Influence of simulated gastric juice on surface characteristics of CAD-CAM monolithic materials

The Effect of Incorporating Dimethylaminohexadecyl Methacrylate and/or 2-Methacryloyloxyethyl Phosphorylcholine on Flexural Strength and Surface Hardness of Heat Polymerized and 3D-Printed Denture Base Materials

BACKGROUND

A major disadvantage of polymethyl methacrylate (PMMA) acrylic resins is susceptibility to biofilm accumulation. The incorporation of antimicrobial agents is a reliable prevention technique. The purpose of this study is to investigate the effect of incorporating dimethylaminohexadecyl methacrylate (DMAHDM) and/or 2-methacryloyloxyethyl phosphorylcholine (MPC) into heat-polymerized (HP) and 3D-printed (3DP) denture base materials on the flexural strength, modulus of elasticity, and surface hardness.

METHODS

DMAHDM and/or MPC were mixed with the acrylic resin liquid of a heat-polymerized (ProBase Hot) and a 3D printed (NextDent Denture 3D) material at mass fractions of 1.5% and 3% and a combination of 3% MPC and 1.5% DMAHDM.

RESULTS

Significant differences in mechanical properties between the control and experimental groups have been detected (p-value < 0.0001). In HP materials, the addition of DMAHDM and/or MPC generally decreased the flexural strength, from (151.18 MPa) in G1 down to (62.67 MPa) in G5, and surface hardness, from (18.05 N/mm2) down to (10.07 N/mm2) in G5. Conversely, in 3DP materials, flexural strength was slightly enhanced, from (58.22 MPa) in G1 up to (62.76 MPa) in G6, although surface hardness was consistently reduced, from (13.57 N/mm2) down to (5.29 N/mm2) in G5.

CONCLUSION

It is recommended to carefully optimize the concentrations of DMAHDM and/or MPC to maintain mechanical integrity.

Effect of simulated gastric acid exposure on the hardness, topographic, and colorimetric properties of machinable and pressable zirconia-reinforced lithium silicate glass-ceramics

STATEMENT OF PROBLEM

The effects of gastric acid on the hardness, topographic, and colorimetric properties of zirconia-reinforced lithium silicate glass-ceramics (ZLSs) for dental restorations remain unknown.

PURPOSE

The purpose of this in vitro study was to investigate the effect of simulated gastric acid exposure on the microhardness, surface roughness, color stability, and relative translucency of ZLSs.

MATERIAL AND METHODS

Two pressable ZLSs (VITA AMBRIA, VA and Celtra Press, CP) and 2 machinable ZLSs (VITA Suprinity, VS and Celtra Duo, CD)(n=64) were randomly allocated to artificial saliva (control) or gastric juice immersion groups simulating 10 and 20 years of clinical exposure. Microhardness (Hv) was measured with a Vickers hardness device, and surface roughness (Sa) was recorded with an optical profilometer. The color stability (ΔE00) and relative translucency parameter (RTP) were measured with a spectrophotometer. Data for Hv, Sa, and RTP were analyzed by repeated 2-way ANOVA, and data for ΔE00 were analyzed by 2-way ANOVA. Post hoc comparisons were obtained from Tukey HSD and Student t tests (α=.05).

RESULTS

Machinable ZLSs exhibited greater Hv after the simulated gastric acid challenge than pressable ZLSs. Sa was significantly impacted by material type (P=.001), storage media (P=.050), and their interaction (P<.001). ΔE00 was significantly affected by the type of simulated aging media (P<.001). After 20 years of simulated gastric acid aging, all ZLS materials surpassed the ΔE00 perceptibility threshold but did not exceed the ΔE00 acceptability threshold. VS displayed significantly lower RTP than other ZLS materials at all time points (P<.001).

CONCLUSIONS

The topographic and colorimetric characteristics of ZLS were significantly altered by exposure to simulated gastric acid.

Effect of Successive At-home Bleaching Sessions on the Surface Properties, Biaxial Flexural Strength, and Reliability of CAD-CAM Monolithic Materials

Although at-home bleaching can recover the optical properties of stained CAD-CAM monolithic materials, little is known about its impact on their surface and mechanical properties, especially when successive sessions are performed. This study evaluated the effect of successive at-home bleaching sessions on the microhardness, roughness, topography, biaxial flexural strength (BFS), and reliability of CAD-CAM monolithic materials. Disks from Lava Ultimate (LU), Vita Enamic (VE), and IPS Empress CAD (EMP) were fabricated and submitted to up to three bleaching sessions. At-home bleaching was performed with 10% carbamide peroxide, and each session consisted of one application for 10 hours/day for 14 days. The analyses of the aforementioned parameters were assessed before and after the first, second, and third bleaching sessions, except for BFS, which was evaluated at baseline and after the third session. The Weibull modulus was calculated from the BFS data. The microhardness of the three materials as well as the roughness of LU were not affected by the sessions, whereas the roughness of VE and EMP increased from the second session. All materials displayed topographic changes, which became more pronounced with the increase in the number of sessions. Although bleaching decreased the BFS of the materials, it did not adversely affect their reliability. Successive at-home bleaching sessions with the protocol used in the present study cannot be considered a safe procedure for the materials evaluated.

Effect of acidic media on surface characteristics of highly filled flowable resin-based composites: An in vitro study

OBJECTIVE

To analyze and compare the impact of acidic media on the surface characteristics of highly filled flowable resin-based composites.

MATERIALS AND METHODS

Two hundred fifty-six specimens were divided into four groups: GUF (G-aenial Universal Flo), GUI (G-aenial Universal Injectable), TEF (Tetric EvoFlow), and FSF (Filtek Supreme Flowable Restorative). Surface characteristics were analyzed before (T0) and after specimens immersion in different media, such as gastric juice (GJ), fizzy drink (FD), citric juice (CJ), or artificial saliva (AS), for 9 h (T1) and 18 h (T2). The analyses included surface roughness (SR) measurements, where average roughness (Ra) was obtained, scanning electron microscopy (SEM) analysis, and surface hardness (SH) evaluation, with Vickers numbers (HV) reported. The differences in values among groups/subgroups within the same stage were assessed using two-way ANOVA and Tukey's post hoc test, whereas repeated measures ANOVA with Bonferroni post hoc test was performed to compare the changes in values through the stages. Data were presented as mean ± standard deviation (SD).

RESULTS

At T0, GUI and GUF revealed lower Ra values (p < 0.05), more evenness in SEM micrographs, and higher HV values (p < 0.05) than FSF and TEF. At T1 and T2, specimens of all groups/subgroups demonstrated an increase in Ra and a decrease in HV compared with T0 (p < 0.05), as well as the changes in surface morphology on SEM micrographs. The lowest Ra and highest HV values were observed in GUI group, in contrast to FSF group, and in specimens immersed in GJ.

CONCLUSIONS

GUI revealed lower SR and higher SH compared to GUF and FSF both before and after exposure to acidic media. The presence of acidic media, especially GJ, significantly increases SR and decreases SH of tested materials.

CLINICAL SIGNIFICANCE

Information on the changes in the surface characteristics of highly filled resin-based composites after exposure to acidic media may be essential for the longevity of restorations like composite veneers fabricated from these materials.

Effects of repetitive firings on mechanical, optical, and phase formation changes of ceramic materials

STATEMENT OF PROBLEM

Studies are sparse on how rapid heating and cooling negatively affect optical properties, including color and transparency, and mechanical properties, including hardness and durability, that affect esthetics and shorten the clinical usage period of the ceramics.

PURPOSE

The purpose of this in vitro study was to determine the effects of repeated firing on the color difference, mechanical properties, and phase formation of different ceramic materials.

MATERIAL AND METHODS

A total of 160 disks (12×1.35 mm) were produced from 4 different ceramic materials: lithium disilicate glass-ceramic, zirconia-reinforced lithium silicate ceramic, zirconia core, and monolithic zirconia. Specimens from all groups were divided into 4 groups (n=10) with a different number of veneer porcelain firings (1 to 4) by simple randomization. After the firings, color measurement, X-ray diffraction analysis, environmental scanning electron micrograph analysis, surface roughness evaluation, Vickers hardness evaluation, and biaxial flexural strength tests were performed. Data were analyzed with analysis of variance (2-way ANOVA) (α=.05).

RESULTS

Repeated firing did not affect the flexural strength of the specimens in any of the groups (P>.05), while the color, surface roughness, and surface hardness were significantly affected (P<.05). The specimens fired 4 times showed the highest mean Vickers hardness and ΔE00 values but the lowest mean surface roughness values. Zirconia core specimens showed the highest mean ΔE00 and flexural strength values, and lithium disilicate glass-ceramic specimens had the highest mean Vickers hardness values.

CONCLUSIONS

The increase in the number of firings affected the color, mechanical properties, and phase formation of the specimens; this change differed according to the ceramic tested.

Effect of glazing and thermocycling on the fracture toughness and hardness of a New fully crystallized aluminosilicate CAD/CAM ceramic material

BACKGROUND

The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics.

METHODS

Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05).

RESULTS

Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P < 0.001). Thermocycling had no significant impact on the fracture toughness of either the glazed or unglazed specimens. Furthermore, statistical analysis revealed no significant effects on hardness with thermocycling in either group, and glazing alone did not substantially affect hardness.

CONCLUSIONS

The impact of glazing on the fracture toughness of LiSiCAD restorations is noteworthy, but it has no significant influence on their hardness. Furthermore, within the parameters of this study, thermocycling was found to exert negligible effects on both fracture toughness and hardness.

Impact of various aging treatments on the microhardness and surface roughness of CAD-CAM monolithic restorative materials

PURPOSE

Dental ceramics deteriorate as a result of thermal aging and exposure to acidic solutions, which change their microhardness and surface roughness. This study assessed the resistance of several computer-aided design and computer-aided manufacturing (CAD-CAM) restorative dental materials in terms of surface roughness and microhardness following exposure to acidic solutions and thermal aging.

MATERIALS AND METHODS

Five different monolithic CAD-CAM restorative materials, two leucite-reinforced glass ceramics (G-Ceram and CEREC Blocs), a zirconia-infiltrated lithium silicate (Celtra Duo), a resin nanoceramic (Grandio), and monolithic zirconia (inCoris TZI), were used to create 2-mm-thick rectangular specimens (n = 100). After being immersed in either acidic saliva (pH = 4.0) (ST) or gastric juice (pH = 1.2) (GT), each material was subjected to 10,000 cycles of thermal aging. The Vickers microhardness and average surface roughness of the specimens were assessed at baseline, following thermal aging and exposure to either gastric juice or acidic saliva. The surface properties were examined using an atomic force microscope. The Mann‒Whitney U test with Bonferroni correction and the Wilcoxon signed-rank test was used for statistical analysis (a = 0.05).

RESULTS

The surface roughness of two leucite-reinforced glass ceramics (G-ceram and CEREC) significantly decreased with ST (p = 0.027 and p = 0.044). Only the CEREC was affected when the aging protocols were compared, and the ST group had a significant reduction in roughness (p = 0.009). The microhardness values significantly decreased after both aging protocols in all groups except for the ST subgroup of G-Ceram. Only inCoris was affected when the aging protocols were compared, and the GT group exhibited a significant reduction in microhardness (p = 0.002).

CONCLUSION

The surface roughness of the tested materials was not affected by the GT. Only leucite ceramics exhibited a decrease in surface roughness in the ST stage. Both aging processes produced a significant decrease in the microhardness of the tested ceramics. Leucite-reinforced glass-ceramic materials may be advantageous for patients with gastroesophageal reflux disease and those with a diet high in acidic foods due to their lower values for changes in microhardness and surface roughness compared to those of other CAD-CAM materials.

Gastric acid challenge of lithium disilicate-reinforced glass-ceramics and zirconia-reinforced lithium silicate glass-ceramic after polishing and glazing-impact on surface properties

OBJECTIVES

To investigate the impact of simulated gastric acid on the surface properties of lithium disilicate-reinforced glass-ceramics and zirconia-reinforced lithium silicate glass-ceramic after certain polishing and glazing procedures.

MATERIALS AND METHODS

Four different types of square-shaped specimens (10 × 10 × 2 mm3, n = 13) were manufactured: lithium disilicate-reinforced glass-ceramic milled and polished (LDS-P); milled, polished, and glazed (LDS-PG); milled, glazed, and no polishing (LDS-G); and milled and polished zirconia-reinforced lithium silicate glass-ceramic (ZR-LS). Specimens were immersed in hydrochloride acid (HCl 0.06 M, pH 1.2) to simulate gastric acid irritation and stored in the acid for 96 h in 37 °C. Specimen weight, surface gloss, Vickers surface microhardness and surface roughness (Ra, Rq, with optical profilometer), and surface roughness on nanometer level (Sq, Sal, Sq/Sal, Sdr, Sds with atomic force microscope) were measured before and after the acid immersion.

RESULTS

ZR-LS specimens lost significantly more weight after acid immersion (p = 0.001), also surface microhardness of ZR-LS was significantly reduced (p = 0.001). LDS-G and LDS-PG showed significantly lower surface roughness (Sa, Sq) values compared to LDS-P before (p ≤ 0.99) and after (p ≤ 0.99) acid immersion and ZR-LS after acid immersion (p ≤ 0.99).

CONCLUSIONS

Gastric acid challenge affects the surface properties of lithium disilicate-reinforced glass-ceramic and zirconia-reinforced lithium silicate glass-ceramic. Glazing layer provides lower surface roughness, and the glazed surface tends to smoothen after the gastric acid challenge.

CLINICAL RELEVANCE

Surface finish of lithium disilicate-reinforced glass-ceramic and zirconia-reinforced lithium silicate glass-ceramic has a clear impact on material's surface properties. Gastric acidic challenge changes surface properties but glazing seems to function as a protective barrier. Nevertheless, also glazing tends to smoothen after heavy gastric acid challenge. Glazing can be highly recommended to all glass-ceramic restorations but especially in patients with gastroesophageal reflux disease (GERD) and eating disorders like bulimia nervosa.

Color stability and surface roughness of resin-ceramics with different surface treatments: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Surface treatments for resin-ceramics have been developed to obtain a smooth surface and improve color stability. However, a consensus on the best treatment for these materials is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the color stability and roughness of glass-ceramics versus resin-ceramics with different surface treatments.

MATERIAL AND METHODS

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed, and the study was registered in the open science framework (OSF) for in vitro studies. The population, intervention, control, and outcome (PICO) question was "Is there a difference in color stability and roughness between resin-ceramic vs vitreous ceramics in different surface treatment protocols?" A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases up to January 2023. The Joanna Briggs Institute's critical assessment guidelines for quasi-experimental studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (α=.05).

RESULTS

A total of 18 laboratory studies were published between 2015 and 2022, with a total of 2160 specimens, all of which were analyzed qualitatively. The meta-analysis indicated significantly less optical alteration for lithium disilicate ceramics (P<.01; MD: 2.69; 95% CI: 2.00-3.39; I²=89%, P<.01), even when compared with resin-ceramics with polish or sealants (P<.01; MD: 2.45; 95% CI: 1.59-3.30; I²=87%, P<.01) and (P<.01; MD: 3.24; 95% CI: 2.02-4.47; I²=89%, P<.01), while there was no significant difference in surface roughness (P=.08; MD: -0.71; CI 95%: -1.52 to 0.09; I²=87%, P<.01) (P=.33; MD: -0.31; CI 95%: -0.94 to 0.32; I²=87%, P<.01), respectively.

CONCLUSIONS

Resin-ceramics that have been polished or treated with sealants have lower color stability than glazed glass-ceramics; however, they are similar in terms of surface roughness.

Effect of simulated gastric acid on aesthetical restorative CAD-CAM materials' microhardness and flexural strength

Background

Gastric acid, which is among erosive substances, gradually rises to the mouth in individuals with reflux and bulimia nervosa disorders, and this causes various effects on dental restorations.

Aim

The objective of this study is in vitro investigation of gastric acid's effect on flexural strength and hardness on aesthetic restorative computer-aided design and computer-aided manufacturing (CAD-CAM) materials.

Materials and Methods

For this study, four materials have been used, namely Enamic (Vita), Superfect Zir (Aidite) Zirconia, IPS e.max CAD (Ivoclar Vivadent), and Mark II (Vita). From these four different materials, 24 samples with 14 × 4 × 1 dimensions in rectangular prism form are used, which makes a total of 96 samples. One group was separated as the control group, while the rest was allowed to wait at 37°C, 5 ml gastric acid for 96 hours. Hardness value and flexural strengths were measured as pre-exposure and post-exposure to gastric acid.

Results

There is a statistically significant difference between the groups in terms of the amount of decrease in the mean hardness after exposure to gastric acid compared to pre-exposure values (p: 0,000; P < 0,05). There was no statistically significant difference between the groups in terms of the amount of decrease in the post-exposure average flexural strength compared to the pre-exposure value (p: 0.063; P > 0.05). There is a statistically significant difference between the groups in terms of the average flexural strength after exposure to the acid.

Conclusions

According to the data obtained, it was concluded that exposure to gastric acid affects the hardness and flexural strength properties of dental restorative ceramic materials.

Evaluation of bond strength of glass and resin-ceramics with laser phototherapy: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Laser phototherapy has been studied as a surface treatment capable of increasing the adhesion of cement to the ceramic surface. However, the bond strength of glass and resin-ceramics after laser phototherapy is unclear.

PURPOSE

The objective of this systematic review and meta-analysis was to compare the bond strength of glass and resin-ceramics using laser therapy and conventional hydrofluoric acid etching.

MATERIAL AND METHODS

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered in the Open Science Framework (OSF) for in vitro studies. A population, intervention, control, and outcome (PICO) question was formulated: "Does phototherapy promote better bond strength in glass and resin-ceramics than conventional hydrofluoric acid etching?" A literature search was performed in PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ProQuest databases up to January 2023. The Joanna Briggs Institute critical assessment guidelines for quasi-experimental studies were used for quality assessment. The meta-analysis was based on the inverse variance (IV) method (α=.05).

RESULTS

A total of 6 in vitro studies published between 2007 and 2019 with a total number of 348 specimens were included for qualitative analysis; 1 study had a positive effect. Five of the studies were included in the meta-analysis, which indicated a significant decrease for feldspathic ceramics that received laser phototherapy and lithium disilicate (P=.002; MD: -2.15; 95% CI: -3.53 to -0.77; I²=89%, P<.01) and (P<.01; MD: -2.13; 95% CI: -2.99 to -1.27; I²=82%, P<.01), respectively.

CONCLUSIONS

Laser irradiation as surface etching of glass ceramics does not produce a bond strength equal to that of conventional hydrofluoric acid etching.

Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials

OBJECTIVE

To investigate the effect of acidic media, including beverages and gastric fluids on flexural strength and fatigue of CAD-CAM materials.

METHODS

Four CAD-CAM materials (high-translucency zirconia (Ceramill Zolid HT+), lithium disilicate (IPS e-max CAD), hybrid ceramic (Vita Enamic), and nanohybrid resin composite (Grandio Blocs) were prepared and immersed in one of five media (gastric HCl, white wine, Coca-Cola, orange juice, and artificial saliva) in an incubator (37 ℃, 24 h). Surface topography and roughness were obtained using a scanning electron microscope (SEM) and a stylus contact profilometer, respectively. Initial 3-point flexural strength was measured for half of the bars (n = 20/gp) using a universal testing machine (0.5 mm/min). The other bars underwent 10⁶ cyclic fatigue loadings before measurement of residual 3-point flexural strength. Data were statistically analyzed (two-way and three-way ANOVA, Tukey's post-hoc, p < 0.05). Weibull distributions were plotted for reliability analysis.

RESULTS

Zirconia bars has the highest initial flexural strengths followed by lithium disilicate, while resin composite and hybrid ceramic groups had the lowest strength regardless of the erosive medium. Cyclic fatigue significantly reduced initial flexural strengths for all materials except for hybrid ceramic and resin composite. Weibull moduli were the highest for zirconia, lithium disilicate and resin composite and lowest for hybrid ceramic.

SIGNIFICANCE

Erosive media significantly changed surface roughness of CAD-CAM materials except for zirconia and resin composite without jeopardizing the flexural strength of the CAD-CAM materials. Despite the higher flexural strengths for zirconia and lithium disilicate, resin composite and hybrid ceramic were more resistant to cyclic fatigue.

Effect of Successive In-office Bleaching Sessions on the Surface Properties, Substance Loss, Biaxial Flexural Strength, and Reliability of CAD-CAM Monolithic Materials

Little is known about the effects of in-office bleaching on the surface properties and on other aspects of CAD-CAM monolithic materials, especially when successive bleaching sessions are conducted. This study evaluated the effect of up to three successive in-office bleaching sessions on the microhardness, roughness, topography, substance loss, biaxial flexural strength (BFS), and reliability of CAD-CAM monolithic materials. Disks from Lava Ultimate (LU), Vita Enamic (VE), and IPS Empress CAD (EMP) were fabricated and submitted to one, two, and three bleaching sessions. In-office bleaching was performed with 40% hydrogen peroxide and each session consisted of three applications of 20 minutes each. The analyses regarding the aforementioned parameters were assessed before and after the first, second, and third bleaching sessions, except for BFS, which was evaluated at the baseline and after the third session. Weibull modulus was calculated from the BFS data. Bleaching decreased the microhardness of LU and VE from the third and second sessions, respectively, and affected neither the roughness nor the BFS of the three materials. However, in LU, it decreased the reliability and caused topographic changes, which were accentuated by the increase in the number of sessions. In general, LU and EMP showed, respectively, the highest and the lowest substance losses. Successive in-office bleaching sessions with the use of the protocol of the present study should be avoided in LU and VE.

Effect of erosive media on microhardness and fracture toughness of CAD-CAM dental materials

Background

Erosive acids might create surface flaws and deteriorate the mechanical properties of CAD-CAM materials. This invitro study aimed to investigate the effect of simulated gastric HCl and extrinsic erosive acids on surface microhardness and fracture toughness of CAD-CAM materials.

Methods

400 bar-shaped specimens (17×4×2 mm³) were prepared from 4 different CAD-CAM dental materials (n = 100/group); monolithic zirconia (Ceramill Zolid HT+, Amanngirbach, Austria), lithium disilicate ceramic (IPS e.max CAD, Ivoclar Vivadent, Liechtenstein), nanohybrid resin composite (Grandio Blocs, VOCO) and polymer-infiltrated glass network (Vita Enamic, VITA Zahnfabrik). Specimens from each material type were further subdivided into 5 groups (n = 20) according to the erosive media applied (simulated gastric HCl, white wine, Coca-Cola®, orange juice, and artificial saliva that served as a control). Specimens were immersed for 24 h in an incubator at 37 ℃, then ultrasonically cleaned in distilled water and air-dried. Half of the specimens were tested for Vickers microhardness (VHN) at parameters of 500 gf for 10 s, while the rest of the specimens underwent 3-point flexure till fracture. Fractured surfaces were examined under a scanning electron microscope (SEM) for fracture toughness (K_IC) calculation using the quantitative fractographic analysis method. Data collected were statistically analyzed using two-way analysis of variance (α = 0.05) after verification of data normality and homogeneity of variances.

Results

Erosive media created surface flaws that lowered the surface microhardness of the material and initiated the fracture pattern under different loads according to material type. The material type was a more predominant factor than erosive media that affected either the microhardness or the fracture toughness of CAD-CAM dental materials. The highest VHN and K_IC values were found among Ceramill Zolid HT+ groups followed by IPS e.max CAD and Grandio Blocs regardless of the erosive media employed. Erosive media significantly reduced the VHN and K_IC in Vita Enamic specimens compared to the rest of the material types.

Conclusion

All CAD-CAM materials used, except Vita Enamic, showed high resistance against the erosive acids indicating higher longevity of the material in patients frequently exposed to either extrinsic or intrinsic acid.

Long-term effects of simulated gastric juice alternated with brushing on hardness, substance loss, flexural strength and reliability of CAD-CAM monolithic materials

OBJECTIVES

The purpose of this study is to evaluate, over a simulated 5-year period, the effect of simulated gastric juice alternated with brushing on CAD-CAM monolithic materials considering microhardness, substance loss, flexural strength, and reliability of the materials.

METHODOLOGY

Blocks from Lava Ultimate (LU), Vita Enamic (VE), IPS Empress CAD (EMP), IPS e.max CAD (EMAX), and Vita Suprinity (VS) were milled into cylinders and sliced into disks. The EMAX and VS were crystallized, and all specimens were polished with silicon carbide papers and allocated as follows: 1) artificial saliva + brushing or 2) simulated gastric juice (0.113% hydrochloric acid (HCl) solution in deionized water, pH 1.2) + brushing, simulating 1, 3, and 5 years of clinical function. Each year of clinical function was simulated by three repetitions of immersion for 3 hours in artificial saliva or simulated gastric juice followed by 1,217 brushing cycles. The microhardness and substance loss were evaluated at baseline (T0) and at each year by using a Vickers hardness tester and an analytical balance. The biaxial flexural strength (BFS) test was performed in a mechanical testing machine at the end of the 5th year. Weibull modulus was calculated from the BFS data.

RESULTS

The microhardness of the LU was not influenced by the treatment, whereas that of the other materials, in certain years, was significantly lower in the gastric juice + brushing groups in comparison with artificial saliva + brushing groups. In general, the materials did not present a significant change in microhardness over time, for either of the treatments. The LU alone showed greater substance loss in the gastric juice + brushing groups for every year. In both treatments, the LU, VE, and EMP exhibited a significant increase in the substance loss over time. The treatment did not affect the BFS of the materials. The gastric juice + brushing decreased the reliability of the VE.

CONCLUSIONS

All materials were somehow impaired by the gastric juice + brushing in at least one of the evaluated parameters, except for the BFS. However, in a deeper analysis, the LU would be the least indicated materials, followed by VE, for patients with eating disorders.

Vickers micro-hardness study of the effect of fluoride mouthwash on two types of CAD/CAM ceramic materials erosion

BACKGROUND

The aim of this study was to evaluate the protective effects of fluoride mouthwash on the surface micro-hardness of two types of CAD/CAM ceramics after exposure to acidic solutions.

METHODS

40 samples (5 × 5 × 3 mm3) were prepared from two different ceramics: Vitabloc Mark II CAD, and IPS e.max CAD. The samples were randomly divided into 5 groups in each ceramic (n = 8) immersed in different solutions: Gs: saliva: GGA: gastric acid, GAA: acetic acid, GFGA: sodium fluoride + gastric acid, GFAA: sodium fluoride + acetic acid. The microhardness of samples was measured before and after immersion in different solutions by Vickers microhardness tester. By subtracting the microhardness values after and before immersion, the microhardness changes of the samples were obtained. Data were analyzed by Two-way analysis of variance, one-way analysis of variance, and Tukey test (α = 0.05).

RESULTS

Immersion in different solutions reduced the microhardness. Microhardness loss was significantly affected in G FAA and G FGA groups in both types of ceramics (P < 0.05). For Vitabloc Mark II groups, the microhardness loss was significantly higher in GFAA and GFGA compared to IPS e.max CAD P < 0.001).

CONCLUSION

Fluoride mouthwash in conjunction with acidic solutions may adversely affect microhardness of Vitabloc Mark II CAD, and IPS e.max CAD that may consequently compromise the clinical service. Vitabloc Mark II CAD was significantly more affected than IPS e.max CAD.

Effects of Simulated Gastric Acid Exposure on Surface Topography, Mechanical and Optical Features of Commercial CAD/CAM Ceramic Blocks

Gastric acid exposure produces tooth structure demineralization and dental ceramic degradation. The most affected patients are those who suffer from gastroesophageal reflux disease, bulimia nervosa, and pregnant women with prolonged severe nausea. In order to protect this kind of patient, the purpose of this study was to determine whether simulated gastric acid exposure leads to microstructural changes in surface topography, hardness, color changes, and translucency of some ceramic materials, which are already on the market. Forty disks (Triluxe Forte, Cerasmart, Enamic and Empress CAD) were analyzed before and after immersion in simulated gastric acid juice, in terms of microhardness, surface roughness, translucency, and surface morphology using scanning electron microscopy. Color change was assessed by using a spectrophotometer based on CIELab parameters and the results showed that, after exposure, ∆Eab remained under the threshold of acceptability and perceptibility. In terms of microhardness, Cerasmart is the only material that did not undergo changes after immersion. SEM images illustrated observable changes surface topography after acid exposure for all the tested materials. In conclusion, Triluxe Forte suffered the most important changes after simulated gastric acid juice exposure, and Cerasmart proved to be the least affected material.

In Vitro Effect of Acidic Solutions and Sodium Fluoride on Surface Roughness of Two Types of CAD-CAM Dental Ceramics

Objectives

This study assessed the effect of immersion in acidic solutions and sodium fluoride on surface roughness of dental ceramics.

Materials and Methods

40 blocks of Vitablocs Mark II and IPS e.max CAD (5 × 5 × 3) were prepared. The samples were divided into five groups (n = 8) for immersion in artificial saliva (control), artificially prepared gastric acid, acetic acid, 0.02% sodium fluoride + gastric acid, and 0.02% sodium fluoride + acetic acid. The samples were immersed for 168 hours in the respective solutions except for sodium fluoride, in which the samples were immersed for 69 hours. The surface roughness of samples was measured before and after immersion using a profilometer. The surface roughness changes of three specimens of each group were evaluated by scanning electron microscopy (SEM). Data were analyzed using one-way and two-way ANOVA, Tukey's test, and independent t-test.

Results

Significant changes were noted in Ra (P=0.002) and Rq (P < 0.0001) in both types of ceramics. The lowest changes in Ra and Rq parameters were seen in artificial saliva and gastric acid and highest changes occurred following immersion in 0.02% sodium fluoride + acetic acid and 0.02% sodium fluoride + gastric acid, respectively. Changes in Rz were also significant following immersion in Vitablocs Mark II (P < 0.05). Immersion in 0.02% sodium fluoride + gastric acid and 0.02% sodium fluoride + acetic acid produced a rougher surface on both types of ceramics (SEM).

Conclusion

Exposure of Vitablocs Mark II CAD and IPS e.max CAD to 0.02% sodium fluoride + gastric acid and 0.02% sodium fluoride + acetic acid significantly increased their surface roughness, while for Vitablocs Mark II, lager defects were seen on its surface.

Erosion of CAD/CAM restorative materials and human enamel: An in vitro study

This in vitro study used the same frequency and duration of acid contact as a previous in situ/in vivo study to evaluate the effect of erosion on CAD/CAM restorative materials and human enamel and to compare the effects of in vitro and in situ/in vivo acid challenges on CAD/CAM restorative materials and human enamel. The CAD/CAM restorative materials (IPS e.max CAD, Lava Ultimate, and PMMA block) and human enamel were eroded by immersion in 150 ml of cola drink for 14 days (4 × 5 min/day). The surface microhardness and surface roughness of the specimens were measured at baseline (T1), day 7 (T2), and day 14 (T3). The substance losses were measured at T2 and T3. The data were statistically analyzed using repeated measures ANOVA and Bonferroni's test (α = 0.05). Erosion significantly decreased the surface microhardness of the CAD/CAM restorative materials and human enamel (all P < 0.001). The overall percentage of surface microhardness loss (%SMH_l) of the PMMA block and enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P = 0.02 and P < 0.001, respectively). Consistent with in situ/in vivo erosion, the surface roughness and profile of the tested restorative materials remained unchanged after in vitro erosion. A significant increase in the surface roughness and substance loss was observed for enamel after in vitro erosion (all P < 0.001). The overall substance loss of enamel due to in vitro erosion was significantly higher than that due to in situ/in vivo erosion (P < 0.001). In conclusion, erosion decreased the surface microhardness of the CAD/CAM restorative materials and human enamel. Moreover, erosion negatively influenced the substance loss and surface roughness of human enamel. For the substance loss of enamel and %SMH_l of PMMA block and enamel, the in vitro erosive effects were approximately 1-2 times greater than the in situ/in vivo effects. However, for the surface roughness and profile of the CAD/CAM restorative materials, no significant difference was found between in vitro and in situ/in vivo erosion.

Repolishing in situ eroded CAD/CAM restorative materials and human enamel

This study aimed to evaluate the effects of repolishing on the surface microhardness (SMH), color change (ΔE), and translucency parameter (TP) of previously in situ eroded computer-aided design/computer-aided manufacturing (CAD/CAM) restorative materials and human enamel. Each of 8 volunteers wore an intraoral appliance containing 3 CAD/CAM restorative material specimens (IPS e.max CAD lithium disilicate ceramic, Lava Ultimate hybrid ceramic, and poly (methyl methacrylate) (PMMA) block) and 1 human enamel specimen. The specimens were subjected to in situ erosion cycles by rinsing with a cola drink (4 × 5 min/day) for 14 days. After erosion, the specimens were polished with a silicone polishing system (Ceramister, Shofu Inc, Kyoto, Japan). The SMH and color of the specimens were determined at baseline (T1), after erosion (T2), and after repolishing (T3). The ΔE and TP values of the specimens were further calculated. The data were statistically analyzed using repeated-measures analysis of variance (ANOVA) and Bonferroni's test (α = 0.05). After erosion, a decrease in the SMH of the restorative materials and enamel was observed (all P < 0.001), and a decrease in the TP of the enamel was observed (P = 0.016). The ΔE values of the enamel (ΔE = 7.32) and Lava Ultimate (ΔE = 3.19) exceeded the clinically unacceptable threshold after erosion. After repolishing, the SMH of the restorative materials and enamel at T3 was significantly higher than that at T2 (all P < 0.001). No significant difference was found in the TP and ΔE values of the restorative materials and enamel between T2 and T3. In conclusion, erosion negatively affected the surface properties and appearance of the CAD/CAM restorative materials and human enamel. Repolishing contributed to restoring the compromised SMH of the eroded restorative materials and enamel to a certain extent. However, repolishing did not restore the color of the eroded restorative materials and enamel.