Fracture strength of copy-milled and conventional In-Ceram crowns

SEM Evaluation of the Marginal Accuracy of Zirconia, Lithium Disilicate, and Composite Single Crowns Created by CAD/CAM Method: Comparative Analysis of Different Materials

(1) Background: The objective of this in vitro study is to evaluate the marginal accuracy of crowns created by CAD/CAM. (2) Methods: A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in a hemi-maxillary stone model and scanned. In total, 27 crowns were fabricated, including 9 lithium disilicate crowns, 9 composite crowns, and 9 zirconia crowns. The measurements were determined by scanning electron microscopy. Descriptive analysis was performed using the mean and standard deviation, while the Kruskal-Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (p < 0.05). (3) Results: The lowest marginal gap value was reported for zirconia (21.45 ± 12.58 µm), followed by composite (44.7 ± 24.96 µm) and lithium disilicate (62.28 ± 51.8 µm). The Kruskal-Wallis tests revealed a statistically significant difference (p-value < 0.05) in the mean marginal gaps between different materials. (4) Conclusions: The proposed digital workflow can be a viable alternative for fixed prosthetic rehabilitations. The best performance in terms of marginal gap was achieved by zirconia crowns, but all three materials demonstrate marginal closure below the clinically accepted threshold value (120 µm). Clinical significance: although significant differences were reported, the investigated CAD/CAM materials showed clinically acceptable marginal gaps.

Fracture load and microcrack comparison of crowns manufactured from tooth-shaped and traditional blocks

This study intended to analyze microcracks and fractographic markings on the surface of all ceramic crowns after milling and compare the fracture loads. 90 crowns were manufactured from two feldspathic (Priticrown-Pr and Vita Mark II-Vi) and a lithium disilicate (EmaxCAD-Em) blocks (n = 30). Two groups (n = 15) were prepared for each ceramic. In the first group, crowns were analyzed twice via the fluorescent penetrant method for microcrack detection, after the manufacturing process and thermal cycles. The load to fracture test was applied at a crosshead speed of 0.5 mm/min until catastrophic failure. Second group crowns were directly cemented onto the Co-Cr dies following the manufacturing process and loaded to fracture. Fractographic markings were analyzed through scanning electron microscope. Spearman correlation analysis, Kruskal-Wallis H test, Mann-Whitney U test, and Wilcoxon Signed Rank test were applied (α = .05). Fracture loads of Em crowns were higher than other groups (p < .05), with and without the aging procedure. Except for second group Pr (r = -.532), no significant relationship was found between microcrack numbers and fracture loads (p > .05). Thermal cycling did not affect microcrack numbers and fracture loads (p > .05). Tooth-shaped multilayered Pr blocks did not provide an advantage in terms of microcrack and fracture loads.

Influence of Intra-Oral Scanner (I.O.S.) on The Marginal Accuracy of CAD/CAM Single Crowns

The aim of this in vitro study was to compare the quality of digital workflows generated by different scanners (Intra-oral digital scanners (I.O.S.s)) focusing on marginal fit analysis. A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in hemi-maxillary stone model and scanned by eight different I.O.S.s: Omnicam^® (Denstply Sirona, Verona, Italy) CS3500^®, CS3600^®, (Carestream Dental, Atlanta, GA, USA), True Definition Scanner^® (3M, St. Paul, MN, USA), DWIO^® (Dental Wings, Montreal, Quebec, Canada), PlanScan^® (Planmeca Oy, Helsinki, Finland), 3D PROGRESS Plus^® (MHT, Verona, Italy), TRIOS 3^® (3Shape, Copenhagen, Denmark). Nine scans were performed by each tested I.O.S. and 72 copings were designed using a dental computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) software (exocad GmbH, Darmstadt, Germany). According to CAD data, zirconium dioxide (ZrO₂) copings were digitally milled (Roland DWX-50, Irvine, CA, USA). Scanning electron microscope (SEM) direct vision allowed for marginal gap measurements in eight points for each specimen. Descriptive analysis was performed using mean, standard deviation, and median, while the Kruskal⁻Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (significance level p < 0.05). The overall mean marginal gap value and standard deviation were 53.45 ± 30.52 μm. The minimum mean value (40.04 ± 18.90 μm) was recorded by PlanScan^®, then 3D PROGRESS Plus^® (40.20 ± 21.91 μm), True Definition Scanner^® (40.82 ± 26.19 μm), CS3500^® (54.82 ± 28.86 μm) CS3600^® (59,67 ± 28.72 μm), Omnicam^® (61.57 ± 38.59 μm), DWIO^® (62.49 ± 31.54 μm), while the maximum mean value (67.95 ± 30.41 μm) was recorded by TRIOS 3^®. The Kruskal⁻Wallis tests revealed a statistically significant difference (p-value < 0.5) in the mean marginal gaps between copings produced by 3D PROGRESS Plus^®, PlanScan, True Definition Scanner, and the other evaluated I.O.S.s. The use of an I.O.S. for digital impressions may be a viable alternative to analog techniques. Although in this in vitro study PlanScan^®, 3D PROGRESS Plus^® and True Definition Scanner^® may have showed the best performances, all I.O.S.s tested could provide clinically encouraging results especially in terms of marginal accuracy, since mean marginal gap values were all within the clinically acceptable threshold of 120 μm.

Evaluation of the bond strength of resin cements used to lute ceramics on laser-etched dentin

OBJECTIVE

The purpose of this study was to investigate the shear bond strength (SBS) of two different adhesive resin cements used to lute ceramics on laser-etched dentin.

BACKGROUND DATA

Erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser irradiation has been claimed to improve the adhesive properties of dentin, but results to date have been controversial, and its compatibility with existing adhesive resin cements has not been conclusively determined.

MATERIALS AND METHODS

Two adhesive cements, one "etch-and-rinse" [Variolink II (V)] and one "self-etch" [Clearfil Esthetic Cement (C)] luting cement, were used to lute ceramic blocks (Vita Celay Blanks, Vita) onto dentin surfaces. In total, 80 dentin specimens were distributed randomly into eight experimental groups according to the dentin surface-etching technique used Er,Cr:YSGG laser and Er:YAG laser: (1) 37% orthophosphoric acid+V (control group), (2) Er,Cr:YSGG laser+V, (3) Er,Cr:YSGG laser+acid+V, (4) Er:YAG laser+V, (5) Er:YAG laser+acid+V, (6) C, (7) Er,Cr:YSGG laser+C, and (8) Er:YAG laser+C. Following these applications, the ceramic discs were bonded to prepared surfaces and were shear loaded in a universal testing machine until fracture. SBS was recorded for each group in MPa. Shear test values were evaluated statistically using the Mann-Whitney U test.

RESULTS

No statistically significant differences were evident between the control group and the other groups (p>0.05). The Er,Cr:YSGG laser+A+V group demonstrated significantly higher SBS than did the Er,Cr:YSGG laser+V group (p=0.034). The Er,Cr:YSGG laser+C and Er:YAG laser+C groups demonstrated significantly lower SBS than did the C group (p<0.05).

CONCLUSIONS

Dentin surfaces prepared with lasers may provide comparable ceramic bond strengths, depending upon the adhesive cement used.

Premolars restored with posts of different materials: fatigue analysis

Previous works studied the effect of the material and the dimensions of the post on the biomechanical performance (fracture strength and stress distribution) of restored teeth, under static loads. The aim of this work was to study the effect of the post material (glass fibre and stainless steel) on restored teeth, which have the final crown, under dynamic conditions. The use of a biomechanical model, including a fatigue analysis from FEA, is presented as a powerful method to study the effect of the material of the intraradicular post. The inclusion of the fatigue analysis allows for a more realistic study that takes into account the dynamic nature of masticatory forces. At the same time, the results obtained are easier to interpret by both dentists and mechanical engineers. No differences were found, with the load and number of cycles considered, between glass fibre and stainless steel as material for the intraradicular post used in premolars restorations.

Influence of the supporting die structures on the fracture strength of all-ceramic materials

This study investigated the influence of the elastic modulus of supporting dies on the fracture strengths of all-ceramic materials used in dental crowns. Four different types of supporting die materials (dentin, epoxy resin, brass, and stainless steel) (24 per group) were prepared using a milling machine to simulate a mandibular molar all-ceramic core preparation. A total number of 96 zirconia cores were fabricated using a CAD/CAM system. The specimens were divided into two groups. In the first group, cores were cemented to substructures using a dual-cure resin cement. In the second group, cores were not cemented to the supporting dies. The specimens were loaded using a universal testing machine at a crosshead speed of 0.5 mm/min until fracture occurred. Data were statistically analyzed using two-way analysis of variance and Tukey HSD tests (α = 0.05). The geometric models of cores and supporting die materials were developed using finite element method to obtain the stress distribution of the forces. Cemented groups showed statistically higher fracture strength values than non-cemented groups. While ceramic cores on stainless steel dies showed the highest fracture strength values, ceramic cores on dentin dies showed the lowest fracture strength values among the groups. The elastic modulus of the supporting die structure is a significant factor in determining the fracture resistance of all-ceramic crowns. Using supporting die structures that have a low elastic modulus may be suitable for fracture strength tests, in order to accurately reflect clinical conditions.

A study on the fracture strength of collarless metal-ceramic fixed partial dentures

PURPOSE

The objective of this study was to evaluate fracture strength of collarless metal-ceramic FPDs according to their metal coping designs.

MATERIALS AND METHODS

Four different facial margin design groups were investigated. Group A was a coping with a thin facial metal collar, group B was a collarless coping with its facial metal to the shoulder, group C was a collarless coping with its facial metal 1 mm short of the shoulder, and group D was a collarless coping with its facial metal 2 mm short of the shoulder. Fifteen 3-unit collarless metal-ceramic FPDs were fabricated in each group. Finished FPDs were cemented to PBT (Polybutylene terephthalate) dies with resin cement. The fracture strength test was carried out using universal testing machine (Instron 4465, Instron Co., Norwood MA, USA) at a cross head speed of 0.5 mm/min. Aluminum foil folded to about 1 mm of thickness was inserted between the plunger tip and the incisal edge of the pontic. Vertical load was applied until catastrophic porcelain fracture occurred.

RESULTS

The greater the bulk of unsupported facial shoulder porcelain was, the lower the fracture strength became. However, there were no significant differences between experimental groups (P > .05).

CONCLUSION

All groups of collarless metal-ceramic FPDs had higher fracture strength than maximum incisive biting force. Modified collarless metal-ceramic FPD can be an alternative to all-ceramic FPDs in clinical situations.

Five-year clinical evaluation of In-Ceram crowns fabricated using GN-I (CAD/CAM) system

This study prospectively evaluated the clinical performance of computer-assisted design and computer-assisted manufacturing (CAD/CAM)-generated In-Ceram Alumina core crowns in Japanese patients for up to 5 years. A total of 101 In-Ceram crowns with aluminium copings fabricated using the GN-I system were placed in Japanese patients. The crowns were evaluated using a California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. Gingival condition was assessed using plaque and bleeding scores. The survival of anterior and posterior crowns was analysed according to the Kaplan-Meier method. The scores of gingival condition were compared between restored crowns and contralateral teeth using a t-test. During the observation period, six crowns were lost to follow-up. Five crowns were fractured from the copings and removed, and four crowns were removed for other reasons. Chipping within the porcelain was detected in three crowns, which were then polished. The cumulative survival rates after 60 months were 96·9% for anterior crowns and 87·7% for posterior ones, and there were no significant differences between anterior and posterior crowns. According to the CDA criteria, most of the crowns were rated as satisfactory during the observation period. There were significant differences in soft tissue conditions between In-Ceram crowns and control teeth at 2- and 5-year examinations. Despite the five fractures from copings, In-Ceram Alumina crowns with copings fabricated using the CAD/CAM (GN-I system) for replacing both anterior and posterior teeth showed predictable results during a 5-year observation period.

Influence of material and diameter of pre-fabricated posts on maxillary central incisors restored with crown

Numerous research works have studied the effect of post-design parameters on the mechanical behaviour of restored teeth without reaching any clear conclusions. Previous works by the authors ascertained the effect of material and post-dimensions for non-crowned restored teeth. The aim of this work was to study the effect of post-material and diameter for crowned teeth. First, an experimental fracture strength test was performed on eighteen extracted human maxillary central incisors. Teeth were decoronated, treated endodontically and restored (nine with glass fibre posts and nine with stainless steel posts). Several post-diameters were used. The final crown restoration was carried out using a reinforced glass-ceramic material. Failure loads were recorded and results were compared using the one-way anova. Secondly, the finite element technique was used to model the restored teeth and to compare the estimated stress distributions. The addition of the crown did not affect the strength of the restoration to any significant extent and post-diameter did not influence the biomechanical performance of either of the post-systems. The crown acts as a protector, thus eliminating the influence of the post-diameter that was found previously when using stainless steel posts, but it does not completely rule out the possibility of a root fracture. Significantly, lower failure loads were found experimentally for teeth restored with stainless steel posts. The stress distributions predicted by the model corroborated these findings and allowed the authors to propose the use of glass fibre posts as a more robust restorative technique.

Clinical marginal and internal gaps of In-Ceram crowns fabricated using the GN-I system

The marginal and internal gaps of ceramic crowns with alumina copings fabricated using a computer-aided design, computer-aided manufacturing system, were evaluated in vivo using silicone materials. Black and white silicone materials were used to record the marginal and internal gaps of 82 In-Ceram crowns before final cementation. The silicone materials were sectioned bucco-lingually and mesio-distally and viewed under a microscope to measure the thickness of the white silicone layer. Sixteen reference points were measured on each specimen. The mean marginal gaps were compared among the anterior, premolar and molar teeth, and the mean gaps at the reference points within the groups were compared by analysis of variance and the Dunnett T3 test. The mean marginal gap was 66.8 mum. There were no differences in marginal gaps among the three groups. In all the groups, the marginal gaps were the smallest, whereas the occlusal gaps were the largest. The mean marginal gaps of the In-Ceram crowns with the alumina copings fabricated using the GN-I system were within the range of clinically acceptable values.

Influence of different adhesive resin cements on the fracture strength of aluminum oxide ceramic posterior crowns

STATEMENT OF PROBLEM

The influence of different types of adhesive resin cements on the long-term prognosis of aluminum oxide ceramic posterior crowns is unclear.

PURPOSE

The purpose of this study was to evaluate the fracture resistance of aluminum oxide ceramic on maxillary posterior crowns cemented with different resin luting agents before and after cyclic thermomechanical loading. Material and methods Forty-eight maxillary first molars were prepared and restored with standardized aluminum oxide ceramic (In-Ceram Alumina) crowns. The test specimens were randomly divided into 3 groups (n=16). The crowns were luted with an acrylic resin cement (Super-Bond C&B, control, Group SB) and 2 composite luting agents (Panavia F, Group PV; and Rely X Unicem, Group RX). Half of the specimens were exposed to thermomechanical fatigue in a masticatory simulator. All specimens were tested for fracture strength (N) using quasistatic loading. The Wilcoxon rank sum test was used to compare the fracture strength (alpha=.05).

RESULTS

All specimens survived the exposure to the simulator. The following median fracture strength values were obtained without/with thermomechanical fatigue loading: Group SB, 2726 N/2673 N; Group PV, 2520 N/2083 N; and Group RX, 2036 N/2369 N. The fracture strength in Group PV after thermomechanical fatigue loading was significantly lower compared to the fracture strength in Group PV without artificial aging (P =.016), as well as significantly lower compared to Group SB with artificial aging (P =.003).

CONCLUSION

Within the limitations of this study, all tested cements are capable of successfully luting aluminum oxide ceramic crowns. The fracture strength of Group PV after artificial aging was comparatively low.

In vitro marginal fit of three all-ceramic crown systems

STATEMENT OF PROBLEM

Studies on marginal discrepancies of single restorations using various systems and materials have resulted in statistical inferences that are ambiguous because of small sample sizes and limited numbers of measurements per specimen.

PURPOSE

The purpose of this study was to compare the marginal adaptation of single anterior restorations made using different systems.

MATERIAL AND METHODS

The in vitro marginal discrepancies of 3 different all-ceramic crown systems (Celay In-Ceram, conventional In-Ceram, and IPS Empress 2 layering technique), and a control group of metal ceramic restorations were evaluated and compared by measuring the gap dimension between the crowns and the prepared tooth at the marginal opening. The crowns were made for 1 extracted maxillary central incisor prepared with a 1-mm shoulder margin and 6-degree tapered walls by milling. Thirty crowns per system were fabricated. Crown measurements were recorded with an optical microscope, with an accuracy of +/-0.1 microm, at 50 points spaced approximately 400 microm along the circumferential margin. The criterion of 120 microm was used as the maximum clinically acceptable marginal gap. Mean gap dimensions and standard deviations were calculated for marginal opening. The data were analyzed with a 1-way analysis of variance (alpha=.05).

RESULTS

Mean gap dimensions and standard deviations at the marginal opening for the incisor crowns were 87 +/- 34 microm for control, 83 +/- 33 microm for Celay In-Ceram, 112 +/- 55 microm for conventional In-Ceram, and 46 +/- 16 microm for the IPS Empress 2 layering technique. Significant differences were found among the crown groups (P<.05). Compared with the control group, the IPS Empress 2 group had significantly smaller marginal discrepancies (P<.05), and the conventional In-Ceram group exhibited significantly greater marginal discrepancies (P<.05). There was no significant difference between the Celay In-Ceram and the control group.

CONCLUSION

Within the limitations of this study, the marginal discrepancies were all within the clinically acceptable standard set at 120 microm. However, the IPS Empress 2 system showed the smallest and most homogeneous gap dimension, whereas the conventional In-Ceram system presented the largest and more variable gap dimension compared with the metal ceramic (control) restoration.