Wear of enamel opposing low-fusing and conventional ceramic restorative materials

Novel methodology for measuring intraoral wear in enamel and dental restorative materials

Objectives

To test the hypotheses that (a) the chairside/handheld dental scanner combined with a metrology software will measure clinical wear in vivo in agreement with measurements from X‐ray computed microtomography and; (b) polished monolithic zirconia does not cause accelerated wear of opposing enamel.

Materials and methods

Thirty single crowns were randomized to receive a monolithic zirconia or metal‐ceramic crown. Two non‐restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned using an intraoral dental scanner. Patients were recalled at 6‐months and 1‐year for re‐scanning. Scanned images were compared using a metrology software to determine maximum vertical wear of teeth. The accuracy of the scanning measurements from this new method was compared with X‐ray computed microtomography (micro‐CT) measurements. Statistical analysis was performed using Mann–Whitney U test to determine significant differences between wear of enamel against zirconia, metal‐ceramic or enamel. Linear regression analysis determined agreement between measurements obtained using intraoral scanning and micro‐CT.

Results

Regression analysis demonstrated that there is a quantitative agreement between depth and volume measurements produced using intraoral scanning and the micro‐CT methodologies. There was no significant difference between the wear of enamel against polished monolithic zirconia crowns and enamel against enamel.

Conclusions

Intraoral scanning combined with a matching software can accurately quantify clinical wear to verify that monolithic zirconia exhibited comparable wear of enamel compared with metal‐ceramic crowns and control enamel. Agreement between the intraoral scanner and the micro‐CT was 99.8%. Clinical Trials.gov NCT02289781.

Hardness and Wear Resistance of Dental Biomedical Nanomaterials in a Humid Environment with Non-Stationary Temperatures

This study discusses a quantitative fatigue evaluation of polymer-ceramic composites for dental restorations, i.e., commercial material (Filtek Z550) and experimental materials Ex-nano (G), Ex-flow (G). Their evaluation is based on the following descriptors: microhardness, scratch resistance, and sliding wear. In order to reflect factors of environmental degradation conditions, thermal fatigue was simulated with a special computer-controlled device performing algorithms of thermocycling. Specimens intended for the surface strength and wear tests underwent 10⁴ hydrothermal fatigue cycles. Thermocycling was preceded by aging, which meant immersing the specimens in artificial saliva at 37 °C for 30 days. Microhardness tests were performed with the Vickers hardness test method. The scratch test was done with a Rockwell diamond cone indenter. Sliding ball-on-disc friction tests were performed against an alumina ball in the presence of artificial saliva. A direct positive correlation was found between thermocycling fatigue and microhardness. The dominant mechanism of the wear of the experimental composites after thermocycling is the removal of fragments of the materials in the form of flakes from the friction surface (spalling). Hydrothermal fatigue is synergistic with mechanical fatigue.

Two-body wear behavior of human enamel versus monolithic zirconia, lithium disilicate, ceramometal and composite resin

PURPOSE

To investigate and compare the surface roughness (SR), weight and height of monolithic zirconia (MZ), ceramometal (CM), lithium disilicate glass ceramic (LD), composite resin (CR), and their antagonistic human teeth enamel.

MATERIALS AND METHODS

32 disc shaped specimens for the four test materials (n=8) and 32 premolars were prepared and randomly divided. SR, weight and height of the materials and the antagonist enamel were recorded before and after subjecting the specimens to 240,000 wear-cycles (49 N/0.8 Hz/5℃/50℃). SR, height, weight, and digital microscopic qualitative evaluation were measured.

RESULTS

CM (0.23 + 0.08 µm) and LD (0.68 + 0.16 µm) exhibited the least and highest mean difference in the SR, respectively. ANOVA revealed significance (P=.001) between the materials for the SR. Paired T-Test showed significance (P<.05) for the pre- and post-SR for all the materials. For the antagonistic enamel, no significance (P=.987) was found between the groups. However, the pre- and post-SR values of all the enamel groups were significant (P<.05). Wear cycles had significant effect on enamel weight loss against all the materials (P<.05). CR and MZ showed the lowest and highest height loss of 0.14 mm and 0.46 mm, respectively.

CONCLUSION

MZ and CM are more resistant to SR against the enamel than LD and CR. Enamel worn against test materials showed similar SR. Significant variations in SR values for the tested materials (MZ, LD, CM, and CR) against the enamel were found. Wear simulation significantly affected the enamel weight loss against all the materials, and enamel antagonist against MZ and CM showed more height loss.

Antagonist Enamel Wears More Than Ceramic Inlays

Wear phenomena of ceramic inlays are not fully understood. The aim of the present study was to evaluate ceramic wear, antagonist enamel wear, and luting cement wear over 8 years. The two-fold null hypothesis was that there would be (1) no difference in wear behavior between ceramic and enamel, and (2) no influence of filler content of luting composites on composite wear. From 96 restorations, 36 Class II inlays from 16 participants were selected. For inlays with opposing enamel cusps (n = 17), replicas of inlays and enamel were scanned with a 3-D laser scanner. Luting gaps of inlays (n = 36) were analyzed with a profilometer, including 3-D data analysis. Ceramic and enamel wear increased between 4 and 8 years, with significantly higher values for enamel after 6 years (p < 0.05). Luting gap wear increased continuously up to 8 years (p < 0.05), with no influence of luting composites (p > 0.05) and location of teeth (p > 0.05).

Tooth wear against ceramic crowns in posterior region: a systematic literature review

The objective of this systematic review was to assess tooth wear against ceramic crowns in posterior region in vitro and in vivo. An electronic PubMed search was conducted to identify studies on tooth wear against ceramic crowns in posterior region. The selected studies were analyzed in regard to type of crowns, natural antagonist, measuring protocol and outcome. From a yield of 1 000 titles, 43 articles were selected for full-text analysis; finally, no in vitro and only five in vivo studies met the inclusion criteria. As there is heterogeneity in design, used measuring method, ceramics and analysis-form, a meta-analysis was not possible. Results of these studies are very controversial which makes a scientifically valid comparison impossible. This review indicated that some all-ceramic crowns are as wear friendly as metal-ceramic crowns. Up to now, it has been impossible to associate tooth wear with any specific causal agent. The role of ceramic surface treatment that might be responsible for the changing in rate of tooth wear seems undetermined as yet through clinical trials. The literature reveals that studies on this topic are subject to a substantial amount of bias. Therefore, additional clinical studies, properly designed to diminish bias, are warranted.

Influence of surface treatment on the wear of solid zirconia

OBJECTIVE

Recently there has been talk of the use of full-contour solid zirconia crowns or bridge restorations with no porcelain overlay. This could be a useful solution for patients with bruxism or limited interocclusal space. However, the hardness of zirconia could affect the opposite natural dentition. The aim of this in-vitro study was to investigate the role of surface treatments on the wear of a zirconia material and its antagonist.

MATERIALS AND METHODS

Fifty plates (10 × 10 × 1 mm) made of zirconia (LavaMulti(™) ZrO2, 3M ESPE), divided into five equal groups, were sandblasted and ground under standardized conditions with a fine-grit diamond bur (Komet Brasseler, Germany) to simulate clinical conditions. Group (a) was only fired, (b) was fired and sandblasted, (c) only ground, (d) was ground and additionally polished (EVE Ceramic Polishing-Set, Pforzheim) and (e) was ground and glazed. Wear behavior was measured with a pin-on-disk apparatus ABREX against 6 mm steatite balls as antagonists (45°, 5 N load, 5000 cycles, water). The amount of wear was determined topographically using a 3-D profilometer (Concept 3D, Mahr, Germany) by measuring the height loss of the antagonist and the depth of wear Pt of the zirconia.

RESULTS

In groups (a), (b), (c) and (d) the wear value Pt could not be determined (<1 μm). Wear values of the antagonists (steatite balls) revealed a similar outcome in contact with (b), (c) and (e) in the range of 81-85 μm, whereas (e) was more abrasive but not significantly. A noticeable difference in the wear of the antagonist showed group (d) to have the smallest value.

CONCLUSION

Polished zirconia seems to have the lowest wear on the antagonists, in contrast with the other kinds of surface treatment.

A comparative evaluation of wear of enamel caused by ceramics with different fusion temperatures

Dental ceramics are the most used esthetic fixed Prosthodontic restorative material today. However, dentists remain suspicious about their potential abrasivity. Lower-fusing ceramic materials developed, are claimed to be wear friendly. This study was conducted to compare the wear of enamel of extracted teeth against one conventionally used ceramic VMK-95 (fusing temperature 930 °C) and two new lower-fusing ceramics-Omega 900 and Finesse with fusing temperatures 900 and 760 °C respectively, used for metal-ceramic restorations. Metal disks were prepared from ceramic alloy and divided into three groups of 10 disks each on which VMK-95, Omega 900 and Finesse ceramics were applied respectively. Ceramic disks and tooth specimen were mounted on custom-made wear simulator and subjected to predefined masticatory test. Each tooth specimen was profiled by laser triangulation sensor before and after masticatory test. Difference in height was calculated. The results showed that mean loss of height of tooth was least against Finesse (0.3431 + 0.0177 mm) followed by Omega 900 (0.4076 + 0.0135 mm) and VMK-95 (0.6177 + 0.014 mm). Statistical analysis revealed statistically significant difference between VMK-95 & Omega 900 and VMK-95 & Finesse. The difference in loss of height of tooth against Finesse & Omega 900 is statistically insignificant (P < 0.001). The results of this study indicate that lower-fusing dental ceramics cause less wear of opposing enamel.

Three years in vivo wear: core-ceramic, veneers, and enamel antagonists

OBJECTIVES

Test the hypotheses that there are equivalent wear rates for enamel-versus-enamel and ceramic-versus-enamel, analyzing the in vivo wear of crown ceramics, their natural enamel antagonists, and the corresponding two contralateral teeth; and, that bite force does not correlate with the wear.

METHODS

A controlled, clinical trial was conducted involving patients needing full coverage crowns opposing enamel antagonists. Bite forces were measured using a bilateral gnathodynamometer. Single-unit restorations of metal/ceramic (Argedent 62, Argen Corp/IPS d.SIGN veneer); or, core-ceramic/veneer from either, Empress2/Eris, or e.max Press core/e.max Ceram glaze (ceramics: Ivoclar Vivadent, USA) were randomly assigned, fabricated and cemented. Impressions were made of the ceramic crowns, as well as each maxillary and mandibular quadrant at one week (baseline) and one, two and three years. Resulting models were scanned (3D laser scanner). Maximum wear was calculated by superimposing baseline with annual images.

RESULTS

There were a total of thirty-six crowns required for thirty-one patients. Each restoration had three associated enamel teeth: crown, (1) antagonist, (2) contralateral and (3) contralateral-antagonist. SAS PROC MIXED (α=0.05) indicated no statistical significance for mean maximum wear among crown ceramics, enamel antagonists and contralaterals. However, enamel wear was statistically significant in relation to intraoral location (p=0.04) and among years (p<0.02). Analyzed alone, the enamel contralateral-antagonist exhibited significantly greater wear (p<0.001). Considering all wear sites, there was no correlation with bite force (p=0.15).

SIGNIFICANCE

The ceramics and their antagonists exhibited in vivo wear rates within the range of normal enamel. Future studies should examine the wear implications of the contralateral-antagonist enamel.

Effects of different polishing techniques on the surface roughness of dental porcelains

Objective

The purpose of this study was to evaluate the effects of different polishing techniques on the surface roughness of dental porcelains.

Material and Methods

Fifty-five cylindirical specimens (15x2 mm) were prepared for each feldspathic (Vita VMK 95, Ceramco III) and low-fusing dental porcelain (Matchmaker). Fifty-five specimens of machinable feldspathic porcelain blocks (Vitablocs Mark II), (12x14x18 mm) were cut into 2-mm-thick slices (12x14 mm) with low speed saw. The prepared specimens were divided into 11 groups (n=5) representing different polishing techniques including control ((C) no surface treatment), glaze (G) and other 9 groups that were finished and polished with polishing discs (Sof-Lex) (Sl), two porcelain polishing kits (NTI (Pk), Dialite II (Di)), a diamond polishing paste (Sparkle) (Sp), a zirconium silicate based cleaning and polishing prophy paste (Zircate) (Zr), an aluminum oxide polishing paste (Prisma Gloss) (Pg), and combinations of them. The surface roughness of all groups was measured with a profilometer. The data were analyzed with a 2-way analysis of variance, and the mean values were compared by the Tukey Honestly Significant Difference test (α=0.05).

Results

For all porcelain material groups, the lowest Ra values were observed in Group Gl, Group Sl, Group Pk, and Group Di, which were not significantly different from each other (p>0.05).When comparing the 4 different porcelain materials, the machinable feldspathic porcelain block group (Mark II) demonstrated statistically significantly less Ra values than the other porcelain materials tested (p<0.05). No significant difference was observed between the VMK 95 and Ceramco III porcelain groups (p=0.919), also these groups demonstrated the highest Ra values.

Conclusion

Subjected to surface roughness, the surfaces obtained with polishing and/or cleaning-prophy paste materials used alone were rougher compared to the surfaces finished using Sof-lex, Dialite, and NTI polishing kit. Polishing kits and discs were found more effective than the polishing pastes used alone or combined use with Sof-lex discs, thus improving surface smoothness.

Ceramics as biomaterials for dental restoration

Sintered ceramics and glass-ceramics are widely used as biomaterials for dental restoration, especially as dental inlays, onlays, veneers, crowns or bridges. Biomaterials were developed either to veneer metal frameworks or to produce metal-free dental restorations. Different types of glass-ceramics and ceramics are available and necessary today to fulfill customers' needs (patients, dentists and dental technicians) regarding the properties of the biomaterials and the processing of the products. All of these different types of biomaterials already cover the entire range of indications of dental restorations. Today, patients are increasingly interested in metal-free restoration. Glass-ceramics are particularly suitable for fabricating inlays, crowns and small bridges, as these materials achieve very strong, esthetic results. High-strength ceramics are preferred in situations where the material is exposed to high masticatory forces.

Wear of ceramic and antagonist—A systematic evaluation of influencing factors in vitro

OBJECTIVE

(1) To systematically review the existing literature on in vitro assessments of antagonist wear of ceramic materials; (2) To systematically evaluate possible influencing factors on material and antagonist wear of ceramic specimens.

METHODS

The database MEDLINE was searched with the terms "enamel," "wear" and "antagonist." The selected studies were analyzed with regard to wear parameters, type of antagonist and outcome. In the laboratory study, three ceramic materials were selected with different compositions and physical properties: IPS d.SIGN low-fusing metal ceramic, IPS Empress leucite ceramic, e.max Press lithium disilicate ceramic. These materials were subjected to the Ivoclar wear method (Willytec chewing simulator, 120,000cycles, 5kg weight) by systematically modifying the following variables which resulted in 36 tests with 8 specimens in each group: (1) configuration (flat, crown specimen), (2) surface treatment (polish, glaze), (3) type of antagonist (ceramic, two types of enamel stylus). Furthermore, the enamel styluses were cut to measure the enamel thickness and cusp width. Wear of both the material and the antagonist was quantified by scanning plaster replicas of the specimens with a laser scanner (etkon es1) and matching baseline and follow-up data with the Match 3D software (Willytec). The data were log-transformed to stabilize the variance and achieve near normality. To test the influence of specific test parameters, a four-way ANOVA with post hoc tests and Bonferroni correction was applied.

RESULTS

The systematic review revealed 20 in vitro studies in which a material and the antagonist wear of the same material was examined. However, the results were inconsistent mainly due to the fact that the test parameters differed widely. Most studies used prepared enamel from extracted molars as the antagonist and flat polished ceramic specimens. The test chamber was filled with water and some sort of sliding movement was integrated in the wear generating process. However, there was a huge variation in relation to the applied force, the used force actuator, the number of cycles, and the frequency of cycles per time as well as the number of specimens. The results of the systematic laboratory tests revealed that the following factors strongly influence the wear: configuration (more material wear of flat versus crown specimens), surface treatment (more antagonist wear of glazed versus polished specimens), the antagonist system (more material wear and less antagonist wear for ceramic stylus versus enamel stylus), and enamel thickness (less wear for thicker enamel). Material wear was not very much different between the materials. However, e.max Press generally caused more antagonist wear than the other two materials, which were quite similar. However, the main influencing factors did not yield consistent results for all the subgroups and there was a huge variability of results within the subgroups especially in those groups that used enamel as antagonist.

SIGNIFICANCE

As far as consistency and correlation with clinical studies is concerned, the set-up that consists of unprepared enamel of molar cusps against glazed crowns seems to be the most appropriate method to evaluate a ceramic material with regard to antagonist wear. However, due to the high variability of results large sample sizes are necessary to differentiate between materials, which calls the whole in vitro approach into question.

The Influence of Fluoride Varnish on the Attrition of Dentine

Previous investigations have shown the potential for fluoride to be protective in an abrasion/erosion laboratory model. The aim of this study was to investigate the effect of high concentrations of fluoride delivered in a varnish on attrition of dentine. Fifteen caries-free, intact lower third molar teeth were sectioned and the enamel removed by a water-cooled diamond disc. Polished dentine surfaces were divided into 8 areas, 4 of which were randomly covered with a high-concentration fluoride varnish for 24 h. The samples were subjected to 5,000 cycles of attrition bathed under artificial saliva. Microhardness testing adjacent to the wear scars showed no statistical difference between the fluoride-treated (71.42 KHN, SD 10.52) and control surfaces (72.66 KHN, SD 9.69). The volume of the wear scar was statistically greater for the fluoride-treated surface at 9.6 microm(3) (SD 4.92) and 8.13 microm(3) (SD 5.54) for the control areas (p = 0.029). The low pH of the fluoride varnish appears to have increased the amount of wear from attrition in this laboratory study.

Mutual wear evaluation of resin composites when opposing enamel and dentin

Mutual wear rates of resin composites and both superficial and deep layers of enamel and dentin were investigated by means of an in vitro wear test. Occlusal surfaces of extracted molars were ground flat to respective layers of enamel and dentin. Hemispherical-shaped styli (n = 8) made of microfilled and microhybrid composites were placed perpendicular to the finished tooth surface (600 grit) in the presence of tap water, and a two-body wear test (75 N load and 1.2 Hz) was performed for 100,000 cycles. The wear depths on both tooth and composite specimens were determined, and the data were statistically analyzed by two-way ANOVA and Boneferroni test (p < 0.05). The values of deep and superficial dentin specimens against Esthet-X (530.2 +/- 213.0 microm and 717.4 +/- 309.6 microm) were significantly greater than those against Epic-TMPT (34.1 +/- 17.6 microm and 29.3 +/- 10.8 microm). The values of Esthet-X against dentin were the smallest (2.4-2.6 microm), followed by those of the same material against enamel (5.5-6.1 microm), and those of Epic-TMPT against enamel (7.2-7.9 microm). It was concluded that the wear rates of dentin varied with the type of composite used while those of enamel showed the consistency.

Effect of finish line variants on marginal accuracy and fracture strength of ceramic optimized polymer/fiber-reinforced composite crowns

STATEMENT OF PROBLEM

Ceramic optimized polymer (Ceromer)/fiber-reinforced composite (FRC) crowns have been promoted as alternatives to conventional crowns. However, little is known regarding the ideal tooth preparation for this type of crown.

PURPOSE

This in vitro study evaluated the marginal adaptation and fracture strength of ceromer/FRC crowns with respect to the various types of finish lines.

MATERIAL AND METHODS

Four metal dies with different finish lines (0.9-mm chamfer, 1.2-mm chamfer, 1.2-mm rounded shoulder, and 1.2-mm shoulder) were prepared. Forty (10 for each finish line) Targis/Vectris crowns were fabricated on duplicated base metal alloy dies. The restorations were stereoscopically evaluated at 56 points along the entire circumferential margin for measuring the margin adaptation before and after cementation with a resin luting agent. The specimens were then compressively loaded to failure using a universal testing machine. The marginal adaptation (microm) was analyzed with the Kruskal-Wallis test and post-hoc Dunnett test (alpha=.05). The fracture load (N) was analyzed with a 1-way analysis of the variance and the Scheffe adjustment (alpha=.05). The fractured surfaces of the crowns were examined with a scanning electron microscope to determine the mode of fracture.

RESULTS

The marginal adaptation of crowns with a shoulder finish line was significantly better than crowns with a chamfer finish line before and after cementation (P<.001). The increased marginal gap after cementation was the lowest in the 1.2-mm rounded shoulder group. The fracture strength of the crowns with the 0.9-mm chamfer and crowns with 1.2-mm chamfer was significantly greater than those of the crowns with the 1.2-mm shoulder or rounded shoulder (P=.011, P=.049, respectively). The mean fracture load of all crowns, regardless of the finish line design, was 1646 N. The fractured surface of the crown revealed adhesive failure and 3 types of cohesive failure (fracture of the Targis and Vectris, Targis fracture with a crack in the Vectris layer, and crushing without fracture).

CONCLUSION

The marginal gaps were greater for the chamfer finish line specimens than in the shoulder finish line specimens. However, the fracture strength of the chamfer finish line specimens was greater than that of the shoulder finish line specimens.

Relative wear of enamel opposing low-fusing dental porcelain

PURPOSE

This study evaluated the wear of human enamel opposing 5 low-fusing dental porcelains and a traditional feldspathic control. In a second experiment, the repeatability of the test method and the effect of ceramic overfiring on enamel wear were also evaluated.

MATERIALS AND METHODS

Five low-fusing dental porcelains--Finesse (FI), Rhapsody (RP), IPS d.Sign (DS), Omega 900 (OM), and Duceram LFC (LFC)--and 1 traditional feldspathic porcelain--VMK 68 (VMK)--were formed into disks (n = 10) and used as substrate for the wear test. Enamel was harvested from extracted human molars and machined into cusps with a 5-mm spherical radius (n = 60). The Oregon Health Sciences University oral wear simulator was used to simulate chewing and the size of the resulting enamel wear facets (in mm(2)) were evaluated after a specified number of chewing cycles. A portion of the experiment was duplicated to assess the repeatability of the data and determine the effects of overfiring on enamel wear. Data were subjected to analysis of variance and post hoc tests to determine significant differences. After wear testing, scanning electron micrographs were made using representative ceramic samples from each group.

RESULTS

The results indicate that none of the low-fusing ceramics resulted in significantly less wear than the VMK control. In fact, 3 of the low-fusing porcelains (OM, RP, LFC) resulted in significantly greater enamel wear than VMK. Enamel wear was not significantly affected (p = 0.29) by the increased ceramic firing temperature. Wear data were repeatable, with no significant difference (p = 0.56) between the enamel wear from 2 separate experiments. The results from both experiments indicated that ceramic material significantly affected enamel wear (p <0.001). There was significantly less enamel wear opposite DS than LFC.

CONCLUSIONS

This work suggests that variations in ceramic composition and microstructure may affect the opposing enamel wear, but that low-fusing temperatures do not necessarily guarantee low enamel wear. Although the clinical relevance of this testing apparatus may be questioned, the testing method was repeatable.

Factors affecting enamel and ceramic wear: a literature review

Enamel wear by ceramics may adversely affect maintenance of the vertical dimension of occlusion and can increase the potential for thermal sensitivity. In this article, factors related to the abrasion of enamel by dental ceramics are critically reviewed. Concepts of physical, microstructural, chemical, and surface characteristics of dental ceramics on wear are presented based on research published since 1950. A PubMed search for key words (wear of enamel and ceramic) was supplemented with a hand search to identify relevant peer-reviewed articles published in English. Based on the literature, it can be concluded that material factors, their proper handling, and control of the patient's intrinsic risk factors related to wear are critically important to the reduction of enamel wear by dental ceramics.