Dynamometric assessment of the mechanical resistance of porcelain veneers related to tooth preparation: A comparison between two techniques

The Influence of a Novel, Crenelated Design of CAD-CAM Ceramic Veneers on the Debonding Strength

(1) Background: Aesthetic dentistry has become one of the most dynamic fields in modern dental medicine. Ceramic veneers represent the most appropriate prosthetic restorations for smile enhancement, due to their minimal invasiveness and highly natural appearance. For long-term clinical success, accurate design of both tooth preparation and ceramic veneers is of paramount importance. The aims of this in vitro study were to assess the stress in anterior teeth restored with Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) ceramic veneers and compare the resistance to detachment and the fracture of ceramic veneers prepared using two different designs. (2) Methods: Sixteen lithium disilicate ceramic veneers were designed and milled using the CAD-CAM technology and divided into two groups according to the preparations (n = 8): Group 1, conventional (CO), with linear marginal contour and Group 2, crenelated (CR), the latter with our novel (patented) sinusoidal marginal design. All samples were bonded to anterior natural teeth. The mechanical resistance to detachment and fracture was investigated by applying bending forces on the incisal margin of the veneers in order to determine which type of preparation leads to better adhesion. An analytic method was employed, as well, and the results of the two approaches were compared. (3) Results: The mean values of the maximum force recorded at the veneer detachment were 78.82 ± 16.55 N for the CO group and 90.20 ± 29.81 N for the CR group. The relative increase, equal to 14.43%, demonstrated that the novel CR tooth preparation provided higher adhesive joints. In order to determine the stress distribution within the adhesive layer, a finite element analysis (FEA) was performed. The statistical t-test showed that the mean value of the maximum normal stresses is higher for the CR-type preparations. (4) Conclusions: The patented CR veneers represent a practical solution to augment the adhesion and mechanical properties of ceramic veneers. The obtained results demonstrated that CR adhesive joints triggered higher mechanical and adhesive forces, which subsequently led to a higher resistance to detachment and fracture.

Marginal Fit of Porcelain Laminate Veneer Materials under Thermocycling Condition: An In-Vitro Study

Objective: The purpose of this study was to evaluate the cervical marginal fit of porcelain laminate veneer (PLV) restorations made from two different types of CAD/CAM ceramic laminates: CEREC C PC and E.max (LD). Materials and Methods: This in-vitro experiment used a total of 32 human maxillary first premolars that were clean and free of any cracks or caries, extracted for orthodontic purposes. The samples were divided in a random way into two study groups: A and B (n = 16). Each sample was mounted on a dental surveyor and a silicon impression was made to create a silicone index for each tooth in both groups. Standardized preparation was carried out for all the samples by using preparation bur kit for the ceramic veneer system. Subsequently, digital impressions were made for all the samples by using Trios 3 shape intraoral camera (Sirona Dental Systems). The design of veneer restorations was made using Sirona inLab CAD SW 16.1 with CEREC inLab MC XL (Dentsply, Sirona Dental Systems, Bensheim, Germany). The veneer restorations were cemented using 3M RelyX veneer resin cement (3M ESPE, Seefeld, Germany) and the samples kept in distilled water for two weeks at 37 °C. All the specimens were subjected to thermocycling in a water bath with temperature varying between 5 °C and 55 °C for 500 cycles. The cervical marginal fit of veneers was evaluated by a digital microscope after sectioning the embedded teeth in acrylic resin. Results: The lowest mean of cervical marginal gap was recorded for Group A (91.59431 ± 1.626069) which was restored with CEREC CAD/CAM veneers, while the highest mean value of the gap was recorded for Group B (106.48863 ± 2.506684) which was restored with IPS E.max CAD. The t-test showed that the type of porcelain veneer restoration had a highly significant effect on the cervical marginal fit (p ≤ 0.01). Conclusions: CEREC CAD/CAM veneers showed smaller cervical marginal gaps, indicating a better fit compared to the IPS E.max CAD.

Dentin Exposure after Tooth Preparation for Laminate Veneers: A Microscopical Analysis to Evaluate the Influence of Operators' Expertise

Background: To assess the quantity of dentin exposure detected by 3 operators with different clinical expertise for 2 designs of tooth preparation for laminate veneers: window (WI) and butt joint (BJ). Methods: 20 intact maxillary central incisors were collected and then prepared for laminate veneers to a depth of 0.6 mm, with a cervical mini-chamfer finish line of 0.3 mm. Each prepared tooth was analyzed by 3 operators with different expertise: undergraduate student (ST), general practitioner (GP), and prosthodontist (PR), at sight under magnification. Besides descriptive statistics (CI 95%), 2-way ANOVA and Games−Howell tests were used to analyze differences among groups (α = 0.05). Results: The means of percentage and area of detected dentin exposure were WI = 30.48%, 21.57 mm2; BJ = 30.99%, 21.97 mm2; ST/WI = 22.82%, 16.44 mm2; GP/WI = 58.05%, 40.64 mm2; PR/WI = 10.55%, 7.63 mm2; ST/BJ = 28.99%, 20.83 mm2; GP/BJ = 40.56%, 28.32 mm2; PR/BJ = 23.42%, 16.75 mm2. Significant differences were found between ST/WI vs. GP/WI (p = 0.005) and GP/WI vs. PR/WI (p < 0.001). Conclusions: There was no difference in detection of exposed dentin among operators with different expertise for BJ preparation, whereas differences were found between the general practitioner and the other 2 operators in WI. Moreover, the quantity of exposed dentin was not related to different tooth preparation designs.

Effect of luting materials, presence of tooth preparation, and functional loading on stress distribution on ceramic laminate veneers: A finite element analysis

STATEMENT OF PROBLEM

How the polymerization shrinkage, loading, and mechanical properties of luting materials affect the shrinkage and functional stresses in ceramic laminate veneers (CLVs) with and without tooth preparation is unclear.

PURPOSE

The purpose of this finite element analysis (FEA) study was to evaluate the effect of the polymerization shrinkage, functional loading, and mechanical properties of different luting materials on the stresses in ultrathin 0.3-mm CLVs with and without tooth preparation.

MATERIAL AND METHODS

Three resin cements, RelyX Veneer (RV), Allcem Veneer APS (AV), Variolink Esthetic LC (VE), and 1 flowable composite resin, Tetric N-Flow (TF), were tested for post-gel shrinkage (Shr), Knoop hardness (KHN), elastic modulus (E), compressive strength (CS), and diametral tensile strength (DTS). IPS e.max CAD disks of 0.3-mm thickness were made for simulating the effects of light attenuation. Eight 2-dimensional finite element models (Marc-Mentat) of a maxillary central incisor were generated to evaluate the polymerization shrinkage stress of different materials for luting 0.3-mm CLVs with or without tooth preparation and the stress during functional loading by using a modified von Mises criterion (mvm). Collected data from Shr, KHN, and E were submitted to 2-way ANOVA and the Tukey HSD test (α=.05).

RESULTS

Light attenuation by the 0.3-mm ceramic disk did not significantly affect the E values, but Shr was significantly lower in VE (26%) and TF (35%). TF had lower volumetric Shr (%) when interposing a ceramic disk (0.31%). Both tested tooth preparation options showed similar stress distributions from polymerization shrinkage or functional loading, with higher stress concentration on the incisal edge and also on the cervical surface. The model featuring tooth preparation and RV resin cement had the highest and VE the lowest stress levels.

CONCLUSIONS

The flowable composite resin had similar mechanical properties as the resin cements. The stress distribution from shrinkage and functional loading was similar for both techniques with or without tooth preparation.

Effect of incisal preparation design on load-to-failure of ceramic veneers

OBJECTIVE

This in vitro study aims to evaluate load-to-failure of ceramic veneers with butt joint (BJ) and feathered edge (FE) incisal preparation designs, and to correlate these results to the failure mode of the restorations.

MATERIALS AND METHODS

One hundred and forty-eight typodont teeth (customized Nissin A25A-UL19B) were divided into two different preparation configurations BJ and FE and two different loading angulations, 0° and 20°. Lithium disilicate ceramic veneers (IPS e.max CAD, Ivoclar Vivadent) were milled using computer-aided-design-and-computer-aided-manufacturing (CAD/CAM) techniques. Veneers were bonded to typodont teeth with resin cement (IPS Variolink Esthetic, Ivoclar Vivadent). Each group was loaded at the incisal edge using an Instron Universal Testing Machine at a crosshead speed of 0.01 mm/s till failure.

RESULTS

Pairwise comparison showed veneers from the BJ groups had a significantly higher load-to-failure value compared to the FE groups. Veneers with a FE preparation design loaded at 20° angulation had the lowest load-to-failure value.

CONCLUSIONS

Within the limitations of the present study, both incisal preparation designs and loading angulations have significant effects on the load-to-failure values of ceramic veneers. BJ group exhibits a significantly higher load-to-failure value compared to the FE group.

CLINICAL SIGNIFICANCE

BJ incisal preparation is preferred over FE preparation design.

Incisal preparation design for ceramic veneers: A critical review

BACKGROUND

The authors reviewed and identified the evidence for the various incisal preparation designs for ceramic veneers.

TYPES OF STUDIES REVIEWED

The authors searched MEDLINE with PubMed and Ovid to identify any articles in the English language related to the topic up through March 2017 using a combination of key words: "porcelain veneer or ceramic veneer or dental veneer or labial veneer" AND "preparation," NOT "composite veneer," NOT "crown," NOT "implant," NOT "fixed partial denture or bridge or denture," NOT "porcelain-fused-to-metal," NOT "marginal gap or fit."

RESULTS

In vitro studies showed that the palatal chamfer preparation design increases the risk of developing ceramic fractures. The butt joint preparation design had the least effect on the strength of the tooth.

CONCLUSIONS

Surveys show the 2 most common incisal preparation designs provided are butt joint and feathered-edge. Clinical studies have identified that incisal ceramic is the most common location of ceramic fracture. In addition, there is a lack in standardization of the modeling structures and type of finite element analysis.

PRACTICAL IMPLICATIONS

The evidence seems to support the use of butt joint over palatal chamfer incisal preparation design. Fracture or chipping is the most frequent complication and the risk increases with time. Incisal ceramic is the most common location of ceramic fracture.

A Finite Element Analysis to Compare Stress Distribution on Extra-Short Implants with Two Different Internal Connections

Background: The goal of this study was to analyze the stress distribution on two types of extra-short dental implants with 5 mm of length: An internal hexagon (IH) and morse taper connection (MT). Methods: The three-dimensional model was composed of trabecular and cortical bone, a crown, an extra-short dental implant and their components. An axial load of 150 N was applied and another inclined 30° with the same magnitude. Results: Stress concentrations on the IH implant are observed in the region of the first threads for the screw. However, in the MT implant the highest stress occurs at the edges of the upper implant platform. Conclusions: In view of the results obtained in this study the two types of prosthetic fittings present a good stress distribution. The Morse taper connections presented better behavior than the internal in both loading configurations.

Thermal-stress analysis of ceramic laminate veneer restorations with different incisal preparations using micro-computed tomography-based 3D finite element models

Main objective of this study is to investigate the thermal behavior of ceramic laminate veneer restorations of the maxillary central incisor with different incisal preparations such as butt joint and palatinal chamfer using finite element method. In addition, it is also aimed to understand the effect of different thermal loads which simulates hot and cold liquid imbibing in the mouth. Three-dimensional solid models of the sound tooth and prepared veneer restorations were obtained using micro-computed tomography images. Each ceramic veneer restoration was made up of ceramic, luting resin cement and adhesive layer which were generated based on the scanned images using computer-aided design software. Our solid model also included the remaining dental tissues such as periodontal ligament and surrounding cortical and spongy bones. Time-dependent linear thermal analyses were carried out to compare temperature changes and stress distributions of the sound and restored tooth models. The liquid is firstly in contact with the crown area where the maximum stresses were obtained. For the restorations, stresses on palatinal surfaces were found larger than buccal surfaces. Through interior tissues, the effect of thermal load diminished and smaller stress distributions were obtained near pulp and root-dentin regions. We found that the palatinal chamfer restoration presents comparatively larger stresses than the butt joint preparation. In addition, cold thermal loading showed larger temperature changes and stress distributions than those of hot thermal loading independent from the restoration technique.

The failure load of CAD/CAM generated zirconia and glass-ceramic laminate veneers with different preparation designs

STATEMENT OF PROBLEM

Fracture of feldspathic porcelain laminate veneers represents a significant mode of clinical failure. Therefore, ceramic materials that withstand a higher load to fracture, especially for patients with parafunctional habits, are needed.

PURPOSE

The purpose of this study was to examine the correlation of material (zirconia, TZP, glass-ceramic, IEC, and feldspathic porcelain, FP) design (incisal overlapped preparation, IOP, and three-quarter preparation, TQP), and fracture mode to failure load for veneers supported by composite resin abutments.

MATERIAL AND METHODS

A typodont tooth prepared with 2 designs (IOP, TQP) and the corresponding 2 definitive dies were used to fabricate the composite resin abutments (30 for IOP and 30 for TQP). Ten veneer specimens for each system (Y-TZP, IEC, and FP), were fabricated for each design. The veneers were cemented, invested, and tested in compression until failure by using a universal testing machine. Significant differences were evaluated by 2-factor ANOVA (α=.05).

RESULTS

No statistical mean load difference was noted between the preparation designs for Y-TZP (IOP: 244 ±81 and TQP: 224 ±58 N), IEC (IOP: 306 ±101 and TQP: 263 ±77 N), and FP veneers (IOP: 161 ±93 and TQP: 246 ±45 N). No statistical difference in the mean load was found among the 3 veneer materials for each preparation design except between IEC (306 ±101 N) and FP (161 ±93 N) veneers for TQP.

CONCLUSIONS

Preparation design did not influence the failure load of the veneer materials. Zirconia veneers were the least likely to fracture but the most likely to completely debond; feldspathic porcelain veneers exhibited the opposite characteristics.

Shear bond strength of porcelain laminate veneers to enamel, dentine and enamel-dentine complex bonded with different adhesive luting systems

OBJECTIVES

The aim of this study was to evaluate the shear bond strength of porcelain laminate veneers to 3 different surfaces by means of enamel, dentine, and enamel-dentine complex.

METHODS

One hundred thirty-five extracted human maxillary central teeth were used, and the teeth were randomly divided into 9 groups (n=15). The teeth were prepared with 3 different levels for bonding surfaces of enamel (E), dentine (D), and enamel-dentine complex (E-D). Porcelain discs (IPS e.max Press, Ivoclar Vivadent) of 2mm in thickness and 4mm in diameter were luted to the tooth surfaces by using 2 light-curing (RelyX Veneer [RV], 3M ESPE; Variolink Veneer [VV], Ivoclar Vivadent) and a dual-curing (Variolink II [V2], Ivoclar Vivadent) adhesive systems according to the manufacturers' instructions. Shear bond strength test was performed in a universal testing machine at 0.5mm/min until bonding failure. Failure modes were determined under a stereomicroscope, and fracture surfaces were evaluated with a scanning electron microscope. The data were statistically analysed (SPSS 17.0) (p=0.05).

RESULTS

Group RV-D exhibited the lowest bond strength value (5.42±6.6MPa). There was statistically no difference among RV-D, V2-D (13.78±8.8MPa) and VV-D (13.84±6.2MPa) groups (p>0.05). Group VV-E exhibited the highest bond strength value (24.76±8.8MPa).

CONCLUSIONS

The type of tooth structure affected the shear bond strength of the porcelain laminate veneers to the 3 different types of tooth structures (enamel, dentine, and enamel-dentine complex).

CLINICAL SIGNIFICANCE

When dentine exposure is necessary during preparation, enough sound enamel must be protected as much as possible to maintain a good bonding; to obtain maximum bond strength, preparation margins should be on sound enamel.

Influence of abutment material on the fracture strength and failure modes of abutment-fixture assemblies when loaded in a bio-faithful simulation

OBJECTIVES

The aim of the present study was to evaluate differences in the ultimate fracture resistance of titanium and zirconia abutments.

MATERIAL AND METHODS

Twenty titanium fixtures were embedded in 20 resin mandible section simulators to mimic osseointegrated implants in the premolar area. The embedded implants were then randomly divided into two groups. Afterwards, specimens in group A (n=10) were connected to titanium abutments (TiDesign™ 3.5/4.0, 5.5, 1.5 mm), while specimens in group B (n=10) were connected to zirconia abutments (ZirDesign ™ 3.5/4.0, 5.5, 1.5 mm). Both groups were loaded to failure in a dynamometric testing machine. Fractured samples were then analyzed by scanning electron microscopy (SEM).

RESULTS

Group A showed a significantly higher fracture strength than that observed in group B. Group A failures were observed at the screw that connects the abutment with the implant while the abutment connection hexagons were plastically bent by the applied load. Group B failures were a result of abutment fractures. SEM analysis showed that in group A the screw failure was driven by crack nucleation, coalescence and propagation, while in group B, the SEM analysis of failed surfaces showed the conchoidal fracture profile characteristic of brittle materials.

CONCLUSIONS

The strength of both tested systems is adequate to resist physiologic chewing forces in the premolar area. Conversely, the titanium and zirconia failure modes evaluated here occurred at unphysiological loads. In addition, because the abutments were tested without crowns, the presented data have limited direct transfer to the clinical situation.

Nonlinear visco-elastic finite element analysis of different porcelain veneers configuration

This study is aimed at evaluating the biomechanical behavior of feldspathic versus alumina porcelain veneers. A 3D numerical model of a maxillary central incisor, with the periodontal ligament (PDL) and the alveolar bone was generated. Such model was made up of four main volumes: dentin, enamel, cement layer and veneer. Incisors restored with alumina and feldspathic porcelain veneers were compared with a natural sound tooth (control). Enamel, cementum, cancellous and cortical bone were considered as isotropic elastic materials; on the contrary, the tubular structure of dentin was designed as elastic orthotropic. The nonlinear visco-elatic behavior of the PDL was considered. The veneer volumes were coupled with alumina and feldspathic porcelain mechanical properties. The adhesive layers were modeled in the FE environment using spring elements. A 50N load applied at 60 degrees angle with tooth longitudinal axis was applied and validated. Compressive stresses were concentrated on the external surface of the buccal side of the veneer close to the incisal margin; such phenomenon was more evident in the presence of alumina. Tensile stresses were negligible when compared to compressive ones. Alumina and feldspathic ceramic were characterized by a different biomechanical behavior in terms of elastic deformations and stress distributions. The ultimate strength of both materials was not overcome in the performed analysis.