is a pilot study, as there are currently no studies that analyze 3D printed dental materials using an AFM. Methods: The present study consisted of a pretest followed by the main test. The resulting break force of the preliminary test was used to determine the force used in the main test. The main test consisted of atomic force microscopy (AFM) surface analysis of the test specimen followed by a three-point flexure procedure. After bending, the same specimen was analyzed with the AFM again, to observe possible surface changes. Results: The mean root mean square (RMS) roughness of the segments with the most stress was 20.27 nm (±5.16) before bending, while it was 26.48 nm (±6.67) afterward. The corresponding mean roughness (Ra) values were 16.05 nm (±4.25) and 21.19 nm (±5.71) Conclusions: Under three-point flexure testing, the surface roughness increased significantly. The p-value for RMS roughness was p = 0.003, while it was p = 0.006 for Ra. Furthermore, this study showed that AFM surface analysis is a suitable procedure to investigate surface changes in 3D printed dental materials.

Influence of thermo-mechanical aging on fracture resistance and wear of digitally standardized chairside computer-aided-designed/computer-assisted-manufactured restorations

OBJECTIVES

To investigate the influence of thermal cycling and mechanical loading (TCML) aging on fracture resistance and wear behavior of various chairside computer-aided-designed/computer-assisted-manufactured (CAD/CAM) premolar crowns cemented on standardized tooth abutments.

METHODS

Eighty chairside CAD/CAM crowns were prepared using lithium disilicate (IPS e.max CAD; EM), zirconia-infiltrated lithium silicate (Celtra Duo; CD), polymer-infiltrated ceramic network (Vita Enamic; VE), and resin nanoceramics (Cerasmart; CS) (n = 20). The specimens were divided into two groups (n = 10). In one group, they were subjected to TCML: thermocycling (6000 cycles in distilled water at 5-55 °C) and mechanical loading (50 N for 1.2 × 10⁶ cycles), while in control group they were stored in distilled water (37 °C for 24 h). The fracture load, height loss, and volume wear of the crowns were measured after TCML. Fractography was performed on fractured specimens. Data were analyzed using analysis of variance and multiple comparison tests (α=0.05).

RESULTS

The mean fracture loads of EM and CD were significantly higher than those of EC and CS (p<0.05). There was no significant change in the fracture load of any CAD/CAM crowns after TCML (p>0.05). CS exhibited a significantly higher volume wear than the other materials investigated. The wear tracts of all TCML crowns acted as failure origins during the fracture test.

CONCLUSIONS

The fracture resistance of glass-ceramic CAD/CAM crowns was significantly higher than that of resin composite crowns. A 5-year TCML aging did not affect the fracture resistance of CAD/CAM crowns investigated. However, TCML treatment produces a larger wear track in CS than in other materials.

CLINICAL SIGNIFICANCE

Appropriate chairside CAD/CAM restorative material should be selected for successful clinical practice after considering the fracture and wear resistance of the crowns.

A brief review on fatigue test of ceramic and some related matters in Dentistry

The characteristics of dental ceramics have been extensively studied over the years to provide highly qualified materials for use in prosthetic restorations. The ability to adhere to dental substrates, outstanding aesthetics (translucency, color, and substrate masking ability) and improved mechanical properties provide these materials with optical features and high strength to withstand masticatory stimuli. Different classifications are adopted, and it is generally considered that glass-ceramics have better optical characteristics due to the high glass content, and polycrystalline ceramics have superior strength favored by their densified and organized crystals, hampering crack growth. This knowledge was largely built-up during years of scientific research through different testing methodologies, but mainly employing static loads. It is important to not only take into account the intensity of loads that these materials will be exposed to, but also the effect of the intermittence of cyclic load application leading to mechanical fatigue and the influence of factors related to the crack origin and their propagation under this condition. Furthermore, the bonding surface of ceramic restorations requires surface treatments that improve the bond strength to luting agents; however, these treatments require caution because of their potential to produce defects and affect the structural behavior. Moreover, ceramic restorations often require internal adjustments for proper seating or external adjustments for fitting the occlusal contact with the antagonist. In this sense, finishing/polishing protocols may alter the defect population, as luting agents may also interact by filling in the superficial defects on the restoration intaglio surface. Thus, the balance among all these factors will define the performance of a restorative setup, as well as the posterior exposure to the humid environment and the masticatory stimuli (cyclical loading), which may favor developing slow and subcritical growth of cracks in ceramic materials and the degradation of the bond interface. Therefore, it is essential that the concepts which explain the fatigue mechanism are understood, as well as the crack propagation and failure patterns of restorative ceramic materials.

Mechanical Properties, Wear Resistance, and Reliability of Two CAD-CAM Resin Matrix Ceramics

Background and Objectives: There are limited data regarding the behavior of resin matrix ceramics for current CAD-CAM materials. Further studies may be beneficial and can help clinicians planning to use these materials during prosthodontic rehabilitation. The aim of this study was to evaluate and compare the flexural strength and strain distributions, filler content, wear, and reliability of two resin matrix ceramic CAD-CAM materials. Materials and Methods: Two resin matrix ceramics, Ambarino High-Class (AH) and Vita Enamic (VE), were tested for flexural strength (n = 24), wear (n = 10), and reliability (n = 18). Thermogravimetric analysis was used to determine the percentage of filler by weight, and digital image correlation (DIC) was used for strain analysis in flexural strength test. Reliability of each resin matrix ceramic was compared after accelerated lifetime testing of crowns using a two-parameter Weibull distribution. Data of flexural strength, wear, and thermogravimetry were analyzed by independent t-tests with significance level at 5%. Results: The results of DIC analysis were analyzed by a qualitative comparison between the images obtained. The materials tested showed different flexural strength (p < 0.05) and strain distributions. The filler content was the same as informed by manufacturers. No difference was observed in the wear or reliability analysis (p > 0.05). The flexural strength of material AH was superior to VE, and the strain distribution was compatible with this finding. Conclusions: The two resin matrix ceramics tested showed similar behavior in wear and reliability analysis. Both can provide safe use for dental crowns.

The influence of aging on the fracture load of milled monolithic crowns

Background

This in-vitro study was conducted to assess the effect of aging on the fracture load of molar crowns fabricated with monolithic CAD/CAM materials.

Methods

The crown restorations were produced from Cerasmart, Vita Enamic, and IPS e.max CAD blocks. Aging was applied to the 10 samples each of monolithic CAD/CAM materials (n = 10). Dual-axis chewing simulator (50 N, 1.1 Hz, lateral movement: 1 mm, mouth opening: 2 mm, 1,200,000 cycles) and thermocycling (± 5–55 °C, 6000 cycles) were applied as an aging procedure. 10 samples each of monolithic CAD/CAM materials without aging (n = 10) were considered the control group. 6 tested groups were obtained. Then, all samples were evaluated in a universal testing machine to determine the fracture loading values’.

Results

There was not a statistically significant difference between the fracture load values before and after aging for all samples of Cerasmart, Vita Enamic, and IPS e.max CAD (p > 0.005). In a comparison of the monolithic materials together, a statistically significant difference was found between the fracture load values of IPS e.max CAD and Vita Enamic crowns before aging (p = 0.02). Also, Vita Enamic crowns (1978,71 ± 364,05 N) were found different from the IPS e.max CAD (p = 0.005) and Cerasmart crowns (p = 0.041) after aging.

Conclusions

Dynamic aging with 1.200.000 cycles was found to have no effect to fracture loading on milled Cerasmart, Vita Enamic, and IPS e.max CAD monolithic crowns.

Influence of Pre-Treatment and Artificial Aging on the Retention of 3D-Printed Permanent Composite Crowns

The aim of this in vitro study is to investigate the bonding properties of a 3D-printable permanent composite material in comparison to milled composite materials. The tested materials are 3D-printed BEGO VarseoSmile Crown plus (VA1_ab, VA1_nt, VA2_ab, VA2_nt), Vita Enamic (EN1, EN2), and 3M Lava Ultimate (UL1, UL2) (N = 64; n = 8). For this purpose, all crowns are luted to polymer tooth stumps #46 (FDI) using dual-curing luting composite, strictly according to the manufacturer’s instructions. VA1_ab and VA2_ab are additionally airborne-particle abraded. 4 groups (VA2_ab, VA2_nt, EN2, UL2) are artificially aged (1,200,000 cycles, 50 N, 10,000 thermocycles), whereby no specimen has failed. All 64 specimens undergo pull-off testing until retention loss. The mean forces of retention-loss is 786.6 ± 137.6 N (VA1_nt, *), 988.6 ± 212.1 N (VA2_nt, *, Ɨ), 1223.8 ± 119.2 N (VA1_ab, Ɨ, ǂ), 1051.9 ± 107.2 N (VA2_ab, *, Ɨ), 1185.9 ± 211.8 N (EN1, Ɨ, ǂ), 1485.0 ± 198.2 N EN2, ǂ), 1533.8 ± 42.4 N (UL1, ǂ), and 1521.8 ± 343.4 N (UL2, ǂ) (one-way ANOVA (Scheffé method); p < 0.05; *, Ɨ, ǂ: group distribution). No characteristic failure modes can be detected. In conclusion, all of the pull-off forces reflect retention values that seem to be sufficiently high for clinical use. Additional airborne-particle abrasion of VA does not result in significantly better retention but can be recommended.

Effect of Bonding Protocols on the Performance of Luting Agents Applied to CAD-CAM Composites

This in vitro study aimed to evaluate the effect of different bonding strategies on the micro-shear bond strength (μSBS) of luting agents to CAD−CAM composites. Surface scanning electron microscopy (SEM) and spectroscopy by energy-dispersive X-ray spectroscopy (EDS) were performed to analyze the surfaces of the composite before and after bonding treatment. Three CAD−CAM composites were evaluated: Lava Ultimate restorative (LU), Brava Blocks (BR), and Vita Enamic (VE). The LU and BR surfaces were sandblasted using aluminum oxide, while the VE surfaces were etched using a 5% hydrofluoric acid gel according to the manufacturers’ recommendations. All surfaces were subjected to the following bonding strategies (n = 15): adhesive with silane and MDP (ScotchBond Universal, 3M Oral Care, St Paul, MI, USA); adhesive with MDP (Ambar Universal, FGM, Joinville, Brazil); adhesive without silane or MDP (Prime&Bond Elect, Dentsply Sirona, Charlotte, NC, USA), pure silane without MDP (Angelus, Londrina, Brazil), and pure silane with MDP (Monobond N, Ivoclar Vivadent, Schaan, Liechtenstei). Afterwards, tygons were filled with RelyX Ultimate (3M Oral Care), AllCem (FGM), or Enforce (Dentsply Sirona), which were light-cured and subjected to the μSBS test. Data were analyzed using two-way ANOVA and Bonferroni’s post hoc test (α = 0.05). Additional blocks (n = 15) were subjected to scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) before and after the surface treatment. The μSBS values on VE surfaces were higher than those observed on LU and BR surfaces (p < 0.001). Silane without MDP (Allcem) promoted the highest μSBS values, while silane with MDP (RelyX Ultimate) provided the highest values among all bonding strategies (p < 0.001). Enforce promoted no significant difference in μSBS values. SEM and EDS analyses detected noticeable changes to the surface morphology and composition after the surface treatment. The effectiveness of the bonding strategy may vary according not only to the CAD−CAM composite but also to resin cement/bonding agent/silane used.

Bending moment of implants restored with CAD/CAM polymer-based restoration materials with or without a titanium base before and after artificial aging

OBJECTIVES

To test and compare two types of implant systems restored with four monolithic polymer-based materials with regard to their bending moments (BM) before and after aging.

METHODS

A total of 192 tissue-level implants (TRI Dental Implants) differing in the presence (TiB, Octa line, n = 96) or absence (NTiB, Matrix line, n = 96) of a titanium base were restored with mandibular right first molar crowns manufactured from composite (CC), polymer-infiltrated ceramic (VE), PMMA (PM) and a 3D printed resin (ND) (n = 24). Half of the specimens (n = 12) were loaded for 1,200,000 cycles (50 N, 1.3 Hz, TC: 5/55 °C, 6000×) and examined for failures. Fracture load was measured according to ISO standard 14801, BM was calculated, and fracture types were examined. Data were analyzed using parametric statistics (p < 0.05).

RESULTS

No failures were observed after 600,000 cycles. After 1,200,000 cycles, wear traces were recorded in all groups except PM, VE and CC on TiB implants. In group CC on NTiB implants, three specimens were rated zero in BM testing as they showed fracture of the screw. Regarding BM, TiB implants exhibited higher values than NTiB implants with aged CC (p = 0.023), aged PM (p < 0.001), initial PM (p = 0.011) and initial VE (p < 0.001). No differences occurred among the implant types with initial CC, initial ND, aged ND and aged VE. With regard to initial BM values, NTiB implants showed higher values for ND and CC compared with PM and VE (p < 0.001). No differences in initial BM values were found for the tested materials on TiB implants (p > 0.116). When aged, restoration material had no impact on the BM values of NTiB implants (p ≥ 0.233). Aged TiB implants showed higher values in combination with CC than with ND (p = 0.001). PM and VE showed similar values as ND and CC. Artificial aging led to a decrease of BM within PM, CC and ND on NTiB implants and ND on TiB implants. The majority of failures after testing were characterized by crown fractures in two to four pieces. Fractures in more pieces with smaller fragments occurred primarily for ND.

SIGNIFICANCE

The use of NTiB implants with the polymer-based materials tested can only be recommended for clinical use as interim prostheses. CC seems to show a positive effect on the BM. Clinical research investigating the in vivo behavior is necessary to confirm these findings.

Effects of Cuspal Inclination and Luting Agent on Fracture Load Values in Composite Resin CAD/CAM Crowns

The purpose of this study was to evaluate whether change in cuspal inclination influences the fracture load values of composite resin computer-aided design/computer-aided manufacturing (CAD/CAM) crowns. Abutment teeth and CAD/CAM crowns were prepared as they would be for treating a mandibular first premolar with two cusps. The CAD/CAM crowns were designed so that 1) the principal stress lines would be radially distributed from the two points of contact with the indenter to the occlusal area of the abutment (Type I), or 2) the principal stress lines would pass outside the occlusal area of the abutment (Types II and III). The CAD/CAM crowns were mounted on the abutments using one of two types of resin or polycarboxylate cement. Fracture load values were measured using a universal tester. The Type I CAD/CAM crowns exhibited the highest mean fracture load value, followed by the Type II crowns and then the Type III crowns, with significant differences seen between all types (p<0.05). The luting agent used (resin or polycarboxylate cement) showed no effect on the fracture load value. With the Type II and Type III crowns, significant differences in the fracture load value were observed between the Super-Bond and Hy-Bond polycarboxylate cement groups (p<0.05).

Effect of decontamination materials on bond strength of saliva-contaminated CAD/CAM resin block and dentin

The aim of this study was to evaluate the effect of decontamination agents against saliva contamination on the bonding of computer-aided design/computer-aided manufacturing (CAD/CAM) resin block. Three commercially available decontamination agents were used in this study. The samples were subjected to microtensile bond strength test. A saliva protein staining test was performed by the pigment binding method to investigate the effect of removing saliva protein. All the decontamination agents could significantly restore the bond strength from the saliva contamination, and KATANA Cleaner showed no significant difference with the control. From the results of the saliva protein staining test, KATANA Cleaner showed higher removal effect of saliva protein for CAD/CAM resin block surface than the other materials due to the surface active effect of MDP salt. It was suggested that cleaners containing MDP salt were more effective in removing artificial saliva contamination than cleaners containing other ingredients for CAD/CAM resin blocks.

Laboratory methods to simulate the mechanical degradation of resin composite restorations

OBJECTIVES

This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations.

METHODS

A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively.

RESULTS

The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used.

SIGNIFICANCE

Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided.

Restoration of Severely Damaged Endodontically Treated Premolars: Influence of the Ferrule Effect on Marginal Integrity and Fracture Load of Resin Nano-ceramic CAD-CAM Endocrowns

OBJECTIVES

To explore the ferrule effect on Resin Nano-Ceramic (RNC) premolar endocrown marginal integrity and fracture resistance.

METHODS

Thirty-six root-canal-treated premolars were cut 2 mm above the cemento-enamel junction (CEJ). They were restored with standardized RNC computer-aided design/computer-aided manufacturing (CAD/CAM) restorations (Lava Ultimate, 3M Oral Care, St. Paul, MN, USA) and divided into three groups (n=12): endocrowns with a 3-mm endo-core (Group 1), endocrowns with a 3-mm endo-core and a 2-mm ferrule (Group 2), and conventional post-and-core crowns with a 2-mm ferrule (Group 3). All specimens were submitted to thermo-mechanical cycling loading (TMCL) (1.7 Hz, 49 N, 600 000 cycles, 1500 thermocycles). Margins were analyzed before and after the TMCL. In the second part of the experiment, the surviving specimens were submitted to unidirectional monotonic loading until fracture. Fragments were then analyzed using scanning electron microscopy (SEM) and the fracture mode was established.

RESULTS

Endocrowns of Groups 1 and 2 performed better than conventional crowns (Group 3) in terms of marginal continuity. Differences in fracture load values within all groups were not statistically significant. Most of the specimens fractured in a non-repairable way.

CONCLUSIONS

The present test failed to provide evidence of any kind of difference between endocrowns with and without a ferrule in terms of load-bearing capacity and marginal integrity after fatigue. Further studies are needed to confirm the role of the ferrule in adhesive restorations of endodontically treated teeth.

Four-year clinical evaluation of CAD/CAM indirect resin composite premolar crowns using 3D digital data: Discovering the causes of debonding

PURPOSE

To analyze the causes of debonding of computer-aided design/computer-aided manufacturing (CAD/CAM) indirect resin composite premolar crowns with a focus on the morphological factors of the crown and abutment teeth.

METHODS

The clinical courses of 109 CAD/CAM indirect resin composite crowns were observed, and the patients' background characteristics, crown locations, luting methods, types of abutments, distal-most/non-distal-most molars, and types of resin blocks were confirmed. To investigate the influence of the morphology of the crown and abutment teeth, the 1) vertical dimension of the abutment teeth, 2) taper, and 3) thickness of the crown occlusal surface during events were measured from the three-dimensional digital data. The Kaplan-Meier method and multivariable Cox proportional hazard model were used for the statistical analyses. The nonlinearity of the effect of each comparison factor was included in the model.

RESULTS

Complications included 21 debonding cases, two crown fractures, five root fractures, and two core debondings. The cumulative no-debonding and no-crown-fracture rate over 1423 days (3 years and 11 months) was 77.4%. The multivariable Cox regression analysis revealed that the abutment teeth type of tooth (first or second premolar) (P = 0.02) and luting materials (P < 0.01) significantly influenced the debonding frequency. All morphological factors (1-3) significantly influenced the debonding. The hazard ratios and nonlinear graph indicated that the crown thickness was less effective than the vertical dimension and taper.

CONCLUSIONS

The combination analysis of clinical outcomes and 3D digital data revealed that preparation of the abutment is important for avoiding crown debonding.

Comparison of Mechanical Properties of Chairside CAD/CAM Restorations Fabricated Using a Standardization Method

The aim of this in vitro study was to investigate the fracture resistance, fracture failure pattern, and fractography of four types of chairside computer-aided design/computer-aided manufacturing (CAD/CAM) restoration materials in teeth and titanium abutments fabricated using a standardization method. An artificial mandibular left first premolar prepared for all-ceramic crown restoration was scanned. Forty extracted mandibular molars and cylindrical titanium specimens were milled into a standardized shape. A total of eighty CAD/CAM restoration blocks were milled into a crown and twenty pieces of each lithium disilicate (LS), polymer-infiltrated-ceramic-network (PICN), resin nano ceramic (RNC), and zirconia-reinforced lithium silicate (ZLS) materials were used. Crowns were bonded to abutments, and all specimens underwent thermal cycling treatment for 10,000 cycles. Fracture resistance was measured using a universal testing machine and fracture failure patterns were analyzed using optical microscopy and scanning electron microscopy. Statistical differences were analyzed using appropriate ANOVA, Tukey HSD post hoc tests, and independent sample t-tests (α = 0.05). The results indicated that, in both teeth abutments and titanium abutments, the fracture resistances showed significantly the highest values in LS and the second highest in ZLS (p < 0.05). The fracture resistances based on teeth abutments and titanium abutments were significantly different in all the CAD/CAM restoration materials (p < 0.05). There are statistically significant correlations between the types of materials and the types of abutments (p < 0.05). Each of the different materials showed different fracture failure patterns, and there was no noticeable difference in fractographic analysis. Lithium disilicates and zirconia-reinforced lithium silicates exhibited statistically high fracture resistance, indicating their suitability as restoration materials for natural teeth or implant abutments. There were no distinct differences in the fracture pattern based on the restoration and abutment materials showed that the fracture initiated at the groove where the ball indenter was toughed and propagated toward the axial wall.

Novel speed sintered zirconia by microwave technology

OBJECTIVE

Continuous efforts have been made to hasten the zirconia densification process without compromising properties. This study evaluated the long-term structural durability of microwave speed-sintered zirconia (MWZ) relative to a conventionally sintered zirconia (CZ).

METHODS

As-machined dental 3Y-TZP discs (Ø12 × 1.2 mm) were speed sintered at 1450 °C for 15 min using an industrial microwave oven, while conventional sintering was conducted in a standard dental furnace at 1530 °C for 2 h. Both were followed by natural cooling. The total sintering time was 105 min for MWZ and 600 min for CZ. Groups were compared regarding density, grain size, phase composition, and fracture resistance. Structural durability was investigated employing two fatigue protocols, step-stress and dynamic fatigue.

RESULTS

Compared to CZ, MWZ exhibited a slightly lower density (MWZ = 5.98 g/cm³, CZ = 6.03 g/cm³), but significantly smaller grain sizes (MWZ = 0.53 ± 0.09 μm, CZ = 0.89 ± 0.10 μm), lower cubic-zirconia contents (MWZ = 15.3%, CZ = 22.7%), and poorer translucency properties (TP) (MWZ = 13 ± 1, CZ = 29 ± 0.8). However, the two materials showed similar flexural strength (MWZ = 978 ± 112 MPa, CZ = 1044 ± 161 MPa). Additionally, step-stress testing failed to capture the fatigue effect in 3Y-TZP, whereas dynamic fatigue revealed structural degradation due to moisture-assisted slow-crack-growth (SCG). Finally, MWZ possessed a slightly higher Weibull modulus (MWZ = 7.9, CZ = 6.7) but similar resistance to SCG (MWZ = 27.5, CZ = 24.1) relative to CZ.

SIGNIFICANCE

Dental 3Y-TZP with similar structural durability can be fabricated six-times faster by microwave than conventional sintering.

Fracture load of zirconia implant supported CAD/CAM resin crowns and mechanical properties of restorative material and cement

PURPOSE

To test if resin CAD/CAM materials should be considered for zirconia implants and how their mechanical properties affect the fracture load.

METHODS

Fracture load of molar crowns of CAD/CAM materials (VITA CAD-Temp [CT], Cerasmart [CS], Lava Ultimate [LU], Pekkton Ivory [PK]) on zirconia implants (ceramic.implant, 4.0 mm) fixed either with no cement, temporary cement (Harvard Implant semi-permanent [HIS]), self-adhesive (VITA Adiva S-Cem [VAS]) or either one of two adhesive cements (Multilink Automix [MLA], VITA Adiva F-Cem [VAF]) was analyzed. The restorative materials were characterized by their flexural strength, fracture toughness, elemental composition and organic/inorganic ratio while compressive strength of the cements was measured.

RESULTS

For the fracture load significantly highest mean values were fo und overall for PK (2921 ±300 N) > LU (2017 ±499 N) > CS (1463 ±367 N) = CT (1451 ±327 N) (p > 0.05). When analyzing the effect of the cement on the fracture load the overall ranking was VAF (2245 ±650 N) ≥ MLA (2188 ±708 N) ≥ VAS (2017 ±563 N) > HIS (1757 ±668 N) = no cement (1595 ±757 N) (p <0.05), meaning fracture load increased with the compressive strength of the cements. Additionally, a linear trend was found between the fracture load and the fracture toughness of the restorative materials.

CONCLUSIONS

All restorative materials exhibited fracture load values similar or higher than lithium disilicate tested previously. Fracture load of CT, CS and LU can be significantly increased when an adhesive cement with a high compressive strength is used.

Influence of Tooth Mold Materials in Composite Resin CAD/CAM Crown Destructive Test

A range of experimental designs have been used in destructive testing of composite resin CAD/CAM crowns. Various materials have been adopted for the abutment in such tests, including human or bovine dentin, stainless steel, PMMA, and composite resin, the selection of which is made in accordance with study objective or preference of the researcher. The purpose of this study was to determine how the material selected for the abutment material affected fracture load and maximum displacement. Destructive tests were conducted on composite resin crowns of the same design. Three types of material were used for the abutments together with 2 types of adhesive material. Images of each sample were acquired before destruction using a microfocus X-ray CT scanner to confirm the feasibility of a non-destructive test.The load required to fracture the composite CAD/CAM resin crowns depended on the abutment material used, with a decrease being observed in the order of composite resin, stainless steel, and PMMA. Maximum displacement decreased in the order of PMMA, composite resin, and stainless steel. Differences in the material used for setting (adhesive resin or polycarboxylate cement) showed no effect on fracture load. These results indicate that the load required to achieve destruction of resin CAD/CAM crowns varies according to the abutment material used.

Correlation between 2D and 3D measurements of cement space in CAD-CAM crowns

STATEMENT OF PROBLEM

Although the 2D analysis of prosthesis cementation space has been popular, its correlation with volumetric comparison (3D data) of cement space is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the cement space in computer-aided design and computer-aided manufacturing (CAD-CAM) crowns of different materials and correlate 2D measurements of cement space with their corresponding 3D values (volume of cement space) by using microcomputed tomography (μCT) analysis of regions of interest.

MATERIAL AND METHODS

Ten molar crowns were milled in lithium disilicate (LD), resin nanoceramic (RN), and zirconia (Z) ceramics. Silicone replicas were produced and used as the analog cement layer and scanned with a desktop X-ray microfocus CT scanner. Twenty-eight slices were evaluated in 3 regions: marginal, axial, and occlusal (n=84 measurement points/specimen). After 3D reconstruction of the cement space, the volume was calculated. Data were statistically evaluated through 2-way ANOVA and Bonferroni test (α=.05). The Pearson correlation test was used to investigate the correlation between the 2D and 3D data.

RESULTS

The volumes of the occlusal (LD 10 ±1 mm³; RN 9 ±1 mm³) and axial regions (LD 9 ±2 mm³; RN 8 ±1 mm³) were significantly higher than the volume of the marginal region for LD and RN specimens (LD 6 ±2 mm³; RN 4 ±1 mm³) (both P<.001). For the Z group, the axial region had the highest volume (19 ±2 mm³), followed by the volumes of the occlusal (15 ±1 mm³) and marginal regions (12 ±1 mm³). The Pearson correlation test determined a moderate positive correlation of the marginal area (r=0.606, P<.001) and of the axial region (r=0.588, P<.001). However, a moderate negative correlation was found between volume and thickness of the occlusal area (r=-0.437, P=.016).

CONCLUSIONS

Z showed more volume of cement space, as well as thicker cement space than LD and RN. The μCT analysis is an efficient method of analyzing cement thickness and volume in ceramic crowns at the selected regions of interest. A moderate positive correlation was found between the 2D and 3D analyses for the axial and marginal regions of ceramic crowns.

Influence of resin-coating on bond strength of resin cements to dentin and CAD/CAM resin block in single-visit and multiple-visit treatment

The purpose of this study was to evaluate the influence of resin-coating using one-bottle adhesives on the bond strength of resin cements in single-visit and multiple-visit treatments. Three one-bottle adhesives were used for resin-coating and/or pre-treatment adhesives prior to cementation, in conjunction with resin cements from the same manufacturers: Clearfil Universal Bond Quick with Panavia V5 (UBQ/Pv5), Scotchbond Universal Adhesive with RelyX Ultimate (SBU/RxU), and Optibond All-in-one with NX3 Nexus (OP/NX3). Bovine dentin surfaces were left uncoated or resin-coated. After 1-h water storage (single-visit) or 1-week water storage with a non-eugenol temporary cement (multiple-visit), a CAD/CAM resin block was cemented to uncoated or resin-coated dentin surfaces. Microtensile bond strengths (µTBSs) were measured and statistically analyzed (α=0.05). Application of resin-coating improved µTBSs. The multiple-visit group exhibited lower values of µTBS than the single-visit group. Selection of the materials affected µTBSs. Resin-coating and single-visit treatment are desirable for CAD/CAM resin composite restorations.

Resin-matrix ceramics for occlusal veneers: Effect of thickness on reliability and stress distribution

OBJECTIVE

To evaluate the influence of resin-matrix ceramic material and thickness on reliability and stress distribution of occlusal veneers (OV).

METHODS

One hundred and twenty-six OV of a mandibular first molar were milled using a CAD/CAM system and allocated according to materials (resin nanoceramic (RNC) or polymer-infiltrated ceramic network (PICN)) and thicknesses (0.5, 1.0 and 1.5 mm), totaling six groups (RNC0.5, RNC1, RNC1.5, PICN0.5, PICN1, and PICN1.5). Step-stress accelerated-life testing was performed (n = 21/group) with the load applied at the distobuccal cusp tip of the occlusal veneer until failure or suspension. The use level probability Weibull curves and reliability were calculated and plotted (90% CI). Finite element analysis evaluated the stress distribution according to maximum principal stress (σ_max) on the restoration and maximum shear stress (τ_max) on the cement layer.

RESULTS

There was no difference in the probability of survival for the estimated missions among the groups, except at 600 N in which the results were significantly lower to PICN1.5 (6%) compared to RNC1 (55%) and RNC1.5 (60%). The σ_max values were higher for PICN (31.85-48.63 MPa) than RNC (30.78-33.09 MPa) in the same thicknesses. In addition, 0.5 mm groups concentrated more stress in the restoration (33.09-48.63 MPa) than 1.0 mm (31.11-35.36 MPa) and 1.5 mm (30.78-31.85 MPa) groups in the same material.

SIGNIFICANCE

Both resin-matrix ceramic materials seem up-and-coming restorative systems for occlusal veneers irrespective of the thicknesses as a consequence of the high reliability.

Current status and perspective of CAD/CAM-produced resin composite crowns: a review of clinical effectiveness

The purpose of the present review was to survey the available literature on computer-aided design/computer-aided manufacturing (CAD/CAM)-produced resin composite materials to provide clinicians with a current overview of the key components necessary for daily clinical use. An electronic search was conducted in the PubMed database. Peer-reviewed articles in English language on the use of resin composites in CAD/CAM dental crowns were included. A total of 122 full-text articles were identified, 15 of which were selected during the initial review. Two additional articles were also discovered through a manual search, to obtain a final total of 17 articles included in the present review. Of these, 16 were to in vitro studies, and one was an in vivo study. Findings from the in vitro studies indicate that resin composite block materials for CAD/CAM applications demonstrate excellent physical properties and are appropriate for the clinical restoration of premolars and molars. However, the in vivo study reported a low 3-year success rate, but high survival rate for resin composite CAD/CAM crowns placed in the premolar region. The key to ensuring the successful prognosis of a resin composite CAD/CAM crown is to ensure that all steps—such as proper case selection, abutment tooth preparation, occlusal adjustment, and bonding—are accurately performed.

Biomechanical planning for minimally invasive indirect restorations

This paper explores the planning and execution of indirect partial-coverage restorations and will outline practical recommendations for maximising the outcomes for minimally invasive (MI) approaches to indirect restorations, with a special focus on vital teeth, endodontically-treated teeth and worn dentitions. Throughout the paper, the supporting evidence for each rationale for partial-coverage restorations will be considered, as well as the risks and benefits of adopting an MI approach to indirect restorations.

Monitoring fatigue damage in different CAD/CAM materials: A new approach with optical coherence tomography

PURPOSE

To investigate fatigue damage over time, monolithic posterior computer-aided-designed/computer-aided-manufactured (CAD/CAM) crowns were artificially aged in a mouth-motion-simulator, and damage was monitored with optical coherence tomography (OCT).

METHODS

Forty-eight crowns were milled of six different CAD/CAM-materials (n=8), including 3Y-TZP (Lava Plus,'3Y'), 4Y-PSZ (Pritidentamultidisc,'4Y'), 5Y-PSZ (Prettauanterior,'5Y'), zirconia-reinforced lithium silicate (CeltraDuo,'ZLS'), hybrid ceramic (Vita Enamic,'VE'),and resin composite (BrilliantCrios,'COM'), and were adhesively luted on CAD/CAM-milled human molars. Specimens were artificially aged in a mouth-motion-simulator (50-500N, 2Hz, 37°C) for a period of 1 million cycles. Before loading and every 250,000 cycles, the specimens were investigated with spectral domain (SD)-OCT (RS-3000). The maximum vertical and horizontal damage were measured with imaging-processing-software (ImageJ). After testing, the specimens were sliced and analysed via light microscope (Zeiss) to compare the new OCT method with the established light microscope method. Data were subjected to ANCOVA and 2x4-ANOVA.

RESULTS

No failure occurred during mouth-motion-simulation. However, all specimens (except for 3Y and 4Y) showed fatigue damage. There was a significant difference in the maximum damage between the CAD/CAM-materials (p<.05). ZLS exhibited the highest damage, followed by VE, COM and 5Y. While damage associated with 5Y was initially noticed after 750,000 cycles, all other materials already showed crack formation after 250,000 cycles. Furthermore, a linear increase in damage over time was noticed in all materials. Due to the shallow light penetration of OCT, damage in the outer area could only be visualized with light microscope.

CONCLUSIONS

OCT is feasible for monitoring fatigue damage over time within different CAD/CAM-materials, particularly for subsurface damages.

Influence of surface treatment on bonding of resin luting cement to CAD/CAM composite blocks

The aim of this study was to determine the influence of different surface treatments of CAD/CAM composite blocks on bonding effectiveness of resin cements, based on the shear bond strength test and the surface science examination. Specimens were fabricated from two types of CAD/CAM composite blocks (Cerasmart and VITA Enamic), and the specimen surfaces were alumina sandblasted. Specimen surfaces were treated with i) silane, ii) primer, and iii) silane+primer, then two types of cements (Block HC Cem and Super Bond) were bonded. After 24 h storage, bond strengths were measured. Surface free energy measurements were performed of the treated CAD/CAM composite blocks surfaces. The groups ii) and iii) showed significantly higher bond strengths than the group i), apart from VITA Enamic with Block HC Cem. Although the total surface free energy showed different trends in different surface treatments, a similar trend was found in both CAD/CAM composite blocks.

Step-stress vs. staircase fatigue tests to evaluate the effect of intaglio adjustment on the fatigue behavior of simplified lithium disilicate glass-ceramic restorations

The aim of the study was to compare the outcomes for the fatigue mechanical behavior of bonded simplified lithium disilicate restorations, with and without an internal adjustment by grinding with diamond bur in running two fatigue tests: Staircase and Step-stress testing approaches. Ceramic discs (IPS e.max CAD) were prepared (Ø = 10 mm; thickness = 1.0 mm), submitted to an in-lab simulation of CAD/CAM milling (#60 SiC paper) and allocated into 2 groups according to the internal adjustment by grinding of the cementation surface: no adjustment (CTRL); or grinding with a coarse diamond bur (GR). Adhesive cementation (Multilink N) was performed onto epoxy resin discs (Ø = 10 mm; thickness = 2 mm) after ceramic/epoxy surface treatments. The cemented assemblies of each group were randomly assigned into 2 subgroups considering two fatigue tests (n = 15): Staircase - SC (250,000 cycles; 20 Hz), or Step-stress - SS (10,000 cycles per step; 20 Hz). Roughness, topographic and fractographic analyses were additionally performed. Statistical analyses were carried out using the Dixon and Mood method for Staircase data, and Kaplan-Meier and Mantel-Cox (log-rank) tests for Step-stress data. Ceramic restorations having its intaglio surface ground (GR group: SC test = 306.67 N; SS test = 646.67 N) presented lower fatigue failure load (FFL) values than the CTRL group (SC test = 879.28 N; SS test = 1090.00 N), regardless of the fatigue testing approach. The percentage of mean FFL decrease comparing the CTRL to GR group was higher for SC (65.1%) than the SS (40.7%) approach. However, a different total number of cycles was applied for each method. Both fatigue tests were able to detect the negative effect of internal adjustments of lithium disilicate glass-ceramic simplified restorations on their mechanical behavior. Therefore, both methods can be applied for similar evaluations (fatigue testing for ceramic restorations).

Fatigue behavior and damage modes of high performance poly-ether-ketone-ketone PEKK bilayered crowns

OBJECTIVES

To evaluate and compare the fatigue behavior (fatigue limit and fatigue life) and damage modes of high-performance poly-ether-ketone-ketone (PEKK), zirconia and alloy bilayered crowns.

MATERIALS AND METHODS

A total of 110 crowns (n = 50 for fatigue limit and n = 60 for fatigue life) were fabricated and used in this study. Pekkton® ivory discs, yttrium stabilized zirconia blanks and NiCr casting alloy were used to produce the respective PEKK, zirconia and alloy copings for crown fabrication. The prepared crowns were veneered with composite resin and subjected to fatigue tests. The fatigue limit was evaluated using the staircase method and the fatigue life of the samples was evaluated by subjecting the crowns to a load lower than the fatigue limit of that particular group, and also with an intermediate load of 522 N. A graphical plot was generated from the shape parameter (β) and life parameter (α) values obtained through the Weibull analysis method. Kruskal-Wallis and Mann-Whitney tests were applied to determine the significance differences in the recorded fracture mode between the study groups. The damage modes of the samples were assessed using Burke's classification.

RESULTS

The recorded fatigue limits of the groups were 442.8 ± 42.1 N, 608.7 ± 7.6 N, and 790.4 ± 29.2 N for zirconia, NiCr and PEKK, respectively. A significant difference in the fatigue limit of the groups was observed (p < 0.05). PEKK samples demonstrated the highest survival cycles of 1,170,000 and the lowest survival cycles was observed with zirconia samples at 100,000 under 522 N loading. The fracture modes in PEKK samples were largely distributed between code 1 and 2 whereas the fracture modes in NiCr group was distributed between code 1 and 4 and YZ crowns exhibited more of code 5 fractures. The difference in fracture modes among the groups was statistically significant (p < 0.05).

CONCLUSION

The PEKK group demonstrated better results compared to zirconia and NiCr based crowns. The PEKK group demonstrated high fatigue limit and survived the highest fatigue life cycles among the tested groups.

Adhesion procedures for CAD/CAM indirect resin composite block: A new resin primer versus a conventional silanizing agent

PURPOSE

The purpose of this study was to evaluate the effectiveness of both a resin primer containing methyl methacrylate (MMA) and a silanizing agent on bonding to indirect resin composite blocks, using two types of build-up hybrid resin composites.

METHODS

SHOFU BLOCK HC (Shofu) specimens were blasted with alumina, after which one of two surface treatments was applied: CERA RESIN BOND (Shofu, the Silane group) or HC primer (Shofu, the MMA group). Resin composites made using either Solidex Hardura (SDH, Shofu) or Ceramage Duo (CMD, Shofu) were built up and micro-tensile bond strength (μTBS) values were measured after storage in water for either 24h or 6 months (n=24 per group). The fracture surfaces after μTBS measurements and the resin block/build-up resin interfaces were observed by scanning electron microscopy (SEM).

RESULTS

The bond strength of the Silane/SDH group significantly decreased after 6 months (p<0.001), whereas in the MMA group there was no significant loss after 24h or 6 months (p=0.99). In the CMD group, the bond strength after 6 months was significantly lowered in both the Silane group (p<0.001) and the MMA group (p<0.001), but the latter still showed greater adhesion. SEM images demonstrated that the matrix resin was partially destroyed at the fracture surfaces of the MMA group and fracture surface unevenness was observed.

CONCLUSIONS

A primer containing MMA produced stronger bonding to CAD/CAM resin even after long-term aging compared to a silane treatment.

Microleakage of thin-walled monolithic zirconia and polymer-containing CAD-CAM crowns

STATEMENT OF PROBLEM

Monolithic restorations facilitate computer-aided design and computer-aided manufacturing (CAD-CAM) processability and provide thin-walled restorations, which require less tooth reduction. For the long-term success of these restorations, their durable sealing is important. However, data in this regard are sparse.

PURPOSE

The purpose of this in vitro study was to investigate the microleakage of monolithic complete crowns made from current CAD-CAM materials after mastication simulation.

MATERIAL AND METHODS

Sixty-four identical test specimens (crown and tooth) were milled based on corresponding standard tessellation language data sets: one for the crowns and another for the human molar teeth. Four CAD-CAM restoration materials were investigated: 2 polymer-containing materials, Brilliant Crios (BC) and Vita Enamic (VE), and 2 zirconia materials, ultra-high-translucent Nacera Pearl Q³ Multi-Shade (ultraHT) and high-translucent Nacera Pearl Multi-Shade (HT). The crowns were adhesively luted to the CAD-CAM milled human molars with 1 of 3 luting systems: OneCoat7Universal and DuoCem (BC); A.R.T.Bond and DuoCement (VE); or EDPrimer/Panavia F2.0 (ultraHT and HT). The specimens were divided in 2 subgroups, and 2 different mastication simulations were applied: normal function (NF) and bruxism (B). A dye penetration test was used to detect microleakage, and the specimens were sectioned. A digital microscope (Zeiss) was used for analysis and to calculate the percentage of leakage in relation to the height of the tooth. Data were subjected to the Mann-Whitney and Kruskal-Wallis tests (α=.05).

RESULTS

Microleakage was identified in all groups. VE reported the highest leakage with a mean of 13.0%, followed by ultraHT (4.8%), HT (3.6%), and BC (3.0%). No significant difference was detected between the 2 simulation programs (normal function and bruxism). However, VE and the zirconia group HT exhibited a significant difference (P<.014), whereas no significant difference was noted among the zirconia groups or the polymer-containing groups BC and VE.

CONCLUSIONS

Thin-walled restorations made of CAD-CAM composite resin and zirconia exhibited reduced microleakage compared with the polymer-containing ceramic. Thus, from the specific viewpoint of microleakage, CAD-CAM composite resins and zirconia seem to be suitable materials for thin-walled complete crowns.

Sliding contact wear and subsurface damage of CAD/CAM materials against zirconia

OBJECTIVE

Most previous work conducted on the wear behavior of dental materials has focused on wear rates and surface damage. There is, however, scarce information regarding the subsurface damage arising from sliding contact fatigue. The aim of this study was to elucidate the wear mechanisms and the subsurface damage generated during sliding contact fatigue in 5 contemporary CAD/CAM materials against a zirconia indenter.

METHODS

Forty discs (Ø12mm, 1.55mm thick) were cut out of IPS e.max CAD (e.CAD), Suprinity PC (SUP), Enamic (ENA), Vitablocs Mark II (VMII) and Lava Ultimate (LU) blocks and mirror polished. After cementation onto a dentin-like composite, off-axis mouth-motion cycling was conducted with a spherical zirconia indenter (r=3.18mm) in water (200N load, 2Hz frequency) for 5 different cycling periods (10², 10³, 10⁴, 10⁵, 10⁶ cycles, n=8). Analysis of the wear scars was conducted using light-microscopy, scanning-electron-microscopy and optical profilometry. Subsurface damage was assessed using sagittal and transverse sections of the samples.

RESULTS

Fatigue wear mechanisms predominated in glassy materials (e.CAD, SUP, VMII), accompanied by extensive subsurface damage, whereas abrasive wear mechanisms were responsible for the large wear craters in the resin composite (LU) with an absolute absence of subsurface fracture. A combination of both mechanisms was observed in the polymer-infiltrated reinforced-glass (ENA), displaying large wear craters and severe subsurface damage.

SIGNIFICANCE

Well-controlled laboratory simulation can identify wear and subsurface damage susceptibility of various classes of restorative materials. Both wear and subsurface fracture are determining factors for the long-term success of restorations.

The flexural strength of CAD/CAM polymer crowns and the effect of artificial ageing on the fracture resistance of CAD/CAM polymer and ceramic single crowns

OBJECTIVES

The purpose of this study was to investigate the fracture resistance, flexural strength and Weibull modulus of an innovative CAD/CAM polymer and to compare its fracture resistance with that of glass ceramics.

MATERIALS AND METHODS

A total of 32 (n = 16 IPS e.max CAD (LIDI); n = 16 LuxaCam Composite (LUXA)) first mandibular molar crowns were fabricated and cemented onto metal dies by use of luting composite. Half of the specimens were loaded until fracture without prior artificial ageing. The other half were subjected to thermal (5°/55 °C) and mechanical (1,200,000 cycles, 80 N) cycling before fracture loading. Scanning electron microscopy was used to analyse fracture behaviour. A three-point bending test of the flexural strength of LUXA was performed according to ISO 6872:2008. Data were analysed by means of the Kolmogorov-Smirnov test, Mann-Whitney U-test (p < 0.05) and Weibull statistical analysis.

RESULTS

Initial fracture resistance of LIDI was significantly higher than that of LUXA. However, the initial fracture resistance of LIDI decreased significantly after artificial ageing. After ageing, fracture resistance was 1050.29 ± 325.08 N for LUXA and 1250.09 ± 32.53 N for LIDI. Three-point bending test yielded a mean flexural strength value for LUXA of 145.28 ± 18.21 MPa and a Weibull modulus of m = 9.51.

CONCLUSIONS

Polymer-based material tested in this study had a lower fracture resistance than that of the glass-ceramic material. Fracture resistance and flexural strength of LuxaCam Composite are sufficient for use in the first molar region.

CLINICAL RELEVANCE

The mechanical properties of this innovative polymer-based material indicate it can be used in the first molar region as a suitable alternative to glass ceramics. Further clinical studies are required to confirm this. The study presents an innovative material as an alternative to glassceramic for the clinical use in dentistry. The materials investigated were differently affected by artificial aging. Clinical use for patients with bruxism may be considered.

Fracture force of CAD/CAM resin composite crowns after in vitro aging

OBJECTIVES

The aim of this in vitro study was to investigate the influence of material, preparation, and pre-treatment on the aging and fracture force of CAD/CAM resin composite molar crowns.

MATERIALS AND METHODS

CAD/CAM molar crowns (n = 80) were milled from four resin composites (Block HC, Shofu; Lava Ultimate, 3 M; Grandio Blocs, Voco; and Tetric CAD, Ivoclar Vivadent, with/without sandblasting). Extracted human teeth were prepared with optimal preparation (height 6-8 mm, angle 6-8°) or worst-case preparation (height 3.5-4 mm, angle 10-15°). Both groups were prepared with a 1-mm deep cervical circular shoulder. Crowns were adhesively bonded after corresponding tooth treatment required for the individual adhesive systems (Table 1). Specimens were aged for 90 days in water storage (37 °C) and subsequently subjected to thermal cycling and mechanical loading (TCML 3000 × 5 °C/3000 × 55 °C, 2 min each cycle, H20 distilled; 1.2 × 10⁶ cycles à 50 N, 1.6 Hz). De-bonding and fracture force was determined.

STATISTICS

one-way-ANOVA; post hoc Bonferroni, α = 0.05.

RESULTS

Four crowns of Lava Ultimate with worst-case preparation de-bonded during TCML. Individual crowns without sandblasting treatment (3x Tetric CAD with optimal preparation; 1x Tetric CAD with worst-case preparation) de-bonded during water storage. One crown of Grandio Blocs with optimal preparation showed a small chipping during TCML. All other crowns survived TCML and water storage without failure. Fracture forces differed between 1272 ± 211 N (Lava Ultimate) and 3061 ± 521 N (Tetric CAD). All Grandio Blocs and Tetric CAD crowns revealed significantly (p ≤ 0.023) higher fracture forces than Block HC or Lava Ultimate crowns. No significantly different (p > 0.05) fracture forces were found between optimal or worst-case preparation/fit groups.

CONCLUSIONS

De-bonding during water storage and TCML was dependent on material and crown pre-treatment. Therefore, surface roughening seems strongly required. Fracture forces were not influenced by preparation but by the type of material.

CLINICAL RELEVANCE

Clinical success and de-bonding of CAD/CAM resin composite crowns is strongly influenced by the type of material and its pre-treatment.

Predicting the Debonding of CAD/CAM Composite Resin Crowns with AI

A preventive measure for debonding has not been established and is highly desirable to improve the survival rate of computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin (CR) crowns. The aim of this study was to assess the usefulness of deep learning with a convolution neural network (CNN) method to predict the debonding probability of CAD/CAM CR crowns from 2-dimensional images captured from 3-dimensional (3D) stereolithography models of a die scanned by a 3D oral scanner. All cases of CAD/CAM CR crowns were manufactured from April 2014 to November 2015 at the Division of Prosthodontics, Osaka University Dental Hospital (Ethical Review Board at Osaka University, approval H27-E11). The data set consisted of a total of 24 cases: 12 trouble-free and 12 debonding as known labels. A total of 8,640 images were randomly divided into 6,480 training and validation images and 2,160 test images. Deep learning with a CNN method was conducted to develop a learning model to predict the debonding probability. The prediction accuracy, precision, recall, F-measure, receiver operating characteristic, and area under the curve of the learning model were assessed for the test images. Also, the mean calculation time was measured during the prediction for the test images. The prediction accuracy, precision, recall, and F-measure values of deep learning with a CNN method for the prediction of the debonding probability were 98.5%, 97.0%, 100%, and 0.985, respectively. The mean calculation time was 2 ms/step for 2,160 test images. The area under the curve was 0.998. Artificial intelligence (AI) technology-that is, the deep learning with a CNN method established in this study-demonstrated considerably good performance in terms of predicting the debonding probability of a CAD/CAM CR crown with 3D stereolithography models of a die scanned from patients.

Fatigue survival and damage modes of lithium disilicate and resin nanoceramic crowns

Polymer-based composite materials have been proposed as an alternative for single unit restorations, due to their resilient and shock absorbing behavior, in contrast to the brittleness of ceramic materials that could result in failure by fracture.