Esthetic Prosthetic Restorations: Reliability and Effects on Antagonist Dentition

Longevity of extrinsic stains on monolithic zirconia restorations: An in vitro study

STATEMENT OF PROBLEM

Three-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) has been commonly used for fixed prosthodontic restorations. The opacity of 3Y-TZP may be masked with external staining, although the longevity of extrinsic stains applied to monolithic zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to analyze the color and surface roughness of extrinsically stained zirconia specimens after thermocycling and toothbrushing.

MATERIAL AND METHODS

Monolithic Ø12.5×1.25-mm zirconia disks were milled from 3Y-TZP blocks, sintered according to manufacturer instructions, and then divided into 3 groups (C, J, and O; n=16) for application of stain and glaze. All specimens underwent 10 000 thermocycles in distilled water before being further divided into 2 dentifrice groups (n=8): normal grit, low relative dentin abrasivity (RDA) (Subgroup N) and abrasive grit, high RDA (Subgroup A). Specimens were brushed in a multistation brushing machine under 1.47 N of force using a 5:8 toothpaste and distilled water slurry for 10 000 cycles with a straight (American Dental Association Standard) toothbrush to simulate 1 year of toothbrushing. Color and surface roughness measurements were obtained at 3 time points: baseline, after thermocycling, and after brushing. A 2-way repeated measures ANOVA was used to independently assess changes in color and surface roughness with respect to thermocycling and brushing (α=.05).

RESULTS

Group J displayed no significant change in color for either dentifrice system (P>.05). However, a significant change in surface roughness was observed for both dentifrice subgroups (P<.001). Group C specimens displayed significant changes in color (P<.001) and surface roughness (P<.001) for both dentifrice systems. Group O specimens displayed significant changes in color (P<.025) for both dentifrice systems and significant changes in surface roughness (P<.004) for subgroup A, but no significant changes for subgroup N (P=.075).

CONCLUSIONS

Artificial aging of monolithic zirconia resulted in changes in color and surface roughness that did not surpass the thresholds for perceptibility and acceptability. This study failed to establish durability limits for extrinsic stains applied to 3Y-TZP.

2D and 3D Wear Analysis of 3D Printed and Prefabricated Artificial Teeth

PURPOSE

This study aimed to assess the 3-body wear of prefabricated and 3D-printed artificial denture teeth.

MATERIALS AND METHODS

Four groups of artificial teeth were used; 3D-printed polymethylmethacrylate (PMMA) teeth (PR) and 3 prefabricated commercially available denture teeth: PMMA (Gnathostar, GN), PMMA (SR Orthotyp PE, SR), and Nanohybrid composite (SR Phonares NHC, PH). The 3-body wear test was performed using a steatite ceramic antagonist in a chewing simulator with 750,000 cycles, temperature 23 ± 2 ˚C, and force of 50 N. The abrasive medium was composed of ground millet seeds and white rice mixed with distilled water. The teeth were 3D-scanned before and after the wear test. The 3D images were assessed for teeth wear by measuring the volumetric (3D wear) and the vertical (2D wear) substance loss. The one-way analysis of variance followed by Tukey post hoc test was used to statistically obtain the data analysis.

RESULTS

Maximum 3D wear was observed in the PR (51.05 ± 4.53 mm³), followed by GN (20.22 ± 6.29 mm³) and SR (12.12 ± 6.29 mm³) artificial teeth. Minimum wear occurred in the PH teeth (6.24 ± 0.87 mm³). The analytical differences amongst the groups were statistically significant (P < .05) except between PH and SR teeth. For 2D wear measurement, the maximum was seen in the GN teeth (6.29 ± 1.64 mm), followed by PR (5.04 ± 0.83 mm) and then SR (4.53 ± 0.87 mm). The PH teeth (3.09 ± 0.68 mm) again showed minimum wear. Statistically, amongst the groups, the major observable differences (P < .05) were between PH and GN, PH and PR, and SR and GN.

CONCLUSIONS

Composite resin teeth had a greater wear resistance than acrylic resin teeth and 3D-printed resin teeth, both of which were comparable. Due to the advancement of digital workflows, manufacturers should devote effort to enhancing 3D-printed teeth.

Zirconia crowns for children: A systematic review

BACKGROUND

Preformed metal crowns (PMCs) have been the restoration of choice for paediatric dentistry; however, PMCs have a non-aesthetic appearance, which has become a point of concern. Recently, prefabricated zirconia crowns (PZCs) have been increasingly used as an aesthetic restorative material for primary teeth, as they have pleasing properties.

AIM

This systematic review summarises the clinical results for PZCs in the primary dentition, including wear on the opposing dentition, retention, fracture resistance, parental satisfaction, gingival health, and cementation materials.

MATERIALS AND METHODS

Electronic database searches were conducted using PubMed, Google Scholar, Web of Science, and the Cochrane Library. Clinical trials, observational studies, and case reports/series were included. The quality of the studies was analysed using the Cochrane tool and the domain-based evaluation for non-randomised studies of interventions.

RESULTS

The search retrieved 166 references, of which 14 studies were included for qualitative analyses. The risk of bias varied from low to unclear. The included studies indicated that prefabricated zirconia crowns are retentive and are not associated with accelerated wear on the opposing dentition. They also exhibit a high fracture resistance, satisfy the parents and are compatible with gingival health. There is, however, inconclusive evidence with regard to cementation materials.

CONCLUSION

Prefabricated Zirconia Crowns appear to be a good alternative to preformed metal crowns in term of esthetics, retention, resistance to fracture, parent satisfaction, and gingival health.

Evaluation Of The Effect Of Different Surface Treatments, Aging And Enzymatic Degradation On Zirconia-Resin Micro-Shear Bond Strength

Purpose

The purpose of this study was to evaluate the effect of surface treatments on zirconia-resin bonding and the effect of aging on bond durability for one year.

Method

Three hundred and twenty zirconia blocks were divided into 4 equal study groups. Group 1 (control): as-sintered, group 2: (GB): grit-blasted, group 3: (LAS): laser-etched, group 4: (SIE): selective infiltration etching. Composite cylinders were bonded to the zirconia with resin cement and ceramic primer. Aging was performed following 3 different aging protocols: thermocycling, storage in distilled water, or storage in an enzymatic esterase solution. Micro-shear bond strength test (μSBS) was recorded using a universal testing machine. μSBS values were analyzed using two-way Analysis of Variance followed by Tukey post-hoc tests. Level of significance was set at 0.05.

Results

GB, LAS and SIE groups showed significantly higher values when compared to control. Groups GB, LAS and SIE reported a significant decrease up to 50% in μSBS after water storage and enzymatic degradation, while control group reported a 90% decrease. Failure analysis showed mainly adhesive failure for control group, while the percentage of cohesive failure in resin cement was higher in SIE group compared to GB and LAS groups.

Conclusion

Water aging and esterase solutions played a significant role by increasing bond degradation. A minimum of one-year water and esterase storage medium should be used to evaluate the durability of the bond between resin cement and zirconia.

Dental biomaterials for chairside CAD/CAM: State of the art

The wide use of chairside CAD/CAM restorations has increased the diversity of the restorative material. For the practitioner, the selection of the appropriate material is difficult amongst the variety offered by the market. Information on the characteristics of the products can be difficult to assess due to the lack of up-to-date classification and the lack of reliability of manufacturer's advertising. The purpose of this article is to structure the data on restorative materials provided by various sources in order for the practitioner to choose the product most suited to the clinical situation. The objective is to classify chairside CAD/CAM materials and to define their characteristics and indications.