Influence of preparation, fitting, and cementation on the vitro performance and fracture resistance of CAD/CAM crowns

Influence of CAD-CAM milling strategies on the outcome of indirect restorations: A scoping review

STATEMENT OF PROBLEM

The influence of computer-aided manufacturing (CAM) parameters and settings on the outcomes of milled indirect restorations is poorly understood.

PURPOSE

The purpose of this scoping review was to summarize the current CAM systems, parameters, and setting changes, and their effects on different outcomes of milled indirect restorations and aspects related to their manufacture.

MATERIAL AND METHODS

The protocol of this review is available online (https://osf.io/x28ps/). Studies that used at least 2 different parameters (CAM units, number of axes, digital spacers, or protocols with different rotatory instruments, grit-sizes, milling speed, or others) for milling indirect restorations were included. A structured search up to July 2023 was performed by 2 independent reviewers for articles written in English in LILACS, MEDLINE via PubMed, EMBASE, Web of Science, and Scopus.

RESULTS

Of 1546 studies identified, 22 were included in the review. Discrepancies were found between the planned and actual measured cement space, with a decreasing linear relationship impacting restoration adaptation at different points. The CEREC MC XL milling machine was the most used system in the included studies, with variations in bur types, milling modes, and number of burs uses affecting internal fit and surface trueness. The results demonstrated the better adaptation of restorations made with 5-axis over 3-axis milling machines. Lithium disilicate and zirconia were the most commonly used materials, and crowns and inlays were popular designs. Marginal and internal adaptation were the primary outcomes assessed using the various techniques.

CONCLUSIONS

The study presented a comprehensive exploration of CAM systems and parameters, and their influence on indirect restorations. The planned cement space was not properly reproduced by the milling. Bur characteristics can affect restoration fit and trueness. The 5-axis units seem to result in better-adapted restorations compared with 3- and 4-axis units.

CAD-CAM resin composites: Effective components for further development

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Quantitative evaluation of the degradation amount of the silane coupling layer of CAD/CAM resin composites by water absorption

PURPOSE

Degradation of silane coupling layers by water ingress in computer-aided design/computer-aided manufacturing (CAD/CAM) of resin composites has been reported qualitatively. In this study, we quantitatively evaluated how water absorption of CAD/CAM resin composites affects the silane coupling layer by in vitro and in silico methods.

METHODS

A Katana Avencia block (KAB) and an experimental matrix block composed of only a matrix resin were used to evaluate the effect of water immersion for seven days on the elastic modulus. X-ray photoelectron spectroscopy (XPS) with fluorine-labeling of the KAB was performed to evaluate the atomic percentage of F1s, which represents the hydrolysis amount by water immersion. In silico analysis of the three-dimensional model of the KAB was performed to determine the coupling ratios before and after water immersion.

RESULTS

The elastic modulus of the KAB was 8.2 GPa before and 6.9 GPa after immersion in water. The atomic percentages of F1s in the after- and before-immersion groups were 14.31% and 11.52%, respectively, suggesting that hydrolysis of the silane coupling layer occurred during water immersion. From in silico analysis of the three-dimensional model of the KAB, the coupling ratio was predicted to be 78.2% before water immersion. After water immersion, the coupling ratio was predicted to be 68.4%.

CONCLUSIONS

The in vitro and in silico approaches established in this study were able to predict the silane coupling ratios of CAD/CAM resin composites, and they showed that the silane coupling ratio decreased by water absorption.

Comparison of the accuracy of resin-composite crowns fabricated by three-dimensional printing and milling methods

This study aimed to compare the dimensional accuracies of three-dimensional (3D)-printed and milled resin-composite crowns, and to determine acceptable abutment-tooth shapes for printing. Four first-molar abutment models were prepared: the master model form and three models with sharp occluso-axial line angles. Crowns were designed on each abutment using computer-aided design software. The drill-offset value was set at 0.0 or 0.5 mm to evaluate the effect on the dimensional accuracy of milling. A digital light processing-based 3D printer was used to fabricate 3D-printed crowns. Milled crowns were fabricated by wet-milling. The trueness was evaluated by superimposing the design data. Regardless of the abutment form, 3D-printed crowns showed higher accuracy with fewer marginal discrepancies than milled crowns. Milled crowns showed significant dimensional deviations, especially at cusps. Moreover, offset correction resulted in grooves on the internal surface of milled crowns with negative deviations, which were especially evident in crowns for the sharp models.

Laboratory methods to simulate the mechanical degradation of resin composite restorations

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Arithmetic Relationship between Fracture Load and Material Thickness of Resin-Based CAD-CAM Restorative Materials

Data on the long-term behavior of computer-aided designed/computer-aided manufactured (CAD-CAM) resin-based composites are sparse. To achieve higher predictability on the mechanical behavior of these materials, the aim of the study was to establish a mathematical relationship between the material thickness of resin-based materials and their fracture load. The tested materials were Lava Ultimate (LU), Cerasmart (GC), Enamic (EN), and Telio CAD (TC). For this purpose, 60 specimens were prepared, each with five different material thicknesses between 0.4 mm and 1.6 mm (N = 60, n = 12). The fracture load of all specimens was determined using the biaxial flexural strength test (DIN EN ISO 6872). Regression curves were fitted to the results and their coefficient of determination (R²) was computed. Cubic regression curves showed the best R² approximation (LU R² = 0.947, GC R² = 0.971, VE R² = 0.981, TC R² = 0.971) to the fracture load values. These findings imply that the fracture load of all tested resin-based materials has a cubic relationship to material thickness. By means of a cubic equation and material-specific fracture load coefficients, the fracture load can be calculated when material thickness is given. The approach enables a better predictability for resin-based restorations for the individual patient. Hence, the methodology might be reasonably applied to other restorative materials.

Assessibility of different CAD/CAM ceramics with optical coherence tomography

OBJECTIVES

To investigate the light penetration depth of various CAD/CAM ceramics and luting agents by spectral-domain optical coherence tomography (SD-OCT).

METHODS

Six CAD/CAM ceramics: lithium disilicate (LS2), zirconia-reinforced lithium silicate (ZLS), lithium aluminosilicate (LAS), polymer infiltrated (PIC), feldspar (FEL) and zirconium oxide (ZRO) and five common luting agents, two self-adhesive and three adhesive materials, were included. SD-OCT wavelengths (1310/1550 nm) and frequencies (5/28 kHz) that are particularly suitable for these materials were investigated. Subsequently, a clinical simulation was performed with an adhesively or self-adhesively inserted partial crown made of a ceramic that had an OCT penetration depth of > 1.0 mm.

RESULTS

Best SD-OCT penetration was obtained at 1550 nm and 28 kHz. For ZLS, LS2 and LAS, SD-OCT light penetration depth of > 4 mm was shown. In contrast, the penetration depth of ZRO, PIC and FEL was less than 1 mm. Adhesive and self-adhesive luting agents could be visualized up to ≥ 0.9 mm. All clinically relevant areas (ceramic restoration, luting area, interfaces and adjacent tooth structures) can be imaged when SD-OCT-suitable ceramics are used.

CONCLUSIONS

SD-OCT can be used to analyze CAD/CAM ceramics based on ZLS, LS2 and LAS, whereas ZRO, PIC, and FEL had insufficient penetration depth for clinical application. The type of luting agent or its thickness played an insignificant role. With suitable ceramics, SD-OCT can be recommended as a non-invasive examination tool.

CLINICAL SIGNIFICANCE

This study indicates that SD-OCT is a useful non-invasive examination method for monitoring lithium silicate-based ceramic restorations and adjacent structures.

Effect of different surface treatments on optical, colorimetric, and surface characteristics of a lithium disilicate glass-ceramic

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.

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

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

Influence of hydrolysis degradation of silane coupling agents on mechanical performance of CAD/CAM resin composites: In silico multi-scale analysis

The aim of this study was to build an in silico computer-aided design and computer-aided manufacturing (CAD/CAM) resin-composite-block (RCB) model with different silane coupling ratios and to evaluate the physical and mechanical properties of the models, including the elastic modulus, Poisson's ratio, compressive strength, and maximum principal strain. Nanoscale CAD/CAM RCB models were designed by using CAD software that consisted of twelve spherical silica nanofiller particles and a resin matrix. Seven nanoscale models with different silane coupling ratios were prepared with the same filler volume contents. Homogenization analysis was conducted by using voxel-base finite-element analysis software to predict the elastic moduli and Poisson's ratio of the macro CAD/CAM RCB. Localization analysis was used to analyze the maximum principal strain distribution in the hydrolysis layer. In silico multi-scale analysis demonstrated that the compressive strength of the CAD/CAM RCB was reduced with a decrease in the silane coupling ratios of the fillers.

Acid Effects on the Physical Properties of Different CAD/CAM Ceramic Materials: An in Vitro Analysis

PURPOSE

To evaluate the flexural strength, elastic modulus, microhardness, and surface roughness of monolithic zirconia, lithium disilicate ceramics, and feldspathic ceramics after being exposed to different acidic solutions.

MATERIALS AND METHODS

Rectangular specimens (n = 180) were prepared from three different ceramic materials: lithium disilicate, monolithic zirconia, and feldspathic porcelain. Initial Surface roughness of ninety specimens (n = 30/material) was evaluated using an optical noncontact profilometer. Thirty specimens of each material were immersed in one of the following solutions (n = 10/group): citric acid; acidic beverage; and artificial saliva, which served as the control. Post immersion surface roughness, flexural strength, and elastic modulus were determined using an optical noncontact profilometer and three-point bending test. Another thirty specimens of each material were immersed in the aqueous solutions (n = 10/group) following the same protocol and subjected to microhardness test using a Vickers diamond microhardness tester. A scanning electron microscope (SEM) was used to examine the surface characteristics changes. ANOVA and Post-hoc Tukey's Kramer tests were used for data analysis (α = 0.05).

RESULTS

Immersion in different solutions did not affect the flexural strength and elastic modulus of lithium disilicate or zirconia. Microhardness and surface roughness were significantly affected in all groups (p < 0.05). For feldspathic porcelain groups, the flexural strength and elastic modulus were significantly decreased in the citric acid group (p = 0.045 and p = 0.019). Also, there were significant differences among all feldspathic porcelain groups (p = 0.001) in terms of microhardness and surface roughness values.

CONCLUSIONS

The tested acidic agents significantly affected the flexural strength, elastic modulus, surface roughness, and microhardness of feldspathic porcelain. However, the flexural strength and elastic modulus of evaluated lithium disilicate and zirconia did not change significantly.

Biomechanical behavior of endocrown restorations with different CAD-CAM materials: A 3D finite element and in vitro analysis

STATEMENT OF PROBLEM

The performance of endocrowns fabricated with different types of computer-aided design and computer-aided manufacturing (CAD-CAM) materials is unclear.

PURPOSE

The purpose of this finite element analysis (FEA) and in vitro study was to compare and evaluate the stress distribution, failure probability, and fracture resistance of endodontically treated teeth restored with endocrowns from CAD-CAM milling blocks including ceramic, polymer-infiltrated ceramic (PICN), and composite resin.

MATERIAL AND METHODS

An endodontically treated first mandibular molar restored with an endocrown was modeled by using a CAD software program and imported into an FEA software program. The model was duplicated and received restorations made from CAD-CAM blocks: Vita Suprinity (VS), IPS e.max CAD (EMX), Vita Enamic (VE), Lava Ultimate (LU), and Grandio blocs (GR). Stress distributions under axial and oblique loading were analyzed. The Weibull function was combined with the FEA results to predict long-term failure probability. The mechanical failure behavior of endocrowns manufactured with these materials was tested by using a universal testing machine. Load-to-failure was recorded, and fractured specimens were subjected to fractography. The data were analyzed by 1-way ANOVA and the post hoc Tukey test (α=.05).

RESULTS

The models of GR and LU exhibited a more even stress distribution. The Weibull analysis revealed that 5 models performed in a similar manner under normal occlusal forces, while LU and VE models achieved the highest probabilities during clenching. The fracture loads of GR (3808 ±607 N) were significantly higher than those of other materials (P<.05). More favorable failure modes were observed in the GR and VE groups. Fractography showed a greater probability of compression curls and arrest lines in the endocrowns of VE, LU, and GR groups.

CONCLUSIONS

When restoring endodontically treated teeth, endocrown fabricated with composite resin exhibited a more uniform stress distribution and higher fracture resistance. More evidence from long-term clinical studies is needed to verify this effect.

Which materials would account for a better mechanical behavior for direct endocrown restorations?

PURPOSE

To investigate the mechanical performance and fracture behavior of endocrown restorations prepared using different composite materials and following a direct technique.

METHODS

Sound molars were cut at 2 mm above the cementoenamel junction, endodontically treated, and allocated according to the type of restoration (n = 7): without post (endocrowns) or with post (post-retained restorations). Endocrowns were fabricated with conventional composite (Filtek Z350); bulk fill composite (Filtek Bulk Fill); conventional composite modeled using resin adhesives (SBMP: Scotchbond Multipurpose Adhesive; or SBU: Scotchbond Universal Adhesive); and lithium disilicate ceramic (E.max; Positive control). The post-retained restorations were fabricated with glass-fiber post combined with conventional or bulk fill composites. All restorations were bonded following an etch-and-rise adhesive approach or self-adhesive resin cement. The teeth were submitted to fatigue (Byocycle) and compression (EMIC DL500) testing at a crosshead speed of 1 mm/min. Data were analyzed with ANOVA and Tukey (p < 0.05) and Weibull analysis was carried out in order to evaluate the reliability of restorations.

RESULTS

The bulk-fill-based endocrown showed a stronger performance than the control. The presence of SBMP or the use of bulk-fill composite resulted in the occurrence of less aggressive fractures than the other restorative systems. Endocrowns bonded directly to the tooth seemed to produce similar fracture strength properties as compared to endocrowns bonded using self-adhesive resin cementation. The bulk-fill-based endocrown showed the greatest reliability of study.

CONCLUSION

Resin-based restorative materials seem to be interesting alternative options to fabricate large dental restorations in lieu of the more traditionally used glass ceramics or root canal post systems.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

STATISTICS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

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

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

Longevity of indirect restorations cemented with self-adhesive resin luting with and without selective enamel etching. A Systematic review and meta-analysis

OBJECTIVE

To investigate the influence of the selective etching in the survival rates of indirect restorations cemented with self-adhesive resin luting.

MATERIALS AND METHODS

The eligibility criteria were formulated based on PICOS strategy. The search without restrictions was performed in PubMed/Medline, the Cochrane Library, Web of Science, Scopus, LILACS databases and gray literature until May 2018. Cochrane Collaboration's tool was performed for assessing the risk of bias. According to the bias risk analysis, the studies were classified as low risk of bias and high quality of evidence. The systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42018091202). The meta-analysis was performed using RevMan 5.3 software (RevMan, Copenhagen, Denmark) and the risk ration and confidence interval was obtained (p < 0.05).

RESULTS

After database screening, removal of duplicates and eligibility criteria application, two studies were selected for this systematic review, with 65 participants (34 in one and 31 in the other). The pooled meta-analysis demonstrated no statistically significant difference in clinical longevity for selective etching in indirect restorations (P > .05; I² = 0%) and risk ratio of 0.46 [0.19-1.09].

CONCLUSIONS

Based on the findings, the results of this systematic review suggest that the selective enamel etching prior to application of self-adhesive luting cements systems for indirect restoration do not influence the clinical longevity of indirect restorations.

CLINICAL SIGNIFICANCE

The knowledge of the clinical steps of adhesive procedures is fundamental to the success of adhesive restorations and their longevity. Self-adhesive resin cements simplify the luting procedure of indirect restorations. However, adding a step that could significantly improve long-term survival would be of great value. Thus, the results of this systematic review will provide data so that the decision making regarding materials used for adhesive cementation is conducted based on scientific evidence.

Effect of Differences in Axial Thickness and Type of Cement on Fracture Resistance in Composite Resin CAD/CAM Crowns

The purpose of this study was to investigate the influence of differences in axial thickness and type of cement on fracture load in CAD/CAM crowns. Assuming the mandibular first premolar to be the abutment tooth, 4 types of crown with different axial thicknesses and radii of curvature were prepared. To unify external design, the morphology of the crown margins was set at 0.15, 0.30, 0.45, or 0.60 mm, thus maintaining uniform axial form of the crowns. The CAD/CAM crowns and abutment teeth were bonded using each of 2 types of resin cement or polycarboxylate cement. The fracture load value was measured using a universal testing machine and the destruction phase observed.No significant difference was observed with change in axial thickness. The fracture load values with each of the 2 types of resin cement used were significantly higher than that with polycarboxylate cement (p<0.01). These results suggest that the fracture load values of CAD/CAM crowns are not influenced by differences in the axial thickness of the crown, and that they are higher when bonding is achieved with resin rather than polycarboxylate cement.

A possible risk of CAD/CAM-produced composite resin premolar crowns on a removable partial denture abutment tooth: a 3-year retrospective cohort study

PURPOSE

To evaluate the early performance of computer-aided design/computer-aided manufacturing (CAD/CAM)-produced composite resin crown (CAD/CAM composite crown) treatment on premolars, specifically, placement on a removable partial denture (RPD) abutment tooth, and the distalmost tooth in the dental arch, as possible clinical risk factors.

METHODS

A retrospective cohort study (April 2014 to July 2017) was performed utilizing the clinical records of patients who received a premolar CAD/CAM composite crown treatment. The variables of time of treatment for (1) successful crowns (complication event-free) and (2) surviving crowns (clinically functional including re-luted) were estimated using Kaplan-Meier analysis. Survival distributions regarding "RPD abutment tooth" and "distalmost tooth" were analyzed with the log-rank test. Multilevel survival analyses were used to identify hazard ratios and associated risk factors.

RESULTS

Five hundred and forty-seven crowns were evaluated (mean follow-up time 1.3±0.9years) in 327 patients. A total of 87 crowns had at least one complication, with loss of crown retention being the most common (70 crowns). Estimated success and survival rates at 3 years were 71.7% and 96.4%, respectively. The risk of complications was significantly higher for an RPD abutment tooth than for a non-RPD abutment tooth. There was no significant difference between the distalmost tooth and non-distalmost tooth in the dental arch.

CONCLUSIONS

The demonstrated complication rate for CAD/CAM composite crowns placed on premolars was 15.9% over a period of up to 3 years. There was a substantial risk of complications with placement of such a crown on an RPD abutment tooth.

Influence of microscale expansion and contraction caused by thermal and mechanical fatigue on retentive strength of CAD/CAM-generated resin-based composite crowns

CAD/CAM-generated resin-based composite crowns have been proposed as an inexpensive alternative to conventional crowns. However, concerns have been raised about crown loosening in clinical use. Therefore, the present in vitro study aimed to evaluate the influence of thermal and mechanical cycling (TC and MC) on retentive strength of CAD/CAM resin-based crowns in relation to microscale expansion and contraction caused by fatigue. Eighty standardized dies were produced using a resin-based composite material. Crowns were milled from resin-based composite (n = 40) and glass-ceramic blocks (n = 40; control) using a dental CAD/CAM system. The crowns bonded to the dies were subjected to TC (temperature: 5 and 55 °C, cycles: 50,000) and MC (load: 200 N, cycles: 1.2 million). After fatigue treatment, retentive strength of the crowns was evaluated by a crown pull-off test at a crosshead speed of 1 mm/min. Coefficient of thermal expansion (CTE) and modulus of elasticity (E-modulus) of each material were also analyzed to estimate the microscale expansion and contraction during TC and MC. TC and MC significantly reduced the retentive strength of the CAD/CAM resin-based crowns whereas that of the CAD/CAM ceramic crowns was only affected by TC. In addition, the resin-based crowns showed a higher number of crown loosening during TC than the ceramic crowns. Analyses of CTE and E-modulus indicated that the resin-based crowns would be more deformed during TC and MC than the ceramic crowns. The present study demonstrated that the resistance of crowns to microscale expansion and contraction caused by thermal and mechanical fatigue would play an important role in maintaining retentive strength.