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Mao Z, Schmidt F, Beuer F, Yassine J, Hey J, Prause E. Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns. Clin Oral Investig 2024; 28:371. [PMID: 38869697 DOI: 10.1007/s00784-024-05767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments. METHODS A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 μm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05). RESULTS Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials. CONCLUSIONS The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials. CLINICAL RELEVANCE Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.
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Affiliation(s)
- Zhen Mao
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Franziska Schmidt
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Jamila Yassine
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Jeremias Hey
- Department of Prosthodontics, School of Dental Medicine, Martin-Luther-University, Magdeburger Str. 16, 06112, Halle, Germany
| | - Elisabeth Prause
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
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Suksuphan P, Krajangta N, Didron PP, Wasanapiarnpong T, Rakmanee T. Marginal adaptation and fracture resistance of milled and 3D-printed CAD/CAM hybrid dental crown materials with various occlusal thicknesses. J Prosthodont Res 2024; 68:326-335. [PMID: 37438119 DOI: 10.2186/jpr.jpr_d_23_00089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE To evaluate the marginal adaptation and fracture resistance of three computer-aided design/computer-assisted manufacturing hybrid dental materials with different occlusal thicknesses. METHODS Ninety single-molar crowns were digitally fabricated using a milled hybrid nanoceramic (Cerasmart, CE), polymer-infiltrated ceramic network (PICN, Vita Enamic, VE), and 3D-printed materials (Varseosmile, VS) with occlusal thicknesses of 0.8, 1, and 1.5 mm (10 specimens/group). Anatomical 3D-printed resin dies (Rigid 10K) were used as supporting materials. A CEREC MCX milling unit and a DLP-based 3D printer, Freeform Pro 2, were utilized to produce the crown samples. Before cementation, the marginal adaptation, absolute marginal discrepancy (AMD), and marginal gap (MG) were assessed using micro-CT scanning. After cementation with self-adhesive resin cement, fracture resistance was evaluated using a universal testing machine. The number of fractured crowns and the maximum fracture values (N) were recorded. Data were statistically analyzed using both one- and two-way ANOVA, followed by Tukey's honestly significant difference (HSD) test. RESULTS For all occlusal thicknesses, the VS crowns demonstrated the lowest AMD and MG distances, significantly different from those of the other two milling groups (P < 0.05), whereas CE and VE did not differ significantly (P > 0.05). All VS crowns were fractured using the lowest loading forces (1480.3±226.1 to 1747.2±108.7 N). No CE and 1 and 1.5 mm VE crowns fractured under a 2000 N maximum load. CONCLUSIONS All hybrid-material crowns demonstrated favorable marginal adaptation within a clinically acceptable range, with 3D printing yielding superior results to milling. All materials could withstand normal occlusal force even with a 0.8 mm occlusal thickness.
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Affiliation(s)
- Pisit Suksuphan
- Department of Restorative and Esthetic Dentistry, Faculty of Dentistry, Thammasat University, Pathumtani, Thailand
| | - Nantawan Krajangta
- Department of Restorative and Esthetic Dentistry, Faculty of Dentistry, Thammasat University, Pathumtani, Thailand
| | | | | | - Thanasak Rakmanee
- Department of Restorative and Esthetic Dentistry, Faculty of Dentistry, Thammasat University, Pathumtani, Thailand
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Dalla-Nora F, Da Rosa LS, Pereira GKR, Valandro LF, Rippe MP. Is dentin analogue material a viable substitute for human dentin in fatigue behavior studies? J Mech Behav Biomed Mater 2024; 150:106312. [PMID: 38134583 DOI: 10.1016/j.jmbbm.2023.106312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
This study aimed to compare the fatigue performance of a lithium disilicate ceramic cemented on different substrates (human dentin and glass fiber-reinforced epoxy resin - GFRER), treated with different types of conditioning (CTR - without surface conditioning; HF5 - 5% hydrofluoric acid; HF10 - 10% hydrofluoric acid; H3PO4 - phosphoric acid 37%; SAND - sandblasting with aluminum oxide). The occlusal surface of human molars (DENT group) (n = 15) was ground for dentin exposure and the root portion was cut, then the dentin slice (2.0 mm thick) was conditioned with 37% phosphoric acid and a dual-curing dental adhesive was applied. The GFRER in a round-rod format was cut into discs (Ø = 10 mm, 2.0 mm thick). Lithium disilicate glass ceramic blocks (IPS e.max CAD, Ivoclar, Schaan, Liechtenstein) were shaped into a cylinder format and cut, resulting in 90 discs (Ø = 10 mm, 1.5 mm thick). The substrate materials of each group were etched according to the groups and the ceramic was etched with 5% hydrofluoric acid for 30 s. A silane coupling agent was applied over the cementation surface in ceramic and GFRER surfaces and a dual cement was used for cementation (ceramic/GFRER or dentin). The disc/disc sets were submitted to thermocycling (25,000 cycles + storage for 6 months), and then tested in step-wise accelerated cyclic fatigue test. The failure pattern and topography were analyzed and the roughness and contact angle were measured before and after surface treatment. The DENT group presented the lowest load to failure values and number of cycles to failure in fatigue (637.33 N; 118.333), showing no statistical similarity with any of the other tested groups (p < 0.05). The topographic analysis showed that all proposed surface treatments modified the substrate surface when compared to the CTR group. All of the fractographical inspections demonstrated failure by radial crack. Considering the roughness analysis, the post-etched DENT group showed similar roughness to all groups of GFRER materials with their surface treated, except for SAND, which showed greater roughness and statistically different from the other groups. The DENT group (49.5) showed statistically different post-conditioning contact angle values from the HF10 group (96.5) and similar to the other groups. The glass fiber-reinforced epoxy resin was not able to simulate the results presented by the human dentin substrate when cemented to lithium disilicate regarding fatigue failure load and number of cycles for failure, regardless of the surface treatment. Lithium disilicate cemented on dentin analogue overestimates the load values for fatigue failure.
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Affiliation(s)
- F Dalla-Nora
- MSciD and PhD Post-Graduate Program in Oral Science [Prosthodontics Units], Faculty of Dentistry, Federal University of Santa Maria [UFSM], Avenue Roraima 1000, Building 26F, room 2383, Zip Code: 97105-900, Santa Maria, Rio Grande do Sul State, Brazil.
| | - L S Da Rosa
- MSciD and PhD Post-Graduate Program in Oral Science [Prosthodontics Units], Faculty of Dentistry, Federal University of Santa Maria [UFSM], Avenue Roraima 1000, Building 26F, room 2383, Zip Code: 97105-900, Santa Maria, Rio Grande do Sul State, Brazil.
| | - G K R Pereira
- MSciD and PhD Post-Graduate Program in Oral Science [Prosthodontics Units], Faculty of Dentistry, Federal University of Santa Maria [UFSM], Avenue Roraima 1000, Building 26F, room 2383, Zip Code: 97105-900, Santa Maria, Rio Grande do Sul State, Brazil.
| | - L F Valandro
- MSciD and PhD Post-Graduate Program in Oral Science [Prosthodontics Units], Faculty of Dentistry, Federal University of Santa Maria [UFSM], Avenue Roraima 1000, Building 26F, room 2383, Zip Code: 97105-900, Santa Maria, Rio Grande do Sul State, Brazil.
| | - M P Rippe
- MSciD and PhD Post-Graduate Program in Oral Science [Prosthodontics Units], Faculty of Dentistry, Federal University of Santa Maria [UFSM], Avenue Roraima 1000, Building 26F, room 2383, Zip Code: 97105-900, Santa Maria, Rio Grande do Sul State, Brazil.
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Liu X, Yao X, Zhang R, Sun L, Zhang Z, Zhao Y, Zhang T, Yan J, Zhang Y, Wu X, Li B. Recent advances in glass-ceramics: Performance and toughening mechanisms in restorative dentistry. J Biomed Mater Res B Appl Biomater 2024; 112:e35334. [PMID: 37776023 DOI: 10.1002/jbm.b.35334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
The use of glass-ceramics in the medical field has grown significantly since the 1980s. With excellent aesthetic properties, semi-translucency, outstanding mechanical properties, corrosion resistance, wear resistance and great biocompatibility and workability glass-ceramics is one of the most commonly used materials in restorative dentistry and is widely used in veneers, inlays, onlays, all-ceramic crowns, and implant abutments. This review provides an overview of the research progress of glass-ceramics in restorative dentistry, focusing on the classification, performance requirements, toughening mechanisms and their association with clinical performance, as well as the manufacturing and fabrication of glass-ceramics in restorative dentistry. Finally, the developments and prospects of glass-ceramics in restorative dentistry are summarized and discussed.
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Affiliation(s)
- Xiaoming Liu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Xuemin Yao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Ran Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Lingxiang Sun
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Zheyuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Yifan Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Tong Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Jingyu Yan
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Yanjie Zhang
- Research Institute of Photonics, Dalian Polytechnic University, Dalian, Liaoning, China
| | - Xiuping Wu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
| | - Bing Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, China
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Farouk AT, Hassanein OES, Fahmy OI, Elkady AM, ElNahass H. Biological evaluation of indirect restorations in endodontically treated posterior teeth with deeply located proximal margins following deep margin elevation versus surgical crown lengthening: a randomized controlled trial. Clin Oral Investig 2023; 28:24. [PMID: 38147139 DOI: 10.1007/s00784-023-05434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The current clinical trial was conducted to evaluate the effect of proximal indirect restorations in endodontically treated posterior teeth with deeply located margins following deep margin elevation compared to surgical crown lengthening. MATERIAL AND METHODS Deep proximal cavities in endodontically treated posterior teeth were randomly assigned into two groups; deep margin elevation (DME) or crown lengthening (CL). The clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), crestal bone level (CBL), and secondary caries were evaluated at the baseline, 1, 3, 6, 9, and 12 months. RESULTS A total of 20 proximal cavities were included in the study; there was no significant difference between the two groups regarding mean CAL values at the baseline and 1 month, while there was a significant difference between the two groups in all other periods. Regarding the PD, there was no statistical significance between the two groups except at 9 and 12 months, where CL showed higher mean PD values than DME. There was no statistically significant difference in BOP or CBL between the two groups. CONCLUSIONS DME and CL are considered clinically successful with favorable biologic responses. CLINICAL RELEVANCE The deep margin elevation approach could provide a more conservative solution when relocating deeply seated cervical margins in a more coronal position. DME reduced the number of visits and time needed for the restoration of endodontically treated teeth. Surgical crown lengthening remains a gold standard procedure in the re-establishment of the supracrestal tissue attachment, especially in cases where cervical margins are beyond the elevation capacity.
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Affiliation(s)
- Ahmed Tarek Farouk
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Operative Dentistry Department, Faculty of Dentistry, Misr International University, Cairo, Egypt
| | | | - Ola Ibrahim Fahmy
- Operative Dentistry Department, Faculty of Dentistry, Misr International University, Cairo, Egypt
| | - Ahmed M Elkady
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Hani ElNahass
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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Park CH, Ko KH, Huh YH, Park CJ, Cho LR. Tensile bond strength of CAD-CAM all ceramic crowns before and after thermomechanical aging. J Prosthodont 2023. [PMID: 38115183 DOI: 10.1111/jopr.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023] Open
Abstract
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.
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Affiliation(s)
- Chan-Ho Park
- Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Kyung-Ho Ko
- Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Yoon-Hyuk Huh
- Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Chan-Jin Park
- Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
| | - Lee-Ra Cho
- Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University, Gangneung, Republic of Korea
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Porto TS, Medeiros da Silva IG, de Freitas Vallerini B, Fernando de Goes M. Different surface treatment strategies on etchable CAD-CAM materials: Part 1-Effect on the surface morphology. J Prosthet Dent 2023; 130:761-769. [PMID: 35094771 DOI: 10.1016/j.prosdent.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials have either a high content of ceramic filler particles or a ceramic network structure. Proper etching of these materials is challenging. Therefore, it is relevant to assess different surface etching strategies and morphological alterations as a result of these techniques. PURPOSE The purpose of this 2-part in vitro study was to evaluate different etching strategies on the surface roughness and its relationship to the surface contact angle with a subsequent morphological characterization of different CAD-CAM materials. MATERIAL AND METHODS Two CAD-CAM polymer-based materials and 1 CAD-CAM ceramic material were selected for this study. The materials were treated with different strategies, including a combination of airborne-particle abrasion and an application of 9% hydrofluoric acid etching. After the surface treatment, roughness measurements (Sa) were assessed by using an optical profilometer on an area of 1.47 mm2. Subsequently, the contact angle on the surface was examined by means of the sessile drop technique and an optical contact angle meter. The data were analyzed by using a 2-way analysis of variance, the post hoc Tukey test (α=.05), and the Pearson correlation coefficient. RESULTS The 3 materials tested showed an increase in surface roughness when treated with surface airborne-particle abrasion. However, the materials with polymer in their composition concomitantly increased the contact angle. More hydrophilic surfaces were observed when hydrofluoric acid was applied, regardless of the composition of the materials. The surface roughness presented a strong positive linear tendency in the surface treatments used. CONCLUSIONS The application of airborne-particle abrasion on the surface of the polymer-based CAD-CAM materials increased the roughness and contact angle. However, the application of acid etching after the airborne-particle abrasion decreased the contact angle for polymer-based CAD-CAM materials, resulting in considerable enhancement of the surface quality for proper bonding.
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Affiliation(s)
- Thiago Soares Porto
- Assistant Professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.
| | - Italo Guimaraes Medeiros da Silva
- Researcher, Department of Macromolecular Science and Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Bruna de Freitas Vallerini
- PhD Candidate, Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Mario Fernando de Goes
- Professor, Department of Restorative Dentistry (Dental Materials Area), Piracicaba Dental School, University of Campinas, UNICAMP, Sao Paulo, Brazil
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Anuntasainont M, Po-Ngam N, Lührs AK, Neoh SP, Pongprueksa P. Fracture resistance of CAD/CAM blocks cemented on dentin using different cementation strategies. J Prosthodont Res 2023; 67:603-609. [PMID: 36792222 DOI: 10.2186/jpr.jpr_d_22_00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
PURPOSE To determine whether the fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin-based composites and polymer-infiltrated ceramic network materials cemented on dentin is influenced by the restoration thickness and composite cement application strategy. METHODS Disc-shaped specimens (Ø = 7 mm) of 0.8 mm and 1.5 mm thicknesses were milled from two CAD/CAM materials: resin-based composite (RBC, Cerasmart 270) and polymer-infiltrated ceramic network (PICN, Vita Enamic). The discs (n = 8 per group) were cemented on flattened dentin using three different cementation strategies: 1) self-adhesive composite cement (RelyX U200) in light-curing mode (LC-SAC), 2) universal adhesive (Single Bond Universal) with composite cement (RelyX Ultimate) in auto-curing mode (AC cement), and 3) adhesive and composite cement as in 2) but in light-curing mode (LC cement). The restorative surface was indented perpendicularly with a compressive load using a universal testing machine until fracture. The fracture resistance (N) of RBC and PICN was separately analyzed using two-way ANOVA and Tukey's post-hoc test (α = 0.05). RESULTS The fracture resistance of each material was significantly influenced by the material thickness and cementation strategy (P < 0.05). Irrespective of the material type and cementation strategy, thicker materials exhibit higher fracture resistance. For RBC, the fracture resistance of the LC cement group was significantly higher than that of AC cement only at 0.8 mm thickness. For PICN, the LC-cement cementation strategy produced superior fracture resistance, regardless of the restoration thickness. CONCLUSIONS The fracture resistance of Cerasmart 270 was higher for the thicker material; the fracture resistance of LC cement was higher than that of AC cement at 0.8 mm thickness cemented to dentin. In comparison, LC cement showed the highest fracture resistance for Vita Enamic for both material thicknesses.
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Affiliation(s)
- Munlika Anuntasainont
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nanthiphorn Po-Ngam
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Anne-Katrin Lührs
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover, Germany
| | - Siew Peng Neoh
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Pong Pongprueksa
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Velho HC, Dapieve KS, Grassi EDA, Borges ALS, de Melo Marinho RM, Pereira GKR, Venturini AB, Valandro LF. Fatigue behavior, failure mode, and stress distribution of occlusal veneers: influence of the prosthetic preparation cusp inclinations and the type of restorative material. Clin Oral Investig 2023; 27:5539-5548. [PMID: 37490118 DOI: 10.1007/s00784-023-05173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To evaluate the effects of cusp inclination of the prosthetic preparation's occlusal surface and type of restorative material on the fatigue behavior, failure mode, and stress distribution of occlusal veneers. MATERIALS AND METHODS Glass fiber-reinforced epoxy resin prosthetic preparations for occlusal veneers with three different occlusal surface cusp inclination degrees (0°, 15°, and 30°) were produced and assigned into six testing groups (n = 11) according to the cusp inclination (0°, 15°, or 30°) and type of restorative material (lithium disilicate-LD or resin composite-RC). Despite different substrate preparation cusp inclination degrees, the restorations were designed maintaining 30° inclination between the cusps at the occlusal surface and a thickness of 0.7 mm at the central groove region of the restorations to be machined in a CAD/CAM system. After cementation, the specimens were stored for about 7 days (under water at 37 °C), and subsequently submitted to a load to failure test (n = 2) and an intermittent cyclic fatigue test (n = 9) (initial load: 100 N; step size: 50 N; cycles/step: 10,000; loading frequency: 20 Hz; loading piston: 6-mm-diameter stainless steel) until observing cracks. The data were analyzed by two-way ANOVA, Kaplan-Meier, and Mantel-Cox post hoc tests. Finite element analysis (FEA) and fractographic analyses were performed. RESULTS The fatigue performance of LD and RC occlusal veneers was evaluated based on different prosthetic preparation cusp inclinations. The 0° inclination showed the best fatigue performance for both materials (LD: 944N, RC: 861N), while the 15° and 30° inclinations had lower values (LD: 800N and 533N, RC: 739N and 717N, respectively). The study also found that for a 0° inclination, LD occlusal veneers performed better than RC ones (LD: 944 N > RC: 861N), while for a 30° inclination, RC occlusal veneers had better fatigue performance than LD ones (LD: 533N < RC: 717N). No significant difference was observed between the materials for a 15° inclination (LD: 800N = RC: 739N). The FEA results showed a higher tensile stress concentration on lithium disilicate than on resin composite occlusal veneers. All lithium disilicate occlusal veneers showed radial crack failures, while resin composite occlusal veneers showed Hertzian cone cracks and radial cracks combined. CONCLUSION Considering mechanical perspective only, RC occlusal veneers should be indicated when prosthetic preparation cusps inclinations are 30°. When 0° prosthetic preparation cusps inclinations are observed, LD occlusal veneers will behave mechanically better. When a 15° cusp inclination is preserved, both restorative materials behave similarly.
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Affiliation(s)
- Helder Callegaro Velho
- Post-Graduate Program in Oral Science, Prosthodontics-Biomaterials Unit, School of Dentistry, Center for Development of Advanced Materials, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26H, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Kiara Serafini Dapieve
- Post-Graduate Program in Oral Science, Prosthodontics-Biomaterials Unit, School of Dentistry, Center for Development of Advanced Materials, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26H, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Elisa Donária Aboucauch Grassi
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), 777, Engenheiro Francisco José Longo Av, São José Dos Campos, São Paulo, 12245-000, Brazil
| | - Alexandre Luiz Souto Borges
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), 777, Engenheiro Francisco José Longo Av, São José Dos Campos, São Paulo, 12245-000, Brazil
| | - Renata Marques de Melo Marinho
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), 777, Engenheiro Francisco José Longo Av, São José Dos Campos, São Paulo, 12245-000, Brazil
| | - Gabriel Kalil Rocha Pereira
- Post-Graduate Program in Oral Science, Prosthodontics-Biomaterials Unit, School of Dentistry, Center for Development of Advanced Materials, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26H, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Andressa Borin Venturini
- Post-Graduate Program in Oral Science, Prosthodontics-Biomaterials Unit, School of Dentistry, Center for Development of Advanced Materials, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26H, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil
| | - Luiz Felipe Valandro
- Post-Graduate Program in Oral Science, Prosthodontics-Biomaterials Unit, School of Dentistry, Center for Development of Advanced Materials, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26H, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil.
- Prosthodontics-Biomaterials Unit, Faculty of Odontology, Federal University of Santa Maria, UFSM Campus, 1000 Roraima Av., T Street, Building 26F, Room 2386, Santa Maria, Rio Grande Do Sul, 97105-900, Brazil.
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Fouda AM, Atta O, Özcan M, Stawarczyk B, Glaum R, Bourauel C. An investigation on fatigue, fracture resistance, and color properties of aesthetic CAD/CAM monolithic ceramics. Clin Oral Investig 2023; 27:2653-2665. [PMID: 36574045 PMCID: PMC10264477 DOI: 10.1007/s00784-022-04833-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate and compare fracture resistance, translucency, and color reproducibility, as well as the effect of aging on the fracture load and color stability of novel monolithic CAD/CAM ceramics. MATERIALS AND METHODS One hundred crowns of uniform thickness were milled from five ceramic blocks (n = 20): partially crystallized lithium disilicate (PLD) and fully crystallized lithium disilicate (FLD), lithium metasilicate (LMS), 4Y-TZP (SMZ), and 5Y-TZP (UMZ) monolithic zirconia. PLD crowns were glazed, LMS was fired, and FLD was polished. SMZ and UMZ crowns were sintered and polished. Crowns were adhesively cemented to epoxy dies. Half of the crowns (n = 10) were subjected to 1.200.000 load cycles with thermal cycling. Color space values L, a, b defined by the Commission Internationale de l´Eclairage (CIELAB) were measured before and after aging, and (∆E) was calculated. Both aged and non-aged specimens were loaded until fracture in a universal testing machine and the fracture load was recorded. X-ray diffraction (XRD) and scanning electron microscope (SEM) fractographic analysis were carried out on fractured fragments of representative samples. For translucency and color reproducibility, 50 rectangular-shaped specimens were fabricated and processed as described previously. Color values were measured over black and white backgrounds, and the translucency parameter (TP) was computed. Using the shade verification mode, (∆E) to shade A3 was calculated. Data were statistically analyzed using one-way and two-way ANOVA, and t-test. RESULTS Aging did not affect fracture resistance significantly (p > 0.05). The highest mean fracture load was obtained for the SMZ and UMZ. A significant color change was observed after aging in all groups. The highest TP was noted for FLD. SMZ and UMZ had the best shade match. CONCLUSIONS Zirconia showed higher fracture resistance and color stability than lithium silicate ceramics. Lithium silicate ceramics were more translucent. The experimental FLD demonstrated high translucency. CLINICAL RELEVANCE Tested ceramics showed sufficient stability to withstand masticatory forces. Characterization of final restorations might be mandatory for better color match.
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Affiliation(s)
- Ahmed Mahmoud Fouda
- Department of Oral Technology, University Hospital Bonn, Bonn University, Welschnonnenstr. 17, 53111, Bonn, Germany.
- Department of Fixed Prosthodontics, Suez Canal University, Ismailia, Egypt.
| | - Osama Atta
- Department of Fixed Prosthodontics, Suez Canal University, Ismailia, Egypt
| | - Mutlu Özcan
- Division of Dental Biomaterials, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Bogna Stawarczyk
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Robert Glaum
- Institute of Inorganic Chemistry, Bonn University, Bonn, Germany
| | - Christoph Bourauel
- Department of Oral Technology, University Hospital Bonn, Bonn University, Welschnonnenstr. 17, 53111, Bonn, Germany
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11
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Dapieve KS, Velho HC, da Rosa LS, Pivetta JP, Maidana FC, Venturini AB, Kleverlaan CJ, Pereira GKR, Valandro LF. Ceramic surface conditioning, resin cement viscosity, and aging relationships affect the load-bearing capacity under fatigue of bonded glass-ceramics. J Mech Behav Biomed Mater 2023; 139:105667. [PMID: 36657192 DOI: 10.1016/j.jmbbm.2023.105667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluate the influence of ceramic surface treatments, resin cement viscosities, and storage regimens on the fatigue performance of bonded glass-ceramics (lithium disilicate, LD; feldspathic, FEL). Ceramic discs (Ø = 10 mm; thickness = 1.5 mm) were allocated into eight groups per ceramic (n = 15), considering three factors: "ceramic surface treatment" in two levels - 5% hydrofluoric acid etching and silane-based coupling agent application (HF), or self-etching ceramic primer (E&P); "resin cement viscosity" in two levels - in high or low viscosity; and "storage regimen" in two levels - baseline, 24 h to 5 days; or aging, 180 days + 25,000 thermal cycles. Adhesive luting was performed onto glass fiber-reinforced epoxy resin discs (Ø = 10 mm; thickness = 2 mm) and the bonded assemblies were subjected to cyclic fatigue tests: initial load = 200 N; step-size = 25 N (FEL) and 50 N (LD); 10,000 cycles/step; 20 Hz. Scanning electron microscopy (SEM) inspections were performed. Regarding the LD ceramic, the fatigue behavior was reduced after aging for HF_HIGH and E&P_LOW conditions, while stable performance was observed for HF_LOW and E&P_HIGH. Regarding the FEL results, aging negatively affected HF_HIGH, E&P_HIGH, and E&P_LOW, being that only the HF_LOW condition presented a stable behavior. The failure initiated from defects on the etched surface of the ceramics, where the cross-sectional analysis commonly revealed unfilled areas. Long-term aging might induce a decrease in mechanical behavior. The 'ceramic microstructure/surface conditioning/resin cement viscosity relationships' modulate the fatigue performance of lithium disilicate and feldspathic glass-ceramics.
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Affiliation(s)
- Kiara Serafini Dapieve
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Helder Callegaro Velho
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Lucas Saldanha da Rosa
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Jordana Pavanelo Pivetta
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Fernanda Cocco Maidana
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Andressa Borin Venturini
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, North-Holland, the Netherlands.
| | - Gabriel Kalil Rocha Pereira
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- Post-Graduate Program in Oral Sciences, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
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12
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Lambert H, Corn S, Léger R, Ienny P, Slangen P, Fages M. Ceramic Bonding Interface under Shear-Compression Stress: Ultra-High-Speed Imaging Contribution. J Dent Res 2023; 102:295-301. [PMID: 36562502 DOI: 10.1177/00220345221138500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of this study is to visualize and characterize by ultra-high-speed imaging (UHSI) the failure phenomena at the resin-ceramic bonding interface of lithium disilicate (LiSi2) samples bonded with gold-standard protocol (Monobond Plus [MB]) and the nontoxic one (Monobond Etch & Prime [MEP]) subjected to mechanical loading. Unprecedented frame rate, image resolution, and recording time were reached by using the most advanced UHSI camera. The finite element analysis (FEA) of the proposed mechanical test confirmed that the specific design of our samples enables a combined shear and compression stress state, prone to test the bonding interface while being close to physiological stresses. Ten LiSi2 samples were pretreated by gold standard (MB, n = 5) and self-etching primer (MEP, n = 5). Axial compression loading gradually increased until catastrophic failure was performed. As shown by the FEA, the angle between the bonding interface and load direction leads to shear-compression stresses at the resin-ceramic bonding interface. Failure was recorded by UHSI at 300,000 fps. All recorded images were analyzed to segregate events and isolate the origin of fracture. For the first time, thanks to the image recording setup, it was observed that debonding is the first event before breakage, highlighting that sample fracture occurs by interfacial rupture followed by slippage and cohesive failure of materials. Failure mode could be described as mixed. MEP and MB showed similar results and behavior.
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Affiliation(s)
- H Lambert
- Laboratory Bioengineering and Nanosciences, University of Montpellier, Montpellier, France.,Department of Prosthetic Dentistry, Faculty of Odontology, Montpellier University, France
| | - S Corn
- LMGC, Univ Montpellier, IMT Mines Ales, CNRS, Ales, France
| | - R Léger
- LMGC, Univ Montpellier, IMT Mines Ales, CNRS, Ales, France
| | - P Ienny
- LMGC, Univ Montpellier, IMT Mines Ales, CNRS, Ales, France
| | - P Slangen
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Ales, France
| | - M Fages
- Laboratory Bioengineering and Nanosciences, University of Montpellier, Montpellier, France.,Department of Prosthetic Dentistry, Faculty of Odontology, Montpellier University, France
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13
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Venturini AB, Dapieve KS, de Kok P, Pereira GKR, Valandro LF, Kleverlaan CJ. Effect of the region of the CAD/CAM block on the flexural strength and structural reliability of restorative materials. J Mech Behav Biomed Mater 2023; 138:105597. [PMID: 36459706 DOI: 10.1016/j.jmbbm.2022.105597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
The aim of the study was to evaluate whether the region (internal or external) of the CAD/CAM block influences the mechanical performance of restorative materials. Blocks of different CAD/CAM materials (Composites: KAV - Katana Avencia; LULT - LULT Ultimate; Ceramics: ENAM - Vita Enamic; NICE - N!CE; EMP - IPS Empress CAD; VMII - Vita Mark II; EMAX - IPS e.max CAD) were selected, and direct resin composite blocks (APX - Clearfil AP-X; FSUP - Filtek Supreme) were built using the incremental technique on a mold from one of the CAD/CAM blocks. All blocks were sectioned into bar-shaped specimens (1 × 1 × 14 mm), which were separated into two groups according to the region of the block (inside or outside). 3-point bending tests were performed following ISO 6872:2015 and flexural strength data were analyzed using one-way ANOVA and Bonferroni post-hoc tests (p < 0.05). Weibull module and characteristic strength were also calculated. In general, the mean flexural strength values were not statistically different (p > 0.05) between the inside and outside regions of each material, except for LULT (inside > outside) and EMAX (outside > inside). Comparing the materials, a similar strength (only discrete variations) was observed for inside, outside or merged (inside and outside data assembled together) regions: EMAX > KAV = LULT > NICE = APX > EMP = ENAM = VMII ≥ FSUP (merged condition). Characteristic strength at 63.2% failure probability and at 5% failure probability generally corroborates such observations. There were no statistical differences for Weibull module data (inside, outside, or merged), except for KAV and NICE (outside > inside). Thus, the region from where the restoration is milled within the CAD/CAM block generally does not influence the mechanical performance hereof (flexural strength, failure probability, risk of premature failures, and mechanical reliability) of the material, except for LULT and EMAX.
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Affiliation(s)
- Andressa Borin Venturini
- Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Kiara Serafini Dapieve
- Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Paul de Kok
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, Noord-Holland, the Netherlands.
| | - Gabriel Kalil Rocha Pereira
- Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, Noord-Holland, the Netherlands.
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14
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Effects of material and piston diameter on the fatigue behavior, failure mode, and stress distribution of feldspathic ceramic simplified restorations. J Mech Behav Biomed Mater 2022; 134:105398. [DOI: 10.1016/j.jmbbm.2022.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
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15
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Thickness and internal adjustment of monolithic resin composite milled crowns: Effect on the load-bearing capacity under fatigue. J Mech Behav Biomed Mater 2022; 134:105407. [DOI: 10.1016/j.jmbbm.2022.105407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
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16
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Souza LFB, Soares PM, Chiapinotto GF, Ribeiro VF, Daudt NDF, Valandro LF, Pereira GKR. Effect of pigmentation techniques on the fatigue mechanical behavior of a translucent zirconia for monolithic restorations. J Mech Behav Biomed Mater 2022; 134:105362. [PMID: 35872462 DOI: 10.1016/j.jmbbm.2022.105362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Abstract
This study aims to characterize the effect of pre- and/or post-sintering pigmentation techniques on the fatigue behavior of a 4YSZ ceramic (4 mol% yttrium stabilized zirconia). First, 4YSZ ceramic discs (IPS e.max ZirCAD, 15 mm diameter, and 1.2 mm thickness) were obtained and allocated according to the 'pigmentation technique' factor into 5 groups: Ctrl - unshaded ceramic disc (IPS e.max ZirCAD BL); Manuf - ceramic discs shaded by the manufacturer at block formation (IPS e.max ZirCAD MT A2); Brush - unshaded ceramic disc pigmented in the pre-sintered stage using a brush; Stain - unshaded ceramic disc pigmented in the post-sintering stage using a stain glaze (shade A2); Brush + Stain - combination of Brush and Stain techniques. The specimens were sintered and analyzed by a spectrophotometer (VITA Easyshade) for color differences (ΔE00 calculated according to CIEDE, 2000) to ensure that they present the same perceived color (ΔE00 ≤ 1.77, acceptability threshold). The specimens (n = 15) were submitted to biaxial flexural fatigue testing using a cyclic fatigue method (frequency of 20 Hz; 10,000 cycles per step; initial stress of 200 MPa; and step-size of 25 MPa) until specimen fracture. Fatigue strength (FS) and number of cycles until failure (CFF) were recorded with statistical purposes. Fractographic, complementary topography, elemental and roughness analyses were performed. The Ctrl shown the highest FS, CFF, and survival rates compared to the other conditions (p < 0.05), being only statistically similar to Brush. Stain showed the lowest FS, CFF and survival rates (p < 0.05). The Manuf and Brush + Stain shown intermediary performance. In regards of Weibull moduli, Brush shown the lowest values (lowest structural reliability), for both FS and CFF, being only statistically similar to Manuf. Topography analysis shown a uniform size of zirconia crystals in Ctrl, Manuf and Brush. In addition, a smooth glassy surface with some spots of impregnated pigment was observed in the groups where glaze was applied (Stain and Brush + Stain). This finding was corroborated by elemental analysis. Despite that, Stain and Brush + Stain presented the roughest surface (p < 0.05). In summary, the pigmentation techniques used to provide a Vita classical A2 color shade have a detrimental effect on the mechanical fatigue properties of a 4YSZ ceramic, except for the technique performed with the brush in the block pre-sintering stage. Despite this, the brush technique presents great variability in mechanical performance, resulting in lower structural reliability.
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Affiliation(s)
- Luiza Freitas Brum Souza
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Pablo Machado Soares
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Gratcheva Falcão Chiapinotto
- Graduate Program in Dentistry, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Vinícius Fogliato Ribeiro
- Graduate Program in Dentistry, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Natália de Freitas Daudt
- MSciD and PhD Post-Graduate Program in Mechanical Engineering, Faculty of Mechanical Engineering, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil; Graduate Program in Dentistry, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Gabriel Kalil Rocha Pereira
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil; Graduate Program in Dentistry, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
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17
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Fathy H, Hamama HH, El-Wassefy N, Mahmoud SH. Clinical performance of resin-matrix ceramic partial coverage restorations: a systematic review. Clin Oral Investig 2022; 26:3807-3822. [PMID: 35320383 PMCID: PMC9072524 DOI: 10.1007/s00784-022-04449-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate clinical performance of the new CAD/CAM resin-matrix ceramics and compare it with ceramic partial coverage restorations. Materials and methods An electronic search of 3 databases (The National Library of Medicine (MEDLINE/PubMed), Scopus, and the Cochrane Central Register of Controlled Trials) was conducted. English clinical studies published between 2005 and September 2020 that evaluated the clinical performance of CAD/CAM resin-matrix ceramics inlays, onlays, or overlays were selected. The primary clinical question was applied according to PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). The included studies were individually evaluated for risk of bias according to the modified Cochrane Collaboration tool criteria. Results A total of 7 studies were included according to the established inclusion and exclusion criteria. From the included studies, 6 were randomized clinical trials while one study was longitudinal observational study without control group. According to the results of the included studies, the success rate of CAD/CAM resin-based composite ranged from 85.7 to 100% whereas the success rate reported for ceramic partial coverage restorations ranged from 93.3 to 100%. Fractures and debondings are found to be the most common cause of restorations failure. Conclusion CAD/CAM resin-based composite can be considered a reliable material for partial coverage restorations with clinical performance similar to glass ceramic restorations. However, this result needs to be confirmed in long-term evaluations. Clinical relevance CAD/CAM resin-based composites provide a potential alternative to ceramic indirect restorations. However, clinicians must be aware of the lake of knowledge regarding long-term outcome.
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Affiliation(s)
- Hanan Fathy
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Algomhoria St, Mansoura City, 35516, Egypt
| | - Hamdi H Hamama
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Algomhoria St, Mansoura City, 35516, Egypt.
| | - Noha El-Wassefy
- Dental Biomaterials Science Dept, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Salah H Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Algomhoria St, Mansoura City, 35516, Egypt
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Niem T, Gonschorek S, Wöstmann B. Investigation of the Damping Capabilities of Different Resin-Based CAD/CAM Restorative Materials. Polymers (Basel) 2022; 14:polym14030493. [PMID: 35160480 PMCID: PMC8839232 DOI: 10.3390/polym14030493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of the present study was to evaluate and quantify the damping properties of common resin-based computer-aided design and computer-aided manufacturing (CAD/CAM) restorative materials (CRMs) and assess their energy dissipation abilities. Leeb hardness (HLD), together with its deduced energy dissipation data (HLDdis), and loss tangent values recorded via dynamic mechanical analysis (DMA) were determined for six polymer, four composite, and one ceramic CRM as well as one metal. Data were statistically analyzed. Among resin-based CRMs, the significantly highest HLDdis data were detected for the fiber-reinforced composite FD (p < 0.001) directly followed by the filler-reinforced Ambarino High Class (p < 0.001). The significantly lowest HLDdis values were observed for the polymer-based CRM Telio CAD (p < 0.001). For loss tangent, both PEEK materials showed the significantly lowest data and the polymer-based M-PM the highest results with all composite CRMs in between. HLDdis data, which simultaneously record the energy dissipation mechanism of plastic material deformation, more precisely characterize the damping behavior of resin-based CRMs compared to loss tangent results that merely describe viscoelastic material behavior. Depending on material composition, resin-based CRMs reveal extremely different ratios of viscoelastic damping but frequently show enhanced HLDdis values because of plastic material deformation. Future developments in CAD/CAM restorative technology should focus on developing improved viscoelastic damping effects.
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Surface Characterisation of Dental Resin Composites Related to Conditioning and Finishing. Polymers (Basel) 2021; 13:polym13234236. [PMID: 34883740 PMCID: PMC8659525 DOI: 10.3390/polym13234236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Due to the little information related to surface processing and conditioning of resin matrix ceramic materials previous glazing, the main purpose of this in vitro study was to investigate the effect of different surface treatments on the surface morphology of different resin composite materials. Five types of resin composite CAD-CAM materials: a resin composite ceramic Vita Enamic (E) and four types of nanoparticle-filled resins, like Lava Ultimate (L), Cerasmart (C), Shofu HC (S), Hyramic (H) were taken into consideration. Specimens received the following surface treatment protocols: conventional polishing [p], polishing and glazing [pg], conditioning with CoJet [c], conditioning with CoJet and glazing [cg], sandblasting [s], sandblasting and glazing [sg], etching [e], etching and glazing [eg]. Surface roughness was analyzed for all samples and nanosurface topographic characterization was made by Atomic Force Microscopy. The highest roughness was registered for sandblasted surfaces [s], followed by tribochemical silica airborne particle abrasion [c], and etching [e]. A very strong correlated conditioning behavior of resin nanoceramic materials, like L, C and S samples was found. The microroughness decreased thus [s] > [c] > [e]. These are moderate correlated with H, and are moderate negative correlated to E, where e is more efficient. Three-dimensional images indicated visible grain boundaries after conditioning, for all materials. After polishing and glazing, surfaces became smoother. For all tested conditioning and finishing methods, surface roughness values were within clinically acceptable limits. Finishing by polishing was proved to be a good choice for all materials taken into consideration, polishing and glazing likewise, excepting Hyramic. For Enamic and Shofu HC sandblasting or tribochemical conditioning and glazing and for Hyramic polishing and glazing are not the best options, related to nanoroughness values. Referring to the nanosurface topography, for Enamic, Cerasmart and Hyramic, glazing would be the method of choice, associated with the adequate conditioning method for each material.
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Grassi EDA, de Andrade GS, Tribst JPM, Machry RV, Valandro LF, Ramos NDC, Bresciani E, Saavedra GDSFA. Fatigue behavior and stress distribution of molars restored with MOD inlays with and without deep margin elevation. Clin Oral Investig 2021; 26:2513-2526. [PMID: 34643807 DOI: 10.1007/s00784-021-04219-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the effect of deep margin elevation (DME) and restorative materials (leucite-reinforced glass-ceramics [C] vs. indirect resin composite [R]) on the fatigue behavior and stress distribution of maxillary molars with 2-mm deep proximal margins restored with MOD inlay. METHODS Fifty-two extracted human third molars were randomly assigned into four groups (n = 13): C; DME + C; R; and DME + R. Inlays were fabricated in CAD-CAM and bonded to all teeth. The fatigue behavior was assessed with the stepwise stress test (10,000 cycles/step; step = 50 N; 20 Hz; initial load = 200 N). Fatigue failure loads and the number of cycles were analyzed with 2-way ANOVA and Tukey's test (p < 0.05) and Kaplan-Meier survival plots. The stress distribution was assessed with finite element analysis. The models were considered isotropic, linear, and homogeneous, and presented bonded contacts. A tripod axial load (400 N) was applied to the occlusal surface. The stress distribution was analyzed with the maximum principal stress criterion. RESULTS For fatigue, there was no difference for DME factor (p > 0.05). For the material factor, the load and number of cycles for failure were statistically higher in the R groups (p < 0.05). The finite element analysis showed that resin composite inlays concentrated more stress in the tooth structure, while ceramic inlays concentrated more stress in the restoration. Non-reparable failures were more frequent in the resin composite inlays groups. CONCLUSIONS DME was not negative for fatigue and biomechanical behaviors. Resin composite inlays were more resistant to the fatigue test, although the failure mode was more aggressive. CLINICAL SIGNIFICANCE DME does not impair mechanical behavior. Resin composite inlays failed at higher loads but with a more aggressive failure mode.
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Affiliation(s)
- Elisa Donaria Aboucauch Grassi
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme Schmitt de Andrade
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - João Paulo Mendes Tribst
- Post-Graduate Program in Dentistry, University of Taubaté (UNITAU), 09th Rua Dos Operários St., Taubaté, SP, 12020-340, Brazil
| | - Renan Vaz Machry
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Luiz Felipe Valandro
- Graduate Program of Oral Science, Prosthodontics Unit, School of Dentistry, Federal University of Santa Maria (UFSM), Roraima Av, Santa Maria, RS, 100097105-340, Brazil
| | - Nathalia de Carvalho Ramos
- School of Dentistry, São Francisco University (USF), 218th São Francisco de Assis Av., Bragança Paulista, SP, 12916-900, Brazil
| | - Eduardo Bresciani
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil
| | - Guilherme de Siqueira Ferreira Anzaloni Saavedra
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), 777th Eng. Francisco José Longo Av., São José dos Campos, SP, 12245-000, Brazil.
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Brescansin FN, Prochnow C, Guilardi LF, Kleverlaan CJ, Bacchi A, Valandro LF, Pereira GKR. Effect of different surface treatments on optical, colorimetric, and surface characteristics of a lithium disilicate glass-ceramic. J ESTHET RESTOR DENT 2021; 33:1017-1028. [PMID: 34105868 DOI: 10.1111/jerd.12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of surface treatments on optical, colorimetric, and surface characteristics of lithium disilicate glass-ceramic. MATERIALS AND METHODS Specimens (n = 5, IPS e.max CAD) were randomly allocated to the following treatments: mirror-polished: SiC papers; as-cut: mimicking CAD-CAM milling; ground: 90-120 μm-grit diamond bur; ground polished: ground, finished (46-30 μm-grit diamond bur), polished (diamond cups, brush and diamond paste); ground glazed: ground, glazed; ground polished glazed: association of methods. CIELAB color coordinates were obtained by a spectrophotometer. CIEDE2000 color differences (ΔE00 ) and the translucency parameter (TP00 ) were calculated. Light transmittance was assessed with a colorimeter. Surface characteristics (topography and roughness) were analyzed. Statistical differences for each condition and outcome were detected using one-way ANOVA with Tukey's post-hoc test (α = 0.05). RESULTS TP00 data show statistical reduction after grinding (p < 0.05), which was only restored with polishing (solely or with glazing). ΔE00 shows that grinding results in perceptible variations in color (above 0.81), which were restored after all post-processing protocols (exception to only glaze application in contact with a black background). Light transmittance data corroborated such performance. Polishing and glazing reduced roughness and improved surface topography. CONCLUSION Grinding statistically increased roughness, reduced translucency, light transmittance through the ceramic, and resulted on color differences. On contrary, polishing (followed or not by glazing) reduced roughness and enhanced ceramic translucency and light transmittance. Glaze also reduced roughness, but it still presented reduced translucency. The positioning (facing up or down) of the ceramic treated surface influenced the considered outcomes. CLINICAL SIGNIFICANCE Grinding with diamond burs results in a deleterious impact to the optical, colorimetric and surface characteristics of lithium disilicate ceramic. Thus, polishing (followed or not by glazing) is recommended for optical and topographical enhancements when lithium disilicate monolithic restorations require occlusal adjustments.
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Affiliation(s)
| | - Catina Prochnow
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontic Unit), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luís Felipe Guilardi
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontic Unit), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil
| | - Cornelis Johannes Kleverlaan
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ataís Bacchi
- MSciD Post-Graduate Program in Dentistry, Paulo Picanço School of Dentistry, Fortaleza, Brazil
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontic Unit), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gabriel Kalil Rocha Pereira
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontic Unit), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil
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Dapieve KS, Machry RV, Pereira GKR, Venturini AB, Valcanaia A, Bottino MC, Valandro LF. Alumina particle air-abrasion and aging effects: Fatigue behavior of CAD/CAM resin composite crowns and flexural strength evaluations. J Mech Behav Biomed Mater 2021; 121:104592. [PMID: 34144359 DOI: 10.1016/j.jmbbm.2021.104592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Kiara Serafini Dapieve
- MSciD and PhD Post-Graduate Program in Oral Science, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Renan Vaz Machry
- MSciD and PhD Post-Graduate Program in Oral Science, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Gabriel Kalil Rocha Pereira
- MSciD and PhD Post-Graduate Program in Oral Science, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Andressa Borin Venturini
- MSciD and PhD Post-Graduate Program in Oral Science, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - André Valcanaia
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA.
| | - Marco Cícero Bottino
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA.
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Oral Science, Prosthetic Dentistry Unit, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
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Lin F, Ordinola-Zapata R, Xu H, Heo YC, Fok A. Laboratory simulation of longitudinally cracked teeth using the step-stress cyclic loading method. Int Endod J 2021; 54:1638-1646. [PMID: 33852743 DOI: 10.1111/iej.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
AIM To simulate in a laboratory setting longitudinal cracking in root filled premolar teeth, using cyclic mechanical fatigue. METHODOLOGY Mesial-occlusal-distal (MOD) cavities were prepared in twenty root filled, single-rooted, mandibular premolars restored with fibre posts and resin composites. The samples were randomly divided into two groups based on the loading approaches: static loading with a crosshead speed of 0.5 mm/min and step-stress cyclic loading (1 Hz) with increasing amplitude. The loads and numbers of cycles to failure were recorded. Micro-CT was also used to identify the fracture modes. Statistical analysis was performed using Student's t-test. The level of significance was set at 0.05. RESULTS The mean fracture loads for the static loading and cyclic loading groups were 769 ± 171 N and 720 ± 92 N, respectively. There was no significant difference between the two groups (P > 0.05). The proportions of longitudinal, cuspal and mixed-mode fractures under cyclic loading were 50%, 20% and 30%, respectively. Longitudinal fractures occurred with larger numbers of cycles and higher average loads per cycle compared with the other fractures. Static loading produced only cuspal fractures. CONCLUSIONS Longitudinally cracked premolar teeth with root fillings were successfully produced using the step-stress cyclic loading method. This provides a more clinically representative methodology for studying cracked teeth in a laboratory setting.
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Affiliation(s)
- F Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - R Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - H Xu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y C Heo
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - A Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
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Cadore-Rodrigues AC, Machado PS, Oliveira JSD, Jahn SL, Dorneles LS, Rippe MP, Pereira GKR, Valandro LF. Surface treatments and its effects on the fatigue behavior of a 5% mol yttria partially stabilized zirconia material. J Mech Behav Biomed Mater 2021; 120:104543. [PMID: 33957570 DOI: 10.1016/j.jmbbm.2021.104543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
This study evaluated the effect of distinct surface treatments on the fatigue behavior (biaxial flexural fatigue testing) and surface characteristics (topography and roughness) of a 5% mol yttria partially stabilized zirconia ceramic (5Y-PSZ). Disc-shaped specimens of 5Y-PSZ (IPS e.max ZirCAD MT Multi) were manufactured (ISO 6872-2015) and allocated into six groups (n = 15) considering the following surface treatments: Ctrl - no-treatment; GLZ - low-fusing porcelain glaze application; SNF - 5 nm SiO2 nanofilm; AlOx - aluminum oxide particle air-abrasion; SiC - silica-coated aluminum oxide particles (silica-coating); and 7%Si - 7% silica-coated aluminum oxide particles (silica-coating). The biaxial flexural fatigue tests were performed by the step-stress method (20Hz for 10,000 cycles) with a step increment of 50N starting at 100N and proceeding until failure detection. The samples were tested with the treated surface facing down (tensile stress side). Topography, fractography, roughness, and phase content assessments of treated specimens were performed. GLZ group presented the highest fatigue behavior, while AlOx presented the lowest performance, and was only similar to SiC and 7%Si. Ctrl and SNF presented intermediary fatigue behavior, and were also similar to SiC and 7%Si. GLZ promoted a rougher surface, Ctrl and SNF had the lowest roughness, while the air-abrasion groups presented intermediary roughness. No m-phase content was detected (only t and c phases were detected). In conclusion, the application of a thin-layer of low-fusing porcelain glaze, the deposition of silica nanofilms and the air-abrasion with silica-coated alumina particles had no detrimental effect on the fatigue behavior of the 5Y-PSZ, while the air-abrasion with alumina particles damaged the fatigue outcomes.
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Affiliation(s)
- Ana Carolina Cadore-Rodrigues
- Post-Graduate Program in Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Pablo Soares Machado
- Post-Graduate Program in Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Jivago Schumacher de Oliveira
- Post-Graduate Program in Chemical Engineering, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Sérgio Luiz Jahn
- Post-Graduate Program in Chemical Engineering, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Lucio Strazzabosco Dorneles
- Post-Graduate Program in Physics, Physics Department, Federal University of Santa Maria, Santa Maria, Brazil.
| | - Marília Pivetta Rippe
- Post-Graduate Program in Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Gabriel Kalil Rocha Pereira
- Post-Graduate Program in Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- Post-Graduate Program in Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
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Zarone F, Ruggiero G, Leone R, Breschi L, Leuci S, Sorrentino R. Zirconia-reinforced lithium silicate (ZLS) mechanical and biological properties: A literature review. J Dent 2021; 109:103661. [PMID: 33864886 DOI: 10.1016/j.jdent.2021.103661] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems. DATA/SOURCES An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers. STUDY SELECTION The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included. CONCLUSIONS After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations. CLINICAL SIGNIFICANCE . As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials.
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Affiliation(s)
- Fernando Zarone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Prosthodontics and Digital Dentistry, University "Federico II" of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Gennaro Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Prosthodontics and Digital Dentistry, University "Federico II" of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Renato Leone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Prosthodontics and Digital Dentistry, University "Federico II" of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Alma Mater Studiorum, Via San Vitale 59, 40125, Bologna, Italy.
| | - Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, School of Medicine, University "Federico II" of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Roberto Sorrentino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Prosthodontics and Digital Dentistry, University "Federico II" of Naples, Via Pansini 5, 80131, Naples, Italy.
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Influence of the foundation substrate on the fatigue behavior of bonded glass, zirconia polycrystals, and polymer infiltrated ceramic simplified CAD-CAM restorations. J Mech Behav Biomed Mater 2021; 117:104391. [PMID: 33618242 DOI: 10.1016/j.jmbbm.2021.104391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 01/09/2023]
Abstract
This study evaluated the influence of distinct substrates on the mechanical fatigue behavior of adhesively cemented simplified restorations made of glass, polycrystalline or polymer infiltrated-ceramics. CAD/CAM ceramic blocks (feldspathic - FEL; lithium disilicate - LD; yttria-stabilized zirconia - YZ; and polymer-infiltrated ceramic network - PICN) were shaped into discs (n = 15, Ø = 10 mm; thickness = 1.0 mm), mimicking a simplified monolithic restoration. After, they were adhesively cemented onto different foundation substrates (epoxy resin - ER; or Ni-Cr metal alloy - MA) of the same shape (Ø = 10 mm; thickness = 2.0 mm). The assemblies were subjected to fatigue testing using a step-stress approach (200N-2800 N; step-size of 200 N; 10,000 cycles per step; 20 Hz) upon the occurrence of a radial crack or fracture. The data was submitted to two-way ANOVA (α = 0.05) to analyze differences considering 'ceramic material' and 'type of substrate' as factors. In addition, a survival analysis (Kaplan Meier with Mantel-Cox log-rank post-hoc tests; α = 0.05) was conducted to obtain the survival probability during the steps in the fatigue test. Fractographic and finite element (FEA) analyzes were also conducted. The factors 'ceramic material', 'type of substrate' and the interaction between both were verified to be statistically significant (p < .001). All evaluated ceramics presented higher fatigue failure load (FFL), cycles for failure (CFF) and survival probabilities when cemented to the metallic alloy substrate. Among the restorative materials, YZ and LD restorations presented the best fatigue behavior when adhesively cemented onto the metallic alloy substrate, while FEL obtained the lowest FFL and CFF for both substrates. The LD, PICN and YZ restorations showed similar fatigue performance considering the epoxy resin substrate. A more rigid foundation substrate improves the fatigue performance of adhesively cemented glass, polycrystalline and polymer infiltrated-ceramic simplified restorations.
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Kim SH, Choi YS, Kang KH, Att W. Effects of thermal and mechanical cycling on the mechanical strength and surface properties of dental CAD-CAM restorative materials. J Prosthet Dent 2021; 128:79-88. [PMID: 33546857 DOI: 10.1016/j.prosdent.2020.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM The properties of dental computer-aided design and computer-aided manufacturing (CAD-CAM) materials vary. Studies regarding the effects of aging on the properties of these materials are lacking. PURPOSE The purpose of this in vitro study was to evaluate the changes in the mechanical and surface properties of different CAD-CAM materials after thermocycling and mechanical loading. MATERIAL AND METHODS In total, 150 bar-shaped specimens (17.0×4.0×2.0 mm) were prepared from feldspathic glass-ceramic (VM; Vitablocs Mark II), lithium disilicate glass-ceramic (EX; IPS e.max CAD), zirconia-reinforced lithium silicate glass-ceramic (CD; Celtra Duo), polymer-infiltrated ceramic network (VE; Vita Enamic), and resin-nanoceramic (CS; Cerasmart). Each type was divided into 2 groups (n=15; each). One group was subjected to thermocycling in distilled water at 5 °C to 55 °C for 6000 cycles and 50 N mechanical loading for 1.2×106 cycles. The other group was stored in 37 °C water for 24 hours. Nanoindentation hardness, Young modulus, and 3-point flexural strength were measured for the analyses of the mechanical properties. Surface roughness, surface microstructure, and elemental composition were measured to analyze the surface characteristics. Statistical analyses were performed with 1-way ANOVA with the Tukey HSD post hoc test, independent samples t test, Kruskal-Wallis test with Bonferroni post hoc test, Mann-Whitney U test, and 2-way ANOVA (α=.05). RESULTS Before and after aging, CS exhibited the lowest hardness (1.20 to 1.04 GPa) and Young modulus (13.76 to 13.48 GPa) values (P<.05). EX exhibited the highest flexural strengths (393.43 to 391.86 MPa), and VM exhibited the lowest (109.98 to 112.73 MPa) values (P<.05). CS exhibited the highest surface roughness (Sa and Sq; 10.60 to 28.82, 14.21 to 38.27 nm) values (P<.05). After aging, the hardness and Young modulus of VM, EX, and VE decreased significantly (P<.001). No significant difference was observed in the flexural strengths of the CAD-CAM materials (P>.05). Significant increases were observed in the surface roughness of all the materials (P<.05), with altered microstructures. Except for the flexural strength, the mechanical properties and surface characteristics of the CAD-CAM materials were significantly affected by the material type after aging. CONCLUSIONS Before and after aging, resin-nanoceramic exhibited the lowest hardness and Young modulus, and the highest surface roughness. Lithium disilicate glass-ceramic exhibited the highest flexural strength and feldspathic glass-ceramic exhibited the lowest value. After aging, increased surface roughness and microstructure alterations were observed. Significant interactions between aging process and material type were found for the mechanical properties and surface characteristics except for the flexural strength.
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Affiliation(s)
- Sung-Ho Kim
- Graduate student, Graduate Prosthodontics, Department of Prosthodontics, College of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Yu-Sung Choi
- Associate Professor, Department of Prosthodontics, College of Dentistry, Dankook University, Cheonan, Republic of Korea; Visiting Professor, Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Mass.
| | - Ki-Ho Kang
- Professor and Advanced Education Program Director, Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Mass
| | - Wael Att
- Professor and Chairman, Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Mass
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Jovanović M, Živić M, Milosavljević M. A potential application of materials based on a polymer and CAD/CAM composite resins in prosthetic dentistry. J Prosthodont Res 2020; 65:137-147. [PMID: 32981910 DOI: 10.2186/jpr.jpor_2019_404] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE A bioactive high performance polymer (BioHPP) and computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin materials are a relatively new class of dental biomaterials, that are biocompatible and have good aesthetic features. In this review paper, we will summarize literature and publication data on the characteristics of the mentioned materials, as well as their potential application in the dental prosthetics. STUDY SELECTION Available studies and literature reviews from PubMed, SCIndex, Scopus and Google Scholar corresponding to polyetheretherketone (PEEK), high-performance polymers, reinforced composite materials, composite materials, resins, glass-fiber reinforced materials, CAD/CAM materials, dental implants, removable and fixed dental were reviewed. RESULTS To avoid many disadvantages of metals and their alloys in dental practice, such as inadequate color, high density, thermal conductivity and possible allergic reactions, materials based on polymers (such as BioHPP), and CAD/CAM composite resins are being developed. These materials have significantly better aesthetics and physical-mechanical properties. They are biocompatible materials that are lightweight, resistant, durable, exhibit high bending and compression resistance. CONCLUSIONS The use of CAD/CAM composite resin materials and BioHPP in dentistry has begun recently, so the data about their potential clinical use are limited. Most of their features have been demonstrated through laboratory testing, while clinical studies are relatively scarce, so the need for further clinical trials is emphasized.
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Affiliation(s)
- Milica Jovanović
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac
| | - Miloš Živić
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac
| | - Marko Milosavljević
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac
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Cadore-Rodrigues AC, Machado PS, Oliveira JSD, Jahn SL, Callegari GL, Dorneles LS, Burgo TADL, Rippe MP, Rocha Pereira GK, Valandro LF. Fatigue performance of fully-stabilized zirconia polycrystals monolithic restorations: The effects of surface treatments at the bonding surface. J Mech Behav Biomed Mater 2020; 110:103962. [PMID: 32957253 DOI: 10.1016/j.jmbbm.2020.103962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
This study evaluated the distinct conditioning effect of the intaglio surface of bonded fully-stabilized zirconia (FSZ) simplified restorations on the mechanical fatigue behavior of the set prior to and after aging. Ceramic disc shaped specimens (Ø= 10 mm and 1 mm thick) were randomly allocated into 14 groups considering: "surface treatments" (Ctrl: no-treatment; PM: universal primer; GLZ: low-fusing porcelain glaze; SNF: 5 nm SiO2 nanofilm deposition; AlOx: air-abrasion with aluminum oxide; SiC: air-abrasion with silica-coated aluminum oxide; 7%Si: air-abrasion with 7% silica-coated aluminum oxide); and "aging" (baseline: 24 h at 37 °C in water; or aged: 90 days at 37 °C in water + 12,000 thermal cycles). The discs were treated, luted with resin cement onto the dentin analog, subjected to aging or not, and then tested under a step-stress fatigue test at 20 Hz, 10,000 cycles/step, step-size of 100N starting at 200N, and proceeding until failure detection. Fractographic, topographic, surface roughness, contact angle, and atomic force microscopy analyzes were performed. The surface treatments at baseline led to statistically similar fatigue failure loads (953N-1313N), except for GLZ (1313N), which was significantly higher than 7%Si (953 N). Meanwhile, Ctrl had 40% pre-test failures (debonding) after aging, and therefore the worst fatigue performance (notable decrease in fatigue results), while all the other groups presented superior and statistically similar fatigue behavior (973-1271N). In fact, when considering baseline Vs aging conditions, stable fatigue results could only be noted when using surface treatments. In conclusion, internal surface treatments of FSZ ceramic restorations are mandatory for fatigue behavior stability after aging the restorative set, while non-treatment induced unstable results.
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Affiliation(s)
| | - Pablo Soares Machado
- Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | | | - Sérgio Luiz Jahn
- Chemical Engineering, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | | | | | | | - Marilia Pivetta Rippe
- Post-Graduate Program in Oral Science, Prosthodontic Unit, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
| | | | - Luiz Felipe Valandro
- Oral Science, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul State, Brazil.
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Step-stress vs. staircase fatigue tests to evaluate the effect of intaglio adjustment on the fatigue behavior of simplified lithium disilicate glass-ceramic restorations. J Mech Behav Biomed Mater 2020; 113:104091. [PMID: 33032009 DOI: 10.1016/j.jmbbm.2020.104091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
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).
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Souza J, Fuentes MV, Baena E, Ceballos L. One-year clinical performance of lithium disilicate versus resin composite CAD/CAM onlays. Odontology 2020; 109:259-270. [PMID: 32705420 PMCID: PMC7790784 DOI: 10.1007/s10266-020-00539-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
To compare the 1-year clinical performance of lithium disilicate and resin composite CAD/CAM onlay restorations. Twenty patients that required two restorations in posterior teeth, with at least one cusp to be covered, received two onlays. One was made with IPS e.max CAD (Ivoclar-Vivadent) and the other with Lava Ultimate (3M Oral Care). Two blind observers evaluated the restorations at baseline and 1 year after the onlays were cemented, according to FDI criteria. At each recall, digital photographs, bite-wing radiographs and impressions of the restorations were taken for SEM evaluation of the interface. Results were analyzed by Mann–Whitney U and Wilcoxon tests (p < 0.05). At baseline and in the 1-year recall, both CAD/CAM materials exhibited excellent results in most criteria with similar esthetic, functional and biological properties (p > 0.05). However, deterioration in surface lustre (p = 0.020) and color match/translucency (p = 0.039) were detected for IPS e.max CAD onlays after 1-year. Under SEM evaluation, there were no statistically differences in micromorphological criteria at baseline nor after a year between IPS e.max CAD and Lava Ultimate onlays. Conclusion: After 1 year of clinical service IPS e.max CAD and Lava Ultimate onlays showed a similar clinical performance that needs to be confirmed in long-term evaluations.
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Affiliation(s)
- Joana Souza
- Area of Stomatology, IDIBO Research Group, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Mª Victoria Fuentes
- Area of Stomatology, IDIBO Research Group, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Eugenia Baena
- Area of Stomatology, IDIBO Research Group, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Laura Ceballos
- Area of Stomatology, IDIBO Research Group, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
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Alves DM, Cadore-Rodrigues AC, Prochnow C, Burgo TADL, Spazzin AO, Bacchi A, Valandro LF, Rocha Pereira GK. Fatigue performance of adhesively luted glass or polycrystalline CAD-CAM monolithic crowns. J Prosthet Dent 2020; 126:119-127. [PMID: 32636073 DOI: 10.1016/j.prosdent.2020.03.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022]
Abstract
STATEMENT OF PROBLEM Data comparing the fatigue performance of adhesively luted glass or polycrystalline ceramic systems for computer-aided design and computer-aided manufacturing (CAD-CAM) are scarce. PURPOSE The purpose of this in vitro study was to evaluate and compare the fatigue performance of monolithic crowns manufactured from glass or polycrystalline CAD-CAM ceramic systems adhesively luted to a dentin analog. MATERIALS AND METHODS Fifty-four pairs of standardized preparations of dentin analog (NEMA Grade G10) and simplified ceramic crowns of 1.5-mm thickness were obtained with 3 ceramic materials: lithium disilicate (LD) glass-ceramic (IPS e.max CAD); zirconia-reinforced lithium silicate (ZLS) glass-ceramic (Vita Suprinity); and translucent yttrium fully stabilized polycrystalline zirconia (Trans YZ) (Prettau Anterior). The simplified crowns (n=15) were adhesively cemented onto the preparations and subjected to step-stress fatigue test (initial load of 400 N, 20 Hz, 10 000 cycles, followed by 100-N increment steps until failure). Collected data (fatigue failure load [FFL] and cycles for failure [CFF]) were submitted to survival analysis with the Kaplan-Meier and Mantel-Cox post hoc tests (α=.05) and to Weibull analysis (Weibull modulus and its respective 95% confidence interval). Failed crowns were submitted to fractography analysis. The surface characteristics of the internal surface (roughness, fractal dimension) of additional crowns were accessed, and the occlusal cement thickness obtained in each luted system was measured. RESULTS Trans YZ crowns presented the highest values of FFL, CFF, and survival rates, followed by ZLS and LD (mean FFL: 1740 N>1187 N>987 N; mean CFF: 149 000>92 613>73 667). Weibull modulus and cement thickness were similar for all tested materials. LD presented the roughest internal surface, followed by ZLS (mean Ra: 226 nm>169 nm>93 nm). The LD and ZLS internal surfaces also showed higher fractal dimension, pointing to a more complex surface topography (mean fractal dimension: 2.242=2.238>2.147). CONCLUSIONS CAD-CAM monolithic crowns of Trans YZ show the best fatigue performance. In addition, ZLS crowns also showed better performance than LD crowns.
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Affiliation(s)
- Daniela Meira Alves
- Post-Graduate Program in Dentistry, School of Dentistry, Meridional Faculty, IMED, Passo Fundo, Rio Grande do Sul, Brazil
| | - Ana Carolina Cadore-Rodrigues
- PhD student, MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Catina Prochnow
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Thiago Augusto de Lima Burgo
- Adjunct Professor, Department of Physics, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Aloísio Oro Spazzin
- Professor, Post-Graduate Program in Dentistry, School of Dentistry, Meridional Faculty, IMED, Passo Fundo, Rio Grande do Sul, Brazil
| | - Ataís Bacchi
- Professor, Post-Graduate Program in Dentistry, School of Dentistry, Meridional Faculty, IMED, Passo Fundo, Rio Grande do Sul, Brazil
| | - Luiz Felipe Valandro
- Professor, MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Gabriel Kalil Rocha Pereira
- Adjunct Professor, MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
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Lo Giudice A, Ortensi L, Farronato M, Lucchese A, Lo Castro E, Isola G. The step further smile virtual planning: milled versus prototyped mock-ups for the evaluation of the designed smile characteristics. BMC Oral Health 2020; 20:165. [PMID: 32503567 PMCID: PMC7275593 DOI: 10.1186/s12903-020-01145-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mock-up based approach allows the preview of the aesthetic rehabilitation, however, it is crucial that the mock-up does not differ from the expected aesthetic outcomes. With CAD-CAM technologies, it is possible to directly create mock-ups from virtual planned smile project, with greater accuracy and efficiency compared to the conventional moulded mock-ups. In this study, we investigated the trueness of mock-ups obtained with milling and 3D printing technology and a full digital work-flow system. METHODS Ten adults subjects were included and digital smile design/digital wax-up were performed to enhance the aesthetic of maxillary anterior region. Ten milled mock-ups and 10 prototyped mock-ups were obtained from the original .stl file and a digital analysis of trueness was carried out by superimposing the scanned-milled mock-ups and the scanned-prototyped mock-ups to the digital wax-up, according to the surface-to-surface matching technique. Specific linear measurements were performed to investigate and compare the dimensional characteristics of the physical manufactures, the 3D project and the scanned mock-ups. All data were statistically analyzed. A clinical test was also performed to assess the fitting of the final manufacture. RESULTS The prototyped mock-ups showed a significant increment of the transversal measurements (p < 0.001) while the milled mock-ups showed a significant increment of all vertical and transversal measurements (p < 0.001). The prototyped mock-ups showed good fitting after clinical tests while none of the milled mock-ups showed good adaptation (no fitting or significant clinical compensation required). Deviation analysis from the original 3D project reported a greater matching percentage for the scanned-milled mock-ups (80,31% ± 2.50) compared to the scanned-prototyped mock-ups (69,17% ± 2.64) (p < 0.001). This was in contrast with the findings from linear measurements as well as from the clinical test and may have been affected by a reductive algorithmic computation after digitization of physical mock-ups. CONCLUSION Both prototype and milled mock-ups showed a slight dimensional increment comparing to the original 3D project, with milled-mock-ups showing less fitting after clinical tests. Caution must be taken when assessing the trueness of scanned manufacture since an intrinsic error in the system can underestimate the dimensions of the real object.
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Policlinico Universitario "Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Luca Ortensi
- Department of General Surgery and Medical-Surgical Specialties, Section of Prosthodontist, School of Dentistry, University of Catania, Policlinico Universitario "Vittorio Emanuele", Via Santa Sofia 78, Catania, 98123, Italy
| | - Marco Farronato
- Department of Medicine, Surgery and Dentistry, Section of Orthodontics, University of Milan, Milan, Italy
| | - Alessandra Lucchese
- Department of Orthodontics, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, Italy
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Monolithic CAD/CAM laminate veneers: Reliability and failure modes. Dent Mater 2020; 36:724-732. [DOI: 10.1016/j.dental.2020.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/12/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
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Alves LMM, Contreras LPC, Campos TMB, Bottino MA, Valandro LF, Melo RMD. In vitro wear of a zirconium-reinforced lithium silicate ceramic against different restorative materials. J Mech Behav Biomed Mater 2019; 100:103403. [DOI: 10.1016/j.jmbbm.2019.103403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
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Dartora G, Rocha Pereira GK, Varella de Carvalho R, Zucuni CP, Valandro LF, Cesar PF, Caldas RA, Bacchi A. Comparison of endocrowns made of lithium disilicate glass-ceramic or polymer-infiltrated ceramic networks and direct composite resin restorations: fatigue performance and stress distribution. J Mech Behav Biomed Mater 2019; 100:103401. [PMID: 31445400 DOI: 10.1016/j.jmbbm.2019.103401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/15/2022]
Abstract
This study compared the fatigue performance and the stress distribution of endodontically treated molars restored with endocrowns obtained with lithium disilicate glass-ceramic or a polymer-infiltrated ceramic network, both processed by CAD-CAM, and direct composite restorations. Forty-eight human mandibular molars were randomly assigned into 03 groups (n = 16) and restored with endocrowns (LD - lithium disilicate glass-ceramic or PICN - polymer-infiltrated ceramic network) or with direct composite restorations. Fatigue testing followed a step-stress approach (initial maximum load of 200 N and 5000 cycles, incremental step load of 200N and 10,000 cycles/step, being the specimens loaded until failure or to a maximum of 135,000 cycles at 2800 N). The fatigue failure load and number of cycles until failure were recorded and statistically analyzed. Fractographic and finite element (FEA) analyzes were conducted as well. There were no differences in fatigue failure load, number of cycles until fracture and mean survival probabilities among groups. However, indirect endocrowns had higher mechanical structural reliability, and LD restorations lasted more time before start to failing. FEA showed that the stress concentration in tooth tissues was higher for the resin composite, followed by PICN and LD in a decreasing order. Almost all fractures were restricted to the restorative material (without tooth involvement), and origins were identified at occlusal surface. The type of restoration did not influence the fatigue failure load, number of cycles until fracture and mean survival probabilities of the restorative strategies. Despite that, the mechanical structural reliability of endocrowns, especially those made of lithium disilicate, was higher and lasted more time before start to failing.
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Affiliation(s)
- Gustavo Dartora
- MSciD Post-Graduate Program in Dentistry, Meridional Faculty, IMED, Passo Fundo, Brazil.
| | | | | | - Camila Pauleski Zucuni
- MSciD and PhD Post-Graduate Program in Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil.
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil.
| | - Paulo Francisco Cesar
- Department of Biomaterials and Oral Biology, University of São Paulo, USP, São Paulo, Brazil.
| | | | - Atais Bacchi
- MSciD Post-Graduate Program in Dentistry, Meridional Faculty, IMED, Passo Fundo, Brazil.
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Fasbinder DJ, Neiva GF, Heys D, Heys R. Clinical evaluation of chairside Computer Assisted Design/Computer Assisted Machining nano-ceramic restorations: Five-year status. J ESTHET RESTOR DENT 2019; 32:193-203. [PMID: 31393651 DOI: 10.1111/jerd.12516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This investigation was a longitudinal, randomized clinical trial to measure the clinical performance of a nano-ceramic material (Lava Ultimate/3M) for chairside Computer Assisted Design/Computer Assisted Machining (CAD/CAM) fabricated restorations. MATERIALS AND METHODS One hundred and twenty chairside CAD/CAM onlays were restored with a CEREC system randomly assigned to 60 leucite-reinforced ceramic (IPS EmpressCAD/Ivoclar Vivadent AGBendererstrasse 2FL-9494 SchaanLiechtenstein) onlays and 60 nano-ceramic (Lava Ultimate/3M) onlays. Equal groups of onlays were cemented using a self-etch and a total etch adhesive resin cement. The onlays were recalled for a period of 5 years. RESULTS At 1 week postoperatively, 10% of the onlays cemented with both the self-etch and total etch adhesive resin cements were reported as slightly sensitive. However, all patients were asymptomatic by the 4th week without treatment. Four leucite-reinforced onlays and one nano-ceramic onlay fractured and required replacement. CONCLUSIONS Adhesive retention with a self-etch or total etch cementation technique resulted in a similar clinical outcome with no reported debonds. The nano-ceramic onlays had a lower incidence of fracture compared to the leucite-reinforced ceramic onlays with both having a very low risk of fracture. Nano-ceramic onlays performed equally as well as glass ceramic onlays over 5 years of clinical service. CLINICAL SIGNIFICANCE Ceramic materials have been a mainstay for chairside CAD/CAM restorations for the past 30 years and a new category of resilient ceramics with a resin matrix has been introduced reported to offer ceramic-like durability and esthetics with resin-like efficiency in handling. There are no long-term clinical studies on the performance of these materials. This is a 5-year randomized clinical trial on the performance of nano-ceramic onlays.
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Affiliation(s)
- Dennis J Fasbinder
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Gisele F Neiva
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Donald Heys
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Ronald Heys
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
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Schmitt de Andrade G, Diniz V, Datte CE, Pereira GKR, Venturini AB, Campos TMB, Amaral M, Bottino MA, Valandro LF, Marques de Melo R. Newer vs. older CAD/CAM burs: Influence of bur experience on the fatigue behavior of adhesively cemented simplified lithium-disilicate glass-ceramic restorations. J Mech Behav Biomed Mater 2019; 95:172-179. [PMID: 31009901 DOI: 10.1016/j.jmbbm.2019.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
This study evaluated the effect of the CAD/CAM burs experience (newer vs older as consequence of the milling sequence) on fatigue failure load (FFL), number of cycles for failure (CFF), and survival rates of lithium disilicate glass-ceramic simplified restorations adhesively cemented to a dentin analogue substrate. Three sets of CAD/CAM burs were used to mill disc-shaped ceramic specimens (1 bur set - 18 milled discs with 10 mm diameter and 1.5 mm thickness), considering the bur experience as a result of the milling sequence to compose the study groups: G1-6 - discs obtained from the 1st to 6th milling of each bur set; G7-12 - specimens from the 7th to 12th milling; G13-18 - discs from the 13th to 18th. Discs of dentin analogue (G10, 10 mm diameter and 2.0 mm thickness) were made to serve as substrate (base material) and randomly assigned into pairs with the respective ceramic discs. Then, the ceramic discs were adhesively cemented onto the dentin analogue substrate, composing a three-layer specimen that mimics a monolithic restoration of a posterior tooth. Specimens were tested under stepwise fatigue approach: frequency = 20 Hz, 5000 cycles at maximum load of 400 N to accommodate the testing assembly, followed by incremental steps of 200 N with initial load ranging from 10 to 1000 N, to a maximum of 20,000 cycles/each step, until the occurrence of failure (radial crack). FFL and CFF were recorded at the end of the testing and subjected to statistical analysis. Supplementary roughness analysis of the milled surface was performed (n = 18) using a contact profilometer. Residual stress after milling and acid etching were accessed via X-ray Diffractometry analysis. FFL and CFF were not affected by increase on bur experience (no statistical differences among groups), despite that, it affected both Ra and Rz parameters (G1-6 had the smoothest surface). The residual stress concentration was negligible (milling did not induce residual stress concentration). It is concluded that the fatigue behavior of adhesively cemented lithium-disilicate glass-ceramic restorations was not influenced by CAD/CAM bur experience (newer vs older as consequence of the milling sequence), and so the residual stress concentration induced by milling was negligible.
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Affiliation(s)
- Guilherme Schmitt de Andrade
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp) - Institute of Science and Technology, São José dos Campos, Brazil.
| | - Vandeberg Diniz
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp) - Institute of Science and Technology, São José dos Campos, Brazil.
| | - Carlos Eduardo Datte
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp) - Institute of Science and Technology, São José dos Campos, Brazil.
| | | | - Andressa Borin Venturini
- Oral Science, Prosthodontics Unit, Faculty of Odontology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.
| | | | - Marina Amaral
- Department of Dentistry (Prosthetic Dentistry), University of Taubaté (UNITAU), Taubaté, Brazil.
| | - Marco Antonio Bottino
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp) - Institute of Science and Technology, São José dos Campos, Brazil.
| | - Luiz Felipe Valandro
- Oral Science, Prosthodontics Unit, Faculty of Odontology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.
| | - Renata Marques de Melo
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp) - Institute of Science and Technology, São José dos Campos, Brazil.
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Schestatsky R, Zucuni CP, Venturini AB, de Lima Burgo TA, Bacchi A, Valandro LF, Rocha Pereira GK. CAD-CAM milled versus pressed lithium-disilicate monolithic crowns adhesively cemented after distinct surface treatments: Fatigue performance and ceramic surface characteristics. J Mech Behav Biomed Mater 2019; 94:144-154. [PMID: 30897502 DOI: 10.1016/j.jmbbm.2019.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/24/2022]
Abstract
To evaluate the fatigue failure load (FFL), number of cycles for failure (CFF) and survival probabilities of lithium-disilicate (LD) monolithic crowns manufactured by two processing techniques (pressing vs. CAD/CAM) adhesively cemented to a dentin-analogue material, considering two surface treatments (conventional vs. simplified). Surface characteristics (topography, roughness and fractal dimensions) were also assessed. Forty (40) monolithic crowns were manufactured considering two specific processing techniques for each ceramic system: LDCAD - CAD/CAM lithium-disilicate (IPS e.max CAD, Ivoclar Vivadent); LDPRESS - pressed lithium-disilicate (IPS e.max Press, Ivoclar Vivadent). The crowns were adhesively cemented (Multilink Automix System, Ivoclar Vivadent) onto dentin analogue preparations considering two distinct protocols of surface treatments (conventional - hydrofluoric acid etching + silane application [HF+Sil] or simplified - etching with one-step primer (Monobond Etch&Prime, Ivoclar Vivadent) [EP]). The cemented assembly was stored in distilled water at 37 °C for 3 days and fatigue tests were run (step-stress approach: load ranging from 400 to 2000 N, step-size of 100 N, 15,000 cycles/step, 20 Hz). Fractography, surface topography, roughness, and fractal dimension analyses were performed. LDPRESS[EP] group depicted higher FFL, CFF and survival probabilities in comparison to LDCAD groups, regardless of the conditioning method. A tendency of higher Weibull modulus (mechanical reliability) was observed when using [EP] for both LDPRESS and LDCAD. SEM and AFM analysis showed very distinct initial surface patterns for the distinct processing techniques considered (LDCAD with higher fractal dimension and lower roughness than LDPRESS), and both surface treatments distinctly affected these surface characteristics. All failures were radial cracks originating at the ceramic-cement interface. Pressed lithium-disilicate monolithic crowns showed better fatigue performance in comparison to CAD/CAM milled crowns, especially when they were treated with self-etching ceramic primer. The surface treatment with self-etching primer led to similar fatigue performance when compared to hydrofluoric acid plus silane application for the same processing technique, but it tended to provide higher mechanical reliability.
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Affiliation(s)
- Ricardo Schestatsky
- MSciD Graduate Program, School of Dentistry, Meridional Faculty - IMED, Passo Fundo, Rio Grande do Sul State, Brazil.
| | - Camila Pauleski Zucuni
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Andressa Borin Venturini
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | | | - Atais Bacchi
- MSciD Graduate Program, School of Dentistry, Meridional Faculty - IMED, Passo Fundo, Rio Grande do Sul State, Brazil.
| | - Luiz Felipe Valandro
- MSciD and PhD Post-Graduate Program in Oral Science (Prosthodontics Units), Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil.
| | - Gabriel Kalil Rocha Pereira
- MSciD Graduate Program, School of Dentistry, Meridional Faculty - IMED, Passo Fundo, Rio Grande do Sul State, Brazil.
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