CAD-FEA modeling and analysis of different full crown monolithic restorations

Five years of radiographic evaluation for the peri-implant bone changes of all-on-four implant prostheses constructed from different framework materials using different digital construction techniques

BACKGROUND

There is insufficient evidence recommending a framework material and a CAD/CAM manufacturing technique for mandibular implant-supported prostheses. The study objective was to evaluate the clinical application of different materials and construction techniques used for mandibular All-on-4 prosthesis on circumferential peri-implant bony changes after 5 years.

METHODS

Thirty-six male patients with all-on-4 mandibular implant-supported prostheses were recalled and divided into three groups. Group PK (patients with frameworks milled from PEEK blocks), Group PSM (patients with frameworks milled from soft metal blocks), and Group SLM (patients with frameworks constructed with additive manufacturing; selective laser melting). The circumferential bone level on all implant faces was assessed with a CBCT. Two-way repeated measures ANOVA was used to compare vertical bone loss (VBL) and horizontal bone loss (HBL) between different groups, implant positions, and observation times followed by Tukey's multiple comparisons.

RESULTS

For all observation times, there was a significant difference in VBL between groups for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the lowest VBL while group PK showed the highest for anterior and posterior implants. For all groups, HBL significantly increased after 5 years for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the highest HBL. For posterior implants, group PK and SLM showed the highest.

CONCLUSION

Within the study's limitations, mandibular implant-supported fixed frameworks fabricated with either milling from PEEK or soft metal blocks, or additive manufacturing (laser melting technology) exhibited significant vertical and horizontal bone height changes after 5 years.

CLINICAL TRIAL REGISTRY NUMBER

(NCT06071689) (11/10/2023).

Influence of prosthetic index structures and implant materials on stress distribution in implant restorations: a three-dimensional finite element analysis

BACKGROUND

Mechanical complications affect the stability of implant restorations and are a key concern for clinicians, especially with the frequent introduction of new implant designs featuring various structures and materials. This study evaluated the effect of different prosthetic index structure types and implant materials on the stress distribution of implant restorations using both in silico and in vitro methods.

METHODS

Four finite element analysis (FEA) models of implant restorations were created, incorporating two prosthetic index structures (cross-fit (CF) and torc-fit (TF)) and two implant materials (titanium and titanium-zirconium). A static load was applied to each group. An in vitro study using digital image correlation (DIC) with a research scenario identical to that of the FEA was conducted for validation. The primary strain, sensitivity index, and equivalent von Mises stress were used to evaluate the outcomes.

RESULTS

Changing the implant material from titanium to titanium-zirconium did not significantly affect the stress distribution or maximum stress value of other components, except for the implant itself. In the CF group, implants with a lower elastic modulus increased the stress on the screw. The TF group showed better stress distribution on the abutment and a lower stress value on the screw. The TF group demonstrated similar sensitivity for all components. DIC analysis revealed significant differences between TF-TiZr and CF-Ti in terms of the maximum (P < 0.001) and minimum principal strains (P < 0.05) on the implants and the minimum principal strains on the investment materials in both groups (P < 0.001).

CONCLUSIONS

Changes in the implant material significantly affected the maximum stress of the implant. The TF group exhibited better structural integrity and reliability.

The influence of hygroscopic expansion of resin supporting dies on the fracture resistance of ceramic restorations during thermal cycling

OBJECTIVES

To evaluate the hygroscopic expansion characterization of resin composite dies during thermal cycling, and their influence on the fracture resistance of dental ceramic materials as well as the effect of pre-immersion on these measurements.

METHODS

Disc-shaped specimens (φ = 15.0 mm, h = 1.2 mm) and anatomical crown dies of four resin composites (epoxy, Z350, P60, G10) were fabricated. Disc-shaped samples were continuously soaked in distilled water and the volume expansion was measured at different time point by Archimedes method. Disc-shaped samples were pre-immersed for 0, 7, or 30 days, elastic modulus and hardness were measured using Nanoindentation test; thermal cycling (TC) test was performed (5 °C-55 °C, 104 cycles), and volume expansion during TC was measured. Four kinds of resin die with pre-immersion for 0, 7, or 30 days were cemented to 5Y-Z crown, or epoxy dies without pre-immersion were cemented to 5Y-Z, 3Y-Z and lithium disilicate glass (LDG) crowns, and load-to-failure testing was performed before and after TC. Finite element analysis (FEA) and fractography analysis were also conducted.

RESULTS

The hygroscopic expansion was in the order: epoxy > Z350 > P60 > G10. Except for G10, the other three resin composites exhibited different degrees of hygroscopic expansion during TC. Only the elastic modulus and hardness of epoxy decreased after water storage. However, only the fracture loads of 5Y-Z and LDG crowns supported by epoxy dies were significantly decreased after TC. FEA showed a stress concentration at the cervical region of the crown after volume expansion of the die, leading to the increase of the peak stress at the crown during loading.

SIGNIFICANCE

Only the hygroscopic expansion of epoxy dies caused by TC led to the decrease in the fracture resistance of the 5Y-Z and LDG crown, which may be related to the decrease in the elastic modulus of the epoxy die and the tensile stress caused by it.

Comparison of fatigue lifetime of new generation CAD/CAM crown materials on zirconia and titanium abutments in implant-supported crowns: a 3D finite element analysis

OBJECTIVES

Due to the dynamic character of the stomatognathic system, fatigue life experiments simulating the cyclic loading experienced by implant-supported restorations are critical consideration. The aim of this study was to examine the effect of different crown and abutment materials on fatigue failure of single implant-supported crowns.

METHODS

Models were created for 10 different designs of implant-supported single crowns including two zirconia-reinforced lithium silicates (crystallized and precrystallized), monolithic lithium disilicate, polymer-infiltrated ceramic networks, and polyetheretherketone supported by zirconia and titanium abutments. A cyclic load of 179 N with a frequency of 1 Hz was applied on palatal cusp of a maxillary first premolar at a 30° angle in a buccolingual direction.

RESULTS

In the models with titanium abutments, the polymer-infiltrated ceramic network model had a lower number of cycles to fatigue failure values in the implant (5.07), abutment (2.30), and screw (1.07) compared to others. In the models with zirconia abutments, the crystallized zirconia-reinforced lithium silicate model had a higher number of cycles to fatigue failure values in the abutment (8.52) compared to others. Depending on the fatigue criteria, polyetheretherketone implant crown could fail in less than five year while the other implant crowns exhibits an infinite life on all models.

CONCLUSIONS

The type of abutment material had an effect on the number of cycles to fatigue failure values for implants, abutments, and screws, but had no effect on crown materials. The zirconia abutment proved longer fatigue lifetime, and should thus be considered for implant-supported single crowns.

One-piece endodontic crown fixed partial denture: Is it possible?

STATEMENT OF PROBLEM

Whether the replacement of a missing tooth with a fixed partial denture supported by an endodontically treated abutment could be improved with 1-piece endodontic crowns is unclear.

PURPOSE

The purpose of the study was to evaluate the mechanical behavior of a fixed partial denture (FPD) according to the preparation of the abutment teeth (1-piece endodontic crown or complete crown) in terms of stress magnitude in the prosthesis, cement layer, and tooth.

MATERIAL AND METHODS

A posterior model with 2 abutment teeth (first molar and first premolar) was modeled with a computer-aided design (CAD) software program for conducting a 3-dimensional finite element analysis (FEA). To replace the missing second premolar, the model was replicated in different possible FPDs according to the abutment preparation design (complete crown [Conventional], 2 1-piece endodontic crowns [EC]) or a 1-piece endodontic crown on one of the abutment teeth (first molar [ECM] and first premolar [ECP]) for a total of 4 designs. All FPDs were in lithium disilicate. The solids were imported to an analysis software program (ANSYS 19.2) in the standard for the exchange of product data (STEP) format. The mechanical properties were considered isotropic and the materials to show linear elastic and homogeneous behavior. An axial load (300 N) was applied at the occlusal surface of the pontic. The results were evaluated by colorimetric stress maps of von Mises and maximum principal stress in the prosthesis, maximum principal stress and shear stresses on the cement layer, and maximum principal stress in the abutment teeth.

RESULTS

The von Mises stresses revealed that all FPD designs behaved similarly and that, considering the maximum principal stress criteria, the pontic was the most stressed region. For the cement layer, the combined designs presented an intermediate behavior, with the ECM more suitable to reducing the stress peak. The conventional preparation allowed less stress concentration in both teeth, and higher stress concentration in the premolar was observed with a 1-piece endodontic crown. The 1-piece endodontic crown decreased the risk of fracture failure. Considering the risk of debonding failure for the prosthesis, the 1-piece endodontic crown preparation was only able to decrease the failure risk when the EC design was used and when only the shear stress was considered.

CONCLUSIONS

Performing 1-piece endodontic crown preparations to retain a 3-unit lithium disilicate FPD is an alternative to conventional complete crown preparations.

Static and dynamic stress analysis of different crown materials on a titanium base abutment in an implant-supported single crown: a 3D finite element analysis

BACKGROUND

This Finite Element Analysis was conducted to analyze the biomechanical behaviors of titanium base abutments and several crown materials with respect to fatigue lifetime and stress distribution in implants and prosthetic components.

METHODS

Five distinct designs of implant-supported single crowns were modeled, including a polyetheretherketone (PEEK), polymer-infiltrated ceramic network, monolithic lithium disilicate, and precrystallized and crystallized zirconia-reinforced lithium silicates supported by a titanium base abutment. For the static load, a 100 N oblique load was applied to the buccal incline of the palatal cusp of the maxillary right first premolar. The dynamic load was applied in the same way as in static loading with a frequency of 1 Hz. The principal stresses in the peripheral bone as well as the von Mises stresses and fatigue strength of the implants, abutments, prosthetic screws, and crowns were assessed.

RESULTS

All of the models had comparable von Mises stress values from the implants and abutments, as well as comparable maximum and minimum principal stress values from the cortical and trabecular bones. The PEEK crown showed the lowest stress (46.89 MPa) in the cervical region. The prosthetic screws and implants exhibited the highest von Mises stress among the models. The lithium disilicate crown model had approximately 9.5 times more cycles to fatique values for implants and 1.7 times more cycles to fatique values for abutments than for the lowest ones.

CONCLUSIONS

With the promise of at least ten years of clinical success and favorable stress distributions in implants and prosthetic components, clinicians can suggest using an implant-supported lithium disilicate crown with a titanium base abutment.

Biomechanical reinforcement by CAD-CAM materials affects stress distributions of posterior composite bridges: 3D finite element analysis

OBJECTIVES

This 3D finite element analysis study aimed to investigate the effect of reinforcing CAD-CAM bars on stress distribution in various components of a posterior composite bridge.

METHODS

A virtual model mimicking the absence of an upper second premolar was created, featuring class II cavity preparations on the proximal surfaces of the adjacent abutment teeth surrounding the edentulous space. Five distinct finite element analysis (FEA) models were generated, each representing a CAD-CAM reinforcing bar material: 3-YTZP (IPS. emax ZirCAD MO; Zr), lithium disilicate (IPS e.max CAD; EX), nano-hybrid resin composite (Grandio Blocs; GB), Fibre-reinforced composite (Trilor; Tri), and polyetheretherketone (PEEK). A veneering resin composite was employed to simulate the replacement of the missing premolar (pontic). In the FEA, an axial force of 600 N and a transverse load of 20 N were applied at the center of the pontic. Subsequently, maximum von Mises (mvM) and maximum principal stresses (σmax) were computed across various components of the generated models. Additionally, shear stresses at the interface between the CAD-CAM bars and the veneering resin composite were determined.

RESULTS

CAD-CAM materials with high modulus of elasticity, such as Zr and EX, exhibited the highest mvM stresses and shear stresses while transferring the lowest stress to the veneering resin composite in comparison to other materials. Conversely, PEEK demonstrated the lowest mvM stresses but produced the highest stresses within the veneering resin composite. There was a uniform distribution of mvM stresses in the remaining tooth structure among all groups, except for a noticeable elevation in the molar region of Zr and EX groups.

SIGNIFICANCE

Reinforcing CAD-CAM bar materials with a high modulus of elasticity, such as Zr and EX, may result in debonding failures at the connector sites of posterior composite bridges. Conversely, GB, PEEK, and Tri have the potential to cause fracture failures at the connectors rather than debonding.

Effect of Different Primers on Shear Bond Strength of Base Metal Alloys and Zirconia Frameworks

Ensuring a secure bond between a framework structure and layering composite resin veneer is essential for a long-lasting dental restoration. A variety of primer systems are available to facilitate the adhesive bonding. Nevertheless, the growing preference for efficiency and simplicity in dentistry has made the one-bottle universal primers a desirable option. This study aims to compare the effectiveness of universal primers on the shear bond strength (SBS) of base metal alloy (BMA) and zirconia to layering composite resin. Each 160 BMA and zirconia 20 × 10 × 5 mm test specimen was fabricated. Eight different primers (SunCera Metal Primer, Metal Primer Z, Reliance Metal Primer, Alloy Primer, MKZ Primer, Monobond Plus, ArtPrime Plus, and Clearfil Ceramic Primer Plus) were applied to 20 specimens in each group. Subsequently, a 5 × 2 mm composite resin build-up was applied. SBS tests were performed after 24 h of water storage and after thermocycling (25,000 cycles, 5-55 °C). On BMA, after water storage for 24 h, the bond strength values ranged from 26.53 ± 3.28 MPa (Metal Primer Z) to 29.72 ± 2.00 MPa (MKZ Primer), while after thermocycling, bond strength values ranged from 25.19 ± 1.73 MPa (MKZ Primer) to 27.69 ± 2.37 MPa (Clearfil Ceramic Primer Plus). On a zirconia base, after 24 h, the bond strengths values ranged from 22.63 ± 2.28 MPa (Reliance Primer) to 29.96 ± 2.37 MPa (MKZ Primer) and from 23.77 ± 3.86 MPa (Metal Primer Z) to 28.88 ± 3.09 MPa (Monobond Plus) after thermocycling. While no significant difference in bond strength was found between the primers on the BMA base, five primer combinations differed significantly from each other on zirconia (p = 0.002-0.043). All primers achieved a bond strength greater than 23 MPa on both framework materials after thermocycling. Thus, all primers tested can be applied to both framework materials with comparable results.

Biomechanical behavior and Weibull survival of CAD-CAM endocrowns with different marginal designs: A 3D finite element analysis

OBJECTIVES

To evaluate and compare the effect of tooth preparation designs and different CADCAM. materials on stress distribution and Weibull survival probability of endocrowns. applied to root canal-treated lower first permanent molar using the 3D finite element. analysis method.

METHODS

A root canal-treated lower first permanent molar was prepared for endocrowns with a. butt joint or with a ferrule design by placing, circumferentially, a 1-mm wide shoulder. finish line. The prepared molar was scanned for the two designs and modeled on a 3D. Finite element model. Monolithic zirconia (IPS e.max ZirCAD MT, FCZ), lithium. disilicate (IPS e.max CAD, EX), and nano-ceramic resin composite (Lava Ultimate, LU). CAD-CAM materials were used for each preparation to design the virtual endocrown. A. total of six models were built according to the different tooth preparation designs and. endocrown materials. An occlusal load of 600 N and a transverse load of 20 N in. magnitude that simulates the average occlusal load was directed toward the occlusal. surfaces. von Mises and maximum principle values were evaluated Weibull risk-ofrupture. analysis was used to analyze the survival probability of the restorations and. tooth in the different models.

RESULTS

The highest von Mises were found in the butt joint design for FCZ, EX, and LU (45.3. MPa, 35.2 MPa, and 24.2 MPa, respectively) compared to the ferrule design for the. same materials (42.6 MPa, 31.2 MPa, and 23.6 MPa, respectively). For von Mises. stress distribution in the remaining part of tooth structure (dentin), the highest stresses. were found in LUFerrule which was closely similar to LUButt joint (135.4 MPa and. 134.7 MPa, respectively), followed by EXFerrule and FCZFerrule (132.2 MPa and. 131.7 MPa, respectively), while the lowest stresses were found in EXButt joint and. FCZButt joint (129.0 MPa and 128.4 MPa, respectively). Shear stresses within the. resin cement were the highest in FCZ and EX compared to LU. EX was found to be the. most reliable material with the highest survival probability, while FCZ showed the. lowest survival probability according to the Weibull risk-of-fracture results.

SIGNIFICANCE

Materials with high elastic modulus transfer more stresses to the endocrown and less. to the remaining tooth structure. Endocrown tooth preparation with ferrule design has. better stress distribution and magnitude compared to the butt joint design.

Finite Element Analysis: Connector Designs and Pontic Stress Distribution of Fixed Partial Denture Implant-Supported Metal Framework

This virtual study was designed to evaluate the stress-deformation of a metal fixed partial dentures (FPDs) pontic under different loads using two different connectors. The STL file was generated for a RPD of two implant-supported restorations. The Co-Cr metal substructure was designed with two types of connector design. The pontic is connected to implant-supported crowns with square and round shape connectors. This study was designed for a cementless-retained implant-supported FPD. Finite element modeling (FEM) is used to assess the stress and deformation of the pontic within a metal substructure as the FEM might provide virtual values that could have laboratory and clinical relevance. The Co-Cr alloy mechanical properties like the Poisson ratio and modulus of elasticity were based on the parameters of the three-dimensional structure additive method. Nonparametric analyses (Mann-Whitney U test) was used. The use of square or round connectors often resulted in non-significant changes in stress, and deformation under either three or each loaded point on the occlusal surface of a pontic (P > 0.05). However, the deformation revealed distinct variations between loads of the three points compared to each loaded point (P ≤ 0.05). According to this study data, the pontic occlusal surface appears to be the same in stress and deformation under different loads depending on whether square or round connectors are used. While at the same connector designs, the pontic occlusal surface deformed significantly at three loaded points than it did at each point.

Biomechanical performance of resin composite on dental tissue restoration: A finite element analysis

This study investigates the biomechanical performance of various dental materials when filled in different cavity designs and their effects on surrounding dental tissues. Finite element models of three infected teeth with different cavity designs, Class I (occlusal), Class II mesial-occlusal (MO), and Class II mesio-occluso-distal (MOD) were constructed. These cavities were filled with amalgam, composites (Young's moduli of 10, 14, 18, 22, and 26 GPa), and glass carbomer cement (GCC). An occlusal load of 600 N was distributed on the top surface of the teeth to carry out simulations. The findings revealed that von Mises stress was higher in GCC material, with cavity Class I (46.01 MPa in the enamel, 23.61 MPa in the dentin), and for cavity Class II MO von Mises stress was 43.64 MPa, 39.18 MPa in enamel and dentin respectively, while in case of cavity Class II MOD von Mises stress was 44.67 MPa in enamel, 27.5 in the dentin. The results showed that higher stresses were generated in the non-restored tooth compared to the restored one, and increasing Young's modulus of restorative composite material decreases stresses in enamel and dentin. The use of composite material showed excellent performance which can be a good viable option for restorative material compared to other restorative materials.

Fatigue behavior of three thin CAD/CAM all-ceramic crown materials

The purpose of this study was to study the effect of crown thickness on the fatigue life of CAD/CAM ceramic materials. CAD/CAM ceramic materials for the crown were virtually designed with three thickness designs of (a) ultra-thin occlusal crown average 0.7 mm thick (group A), (b) thin occlusal crown 1.1 mm average thick (group B), (c) thick occlusal crown 1.5 mm thick. The materials are: zirconia Cercon ZC and IPS e.max CAD (LD). Finite Element Analysis (FEA) simulations were carried out to estimate the fatigue lives of restorative materials. The lives for groups B and C under fatigue load were not significantly different from each other for Zirconia. The predicted lives for group A zirconia crowns, under fatigue load 50 N, 100 N, 120 N is 24 years, 4.3 years, 1.9 years, respectively. Results for crowns made of LD can be summarized as follows: under load 50 N, all groups have survived longer than 5 respectively, while under the load of 100 N, only group C survived longer than 5 years. 0.7 mm thick full contour Zirconia crowns possessed adequate endurance strength to survive under physiologic conditions. On the other hand, the crown made of LD should have at least 1.5 mm thickness to survive longer than 5 years.

The influence of pre-heating the restoration and luting agent on the flexural strength of indirect ceramic and composite restorations

Background

This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites.

Materials and Methods

400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated.

Results

There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations.

Conclusion

Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations.

Mechanical properties of cracked teeth with different dental materials and crown parameters: An in vitro proof-of-concept

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.

Effects on different full-coverage designs and materials of crack propagation in first mandibular molar: an extended finite element method study

Objectives: This study aims to investigate the biomechanical properties of fracture resistance in cracked teeth using five different full-coverage restorations made of three different materials. Materials and Methods: A 3D model of a mandibular first molar was created to design five different full-coverage repair models: crown, crown with composite resin filling inside, occlusal veneer, occlusal veneer with composite resin filling inside and onlay. These repair models were fabricated using three different materials, namely, zirconia, lithium disilicate (LDS), and a hybrid polymer-infiltrated ceramic network material (PIC). In total, 15 repair models were tested using the extended finite element method (XFEM), with an occlusal load of 5000 N applied slowly to the occlusal surface of the restoration. The analysis of stress distribution in the restoration and dentin crack line was conducted to measure and record the crack initial load on the restoration and dentin. Results: The results showed that restorations on the occlusal surface significantly improved crack resistance, with zirconia exhibiting superior fracture resistance among the materials tested. Restorations of crown with composite resin filling inside demonstrated the highest resistance to fracture, while occlusal veneers showed the lowest. MPS concentration was observed at the interface between the restoration and dentin and at the root bifurcation, with the highest values at the top of crack development. Dentin covered by oxidized restorations had the highest displacement, while PIC restorations exhibited the lowest. Pulp analysis revealed selective MPS concentration and strain patterns in models with zirconia restorations and onlay, with pronounced pulp displacement in zirconia restorations and onlay. Enamel analysis indicated larger MPS values and displacements in zirconia restoration models and onlay, with higher strain in onlay. Restoration played a crucial role in protecting the tooth, with crack propagation initial loads in dentin surpassing restorations in experimental groups. Conclusion: This study confirms that full-coverage restorations significantly increased the fracture resistance of cracked teeth, with zirconia restorations significantly protecting the underlying cracked tooth. Elimination of fracture lines in the restoration design can improve fracture resistance in cracked teeth. The findings have implications for dental prosthetic design and clinical practice.

In-Vitro Comparison of Fracture Strength of Endocrowns and Overlays in Endodontically Treated Teeth Manufactured with Monolithic Lithium Disilicate and Zirconia

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.

Microtensile Bond Strength of CAD-CAM Restorative Dental Material Blocks to Resin Cement: An In Vitro Study

INTRODUCTION

Today's dentistry frequently employs bonded partial restorations, which are usually fabricated in ceramic materials. In the last decade, hybrid materials have emerged that attempt to combine the properties of composites and ceramics.

OBJECTIVES

To evaluate in vitro, by means of a microtensile test, the bond strength between CAD-CAM restorative materials and the cement recommended by their manufacturer.

MATERIAL AND METHOD

From blocks of CAD-CAM restorative material bonded to composite blocks (Filtek 500^®), beams with a bonding area of approximately 1 mm² were made and divided into four groups: EMAX (IPS e.max CAD^® lithium disilicate), VE (VITA Enamic^® polymer-infiltrated ceramic matrix), LUA (Lava Ultimate^® nano-ceramic resin with sandblasting protocol) and LUS (Lava Ultimate^® nano-ceramic resin with silica coating protocol). In each group, perimeter (external) or central (internal) beams were differentiated according to the position in the block. The samples were tested on the LMT 100^® microtensile machine. Using optical microscopy, the fractures were categorized as adhesive or cohesive (of the restorative material or composite), and the data were analysed with parametric tests (ANOVA).

RESULTS

The LUS group had the highest results (42 ± 20 MPa), followed by the LUA group (38 ± 18 MPa). EMAX had a mean of 34 ± 16 MPa, and VE was the lowest in this study (30 ± 17 MPa). In all groups, the central beams performed better than the perimeter beams. Both EMAX and VE had the most adhesive fractures, while LUA and LUS had a predominance of cohesive fractures.

CONCLUSIONS

Lava Ultimate^® nanoceramic resin with the silica coating protocol obtains the best bond strength values.

Post-fatigue fracture load, stress concentration and mechanical properties of feldspathic, leucite- and lithium disilicate-reinforced glass ceramics

Objective

To evaluate the mechanical properties of different CAD/CAM ceramic systems and the post-fatigue fracture and stress distribution when used as cemented crowns.

Materials and methods

Sixty (60) CAD/CAM monolithic crowns were milled using three different ceramic materials (FD - Feldspathic [Vita Mark II]), LE - Leucite-based ceramic [IPS Empress CAD] and LD - Lithium Disilicate [IPS e.max CAD]) and adhesively cemented on resin composite dyes. Specimens were stored in distillated water (37 °C) for 7 days. After, half of the crowns were submitted to immediate fracture load test while the other half was submitted to fatigue cycling. The average cement layer of approximately 80 μm was assessed using scanning electron microscopy (SEM). The average thickness was used in the three-dimensional (3D) Finite Element Analysis (FEA). For each ceramic material, the density, Poisson ratio, shear modulus, Young modulus, fracture toughness, and true hardness were assessed (n = 3). The data was used to assess the Maximum Principal Stress throughout 3D-FEA according to each material during load to fail and post-fatigue. Data were submitted to two-way ANOVA and Tukey test (α = 0.05).

Results

LD showed the highest compression load, density, shear modulus, Young modulus, fracture toughness and true hardness values. While LE presented the lowest mechanical properties values. There is no difference in the Poisson ratio between the evaluated ceramics.

Conclusion

LD was susceptible to aging process but presented stronger physicomechanical properties, showing the highest post-fatigue fracture load and highest stress magnitude.

Evaluation of Biomechanical Stability of Teeth Tissue According to Crown Materials: A Three-Dimensional Finite Element Analysis

The biomechanical effects of dental tissue according to various dental crown materials were investigated using finite element analysis. Bone, prepared tooth, root canal, and periodontal ligament were modeled based on computed tomography. Depending on the characteristics of the crown material, it was classified into zirconia, hybrid ceramic, gold alloy, and acrylic resin. A loading force of 200 N was applied in the vertical direction to the occlusal surface of the crown, and analysis was performed under the condition that all interfaces were tied. The results demonstrate that the highest von Mises stress was shown in the prepared tooth of the acrylic resin model, which is a temporary prosthesis, and the pulpal pressure was also the highest. Additionally, among the final prosthesis, the highest stress was shown in the hybrid ceramic model prepared teeth. The properties of restoration materials can be a factor influencing the tooth structure. Thus, in order to make a correct decision when selecting a material for restorative treatment, it is necessary to understand, analyze, and evaluate the properties of these restoration materials.

In silico fatigue performance of molars restored with full crowns under alternating cyclic loadings

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.

Effect of veneering material type and thickness ratio on flexural strength of bi-layered PEEK restorations before and after thermal cycling

OBJECTIVE

The purpose of this study was evaluating the biaxial strength of bi-layered PEEK restorations before and after aging using different veneering materials in different thickness ratios.

MATERIAL AND METHODS

Ninety specimens of thickness 1.5 mm were divided into three groups according to their veneering material. Group (CAD LD): BioHPP discs veneered with CAD milled lithium disilicate (n=30), group (CAD C): BioHPP discs veneered with CAD milled composite (n=30), and group (LC): BioHPP discs veneered with conventionally layered composite (n=30). Each group was subdivided into 3 subgroups (n=10) according to the different thickness ratios between the core and the veneering material (TC:TV). Subgroup 1: TC:TV=1:0.5, subgroup 2: TC:TV=0.7:0.8, and subgroup 3: TC:TV=0.5:1. Half of the specimens of each subgroup were subjected to thermocycling, and the bi-axial flexural strength of all specimens was tested before and after aging. Three-way ANOVA followed by Bonferroni's post hoc test were used for data analysis. The significance level was set at P ≤ 0.05.

RESULTS

Material, thickness ratio, and aging all had a significant effect on biaxial flexural strength. (LC) group had the highest biaxial flexural strength. TC:TV=0.5:1 showed the lowest biaxial flexural strength. All groups showed significant decrease in biaxial flexural strength after aging.

CONCLUSIONS

Veneering material for PEEK together with the thickness ratio between the core and veneering material greatly affect the flexural strength of bi-layered restorations. Thermocycling negatively impacts the flexural strength of PEEK bi-layered restorations.

CLINICAL SIGNIFICANCE

According to the results of that study, PEEK cores are best veneered with conventionally layered composite with core to veneering thickness ratio being 1:0.5.

Biomechanical Investigation of Hallux Valgus Deformity Treated with Different Osteotomy Methods and Kirschner Wire Fixation Strategies Using the Finite Element Method

The aim of this study was to propose a finite element method based numerical approach for evaluating various hallux valgus treatment strategies. We developed three-dimensional hallux valgus deformity models, with different metatarsal osteotomy methods and Kirschner wire fixation strategies, under two types of standing postures. Ten Kirschner wire fixations were analyzed and compared. The fixation stability, bone stress, implant stress, and contact pressure on the osteotomy surface were calculated as the biomechanical indexes. The results showed that the biomechanical indexes of the osteotomy and Kirschner wire fixations for hallux valgus deformity could be effectively analyzed and fairly evaluated. The distal metatarsal osteotomy method provided better biomechanical indexes compared to the proximal metatarsal osteotomy method. This study proposed a finite element method based numerical approach for evaluating various osteotomy and Kirschner wire fixations for hallux valgus deformity before surgery.

Bonding Performance of Surface-Treated Zirconia Cantilevered Resin-Bonded Fixed Dental Prostheses: In Vitro Evaluation and Finite Element Analysis

Debonding of zirconia cantilevered resin-bonded fixed dental prostheses (RBFDPs) remains the main treatment complication, therefore, the present in vitro study aimed to evaluate the effect of different surface pretreatments on the bonding of zirconia RBFDPs. Eighty milled zirconia maxillary central incisors, with complementary zirconia cantilevered RBFDPs, were randomly subjected to four different surface pretreatments (n = 20): as-machined (AM); airborne-particle abraded (APA); coated with nanostructured alumina coating (NAC); incisor air-abraded and RBFDP coated (NAC_APA). After bonding, half of each group (n = 10) was stored in deionized water (150 days/37 °C), thermocycled (37,500 cycles, 5-55 °C), and cyclically loaded (50 N/1.2 × 10⁶). Load-bearing capacity (LBC) was determined using a quasi-static test. Additionally, finite element analysis (FEA) and fractography were performed. t-test and one-way ANOVA were used for statistical-analysis. Before aging, the NAC group provided superior LBC to other groups (p < 0.05). After aging, the AM specimens debonded spontaneously, while other groups exhibited comparable LBC (p ˃ 0.05). The FEA results correlated with the in vitro experiment and fractography, showing highly stressed areas in the bonding interface, cement layer, and in RBFDP's retainer wing and connector. The NAC RBFDPs exhibited comparable long-term bonding performance to APA and should be regarded as a zirconia pretreatment alternative to APA.

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.

Which dentine analogue material can replace human dentine for crown fatigue test?

OBJECTIVE

To seek dentine analogue materials in combined experimental, analytical, and numerical approaches on the mechanical properties and fatigue behaviours that could replace human dentine in a crown fatigue laboratory test.

METHODS

A woven glass fibre-filled epoxy (NEMA grade G10; G10) and a glass fibre-reinforced polyamide-nylon (30% glass fibre reinforced polyamide-nylon 6,6; RPN) were investigated and compared with human dentine (HD). Flexural strength and elastic modulus (n = 10) were tested on beam-shaped specimens via three-point bending, while indentation hardness (n = 3) was tested after fracture. Abutment substrates of G10, RPN and HD were prepared and resin-bonded with monolithic lithium disilicate crowns (n = 10), then subjected to wet cyclic loading in a step-stress manner (500 N initial load, 100 N step size, 100,000 cycles per step, 20 Hz frequency). Data were statistically analysed using Kruskal-Wallis one-way ANOVA followed by post-hoc comparisons (α = 0.05). Survival probability estimation was performed by Mantel-Cox Log-Rank test with 95% confidence intervals. The fatigue failure load (FFL) and the number of cycles until failure (NCF) were evaluated with Weibull statistics. Finite Element Models of the fatigue test were established for stress distribution analysis and lifetime prediction. Fractographic observations were qualitatively analysed.

RESULTS

The flexural strength of HD (164.27 ± 14.24 MPa), G10 (116.48 ± 5.93 MPa), and RPN (86.73 ± 3.56 MPa) were significantly different (p < 0.001), while no significant difference was observed in their flexural moduli (p = 0.377) and the indentation hardness between HD and RPN (p = 0.749). The wet cyclic fatigue test revealed comparable mean FFL and NCF of G10 and RPN to HD (p = 0.237 and 0.294, respectively) and similar survival probabilities for the three groups (p = 0.055). However, RPN promotes higher stability and lower deviation of fatigue test results than G10 in Weibull analysis and FEA.

SIGNIFICANCE

Even though dentine analogue materials might exhibit similar elastic properties and fatigue performance to human dentine, different reliabilities of fatigue on crown-dentine analogues were shown. RPN seems to be a better substrate that could provide higher reliability and predictability of laboratory study results.

Sintering mode of a translucent Y-TZP: Effects on its biaxial flexure fatigue strength, surface morphology and translucency

OBJECTIVE

This investigation evaluated the effect of two sintering modes of a translucent zirconia (Y-TZP) on its surface roughness, topography, phase-transformation (t → m), translucency and biaxial flexure fatigue strength.

MATERIALS AND METHODS

To do so, 50 Y-TZP discs (Ø = 15 mm; thickness = 1.2 mm; IPS e.max ZirCAD LT) were prepared and divided into two groups: Standard mode (SM) and Fast mode (FM). Staircase fatigue testing was performed (piston-on-three balls set-up, ISO 6872:2015), as well as surface roughness, profilometry, scanning electron microscopy (SEM-FEG), energy dispersive X-ray spectroscopy (EDX), phase transformation (t → m) using X-ray diffraction analysis (XRD), translucency parameter analysis (TP and TP₀₀ ) and fractography.

RESULTS

The results showed no statistical significant differences for roughness parameters (p > 0.05, SM: Ra = 0.13 ± 0.02, Rz = 1.21 ± 0.26 and RSm = 24.91 ± 2.19; FM: Ra = 0.14 ± 0.03, Rz = 1.32 ± 0.25 and RSm = 24.68 ± 2.16) or flexural fatigue strength (SM: 512 (464-560) MPa; FM: 542 (472-611) MPa) between the groups. In addition, similarity in surface morphological features (SEM and profilometry), composition and phases (EDX and XRD) was observed between the firing protocols. Fractography showed that the failure origin occurred on the tensile side. Sintering mode did not affect the TP (F = 0.001, p = 0.97) and TP₀₀ (F = 0.12, p = 0.72).

CONCLUSIONS

Therefore, the fast-sintering mode is suggested as a viable alternative to the standard mode since it does not influence the evaluated surface morphology, microstructure, fatigue strength and translucency of a translucent monolithic zirconia.

CLINICAL SIGNIFICANCE

The fast sintering mode is a viable alternative for zirconia without compromising its topography, microstructure, mechanical performance or translucency.

Three-Dimensional Finite Element Analysis of Worn Molars With Prosthetic Crowns and Onlays Made of Various Materials

Background/Purpose

Restoration of worn teeth represents a challenge for practitioners in terms of preserving dental tissues, achieving restoration requirements, and choosing the most appropriate material. This study aimed to evaluate the effect of both preparation and restoration type on stress distribution in modeled first mandibular molars when functional and parafunctional occlusal forces were applied.

Materials and methods

The study sample consisted of 40 three-dimensional computer models of restored lower first molars with full crowns (gold, nickel-chrome, lithium disilicate, BruxZir® zirconia, and porcelain fused to metal) and onlays (gold, nickel, chrome, lithium disilicate, and direct and indirect composites). Forces of different intensities and directions were applied, and then finite element analysis was carried out based on the von Mises equivalent stress theory to predict the failure that could occur in the restoring materials and luting cement or bonding agent.

Results

In functional forces groups, zirconia crowns showed the lowest value of the failure risk, while the highest value was in veneering porcelain with values close to the rest of the models. For onlays, gold onlays represented the best stress distribution with the lowest value of the failure risk, in contrast to the composite onlays that had the highest failure risk. In parafunctional forces groups, the preference remained for zirconia and gold crowns, as well as for metal onlays, with greater differences in the values of the failure risk.

Conclusion

Gold alloy exhibited better behavior in the stress distribution. All restorations showed similar behavior when applying functional forces; however, when applying parafunctional forces, both gold and zirconia crowns have shown the best results.

Effect of Surface-Etching Treatment, Glaze, and the Antagonist on Roughness of a Hybrid Ceramic after Two-Body Wear

Stains and glaze are effective procedures for achieving an aesthetic smoothness on indirect restorations. Thus, the effect of surface-etching treatments previous to the stain layer and the glaze application on the occlusal and antagonist wear of a hybrid ceramic were evaluated against different antagonists. Disc-shaped samples were prepared from polymer-infiltrated ceramic network (PICN) blocks. The specimens were divided into eight groups, according to the surface-etching treatment and glaze application: P (polished specimens); PG (polishing plus glaze); E (hydrofluoric acid etching plus stain); EG (acid etching plus stain plus glaze); A (aluminum oxide sandblasting plus stain); AG (sandblasting plus stain plus glaze); S (self-etching primer plus stain); SG (self-etching primer plus stain plus glaze). Half of the samples were subjected to a wear simulation with a steatite antagonist, and the other half was tested using a PICN antagonist. The test parameters were: 15 N, 1.7 Hz, 6 mm of horizontal sliding, 5000 cycles. The discs and the antagonists' masses were measured before and after the wear tests. The average roughness and spacing defects were evaluated. The etching treatment affected the surface and antagonist mass loss when tested against steatite. AG showed the highest mass loss. This influence was not detected when using the PICN antagonist. The glaze application after staining ensures a smoother surface and avoids antagonist wear.

Mechanical Properties and In Vitro Biocompatibility of Hybrid Polymer-HA/BAG Ceramic Dental Materials

The aim of this study is to prepare hybrid polymer-ceramic dental materials for chairside computer-aided design/computer-aided manufacturing (CAD/CAM) applications. The hybrid polymer-ceramic materials were fabricated via infiltrating polymerizable monomer mixtures into sintered hydroxyapatite/bioactive glass (HA/BAG) ceramic blocks and thermo-curing. The microstructure was observed by scanning electron microscopy and an energy-dispersive spectrometer. The phase structure was analyzed by X-ray diffraction. The composition ratio was analyzed by a thermogravimetric analyzer. The hardness was measured by a Vickers hardness tester. The flexural strength, flexural modulus, and compressive strength were measured and calculated by a universal testing machine. The growth of human gingival fibroblasts was evaluated by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) colorimetric assay and immunofluorescence staining. The results showed that the sintering temperature and BAG content affected the mechanical properties of the hybrid polymer-ceramic materials. The X-ray diffraction analysis showed that high-temperature sintering promoted the partial conversion of HA to β-tricalcium phosphate. The values of the hardness, flexural strength, flexural modulus, and compressive strength of all the hybrid polymer-ceramic materials were 0.89-3.51 GPa, 57.61-118.05 MPa, 20.26-39.77 GPa, and 60.36-390.46 MPa, respectively. The mechanical properties of the hybrid polymer-ceramic materials were similar to natural teeth. As a trade-off between flexural strength and hardness, hybrid polymer-ceramic material with 20 wt.% BAG sintered at 1000 °C was the best material. In vitro experiments confirmed the biocompatibility of the hybrid polymer-ceramic material. Therefore, the hybrid polymer-ceramic material is expected to become a new type of dental restoration material.

Comparison of Short-Term Restorative Effects and Periodontal Health Status of Restorations Made of Different Materials in Full-Crown Restoration of Mandibular Premolar Tooth Defects

Purpose

To compare the short-term restorative effect and periodontal health status of restorations with different materials in full-crown restoration of mandibular premolar tooth defects.

Methods

A total of 105 cases (123 affected teeth) of mandibular premolar tooth defects who visited the Department of Stomatology between January 2019 and January 2020 were selected, of which 58 cases (68 affected teeth) restored with cobalt-chromium alloy porcelain crowns were included in the metal-ceramic crown (MCC) group and 47 cases (55 affected teeth) repaired by zirconium dioxide all-ceramic crowns were assigned to the zirconia crown (ZC) group. The restorative effect, inflammatory factors (high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α)) and periodontal health indicators (human cartilage glycoprotein-39 (YKL-40), resistin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP)) after treatment, and the occurrence of adverse reactions were compared between the two groups.

Results

The ZC group outperformed the MCC group in terms of margin fitness, restoration fracture, gingival condition, and color matching. After restoration, hs-CRP and TNF-α were statistically decreased in both groups, while YKL-40, resistin, AST, and ALP were significantly increased; and compared with the MCC group, hs-CRP, TNF-α, YKL-40, resistin, AST, and ALP were lower in the ZC group. The ZC group also scored statistically higher in retention effect, aesthetic effect, masticatory function, voice function, and comfort. Moreover, the ZC group had a higher total effective rate and a lower incidence of adverse reactions than the MCC group, with statistical significance.

Conclusions

Zirconia dioxide all-ceramic crowns contribute to a better short-term restorative effect in the full-crown restoration of mandibular premolar tooth defects, with little impact on periodontal health and high patient satisfaction, which deserves popularization and application.

PEEK in Fixed Dental Prostheses: Application and Adhesion Improvement

Polyetheretherketone (PEEK) has been widely applied in fixed dental prostheses, comprising crowns, fixed partial dentures, and post-and-core. PEEK’s excellent mechanical properties facilitate better stress distribution than conventional materials, protecting the abutment teeth. However, the stiffness of PEEK is not sufficient, which can be improved via fiber reinforcement. PEEK is biocompatible. It is nonmutagenic, noncytotoxic, and nonallergenic. However, the chemical stability of PEEK is a double-edged sword. On the one hand, PEEK is nondegradable and intraoral corrosion is minimized. On the other hand, the inert surface makes adhesive bonding difficult. Numerous strategies for improving the adhesive properties of PEEK have been explored, including acid etching, plasma treatment, airborne particle abrasion, laser treatment, and adhesive systems.

Mechanical Behavior of Alkasite Posterior Restorations in Comparison to Polymeric Materials: A 3D-FEA Study

The present investigation evaluated the effect of the combination of different dental filling materials in Class I cavities under occlusal loading using three-dimensional finite elements analysis (FEA). Six computer-generated and restored models of a lower molar were created in the CAD software and compared according to the biomechanical response during chewing load condition. Two adhesively bonded bulk restorative materials [bulk-fill resin composite (BF) or Alkasite (Alk)] were evaluated with or without the presence of a base material below (flowable resin composite or glass ionomer cement). A food bolus was placed on the occlusal surface mimicking the compressive occlusal load (600 N) during the static linear analysis. The maximum principal stress (tensile) was calculated as stress criteria in enamel, dentin and restoration. All models showed high stresses along the enamel/restoration margin with a similar stress trend for models restored with the same upper-layer material. Stress values up to 12.04 MPa (Alk) or up to 11.12 MPa (BF) were recorded at the enamel margins. The use of flexible polymeric or ionic base material in combination with bulk-fill resin composite or Alk did not reduce the stress magnitude in dentine and enamel. Class I cavities adhesively restored with bulk-fill resin composite showed lighter stress concentration as well as Alk. Therefore, adhesively bonded Alk restoration showed a promising mechanical behavior when used with different base materials or as a bulk restoration for posterior Class I cavity.

Comparative Stress Analysis of Polyetherketoneketone (PEKK) Telescopic Crowns Supported by Different Primary Crown Materials

The present study aimed to investigate the stress distribution of secondary telescopic crowns made of polyetherketoneketone (PEKK) combined with different primary crown (PC) materials (Zirconia, CoCr, Titanium, and PEKK) using finite element analysis. The geometric model was composed of bone tissue, periodontal ligament, root dentin, cement layer, primary crown, and secondary telescopic crown (SC). A total of four models were evaluated in which the secondary crowns were simulated in PEKK. The models were designed in CAD software and exported to the computer aided engineering software for the statistic structural analysis simulation. The materials were considered isotropic, with linear behavior and elastic properties. The model was fixed in the bone base and the load was applied at the occlusal surface of the crowns with 600 N. The results were required in von-Mises stress for the primary crown, secondary crown, cement layer, and Equivalent Strain to the periodontal ligament and bone tissue. Results show that the material influenced the stress distribution. The higher the PC elastic modulus, the higher the stress magnitude on the SC and cement layer. In the present study, the use of milled high-density polymer for primary crown presented a promising biomechanical behavior as an alternative material for double-crown design.

Study on fracture behavior of molars based on three-dimensional high-precision computerized tomography scanning and numerical simulation

A series of three-dimensional (3D) numerical simulations are conducted to investigate the gradual failure process of molars in this study. The real morphology and internal mesoscopic structure of a whole tooth are implemented into the numerical simulations through computerized tomography scanning, digital image processing, and 3D matrix mapping. The failure process of the whole tooth subject to compressions including crack initiation, crack propagation, and final failure pattern is reproduced using 3D realistic failure process analysis (RFPA3D) method. It is concluded that a series of microcracks are gradually initiated, nucleated, and subsequently interconnect to form macroscopic cracks when the teeth are under over-compressions. The propagation of the macroscopic cracks results in the formation of fracture surfaces and penetrating cracks, which are essential signs and manifestations of the tooth failure. Moreover, the simulations reveal that, the material heterogeneity is a critical factor that affects the mechanical properties and fracture modes of the teeth, which vary from crown fractures to crown-root fractures and root fractures depending on different homogeneity indices.

Influence of margin design and restorative material on the stress distribution of endocrowns: a 3D finite element analysis

Background

This study aimed to evaluate the stress distributions in endocrown restorations as applied to endodontically treated teeth (ETT), according to the factors of “margin design” (four levels) and “restorative material” (six levels).

Methods

Four 3D-finite elements models were constructed for endocrown restored molars considering different margin designs. Model A was prepared with a flat butt joint margin and received an endocrown with a 2.0-mm occlusal thickness. Model B was prepared with a 20° bevel margin and received an endocrown with a 2.0-mm occlusal thickness. Model C was prepared with an axial reduction and 1-mm shoulder margin and received an endocrown with a 2.0-mm occlusal thickness. Model D was prepared with an anatomic margin and received an endocrown with a 2.0-mm occlusal thickness. The following endocrown materials were used: In-Ceram Zirconia (Zr), Vita Suprinity (VS), IPS Empress (IE), Grandio blocs (GR), VisCalor bulk (VS), and CopraPeek Light (CP). The Load application (600 N) was performed at the food bolus and tooth surface during the closing phase of the chewing cycle. The results for the endocrown and tooth remnants were determined according to the von Mises stress. The failure risk of the cement layer was also calculated based on the normal stress criterion.

Results

Model D (with an anatomic margin) showed the greatest stress concentrations, especially in the irregular and sharp angles of the restoration and tooth remnants. The stress concentrated on the dentin was significantly lower in Model B with a 20° bevel margin (20.86 MPa), i.e., 1.3 times lower than the other three margin designs (27.80 MPa). Restorative materials with higher elastic moduli present higher stress concentrations inside the endocrown and transmit less stress to the cement layer, resulting in lower bonding failure risks. In contrast, materials with an elastic modulus similar to that of dentin presented with a more homogeneous stress distribution on the whole structure.

Conclusions

An endocrown with a 20° bevel margin design could be a favorable preparation option for ETT. Composite resins (GR and VC) exhibit a more even stress distribution, and seem to be more promising materials for endocrown molars.

Influence of Framework Material and Posterior Implant Angulation in Full-Arch All-on-4 Implant-Supported Prosthesis Stress Concentration

This study evaluated the influence of distal implants angulation and framework material in the stress concentration of an All-on-4 full-arch prosthesis. A full-arch implant-supported prosthesis 3D model was created with different distal implant angulations and cantilever arms (30° with 10-mm cantilever; 45° with 10-mm cantilever and 45° with 6-mm cantilever) and framework materials (Cobalt–chrome [CoCr alloy], Yttria-stabilized tetragonal zirconia polycrystal [Y-TZP] and polyetheretherketone [PEEK]). Each solid was imported to computer-aided engineering software, and tetrahedral elements formed the mesh. Material properties were assigned to each solid with isotropic and homogeneous behavior. The contacts were considered bonded. A vertical load of 200 N was applied in the distal region of the cantilever arm, and stress was evaluated in Von Misses (σVM) for prosthesis components and the Maximum (σMAX) and Minimum (σMIN) Principal Stresses for the bone. Distal implants angled in 45° with a 10-mm cantilever arm showed the highest stress concentration for all structures with higher stress magnitudes when the PEEK framework was considered. However, distal implants angled in 45° with a 6-mm cantilever arm showed promising mechanical responses with the lowest stress peaks. For the All-on-4 concept, a 45° distal implants angulation is only beneficial if it is possible to reduce the cantilever’s length; otherwise, the use of 30° should be considered. Comparing with PEEK, the YTZP and CoCr concentrated stress in the framework structure, reducing the stress in the prosthetic screw.

Influence of fiber insertion and different material type on stress distribution in endocrown restorations: a 3D-FEA study

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.

Effect of occlusal anatomy of CAD/CAM feldspathic posterior crowns in the stress concentration and fracture load

OBJECTIVES

This study evaluated the effect of restoration occlusal design on the maximum fracture load and stress distribution of a feldspathic ceramic crown.

MATERIALS AND METHODS

Twenty dentin analogues were used to simulate a full-crown preparation. Next, 20 feldspathic crowns were milled according to the occlusal design parameter available in the CAD database (Young or Adult). The crowns were cemented with dual cure resin-cement and loaded until fracture at 1 mm/min crosshead speed. Data were analyzed by using one-way ANOVA and Tukey tests (p < 0.05). The same geometry and experimental setup was modeled and exported to the computer aided engineering software and tensile stress concentration was calculated using the finite element method with 300 N occlusal load simulation.

RESULTS

The occlusal anatomy significantly influenced the load-to-fracture (p < 0.05). Adult design showed higher mean values (1149 ± 201 N) than Young design (454 ± 77 N). The maximum principal stress criteria showed similar stress pattern for both designs, however, the highest stress concentration was calculated for Young design (91 MPa) in the occlusal surface.

CONCLUSIONS

An anatomy design with reduced cusp angulation and less evident occlusal sulcus can reduce the stress concentration and increase the fracture load for feldspathic CAD/CAM posterior crowns.

Effect of active application of self-etching ceramic primer on the long-term bond strength of different dental CAD/CAM materials

Background

The objective of this in vitro study was to evaluate the effect of the active application of self-etching ceramic primer (ME&P) on the bond strength of different dental CAD/CAM materials (Lithium Disilicate ceramic (LD), Leucite ceramic (LE), Zirconia reinforced lithium silicate ceramic (ZLS), and Hybrid ceramic (HC)) with thermocycling aging.

Material and Methods

The samples were randomly divided into 16 groups (n = 20). Dual resin cement cylinders were made and light cured for 10 s (1.200 mW/cm2) for the shear bond strength test. 3-way ANOVA revealed that the factors were statistically significant (P< 0.05).

Results

The aging process had a negative impact on the bond strength for all groups except for Lithium Disilicate, with active application. ZLS and LE showed promising results with high bond strength values for the ME&P active application; however, after aging the bond strength value was significantly reduced. HC showed reduced bond strength values regardless the ME&P application.

Conclusions

In order to obtain a durable bond strength, the recommended protocol of 20 s of active application followed by 40 s of sitting time in the self-etching ceramic primer should be followed when using reinforced-glass ceramics as restorative materials.

Key words:Dentistry, dental materials, silane, shear strength, computer-aided design

Cyclic fatigue tests on non-anatomic specimens of dental ceramic materials: A scoping review

The aim of the present scoping review was to identify and discuss the methods, testing parameters, and characteristics used to induce cyclic fatigue on non-anatomic dental ceramic specimens. In vitro studies written in English which evaluated commercially-available non-anatomic dental ceramic specimens subjected to mechanical cyclic fatigue were selected. The search was performed in the PubMed, Scopus and Web of Science databases. The initial search yielded 1,636 articles, of which 81 were included. Based on the collected data, most of the included studies evaluated dental ceramic specimens cemented to supporting substrate (n= 42; 51.9%); used step-stress (n= 35; 42.2%) accelerated fatigue test, loading frequencies above 10 Hz (n= 31, 35.6%), stainless steel (n = 28, 32.6%) load applicator with spherical shaped tip 40 mm diameter (n= 25, 30.9%); applied only axial loads (n= 77, 95.1%); and considered a wet testing environment (n= 65, 78.3%). The definition of test geometry, method, and testing parameters must be cautiously considered according to the study objective and the scenario that is simulated. Accelerated fatigue tests, load frequencies up to 20 Hz, a 40 mm stainless steel spherical load applicator and a wet testing environment are the major common defined parameters presented in the existing literature. More studies exploring the influence of such factors on fatigue mechanism are necessary.

Influence of Resin Cement Thickness and Elastic Modulus on the Stress Distribution of Zirconium Dioxide Inlay-Bridge: 3D Finite Element Analysis

The mechanical properties and the thickness of the resin cement agents used for bonding inlay bridges can modify the clinical performance of the restoration such as debonding or prosthetic materials fracture. Thus, the aim of this study was to evaluate the stress distribution and the maximum strain generated by resin cements with different elastic moduli and thicknesses used to cement resin-bonded fixed partial denture (RBFPD). A three-dimensional (3D) finite element analysis (FEA) was used, and a 3D model was created based on a Cone-Beam Computed Tomography system (CBCT). The model was analyzed by the Ansys software. The model fixation occurred at the root of the abutment teeth and an axial load of 300 N was applied on the occlusal surface of the pontic. The highest stress value was observed for the Variolink 0.4 group (1.76 × 10⁶ Pa), while the lowest was noted for the Panavia 0.2 group (1.07 × 10⁶ Pa). Furthermore, the highest total deformation value was found for the Variolink 0.2 group (3.36 × 10^-4 m), while the lowest was observed for the Panavia 0.4 group (2.33 × 10^-4 m). By means of this FEA, 0.2 mm layer Panavia F2.0 seemed to exhibit a more favorable stress distribution when used for cementation of posterior zirconium-dioxide-based RBFPD. However, both studied materials possessed clinically acceptable properties.

Resistance fracture of minimally prepared endocrowns made by three types of restorative materials: a 3D finite element analysis

A thin endocrown restoration was often applied in endodontically treated teeth with vertical bite height loss or inadequate clinical crown length. A model of mandibular molars made by endocrown restoration with 1 mm thickness and 2 mm depth of pulp chamber was constructed and imported into FEA ANSYS v18.0 software. The three CAD/CAM materials, feldspathic (Mark2), lithium disilicate (EMAX), and lava ultimate (LU), were assigned, and the five load indenters were loaded on the full occlusal (FO), occlusal center (OC), central fossa (CF), buccal groove (BG), and mesiobuccal cusp (MC) of restoration in the model. The MinPS and MaxPS of the thin endocrown were significantly higher than those of tooth tissue in five types of loads except for the LU endocrown loaded in the FO group. The smaller the contact surface of the load was, the higher MaxPS and MinPS were. MaxPS and MinPS of the MC were the highest, followed by the BG and CF in the restoration. In the stress distribution of tooth tissue, MaxPS in the LU endocrown accumulated at the external edge of enamel and was significantly higher than MaxPS in Mark2 and EMAX endocrown concentrated on the chamber wall of dentin under OC, CF and BG loads. Within the limitations of this FEA study, the LU endocrown transferred more stress to tooth tissue than Mark2 and EMAX, and the maximum principal stress on endocrown restoration and tooth tissue at the mesiobuccal cusp load was higher than that at the central fossa and buccal groove load.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Influence of restorative material and cement on the stress distribution of endocrowns: 3D finite element analysis

Purpose

This study aimed to evaluate the influence of different types of restorative materials and resin cements on the stress distribution in the regions of the restoration, cement layer and dental remnant in endodontically treated posterior endocrowns.

Methods

A 3D finite element analysis (FEA) model of the first mandibular molar that was restored with an endocrown designed by computer-aided design (CAD) software was generated. Three kinds of restorative materials (Vita Enamic (VE), IPS e.max CAD (EMX) and Grandio blocs (GR)) and two types of cementing materials (NX3 and Maxcem Elite Chroma (MX)) were analysed with such a model. The food layer was also designed before vertical (600 N) forces were applied to simulate physiological masticatory conditions. Thermal expansion was used to simulate the polymerization shrinkage effects of cement layers. The results were obtained by colorimetric graphs of the maximum principal stress in the restoration and tooth remnant. The failure risk of the cement layer was also calculated based on the normal stress.

Results

The elastic modulus was positively correlated with the tensile stress peak values in the restoration, mainly at the intaglio surface. However, in the cervical enamel and cement layer, restorative material with a higher elastic modulus generated lower peak stress values. The cement with a higher elastic modulus resulted in higher stress peak values inside the cement layer. The combination of EMX (restorative material) and NX3 (cement material) in the cement layer resulted in the lowest failure risk.

Significance

The ceramic material EMX with a higher elastic modulus appeared to be more effective at protecting the cement layer and residual enamel tissue. Based on the analysis of the failure risk of the cement layer, the combination of EMX and NX3 was recommended as an optional material for endocrowns for endodontically treated posterior teeth.

Alumina particle air-abrasion and aging effects: Fatigue behavior of CAD/CAM resin composite crowns and flexural strength evaluations

The aim of this study was to characterize the flexural strength and elastic modulus of CAD/CAM resin composite material and to evaluate the influence of different surface treatments and storage conditions on the fatigue behavior of bonded composite crowns. Bars (flexural strength, n= 30; elastic modulus, n= 5) (1.2 × 4 × 12 mm) were produced for three-point bending test and CAD/CAM milled crowns (n= 5) (thickness= 1 mm) adhesively cemented to an epoxy resin substrate for fatigue tests. Bars and crowns were randomly allocated into two "surface treatments": no surface treatment (CTRL) and air-abrasion with 110 μm Al₂O₃ particles (AlOx); while the crowns were also subdivided into "aging condition" (baseline - storage for 24 h to 7 days, and aging - storage for 150 days + 25,000 thermal cycles). The three-point bending test was performed according to ISO 6872 and the luted crowns were subjected to step-stress fatigue test (initial load of 200 N; step-size of 50 N; 10,000 cycles per step; 20 Hz). Complementary analysis by Stereomicroscopy and Field Emission Scanning Electron Microscopy (FE-SEM) were performed. The flexural strength and fatigue data were submitted to statistical tests (α= 0.05). The results showed that air-abrasion reduces the flexural strength and the characteristic strength of the resin composite, without modifying its elastic modulus or its structural reliability (Weibull Modulus). Air-abrasion did not influence the fatigue behavior of the cemented crowns. Notwithstanding, a decrease in the survival rate was observed after 445,000 cycles (2,400 N) when subjected to aging at both the CTRL or AlOx conditions. FE-SEM micrographs of the crowns showed that alumina particle air-abrasion treatment can modify the topography of its treated inner surface. Therefore, air-abrasion with alumina powder introduces defects onto the surface of the CAD/CAM resin composite material, decreasing the flexural strength, but without changing its elastic modulus and reliability. Adhesive cementation onto an epoxy resin substrate prevented an influence of the introduced defects on the fatigue performance of the resin composite restoration. Nevertheless, the fatigue behavior may be damaged by aging regimen.

Influence of Cavity Geometry on the Fracture Strength of Dental Restorations: Finite Element Study

The main purpose of this work was to analyze the stress distribution in premolars restored with indirect IPS Empress® CAD onlays or inlays. The three-dimensional geometry of a human first premolar was created using modeling software. The tooth fixation system was simulated through box geometry, comprising a cortical bone layer with 2 mm of thickness over a layer of trabecular bone with 15 mm of thickness. The tooth had the following approximated crown dimensions: 10.35 mm buccolingual length; 7.1 mm mesiodistal width; and 7.0 mm cervico-occlusal height. The mesio-occluso-distal (MOD) cavity preparations followed the suggestions available in the literature. The cement geometry was modified to include cohesive zone models (CZM) to perform the adhesive joint’s strength prediction. The loading body was created assuming contact between the food bolus and the tooth surface. Numerical solutions were obtained by performing static analysis and damage analysis using the finite element method. Von Mises stress values generated in the ceramic inlay restoration ranged from 1.39–181.47 MPa, which were on average 4.4% higher than those of the onlay ceramic restoration. The fracture strength of the onlay restoration was about 18% higher than that of the inlay restoration. The onlay design seems to contribute to higher homogenization of the adhesive resin cement strain and higher tooth structure protection.