Ceramic restorations for posterior teeth: guidelines for the clinician

Fracture resistance of endodontically treated teeth restored with indirect composite inlay and onlay restorations - An in vitro study

Objective

The purpose of this in vitro study was to evaluate and compare the fracture resistance and fracture mode of extensive indirect inlay and onlay composite resin restorations performed for endodontically treated premolars.

Materials and methods

A total of 55 extracted maxillary premolars were randomly divided into four groups. The first group (n = 15) remained untreated to serve as a positive control; the second group (n = 15) was endodontically treated with inlay cavities prepared and restored with indirect composite inlay restorations; the third group (n = 15) was also endodontically treated with onlay cavities prepared and restored with indirect composite onlay restorations; and the fourth group (n = 10) was endodontically treated with mesio-occlusodistal (MOD) cavities prepared and left unrestored to serve as negative controls. Dual cure indirect composite resin was used to fabricate the inlay and onlay restorations performed for the second and third groups, respectively. All teeth were subjected to compressive axial loading test using a metal ball (6 mm in diameter) in a universal testing machine (Instron 1195) with a cross-head speed of 0.5 mm/min until a fracture occurred. Statistical analysis of fracture resistance and fracture mode were performed with analysis of variance (ANOVA) (α = 0.05) and Kruskal–Wallis (α = 0.05) tests, respectively.

Results

For the four treatment groups, the mean fracture resistance values were 1326.9 N, 1500.1 N, 1006.1 N, and 702.7 N, respectively. Statistical analyses showed no significant differences between the mean fracture resistance of the intact tooth group and the inlay restoration group (p > 0.05), while significant differences were observed between the mean fracture resistance of all the other groups (p < 0.05). The Kruskal–Wallis test showed statistically significant differences between the fracture modes of the four groups.

Conclusion

Within the limitations of this study, endodontically treated teeth were successfully restored with indirect composite inlay and onlay restorations. However, the fractures that accompanied the inlay restorations were more severe and were unable to be restored.

Light-activation through indirect ceramic restorations: does the overexposure compensate for the attenuation in light intensity during resin cement polymerization?

Objectives

This study evaluated the effects of light exposure through simulated indirect ceramic restorations (SICR) on hardness (KHN) of dual-cured resin cements (RCs), immediately after light-activation and 24 h later.

Material and Methods

Three dual-cured RCs were evaluated: eco-Link (Ivoclar Vivadent), Rely X ARC (3M eSPe), and Panavia F (Kuraray Medical Inc.). The RCs were manipulated in accordance to the manufacturers’ instructions and were placed into cylindrical acrylic matrixes (1-mm-thick and 4-mm diameter). The RC light-activation (Optilux 501; Demetron Kerr) was performed through a glass slide for 120 s (control group), or through 2-mm or 4-mm thick SICRs (IPS empress II; Ivoclar Vivadent). The specimens were submitted to KHN analysis immediately and 24 h after light-activation. The data obtained at the 2 evaluation intervals were submitted to 2-way ANOVA repeated measures and post-hoc Tukey’s test (pre-set alpha of 5%).

Results

Lower KHN was observed when light-activation was performed through SICRs for eco-Link at all evaluation intervals and for Rely X ARC 24 h later. For Panavia F, no significant difference in KHN was observed between control and experimental groups, regardless of evaluation interval. Most groups exhibited higher KHN after 24 h than immediately after light-activation, with the exception of Rely X ARC light-activated through SICR, as no significant difference in KHN was found between evaluation intervals.

Conclusion

Light overexposure did not compensate for light intensity attenuation due to the presence of SICR when Rely X and eco-Link were used. Although hardness of such RCs increased over a 24-h interval, the RCs subjected to light overexposure did not reach the hardness values exhibited after direct light exposure.

Two-year Clinical Evaluation of IPS Empress II Ceramic Onlays/Inlays

The two-year success rate of restorations reported in the current study demonstrates that IPS Empress II ceramics are clinically acceptable for onlay/inlay restorations on molars.

Fracture resistance of thermal cycled and endodontically treated premolars with adhesive restorations

STATEMENT OF PROBLEM

Cavity preparations have routinely been associated with decreased fracture strength of restored teeth.

PURPOSE

The purpose of this study was to evaluate the influence of endodontic treatment and thermal cycling on the fracture resistance of teeth restored with ceramic or composite resin inlay restorations.

MATERIAL AND METHODS

One hundred sound, maxillary premolars were selected. Twenty intact teeth served as a control group. Eighty teeth were prepared with MOD cavity preparations; half of them were also endodontically treated. Inlay restorations were prepared with composite resin (Filtek Z250) or feldspathic ceramic (Vitadur Alpha). Half of the specimens for each group were submitted to thermal cycling (500 cycles, between 5 and 55 degrees C, dwell time of 30 seconds). The specimens were subjected to compressive axial loading using a steel ball. Data were analyzed using 3-way ANOVA and post hoc Tukey's test (alpha=.05).

RESULTS

Except for those teeth restored with ceramic without endodontic treatment and thermal cycling, no other group achieved fracture strength similar to sound teeth. Ceramic and composite resin restorations provided similar resistance to fracture. There was a significant interaction between endodontic therapy and thermal cycling (P<.001). In the nonthermal cycled groups, endodontically treated teeth showed significantly lower fracture resistance (P<.001). All experimental groups had similar fracture strength when submitted to thermal cycling.

CONCLUSIONS

Both restorative techniques provided similar fracture resistance. Endodontic treatment decreased the fracture resistance of nonthermal cycled specimens, while thermal cycling decreased the fracture resistance of nonendodontically treated specimens.

An overview of treatment considerations for esthetic restorations: a review of the literature

Controversy persists regarding the treatment planning criteria for esthetic restorations. This article reviews the literature regarding the biocompatibility, marginal adaptation, color matching, patient selection, technique sensitivity, and mode and rate of failure of tooth-colored restorations. A Medline search was completed for the period from 1986 to 2006, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks. The key words used were amalgam, posterior composite resin, ceramic inlays/onlays, CEREC, porcelain laminate veneers, all-ceramic crowns, and all-ceramic fixed partial dentures.

Fracture Resistance of Premolars Restored with Partial Ceramic Restorations and Submitted to Two Different Loading Stresses

The fracture resistance of ceramic restorations is associated with the quantity of the dental structure removed. In relation to the fracture resistance, preference should be given to inlay restorations rather than to onlays; however, no restorative technique was able to attain the fracture resistance of intact teeth.

Shear Bond Strengths of Different Substrates Bonded to Lithium Disilicate Ceramics

The aim of this study was to evaluate the shear bond strengths of pre- and untreated resin core materials to lithium disilicate ceramics. Bond strengths to dental hard tissues served as controls. Ceramic cubes (IPS-Empress II) were luted either with a one-step (Variolink II/Excite DSC) or multiple-step total etching bonding system (Tetric Flow/Syntac Classic) to ground surfaces of human enamel, dentin, and resin core materials (Clearfil Core, Multicore). Resin core materials were additionally pretreated with hydrofluoric acid (HF) or were silica-coated (CoJet System). Shear bond strengths were determined after 24-hour water storage (n=10) and thermocycling (TC) (n=10; 2000 cycles, 5-55 degrees C, 30 seconds). Bond strengths to enamel, dentin, and silica-coated composites were significantly higher compared to untreated and HF-pretreated composites (p<0.05; Tukey B). Indeed, silica coating of the composite resins significantly increased the bond strength to ceramics (p<0.05; Tukey B). Due to the lower bond strength values of ceramics to untreated composite resins (as compared to enamel and dentin), any indication for a resin core build-up prior to the preparation of a ceramic restoration should be considered carefully.

Influence of margin design on the fit of high-precious alloy restorations in patients

OBJECTIVE

It was the objective of this study, to analyze the influence of the marginal design on the marginal accuracy of a casting in a clinical setup in patients.

METHODS

Ninety volunteer patients' teeth-which were intended for extraction due to medical reasons-were prepared prior to extraction. Three different types of finishing line-chamfer, 135 degrees shoulder and 90 degrees shoulder-were employed. Two each c-silicone and pvs impressions were taken of each tooth using either a two-stage or a one-stage putty-wash technique. After preparation and impression taking the teeth were extracted. Gypsum casts were poured from the impressions and high precious alloy castings fabricated on the dies and marginal discrepancies were determined on the extracted teeth.

RESULTS

The median value of marginal discrepancies was lower than 150 microm for all groups. The difference between the three different preparation types was significant (H-test, p<0.05). The lowest median values were obtained for the chamfer preparations, while the 90 degrees shoulders always produced the highest median values. Preparations at gingva level exhibited more accurate marginal fit than subgingival preparations. No significant differences could be observed between the pvs and c-silicone materials or the one-step and two-step putty-wash techniques.

CONCLUSIONS

The marginal designs of the preparations had much less influence on the marginal fit of high precious alloy castings than expected. There is considerable reason to assume that technical but clinical parameters influence the quality of fixed prosthodontics much more than has been believed in the past.

Ceramic Inlays and Onlays: Clinical Procedures for Predictable Results

The use of ceramics as restorative materials has increased substantially in the past two decades. This trend can be attributed to the greater interest of patients and dentists in this esthetic and long-lasting material, and to the ability to effectively bond metal-free ceramic restorations to tooth structure using acid-etch techniques and adhesive cements. The purpose of this article is to review the pertinent literature on ceramic systems, direct internal buildup materials, and adhesive cements. Current clinical procedures for the planning, preparation, impression, and bonding of ceramic inlays and onlays are also briefly reviewed. A representative clinical case is presented, illustrating the technique.

CLINICAL SIGNIFICANCE

When posterior teeth are weakened owing to the need for wide cavity preparations, the success of direct resin-based composites is compromised. In these clinical situations, ceramic inlays/onlays can be used to achieve esthetic, durable, and biologically compatible posterior restorations.

A new adhesive technology for all-ceramics

OBJECTIVES

Evaluation of a new surface treatment method to obtain a good bond strength between a luting composite and several ceramics.

METHODS

Specimen preparation and test procedure were done according to ISO 10477 Amendment 1. The surfaces of Empress II, InCeram-Alumina, InCeram-Zirconia and Frialit (ZrO2) were ground under water-cooling with 400 grit grinding paper, afterwards polished with 800 grit and air-dried. Each ceramic material investigated was divided into three groups of 10 specimens each. Group 1 was flame-treated with the PyrosilPen for 2.5 s, group 2 for 5 s and group 3 for 10 s/cm(2). After the flame treatment, a methacryl silane was applied followed by a luting composite. Prior to measuring shear bond strength, the specimens were thermocycled 5,000 times in a water-bath between +5 and +55 degrees C. Furthermore, SEM- and Fourier-transform infrared spectrophotometer (FT-IR)-investigations were done. As a control, Empress II etched and silaned was used.

RESULTS

Shear bond strength measurements indicated that the optimal treatment time was 5 s/cm(2). Regarding this time the following bond strength values between the luting composite and the various ceramics were obtained: Empress II 23 (5)MPa, InCeram-Alumina 23 (5)MPa, InCeram-Zirconia 13 (8)MPa, and Frialit 16 (6)MPa. The control achieved 27 (6)MPa. On all surfaces of the flamed specimens Si could be detected by FT-IR.Significance. The PyrosilPen-Technology is an easy and effective method for surface-treating silicate, aluminum oxide and zirconium oxide ceramics to obtain good bonding to luting composites.