Durability and Weibull Characteristics of Lithium Disilicate Crowns Bonded on Abutments with Knife-Edge and Large Chamfer Finish Lines after Cyclic Loading

[Compressive stress in three types of finishing lines with lithium disilicate crowns in permanent teeth: finite element analysis]

Introduction

In oral rehabilitation, the use of ceramic restorations is widely accepted due to its aesthetic capacity to mimic the naturalness of the dental tissue, provide longevity of the material, and present a greater marginal fit compared to crowns with a metal structure. Termination lines are biological preparations whose function is to minimize the cervical opening of the marginal seal. Consequently, analyzing the behavior of restorative materials under compressive forces decreases the risk of fracture and increases the success of the treatment.

Objective

To compare the compressive stresses of lithium disilicate crowns with three different finishing lines.

Methodology

In silico study of the simulation of a dental preparation on a lower right first molar with chamfer (0.6 mm), shoulder (0.5 mm) and deep chamfer (0.5 mm) finish lines. Using the SolidWorks®️ version 2017 software, the maximum stresses, minimum stresses, and location of the compressive force were collected on the Megapascal (Mpa) measurement scale.

Results

The chamfer type termination line (0.6mm) obtained a lower compressive stress compared to the other two shoulder type termination lines (0.5mm) and deep chamfer (0.5mm).

Conclusions

It was shown that the chamfer type finishing line (0.6mm) presented a better force distribution, determining greater reliability in the selection of this finishing line with the use of a lithium disilicate crown in a unitary manner.

A diagnostically and digitally driven tooth preparation protocol by using a patient monitoring tool with an intraoral scanner

Finding the right balance between the preservation of tooth structure and providing adequate space for the restorative material is a major challenge in prosthetic dentistry. A technique is presented using the patient monitoring tool available in standard software programs of an intraoral scanner to constantly monitor preparation dimensions in relation to the optimal definitive restoration.

Additive manufacturing of lithium disilicate glass-ceramic by vat polymerization for dental appliances

OBJECTIVES

The objectives of this study were to evaluate the mechanical properties of lithium disilicate components produced by additive manufacturing (AM) and to assess the effect of build orientation on the resistance to fracture.

METHODS

Oversized bars were printed with a glass-filled photoactive resin using a digital light processing technique. After sintering and post-processing, flexure and chevron notch fracture toughness bars were obtained in three principal orientations (0°, 45°, and 90°) with respect to the build direction. Mechanical properties were obtained according to the relevant ASTM standards. The hardness, indentation fracture resistance, and elastic modulus were measured for each orientation, and a Weibull analysis was conducted with the flexure responses. Fractography of the fracture surfaces was performed to identify the failure origins.

RESULTS

The 0° orientation exhibited characteristic strength, Weibull modulus, and elastic modulus of 313 MPa, 4.42, and 168 ± 3 GPa, respectively, which are comparable to lithium disilicate materials from traditional processes. However, build orientation contributed significantly to the flexure strength, elastic modulus, and Weibull modulus; the characteristic strengths for the 45° and 90° build orientations were 86 MPa and 177 MPa, respectively. The primary contribution to the orientation dependence was the number of residual build layer-related flaws from incomplete union between printed layers. Of note, hardness and the fracture toughness were not dependent on build orientation.

SIGNIFICANCE

AM of lithium disilicate materials can achieve the mechanical properties of materials produced by traditionally processing. Thus, while further process development is warranted, the outlook for dentistry is promising.

Flexural strengths, failure load, and hardness of glass-ceramics for dental applications

STATEMENT OF PROBLEM

Glass-ceramics are often selected for use in dental restorations based upon advertised flexural strengths obtained from standardized tests on prefabricated specimens (bars and disks); these may not accurately reflect their performance in dental applications.

PURPOSE

The purpose of this in vitro study was to determine and compare 4-point flexural strength, biaxial flexural strength, hardness, and crown failure loads for 3 commercially available glass-ceramics.

MATERIAL AND METHODS

Specimens were pressed and prepared from 3 brands of glass-ceramics: Celtra (CEL), IPS e.max (EMA), and Lisi (LIS). Rectangular bars, circular disks, and fully contoured crowns were created (n=15 specimens per glass-ceramic, 45 specimens per geometry, totaling 135 specimens). Disks were tested for biaxial flexural strength by using a piston-on-3-ball (POB) test, while bars were tested for 4-point flexural strength by using 4-point bending (4PB) and Vickers hardness (VH) tests. Crown failure loads were assessed in "crunch-the-crown" (CTC) tests. The results were analyzed by using general linear modeling, the Pearson correlation coefficient, and Weibull analysis.

RESULTS

The general linear modeling revealed significant differences (P<.05) in the failure load for crown specimens (EMA>LIS>CEL), the 4-point flexural strength (EMA>LIS>CEL), and the biaxial flexural strength (EMA>LIS=CEL). The disk specimens had higher flexural strengths than the bar specimens for CEL and EMA materials. LIS had a higher Weibull modulus than EMA and CEL for bar and crown specimens. CEL had a higher Weibull modulus than LIS and EMA for disk specimens. There was no correlation among the VH (R²=0.86 and P=.24), biaxial flexural strength (R²=0.84 and P=.26), and crown failure load. However, there was a high correlation between the failure load (crown specimens) and 4-point flexural strength (bar specimens) (R²=0.99 and P=.03).

CONCLUSIONS

The 4-point flexural strength correlated significantly with crown failure load.

Fracture Strength of Monolithic Zirconia Crowns with Modified Vertical Preparation: A Comparative In Vitro Study

Objective  The aim of this study was to evaluate the influence of different marginal designs (deep chamfer, vertical, and modified vertical with reverse shoulder) on the fracture strength and failure modes of monolithic zirconia crowns.

Materials and Methods  Thirty sound human maxillary first premolar teeth with comparable size were used in this study. The teeth were divided randomly into three groups according to the preparation design ( n = 10): (1) group A: teeth prepared with a deep chamfer finish line; (2) group B: teeth prepared with vertical preparation; and (3) group C: teeth prepared with modified vertical preparation, where a reverse shoulder of 1 mm was placed on the buccal surface at the junction of middle and occlusal thirds. All samples were scanned by using an intraoral scanner (CEREC Omnicam, Sirona, Germany), and then the crowns were designed by using Sirona InLab 20.0 software and milled with a 5-axis machine. Each crown was then cemented on its respective tooth with self-adhesive resin cement by using a custom-made cementation device. A single load to failure test was used to assess the fracture load of each crown by using a computerized universal testing machine that automatically recorded the fracture load of each sample in Newton (N).

Statistical Analysis  The data were analyzed statistically by using one-way analysis of variance test and Bonferroni test at a level of significance of 0.05.

Results  The highest mean of fracture load was recorded by chamfer (2,969.8 N), which followed by modified vertical (2,899.3 N) and the lowest mean of fracture load was recorded by vertical (2,717.9 N). One-way ANOVA test revealed a significant difference among the three groups. Bonferroni test showed a significant difference between group A and group B, while a nonsignificant difference was revealed between group C with group A and group B.

Conclusion  Within the limitations of this in vitro study, the mean values of fracture strength of monolithic zirconia crowns of all groups were higher than the maximum occlusal forces in the premolar region. The modification of the vertical preparation with a reverse shoulder placed at the buccal surface improved the fracture strength up to the point that it was statistically nonsignificant with the chamfer group.

Effect of sintering and aging processes on the mechanical and optical properties of translucent zirconia

STATEMENT OF PROBLEM

Sintering holding times and aging conditions may affect the optical, mechanical, and structural properties of polychromatic multitranslucent zirconia. However, a consensus on the ideal sintering condition for this material is lacking.

PURPOSE

The purpose of this in vitro study was to investigate the effect of different sintering holding and autoclave aging times on the flexural strength (FS), grain size, and translucency parameter (TP₀₀) of a translucent zirconia.

MATERIAL AND METHODS

Sixty bar-shaped and 60 rectangular-shaped specimens were prepared from computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia blocks and split into 2 groups to be sintered at 1550 °C for different holding times (regular: 2 hours, prolonged: 5 hours). The specimens were then divided into 3 subgroups and subjected to aging processes (control, aging for 60 minutes, aging for 120 minutes). FS values were obtained by using a 3-point bend test and Weibull analysis was conducted. Grain size evaluations were performed by using scanning electron microscope (SEM) observations. TP₀₀ was measured with a spectrophotometer. Statistical evaluation included the Kolmogorov-Smirnov, 2-way ANOVA, and Tukey HSD tests (α=.05).

RESULTS

The sintering procedure, aging, and their interaction significantly influenced the TP₀₀ (P<.05). FS values and grain sizes were affected by aging only (P<.001). Both aging times resulted in reduced FS and increased grain sizes. Prolonged sintering in combination with 120 minutes of aging negatively affect the TP₀₀ scores (P<.05).

CONCLUSIONS

FS values were similar under regular and prolonged sintering. Prolonged sintering led to a decrease in translucency after 120 minutes of aging. Steam autoclave aging can affect the optical and mechanical properties of translucent zirconia.

The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium

PURPOSE

To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses.

MATERIALS AND METHODS

PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design.

RESULTS

While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs.

CONCLUSIONS

Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.

Evaluation of zirconia and zirconia-reinforced glass ceramic systems fabricated for minimal invasive preparations using a novel standardization method

OBJECTIVE

Currently, minimal invasive approaches combining less invasive finish line preparations and reduced ceramic thickness are required. The aim of this study was to evaluate the fracture resistance of two ceramic systems fabricated with two preparation designs using CAD/CAM standardization technology.

MATERIALS AND METHODS

Forty intact human maxillary premolars were divided into two main groups according to the preparation technique. Group H (Horizontal): teeth with shoulder finish line and group V (Vertical): teeth with feather edge. Each main group was subdivided randomly into two subgroups according to the material used. Group CD (Celtra Duo) zirconia-reinforced glass ceramics and group K (KATANA) monolithic zirconia. CAD/CAM was used for standardization of natural teeth preparation. After cementation using self-adhesive resin cement, all specimens were subjected to 5000 thermal cycles and then were loaded until fracture. Failure types were evaluated using Stereomicroscopy and Scanning Electron Microscopy (SEM).

RESULTS

Nonsignificant; the higher mean value was recorded with VCD group (482.5 ± 103.8 N) and VK group (1347.6 ± 177.4 N) vs HCD group (471 ± 107.6 N) and HK group (1255.6 ± 121.3 N). SEM findings showed that fractures occurred mainly at the occlusal side of the crowns.

CONCLUSIONS

Vertical preparation showed a promising alternative to horizontal preparation. Moreover, both Celtra Duo and KATANA crowns can be used in premolar area with 0.5 mm margin thickness.

CLINICAL SIGNIFICANCE

Zirconia-reinforced glass ceramic and monolithic zirconia crowns may not necessitate the preparation of invasive finish lines as the type of finish line did not impair the strength after aging conditions.

A pilot trial on lithium disilicate partial crowns using a novel prosthodontic functional index for teeth (FIT)

Background

Lithium disilicate is now a well accepted material for indirect restorations. The aim of this trial was to evaluate two lithium disilicate systems using a novel prosthodontic Functional Index for Teeth (FIT).

Methods

Partial adhesive crowns on natural abutment posterior teeth were made on sixty patients. Patients were divided into two groups: Group 1 IPS e.max press (Ivoclar-Vivadent, Schaan, Liecthestein), and Group 2 Initial LiSi press (GC Co., Tokyo, Japan). The restorations were followed-up for 3 years, and the FIT evaluation was performed at last recall. The FIT is composed of seven variables (Interproximal, Occlusion, Design, Mucosa, Bone, Biology and Margins), each of them are evaluated using a 0–1-2 scoring scheme, and is investigated by an oral radiograph and occlusal and buccal pictures. More in details, three variables have the three scores made on the presence or not of major, minor or no discrepancy (for ‘Interproximal’, ‘Occlusion’ and ‘Design’), presence or not of keratinized and attached gingiva (‘Mucosa’), presence of bone loss > 1.5 mm, < 1.5 mm or not detectable (‘Bone’), presence or not of Bleeding on Probing and or Plaque Index (‘Biology’), presence of detectable gap and marginal stain or not (‘Margins’). The Mann-Whitney ‘U’ test was used and the level of significance was set at p < 0.05. Also, “success” of the crowns (restoration in place without any biological or technical complication) and “survival” (restoration still in place with biological or technical complication) were evaluated.

Results

Regarding FIT scores, all partial crowns showed a stable level of the alveolar crest without detectable signs of bone loss in the radiographic analysis. All other evaluated parameters showed a high score, between 1.73 and 2. No statistically significant difference emerged between the two groups in any of the assessed variables (p > 0.05). All FIT scores were compatible with the outcome of clinical success and no one restoration was replaced or repaired and the success rate was 100%.

Conclusions

The results showed that it is possible to evaluate the clinical performance of partial crowns using FIT. The FIT proved to be an effective tool to monitor the performance of the restorations and their compatibility with periodontal tissues at the recall. The FIT can be really helpful for a standardized evaluation of the quality of the therapy in prosthodontic dentistry. The two lithium disilicate materials showed similar results after 3 years of clinical service.

Trial registration

The study protocol was approved by the Ethical Committee of University of Siena (clinicaltrial.gov # NCT 01835821), ‘retrospectively registered’.

Clinical performance of chairside monolithic lithium disilicate glass-ceramic CAD-CAM crowns

OBJECTIVES

To evaluate the clinical performance and the effect of various patient and provider-related factors on the longevity of chairside monolithic posterior lithium disilicate glass-ceramic (LDGC) computer-aided design (CAD)-computer-aided manufacturing (CAM) crowns provided by predoctoral students.

MATERIALS AND METHODS

A sample of posterior LDGC CAD-CAM crowns was evaluated. Crown preparations were milled chairside using the CEREC Omnicam system and cemented with Rely-X Unicem or Calibra Universal resin cements. Clinical assessment of the crowns and supporting periodontal structures was performed using the modified California Dental Association (CDA) criteria. Intraoral photographs as well as radiographs were taken for further assessment by two evaluators. Kaplan-Meier survival analysis was performed.

RESULTS

A total of 40 crowns were inserted in 32 patients and evaluated for 4 years. Three complications were observed (two-technical and one-biological). No chipping or fracture of crowns was observed. No significant association was found between age, sex, periodontal condition, tooth type, tooth vitality, cement type, and longevity. The 4-year cumulative survival and success rates were 95.0 and 92.3%, respectively.

CONCLUSION

Chairside LDGC CAD-CAM crowns exhibited a high survival rate after 4 years in function and were shown to be a viable and reliable treatment option for posterior teeth.

CLINICAL SIGNIFICANCE

The high survival rate of chairside CAD-CAM crowns observed in this study suggests the likelihood of predictable performance in the predoctoral setup.

Effect of margin design on fracture load of zirconia crowns

Zirconia‐based restorations are showing an increase as the clinicians’ preferred choice at posterior sites because of the strength and esthetic properties of such restorations. However, all‐ceramic restorations fracture at higher rates than do metal‐based restorations. Margin design is one of several factors that can affect the fracture strength of all‐ceramic restorations. The aim of this study was to assess the effect of preparation and crown margin design on fracture resistance. Four groups of bilayer zirconia crowns (with 10 crowns in each group) were produced by hard‐ or soft‐machining technique, with the following four different margin designs: chamfer preparation (control); slice preparation; slice preparation with an additional cervical collar of 0.7 mm thickness; and reduced occlusal thickness (to 0.4 mm) on slice preparation with an additional cervical collar of 0.7 mm thickness. Additionally, 10 hard‐machined crowns with slice preparation were veneered and glazed with feldspathic porcelain. In total, 90 crowns were loaded centrally in the occlusal fossa until fracture. The load at fracture was higher than clinically relevant mastication loads for all preparation and margin designs. The crowns on a chamfer preparation fractured at higher loads compared with crowns on a slice preparation. An additional cervical collar increased load at fracture for hard‐machined crowns.

Influence of preparation design and spacing parameters on the risk of chipping of crowns made with Cerec Bluecam before cementation

PURPOSE

To evaluate the influence of the preparation design and spacing parameters on the risk of chipping of crowns made by CEREC Bluecam before cementation.

METHODS

A knife-edge preparation and a chamfer preparation were made on upper premolars. The teeth were scanned and two Co-Cr alloy replicas were made. Fifteen full crowns were manufactured for four groups using CEREC. The groups differed in type of preparation (knife-edge (KE) or chamfer (CHA)) and spacing parameters: spacer (0 or 150μm), marginal adhesive gap (10 or 50 or 150μm) and margin thickness (0 or 300μm). The four groups were: CHA 150 (spacer)- 50 (marginal adhesive gap)- 0 (margin thickness), KE 150-50-0, KE 150-50-300 and KE 150-150-300. The crowns were loaded before cementation by using an Instron machine to simulate the masticatory load applied during a trial. Differences in means were compared using two-way ANOVA and a post-hoc test (Tukey Test). The level of significance was set at P=0.05.

RESULTS

The fracture values, ordered from least to most resistant, were: KE 150-50-300 group, CHA 150-50-0 group, KE 150-50-0 group and KE 150-150-300 group. Two-way ANOVA revealed statistically significant differences between pairs of means (p<0.05). Tukey's test showed that restorations of the KE 150-150-300 group can withstand a load significantly higher than that of other groups (p<0.01). In this group, the failures were mostly minor chippings, while the other groups had mostly major chippings and fractures.

CONCLUSIONS

Marginal adhesive gap can affect the trial of a full crown.