Fatigue analysis of computer-aided design/computer-aided manufacturing resin-based composite vs. lithium disilicate glass-ceramic

The influence of hygroscopic expansion of resin supporting dies on the fracture resistance of ceramic restorations during thermal cycling

OBJECTIVES

To evaluate the hygroscopic expansion characterization of resin composite dies during thermal cycling, and their influence on the fracture resistance of dental ceramic materials as well as the effect of pre-immersion on these measurements.

METHODS

Disc-shaped specimens (φ = 15.0 mm, h = 1.2 mm) and anatomical crown dies of four resin composites (epoxy, Z350, P60, G10) were fabricated. Disc-shaped samples were continuously soaked in distilled water and the volume expansion was measured at different time point by Archimedes method. Disc-shaped samples were pre-immersed for 0, 7, or 30 days, elastic modulus and hardness were measured using Nanoindentation test; thermal cycling (TC) test was performed (5 °C-55 °C, 104 cycles), and volume expansion during TC was measured. Four kinds of resin die with pre-immersion for 0, 7, or 30 days were cemented to 5Y-Z crown, or epoxy dies without pre-immersion were cemented to 5Y-Z, 3Y-Z and lithium disilicate glass (LDG) crowns, and load-to-failure testing was performed before and after TC. Finite element analysis (FEA) and fractography analysis were also conducted.

RESULTS

The hygroscopic expansion was in the order: epoxy > Z350 > P60 > G10. Except for G10, the other three resin composites exhibited different degrees of hygroscopic expansion during TC. Only the elastic modulus and hardness of epoxy decreased after water storage. However, only the fracture loads of 5Y-Z and LDG crowns supported by epoxy dies were significantly decreased after TC. FEA showed a stress concentration at the cervical region of the crown after volume expansion of the die, leading to the increase of the peak stress at the crown during loading.

SIGNIFICANCE

Only the hygroscopic expansion of epoxy dies caused by TC led to the decrease in the fracture resistance of the 5Y-Z and LDG crown, which may be related to the decrease in the elastic modulus of the epoxy die and the tensile stress caused by it.

Clinical performance comparison between lithium disilicate and hybrid resin nano-ceramic CAD/CAM onlay restorations: a two-year randomized clinical split-mouth study

A total of 20 lithium disilicate glass-ceramics (IPS e.max CAD, Ivoclar Vivadent) and 20 resin nano-ceramic (Voco Grandio Blocks) onlay restorations were performed in 20 patients using a split-mouth design to compare the two-year clinical performance of lithium disilicate and resin nano-ceramic onlay restorations. Both restorations were evaluated at baseline, one-year, and two-year clinical follow-ups based on the modified United States Public Health Service (USPHS) criteria. Chi-square and Fisher's exact tests showed no statistically significant difference between Voco Grandio and IPS e.max ceramic restorations for all evaluated parameters during the different follow-up periods (p > 0.05). Cochrane's and MC-Nemar's tests indicated statistically significant differences regarding color match within the Voco Grandio group. They also indicated statistically significant differences in marginal discoloration, marginal adaptation, surface texture, and postoperative hypersensitivity within both ceramic material groups (p < 0.05). Kaplan-Meier curve indicated that the survival rate of both ceramic materials was 90%. After two years of clinical service, IPS e.max CAD and Voco Grandio onlay restorations exhibited similar clinical performance.

Effect of Thermo-mechanical Cycling on Fracture Resistance of Different CAD/CAM Crowns: An In Vitro Study

AIM

To evaluate the effect of thermo-mechanical cycling (TMC) on fracture resistance of different computer-aided design/computer-aided manufacture (CAD/CAM) crowns.

MATERIALS AND METHODS

A total of 42 CAD/CAM crowns were fabricated on epoxy resin maxillary first premolar teeth and divided into three groups (n = 14) according to the material used: IPS e.max CAD (Ivoclar Vivadent) lithium disilicate (LD), Vita ENAMIC (VE) (VITA Zahnfabrik), Tetric CAD (Ivoclar Vivadent). Also, each group was subdivided into two equal subgroups according to TMC (n = 7). Subgroups (O) without TMC and subgroup (W) with TMC (5-55°C, 30 second, 75,000 cycles). All samples in each group were cemented with a universal bond (Tetric N bond universal) and adhesive resin cement (Variolink Esthetic DC) (Ivoclar Vivadent). Subsequently, the samples were loaded to failure in a universal testing machine at a crosshead speed of 1 mm/min, and the fracture pattern and the fracture resistance in each group were recorded.

RESULTS

Fracture resistance was analyzed by one-way analysis of variance (ANOVA) test, followed by Tukey's post hoc test for pairwise comparison. Fracture resistance showed a significant difference between the tested groups before and after TMC; IPS e.max CAD has the highest value (1233.35 ± 97.72, 1165.73 ± 199.54 N) followed by Tetric CAD (927.62 ± 42.5, 992.04 ± 53.46 N) and Vita ENAMIC has lowest value (506.49 ± 74.24, 354.69 ± 90.36 N).

CONCLUSION

Thermo-mechanical cycling affected the fracture resistance of both polymer-based CAD/CAM crowns.

CLINICAL SIGNIFICANCE

For dental practitioners, both IPS e.max CAD and Tetric CAD can be used clinically for posterior teeth, providing satisfactory results and resistance to fracture. How to cite this article: Elmokadem MI, Haggag KM, Mohamed HR. Effect of Thermo-mechanical Cycling on Fracture Resistance of Different CAD/CAM Crowns: An In Vitro Study. J Contemp Dent Pract 2024;25(1):29-34.

The Biological Activity of Fragmented Computer-Aided Design/Manufacturing Dental Materials before and after Exposure to Acidic Environment

Three ceramic and composite computer-aided design/computer-aided manufacturing (CAD/CAM) materials from different manufacturers (Cerasmart (CS)-nanoceramic resin; Straumann Nice (SN)-glass ceramic and Tetric CAD (TC)-composite resin) were tested to investigate the biocompatibility and sustainability on human fibroblasts and keratinocytes cells. Each type of CAD/CAM blocks restorative materials with fine and rough surfaces was exposed to an acidic environment for one month. After that, various powders were obtained by milling. In parallel, powders were also prepared from each restorative material, which were not exposed to the acidic environment. The cytotoxic effects were investigated by means of MTT and LDH assays, as well as nitric oxide production on two human normal cell lines, namely, fibroblasts (BJ) and keratinocytes (HaCaT). In addition, the degree of adhesion of fibroblast cells to each CAD/CAM material was evaluated by scanning electron microscopy (SEM). The results showed that the two samples that were exposed to an acidic environment (CS and SN) induced a reduction of mitochondrial activity and plasma membrane damage as regards the fibroblast cells. A similar effect was observed in TC_fine-exposed material, which seemed to induce necrosis at the tested concentration of 1 mg/mL. No oxidative stress was observed in fibroblasts and keratinocytes treated with the CAD/CAM materials. Regarding the adhesion degree, it was found that the fibroblasts adhere to all the occlusal veneers tested, with the mention that the CS and SN materials have a weaker adhesion with fewer cytoplasmic extensions than TC material. With all of this considered, the CAD/CAM restorative materials tested are biocompatible and represent support for the attachment and dispersion of cells.

Bonding of Clear Aligner Composite Attachments to Ceramic Materials: An In Vitro Study

Background: We aim to evaluate the effect of surface conditioning, bonding agents and composite types on surface roughness (SR) and shear bond strength (SBS) of clear aligner composite attachments bonded to ceramics. Methods: One hundred and eighty IPS e.max CAD specimens were prepared. For SR, 60 specimens were divided according to surface conditioning (n = 15) into four groups: control, 9.6% hydrofluoric acid (HFA), 37% phosphoric acid (PhA), air abrasion (AA). SR was measured using a Profilometer and Atomic Force Microscopy. For SBS, 120 specimens were divided according to conditioning methods (n = 40) (9.6% HFA and 37% PhA or AA), then according to bonding agents (n = 20) (Assure universal bond (AUB) or Single bond universal (SBU)) and then according to composite type (n = 10): Filtek™ Z350 and Filtek™ Z350 XT flowable composite. SBS was measured using Instron testing machine. Descriptive and group comparison were calculated (p < 0.05). Results: AA had the highest SR, while the control had the lowest SR (p < 0.05). HFA had the highest, but insignificant SBS, followed by AA (p > 0.05). AUB had higher SBS than SBU (p < 0.001). Filtek™ Z350 produced higher SBS than Filtek™ Z350 XT flowable composite (p < 0.01). Conclusion: The combination of AA, AUB, and Filtek Z350 produced the highest SBS, followed by HFA, AUB, and Filtek Z350.

Potential complications of CAD/CAM-produced resin composite crowns on molars: A retrospective cohort study over four years

Purpose

Evaluation of the clinical performance of computer-aided design/computer-aided manufacturing-produced resin composite crowns (CAD/CAM composite crowns) on molars with a particular focus on placement location.

Methods

A retrospective cohort study was performed based on the clinical records of patients with CAD/CAM composite crowns on molars (June 2016 to March 2021). The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated based the Cox proportional hazard model to evaluate the effect of tooth location on complication type and occurrence. Covariates included crown location (maxilla/mandible, distalmost tooth/not distalmost tooth, and first molar/second or third molar) and endodontically treated (nonvital) or untreated (vital) tooth.

Results

Overall, 362 crowns were evaluated (mean follow-up: 378 days, median: 286 days), and 106 crowns (29.3%) showed complications, most frequently crown debonding. The cumulative success and survival rates were 70.9% and 93.7%, respectively, after 1 year and 49.5% and 86.5%, respectively, after 3 years. There was no significant difference in the HRs and log-rank tests in the Kaplan–Meier curves based on crown location parameters (P > 0.05). However, placement on vital teeth was associated with higher risks than on nonvital teeth (HR, 1.55; 95% CI, 1.03–2.23). In addition, the cement as a covariate yielded a high HR.

Conclusions

The location of CAD/CAM composite molar crowns is unlikely a risk factor for complications; therefore, these crowns can be clinically applied to all molars. However, the application of such molar crowns to vital teeth and the use of a cement other than adhesive resin cement present risks.

Influence of crystalline phase transformation induced by airborne-particle abrasion and low-temperature degradation on mechanical properties of dental zirconia ceramics stabilized with over 5 mol% yttria

Monolithic dental prostheses fabricated from 5 mol% yttria-stabilized zirconia (5YZ) have been developed to improve the translucency of conventional 3 mol% yttria-stabilized zirconia. In this study, we aimed to evaluate the influence of airborne-particle abrasion (APA) and low-temperature degradation (LTD) on the mechanical properties of 5YZ in association with the crystalline phase transformation. In total, 120 disc-shaped specimens of two brands of 5YZ (Lava Esthetic and Katana UTML) were prepared. The specimens were divided into four groups (n = 15 for each group): (i) control, (ii) APA, (iii) LTD, and (iv) APA + LTD groups. APA was performed with 50 μm alumina particles, and LTD was induced by autoclaving at 134 °C for 50 h. The biaxial flexural strength of the specimens was assessed using a piston-on-three-ball test according to ISO 6872:2015, and Vickers hardness was determined using a microhardness tester. The crystalline phase was analyzed by the Rietveld refinement of X-ray diffraction patterns. APA significantly increased the flexural strength of the Lava Esthetic specimens, whereas LTD hardly affected the strength of both materials. APA and APA + LTD significantly increased the Vickers hardness of both materials. According to Rietveld analysis, the pseudocubic phase was predominant in both materials, i.e., 66 mass% and 81 mass% in the Lava Esthetic and Katana UTML specimens, respectively. APA induced the rhombohedral phase at approximately 37 mass% in both materials, while LTD induced the monoclinic phase at 2.8 mass% in the Lava Esthetic specimens and 0.9 mass% in the Katana UTML specimens. APA + LTD weakly affected the amount of the rhombohedral phase but slightly increased the amount of the monoclinic phase. These findings suggest that APA may improve the mechanical properties of 5YZ, particularly hardness, via the generation of the rhombohedral phase. In contrast, the influence of LTD on the mechanical and microstructural properties of 5YZ was limited.

Effect of sandblasting and/or priming treatment on the shear bond strength of self-adhesive resin cement to CAD/CAM blocks

The aim of this study was to investigate the effect of two different priming agents and/or sandblasting on the shear bond strength of self-adhesive resin cement to the resin composite for core build-up to CAD/CAM blocks. A CAD/CAM ceramic block (GN I CERAMIC BLOCK, GC) and a CAD/CAM resin composite block (CERASMART 270, GC), a self-adhesive resin cement (G-CEM ONE, GC) and two different primers, i.e., a multipurpose primer (MP; G-Multi Primer, GC) and a ceramic primer (CP; Ceramic Primer II, GC), were examined. Five different surface treatments with priming and/or sandblasting and no surface treatment (control) were performed on the block. Disk specimens (6 mm in diameter and 4 mm in thickness) made from core composites were cemented to the blocks after the surface treatments. Then, the 24-h shear bond strength of the resin cement between the block and the resin composite core was determined (n = 15). Sandblasted specimens had greater bond strength than controls for both blocks (p < 0.05). Priming to both blocks significantly increased the bond strength of resin cement compared to that of controls (p < 0.05). Although Weibull moduli were not significantly changed among all surface treatments for both blocks, the strengths with 5% and 95% failure probability of sandblasted and/or primed blocks were estimated to be greater than those of controls. The combination of priming and sandblasting to the CAD/CAM composite and ceramic surface was effective in increasing the bond strength of the resin cement.

Effect of different ceramic materials and substructure designs on fracture resistance in anterior restorations

STATEMENT OF PROBLEM

Materials have been developed to reduce the chipping of ceramic veneer and improve the esthetics of anterior ceramic veneered restorations. However, studies of the effects of material and substructure design on fracture resistance are sparse.

PURPOSE

The purpose of this in vitro study was to investigate the fracture resistance of metal-ceramic (MC), zirconia-feldspathic porcelain (ZC), and zirconia-lithium disilicate (ZL) anterior restorations and evaluate the effect of material and substructure design.

MATERIAL AND METHODS

After preparing and scanning artificial maxillary central incisor teeth, titanium abutments and restoration specimens (n=90) were fabricated. MC, ZC, and ZL materials were prepared with substructure designs A (two-third coverage of the palatal surface) and B (one-third coverage of the palatal surface). After cementation, the specimens were thermocycled (10 000 cycles, 5 and 55 °C). Fracture load measurements, failure mode analysis, energy dispersive X-ray spectroscopy (EDS), line scan analysis, fractography, finite element analysis (FEA), and Weibull analysis were performed. Two-way ANOVA was used to identify the effects of material and substructure design on fracture load. One-way ANOVA was used to identify significant differences of fracture load (α=.05).

RESULTS

MC and ZL showed significantly higher fracture load than ZC (P<.05). MC_A showed a significantly higher fracture load than MC_B (P<.05). ZC_A exhibited the lowest Weibull modulus. FEA revealed that the maximum principal stress occurred near the loading area of the veneer. ZL displayed the lowest maximum principal stress among all the materials.

CONCLUSIONS

ZL and MC_A exhibited more favorable fracture resistance. The substructure design of MC, with increased metal coverage of the palatal surface, improved fracture resistance significantly.

Current status and perspective of CAD/CAM-produced resin composite crowns: a review of clinical effectiveness

The purpose of the present review was to survey the available literature on computer-aided design/computer-aided manufacturing (CAD/CAM)-produced resin composite materials to provide clinicians with a current overview of the key components necessary for daily clinical use. An electronic search was conducted in the PubMed database. Peer-reviewed articles in English language on the use of resin composites in CAD/CAM dental crowns were included. A total of 122 full-text articles were identified, 15 of which were selected during the initial review. Two additional articles were also discovered through a manual search, to obtain a final total of 17 articles included in the present review. Of these, 16 were to in vitro studies, and one was an in vivo study. Findings from the in vitro studies indicate that resin composite block materials for CAD/CAM applications demonstrate excellent physical properties and are appropriate for the clinical restoration of premolars and molars. However, the in vivo study reported a low 3-year success rate, but high survival rate for resin composite CAD/CAM crowns placed in the premolar region. The key to ensuring the successful prognosis of a resin composite CAD/CAM crown is to ensure that all steps—such as proper case selection, abutment tooth preparation, occlusal adjustment, and bonding—are accurately performed.

Effect of surface treatment of CAD/CAM resin composites on the shear bond strength of self-adhesive resin cement

This study examined the effects of sandblasting, hydrofluoric acid etching and priming on the shear bond strength of self-adhesive resin cement between seven different CAD/CAM resin composites and a resin composite core material at 24-h after cement mixing. Five surface treatments [control (C), sandblasting (S), priming (P), sandblasting with priming (SP), and 9% HF etching with priming (HFP)] were performed respectively for disc specimens of CAD/CAM blocks. There were no significant differences in bond strength among the C, S, and P, except for one block (p>0.05). SP showed a greater bond strength than S. Weibull moduli were not changed significantly among all treatments for all blocks, whereas the strengths with 5% and 95% failure probability of SP and HFP showed greater values than the others. The bond strengths of HFP were comparable to those of SP. Priming after sandblasting or HF etching could be effective to increase the bond strength of CAD/CAM blocks.

Mechanical and microstructural properties of ultra-translucent dental zirconia ceramic stabilized with 5 mol% yttria

Monolithic dental prostheses fabricated from 3 mol.% yttria-stabilized zirconia (3YZ) are becoming increasingly popular. Recently, 5 mol.% yttria-stabilized zirconia (5YZ) which significantly improves the translucency of 3YZ has been prepared. However, its mechanical and microstructural properties, especially those affected by low-temperature degradation (LTD), have not been fully elucidated yet. The objective of the present study was to establish the relationship between the flexural strength of 5YZ with or without autoclave-induced LTD and its microstructural properties. For this purpose, a total of 320 bar-shaped specimens were cut from 5YZ and 3YZ blocks, and half of the specimens in each group were autoclaved at 134 °C for 50 h. Their flexural strengths were determined by conducting three-point bending tests, and the obtained results were analyzed by the Weibull statistical method. Grain sizes and crystalline structures of the specimens were analyzed by scanning electron microscopy (SEM) and X-ray diffraction, respectively. Additionally, the LTD-induced phase transformation was examined by Raman microscopy and cross-sectional surface analysis. The characteristic strengths of 5YZ and 3YZ were approximately 620 and 950 MPa, respectively, and 5YZ was found to be more resistant to LTD in terms of phase transformation than 3YZ. However, a low amount of the monoclinic phase was detected even in 5YZ after 50 h of autoclaving, which significantly decreased its flexural strength and reliability. The results of SEM analysis revealed that 5YZ was composed of two distinct regions: a dominant matrix with large grains (median size: 0.8 μm) and scattered areas with small grains (median size: 0.4 μm). Phase transformation analysis and fractography data indicated that the small-grain region was strongly affected by LTD and likely represented a fracture origin. The described properties should be considered during the clinical application of monolithic 5YZ dental prostheses.

The flexural strength of CAD/CAM polymer crowns and the effect of artificial ageing on the fracture resistance of CAD/CAM polymer and ceramic single crowns

OBJECTIVES

The purpose of this study was to investigate the fracture resistance, flexural strength and Weibull modulus of an innovative CAD/CAM polymer and to compare its fracture resistance with that of glass ceramics.

MATERIALS AND METHODS

A total of 32 (n = 16 IPS e.max CAD (LIDI); n = 16 LuxaCam Composite (LUXA)) first mandibular molar crowns were fabricated and cemented onto metal dies by use of luting composite. Half of the specimens were loaded until fracture without prior artificial ageing. The other half were subjected to thermal (5°/55 °C) and mechanical (1,200,000 cycles, 80 N) cycling before fracture loading. Scanning electron microscopy was used to analyse fracture behaviour. A three-point bending test of the flexural strength of LUXA was performed according to ISO 6872:2008. Data were analysed by means of the Kolmogorov-Smirnov test, Mann-Whitney U-test (p < 0.05) and Weibull statistical analysis.

RESULTS

Initial fracture resistance of LIDI was significantly higher than that of LUXA. However, the initial fracture resistance of LIDI decreased significantly after artificial ageing. After ageing, fracture resistance was 1050.29 ± 325.08 N for LUXA and 1250.09 ± 32.53 N for LIDI. Three-point bending test yielded a mean flexural strength value for LUXA of 145.28 ± 18.21 MPa and a Weibull modulus of m = 9.51.

CONCLUSIONS

Polymer-based material tested in this study had a lower fracture resistance than that of the glass-ceramic material. Fracture resistance and flexural strength of LuxaCam Composite are sufficient for use in the first molar region.

CLINICAL RELEVANCE

The mechanical properties of this innovative polymer-based material indicate it can be used in the first molar region as a suitable alternative to glass ceramics. Further clinical studies are required to confirm this. The study presents an innovative material as an alternative to glassceramic for the clinical use in dentistry. The materials investigated were differently affected by artificial aging. Clinical use for patients with bruxism may be considered.

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.

Critical considerations on load-to-failure test for monolithic zirconia molar crowns

Application of monolithic zirconia crowns (MZCs) with reduced thickness to the molar region has been proposed, but potential complications have yet to be fully evaluated in laboratory tests. The present study aimed to develop a clinically relevant load-to-failure test in combination with fatigue treatments involving thermal and mechanical cycling (TC and MC) to evaluate the fracture resistance of molar MZCs. MZCs with a minimal thickness of 0.5 mm were bonded to dies made of resin-based composite (RBC), epoxy resin (EP), or polyoxymethylene-copolymer (POM-C). The samples were either untreated (UT) or subjected to TC (5-55 °C for 1 × 10⁵ cycles) and MC (300 N for 2.4 × 10⁶ cycles). The stress generated by TC and MC was simulated by finite element modeling. The load-to-failure test was performed using an inverse V-shaped two-plane indenter and was followed by fractographic analysis. The median values of fracture load for MZC/RBC and MZC/EP in the TC group were significantly lower than those in the UT group. MC also decreased the median value of fracture load for MZC/RBC significantly, but not that for MZC/EP and MZC/POM-C. Fractography revealed that the fracture started in the cervical area in all groups, which is similar to clinically failed crowns. The simulation confirmed stress concentration at the cervical area in both TC and MC groups. The present study suggests that the load-to-failure test using a two-plane indenter could induce clinically relevant fracture of MZCs, the vulnerability of the MZCs depends largely on the die material employed, and MZCs are more likely to be damaged by thermal fatigue than mechanical fatigue.

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.

Macro- and microtopographical examination and quantification of CAD-CAM composite resin 2- and 3-body wear

STATEMENT OF PROBLEM

The selection of an appropriate restorative material based on wear behavior is important for the long-term success of a dental restoration. For computer-aided design and computer-aided manufacturing (CAD-CAM) composite resins, information about their wear resistance and wear mechanism is scarce.

PURPOSE

The purpose of this in vitro study was to compare the 2- and 3-body wear of CAD-CAM composite resins with that of lithium disilicate ceramic and to develop analysis software.

MATERIAL AND METHODS

Flat specimens were prepared from the following CAD-CAM composite resins: Cerasmart (CS), SHOFU Block HC (SH), Katana Avencia (KA), Brilliant Crios (BC), an experimental composite resin (EXP), and lithium disilicate ceramic IPS e.max CAD (REF). The specimens underwent 2-body wear (50 N, 5/55°C, 400 000 cycles) opposed by human enamel antagonists. Specimen wheels were prepared with each material on each wheel for 3-body wear with a millet slurry (15 N, 15% slip, 200 000 cycles). All specimens were digitized by using a dedicated laser scanner. Analysis software was developed to calculate macrotopographical examination of volume loss. The microtopography of the surfaces was examined by using scanning electron microscopy. For data analysis, the Kruskal-Wallis test with the Tukey-Kramer post hoc test and the 1-sample Wilcoxon test were used (α=.05).

RESULTS

After 2-body wear simulation, SH and KA presented higher volume loss than the other CAD-CAM materials. For 3-body wear, REF had lower volume loss than CS, SH, or BC. In addition, BC led to higher volume loss than EXP. The patterns of 2- and 3-body wear were different.

CONCLUSIONS

The ceramic showed good global wear resistance. The volume loss of the CAD-CAM composite resins differed and depended on the material. The 2- and 3-body wear test methods tended to differ with regard to volume loss. Examination of the worn surfaces revealed different mechanisms acting in 2- and 3-body wear test.

Load-bearing capacity of various CAD/CAM monolithic molar crowns under recommended occlusal thickness and reduced occlusal thickness conditions

PURPOSE

The goal of this study was to evaluate the fracture resistances of various monolithic crowns fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) with different thickness.

MATERIALS AND METHODS

Test dies were fabricated as mandibular molar forms with occlusal reductions using CAD/CAM. With different occlusal thickness (1.0 or 1.5 mm), a polymer-infiltrated ceramic network (Enamic, EN), and zirconia-reinforced lithium silicate (Suprinity, SU and Celtra-Duo, CD) were used to fabricate molar crowns. Lithium disilicate (e.max CAD, EM) crowns (occlusal: 1.5 mm) were fabricated as control. Seventy crowns (n=10 per group) were bonded to abutments and stored in water for 24 hours. A universal testing machine was used to apply load to crown until fracture. The fractured specimens were examined with a scanning electron microscopy.

RESULTS

The type of ceramics and the occlusal thickness showed a significant interaction. With a recommended thickness (1.5 mm), the SU revealed the mean load similar to the EM, higher compared with those of the EN and CD. The fracture loads in a reduced thickness (1.0 mm) were similar among the SU, CD, and EN. The mean fracture load of the SU and CD enhanced significantly when the occlusal thickness increased, whereas that of the EN did not.

CONCLUSION

The fracture loads of monolithic crowns were differently influenced by the changes in occlusal thickness, depending on the type of ceramics. Within the limitations of this study, all the tested crowns withstood the physiological masticatory loads both at the recommended and reduced occlusal thickness.

Does 8-methacryloxyoctyl trimethoxy silane (8-MOTS) improve initial bond strength on lithium disilicate glass ceramic?

OBJECTIVES

Dental ceramic surfaces are modified with silane coupling agents, such as γ-methacryloxypropyl trimethoxy silane (γ-MPTS), to improve bond strength. For bonding between lithium disilicate glass ceramic and resin cement, the objective was to investigate if 8-methacryloxyoctyl trimethoxy silane (8-MOTS) could yield a similar performance as the widely used γ-MPTS.

METHODS

One hundred and ten lithium disilicate glass ceramic specimens were randomly divided into 11 groups (n=10) according to pretreatment regime. All specimens were pretreated with a different solution composed of one or a combination of these agents: 10 or 20wt% silane coupling agent of γ-MPTS or 8-MOTS, followed by a hydrolysis solution of acetic acid or 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP). Each pretreated surface was luted to a stainless steel rod of 3.6mm diameter and 2.0mm height with resin cement. Shear bond strength between ceramic and cement was measured after 24-h storage in 37°C distilled water.

RESULTS

8-MOTS produced the same bonding performance as γ-MPTS. Both silane coupling agents significantly increased the bond strength of resin cement, depending on their concentration. When activated by 10-MDP hydrolysis solution, 20wt% concentration produced the highest values (γ-MPTS: 24.9±5.1MPa; 8-MOTS: 24.6±7.4MPa). Hydrolysis with acetic acid produced lower bond strengths than with 10-MDP.

SIGNIFICANCE

Silane coupling pretreatment with 8-MOTS increased the initial bond strength between lithium disilicate glass ceramic and resin cement, rendering the same bonding effect as the conventional γ-MPTS.