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Hiraba H, Nishio K, Takeuchi Y, Ito T, Yamamori T, Kamimoto A. Application of one-piece endodontic crowns fabricated with CAD-CAM system to molars. JAPANESE DENTAL SCIENCE REVIEW 2024; 60:81-94. [PMID: 38303746 PMCID: PMC10830429 DOI: 10.1016/j.jdsr.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/04/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Computer-aided design-computer-aided manufacturing (CAD-CAM) systems have been widely used as a fabrication method for restorations because of their high efficiency and accuracy, which significantly reduces fabrication time. However, molars with insufficient clearance or short clinical crown lengths require retention holes or grooves on the preparation, making it difficult to replicate the shapes with the CAM milling system. In these cases, restorations using the lost-wax method are selected. This article focuses on one-piece endodontic crowns (endocrowns) fabricated with a CAD-CAM system (CAD-CAM endocrowns), in which their posts and crowns are integrated. Articles from July 2012 to August 2023 were searched in PubMed with the keyword "endocrown". This review discusses the application of CAD-CAM endocrowns to molars from the viewpoint of model experiment (fracture resistance, adaptation) and clinical research. This technique, which allows margins and internal gaps to be set within the clinically acceptable range, is reported to be an effective way of restoring molars with high survival rates in clinical research.
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Affiliation(s)
- Haruto Hiraba
- Department of Dental Materials, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
- Division of Biomaterials Science, Dental Research Center, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
| | - Kensuke Nishio
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
| | - Yoshimasa Takeuchi
- Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
| | - Takashi Ito
- Center of Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8525, Japan
| | - Tetsuo Yamamori
- Department of Prosthetic Dentistry, School of Dentistry, Ohu University School of Dentistry, 31-1 Misumido, Tomita, Koriyama, Fukushima 963-8611, Japan
| | - Atsushi Kamimoto
- Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, 1-8-13, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
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Dikici B, Can E, Türkeş Başaran E, Barut G, Dönmez N. Fracture strength of endocrowns after thermomechanical aging. Odontology 2024; 112:884-894. [PMID: 38289451 DOI: 10.1007/s10266-023-00884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/04/2023] [Indexed: 07/25/2024]
Abstract
This in-vitro study aimed to evaluate the fracture strength (FS; N) of composite, feldspathic, and glass-ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) endocrowns after thermomechanical aging. Seventy non-carious human molars were randomly divided into seven groups, according to the CAD/CAM material used for endocrown fabrication. Intact molars without cavity preparations were used as control (n = 10). Following endodontic treatment, standardized endocrown cavities were prepared and endocrowns were fabricated using composite (Cerasmart270, CS and Grandio Blocs, GB), fired and milled zirconia-reinforced lithium silicate (Celtra Duo, CD), leucite-reinforced feldspar ceramic (LRF Initial, LRF), and feldspathic (Cerec Blocks, CE) materials which were luted with universal adhesive (Futurabond U; Voco) and dual-cure resin cement (Bifix QM). Following thermocycling for 20,000 cycles and 480,000 load cycles in a chewing simulator (CS-4.2, SD Mechatronik), FS was evaluated (Instron). Data were analyzed with one-way ANOVA and post hoc Tukey's tests (p < 0.05). FS was significantly influenced by the tested material (p = 0.00). CS had the highest FS, which was not significantly different from intact molars and fired CD (p > 0.05). There were no significant differences in FS between LRF, GB, and CD, which were significantly higher than CE. Most of the failure modes of CS, CD, and GB were repairable, whereas those of CE were irreparable. All the tested materials withstood clinically relevant axial forces. Composite endocrowns exhibited more favorable fracture pattern, whereas feldspathic and leucite-reinforced feldspar ceramic endocrowns exhibited mostly irreparable fractures.
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Affiliation(s)
- Burcu Dikici
- Faculty of Dentistry, Department of Restorative Dentistry, Yeditepe University, Istanbul, Turkey
| | - Esra Can
- Faculty of Dentistry, Department Head of Restorative Dentistry, Yeditepe University, Bağdat Caddesi No: 238, 34728 Göztepe, Istanbul, Turkey.
| | - Elif Türkeş Başaran
- Faculty of Dentistry, Department of Restorative Dentistry, Yeditepe University, Istanbul, Turkey
| | - Güher Barut
- Faculty of Dentistry, Department of Endodontics, Yeditepe University, Istanbul, Turkey
| | - Nazmiye Dönmez
- Faculty of Dentistry, Department of Restorative Dentistry, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Ali AAEM, Abo-ELsoud AAE, Helmy YS. The fracture resistance of pulpotomized primary molars restored with zirconia crowns, lithium disilicate or resin based ceramic endocrowns. BMC Oral Health 2024; 24:583. [PMID: 38764030 PMCID: PMC11103835 DOI: 10.1186/s12903-024-04332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Endocrown in pediatric dentistry was rooted in the fundamental principles of preserving healthy dental tissues, leveraging contemporary adhesive methodologies. AIM This research aimed on assessing and comparing the fracture resistance of pulpotomized primary molars when rehabilitated with zirconia crowns and two distinct types of endocrowns, namely E-Max and Brilliant Crios. METHODS The study involved thirty, anonymized, freshly extracted second primary molars that underwent pulpotomy. These teeth were then evenly divided into three groups, each consisting of ten specimens: the zirconia crown, the E-Max endocrown, and the Brilliant Crios endocrown groups. Post-pulpotomy, the teeth were prepared for their respective restorations. Subsequent to this preparation, the zirconia crowns, E-Max endocrowns, and Brilliant Crios endocrowns were secured. To evaluate the fracture resistance using a computer-controlled testing machine (Instron), a progressively increasing load was applied to each group until fracture occurred. The gathered data were then analyzed for outliers and subjected to normality testing using the Shapiro-Wilk and/or Kolmogorov-Smirnov tests, with a significance threshold set at 0.05. RESULTS There was no statistically significant difference in fracture resistance of pulpotomized primary molars among lithium disilicate (E-Max) group (mean=1367.59N), Brilliant Crios group (mean=1349.73N) and zirconia group (mean=1240.82N). CONCLUSION Endocrowns can be considered a promising restoration for pulpotomized primary molars.
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Affiliation(s)
- Amany Abd Elhady Muhammad Ali
- Department of Pediatric Dentistry, Preventive Dentistry and Dental Public Health, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
| | - Asmaa Ali Emam Abo-ELsoud
- Department of Pediatric Dentistry, Preventive Dentistry and Dental Public Health, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.
| | - Yousra Samir Helmy
- Department of Pediatric Dentistry, Preventive Dentistry and Dental Public Health, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.
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Elraggal A, Abdelraheem IM, Watts DC, Roy S, Dommeti VK, Alshabib A, Althaqafi KA, Afifi RR. Biomechanical reinforcement by CAD-CAM materials affects stress distributions of posterior composite bridges: 3D finite element analysis. Dent Mater 2024; 40:869-877. [PMID: 38609774 DOI: 10.1016/j.dental.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES This 3D finite element analysis study aimed to investigate the effect of reinforcing CAD-CAM bars on stress distribution in various components of a posterior composite bridge. METHODS A virtual model mimicking the absence of an upper second premolar was created, featuring class II cavity preparations on the proximal surfaces of the adjacent abutment teeth surrounding the edentulous space. Five distinct finite element analysis (FEA) models were generated, each representing a CAD-CAM reinforcing bar material: 3-YTZP (IPS. emax ZirCAD MO; Zr), lithium disilicate (IPS e.max CAD; EX), nano-hybrid resin composite (Grandio Blocs; GB), Fibre-reinforced composite (Trilor; Tri), and polyetheretherketone (PEEK). A veneering resin composite was employed to simulate the replacement of the missing premolar (pontic). In the FEA, an axial force of 600 N and a transverse load of 20 N were applied at the center of the pontic. Subsequently, maximum von Mises (mvM) and maximum principal stresses (σmax) were computed across various components of the generated models. Additionally, shear stresses at the interface between the CAD-CAM bars and the veneering resin composite were determined. RESULTS CAD-CAM materials with high modulus of elasticity, such as Zr and EX, exhibited the highest mvM stresses and shear stresses while transferring the lowest stress to the veneering resin composite in comparison to other materials. Conversely, PEEK demonstrated the lowest mvM stresses but produced the highest stresses within the veneering resin composite. There was a uniform distribution of mvM stresses in the remaining tooth structure among all groups, except for a noticeable elevation in the molar region of Zr and EX groups. SIGNIFICANCE Reinforcing CAD-CAM bar materials with a high modulus of elasticity, such as Zr and EX, may result in debonding failures at the connector sites of posterior composite bridges. Conversely, GB, PEEK, and Tri have the potential to cause fracture failures at the connectors rather than debonding.
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Affiliation(s)
- Alaaeldin Elraggal
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Islam M Abdelraheem
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - David C Watts
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sandipan Roy
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India
| | - Vamsi Krishna Dommeti
- Department of Mechanical Engineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India
| | - Abdulrahman Alshabib
- Restorative Dentistry Department, Faculty of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Abid Althaqafi
- Restorative Dentistry Department, Faculty of Dentistry, College of Dental Medicine, University of Umm Al Qura, Makkah, Saudi Arabia
| | - Rania R Afifi
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Vervack V, Johansson C, Coster PD, Fokkinga W, Papia E, Vandeweghe S. The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth. J ESTHET RESTOR DENT 2024; 36:796-803. [PMID: 38152852 DOI: 10.1111/jerd.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.
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Affiliation(s)
- Valentin Vervack
- Department of Oral Health Sciences, Reconstructive Dentistry, Faculty of medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Camilla Johansson
- Faculty of Odontology, Material Science and Technology, Dental Technology, Malmö University, Malmö, Sweden
| | - Peter De Coster
- Department of Oral Health Sciences, Reconstructive Dentistry, Faculty of medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wietske Fokkinga
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Evaggelia Papia
- Faculty of Odontology, Material Science and Technology, Dental Technology, Malmö University, Malmö, Sweden
| | - Stefan Vandeweghe
- Department of Oral Health Sciences, Reconstructive Dentistry, Faculty of medicine and Health Sciences, Ghent University, Ghent, Belgium
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Jalali S, Asgari N, Pirooz P, Younespour S, Atri F. Comparison of Clinical Efficacy of CAD/CAM Endocrowns Made of Feldspathic, Zirconia Lithium Silicate, and Lithium Disilicate: A Two-year Mixed Cohort Study. J Dent 2024:105019. [PMID: 38670333 DOI: 10.1016/j.jdent.2024.105019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Endocrowns can be fabricated from various materials as a treatment option for endodontically treated teeth. This mixed cohort study aimed to demonstrate the clinical efficacy of endocrowns made of feldspathic, zirconia lithium silicate, and lithium disilicate ceramics using a chairside CAD/CAM system. METHODS The present study compared the clinical outcomes of 141 endocrown restorations in posterior teeth of 85 patients in a two-year follow-up. The efficacy of restorations was evaluated in three aspects: esthetics, biological response, and function, with the aid of the FDI guideline, and presented as descriptive analyses. Additionally, the data were analyzed using Chi-square and Spearman correlation tests. The significance level was set at p = 0.05. RESULTS The study findings revealed that the type of restorations (feldspathic, zirconia lithium silicate, and lithium disilicate) (p > 0.05) and underlying teeth (molars and premolars) (p > 0.05) play no part in restorations' failure. Caries' recurrence is primarily responsible for the failure of the endocrowns. Secondary caries and radiolucency were observed in four teeth (2.83%). The clinical efficacy of 126 restorations (89.36%) fell into the category of "clinically excellent" and "clinically good." Ten restorations (7.09%) were classified as "clinically sufficient/satisfactory," and only five restorations (3.54%) needed replacement due to having "clinically unsatisfactory" and "clinically poor" quality. CONCLUSIONS With endocrowns made of the mentioned ceramics showing a high success rate and durability in the short term, they can be considered a safe choice for restoring endodontically treated teeth. It is worth noting that caries were the most common reason for the failure of the restorations. CLINICAL SIGNIFICANCE Endocrowns made of different ceramics have been proven reliable restorations for endodontically treated molars and premolars.
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Affiliation(s)
- Samar Jalali
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Nafise Asgari
- Department of Prosthodontics, School of Dentistry, Qazvin university of Medical Sciences, Qazvin, Iran
| | - Parsa Pirooz
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Atri
- Department of Prosthodontics, School of Dentistry, Dentistry Research Institute, Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Nassani LM, Bencharit S, Schumacher F, Lu WE, Resende R, Fernandes GVO. The Impact of Technology Teaching in the Dental Predoctoral Curriculum on Students' Perception of Digital Dentistry. Dent J (Basel) 2024; 12:75. [PMID: 38534299 DOI: 10.3390/dj12030075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
The goal was to assess dental students' perception of digital technologies after participating in a CAD/CAM exercise for scanning, designing, and manufacturing computer-aided provisional fixed dental restorations. A survey was conducted among second- (pre-D2 and post-D2), first- (D1, negative control), third-, and fourth-year dental students (D3 and D4, positive controls). Only OSU College of Dentistry students who completed the activity and completed the surveys were included. Seven questions were rated, which evaluated changes in knowledge, skill, interest, the importance of technology availability in an office, patients' perception of technology, the importance of having the technology, and the expected frequency of clinics utilizing the technology. Statistical analysis was performed with a significance level of 0.05. A total of 74 pre-D2 and 77 post-D2 questionnaires were completed. Additionally, 63 D1, 43 D3, and 39 D4 participants responded to the survey. Significant differences were found for "knowledge" and "skill" between the pre-D2 and post-D2 and pre-D2 and control groups (p < 0.001). There was a significant difference between the post-D2 participants and all the controls in terms of "interest" (p = 0.0127) and preference for in-practice technology availability (p < 0.05). There were significant results between the post-D2 participants and all the controls regarding the importance of technology availability in an office (p < 0.001) and the expected frequency of clinics utilizing the technology (p = 0.01). No significance was found for "value of technology to patients" and "the importance of having the technology". The presence of technology in practice and in educational academic environments significantly improved students' interest and perception of their knowledge and skill.
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Affiliation(s)
- Leonardo M Nassani
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, 3005F Postle Hall, 305 W 12th Ave, Columbus, OH 43210, USA
| | - Sompop Bencharit
- Department of Oral Rehabilitation, Medical University of South Carolina College of Dental Medicine, BSB 335C, 175 Ashley Ave, Charleston, SC 29425, USA
| | - Fernanda Schumacher
- Division of Biostatistics, The Ohio State University College of Public Health, 280A Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
| | - Wei-En Lu
- Department of Biostatistics, The Ohio State University College of Arts and Sciences, 305E Cockins Hall, 1958 Neil Ave, Columbus, OH 43210, USA
| | - Rodrigo Resende
- Faculty of Dentistry, Fluminense Federal University, Niteroi 24020-140, RJ, Brazil
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AboElhassan RG, Watts DC, Alamoush RA, Elraggal A. Biomechanical behavior and Weibull survival of CAD-CAM endocrowns with different marginal designs: A 3D finite element analysis. Dent Mater 2024; 40:227-235. [PMID: 37977990 DOI: 10.1016/j.dental.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To evaluate and compare the effect of tooth preparation designs and different CADCAM. materials on stress distribution and Weibull survival probability of endocrowns. applied to root canal-treated lower first permanent molar using the 3D finite element. analysis method. METHODS A root canal-treated lower first permanent molar was prepared for endocrowns with a. butt joint or with a ferrule design by placing, circumferentially, a 1-mm wide shoulder. finish line. The prepared molar was scanned for the two designs and modeled on a 3D. Finite element model. Monolithic zirconia (IPS e.max ZirCAD MT, FCZ), lithium. disilicate (IPS e.max CAD, EX), and nano-ceramic resin composite (Lava Ultimate, LU). CAD-CAM materials were used for each preparation to design the virtual endocrown. A. total of six models were built according to the different tooth preparation designs and. endocrown materials. An occlusal load of 600 N and a transverse load of 20 N in. magnitude that simulates the average occlusal load was directed toward the occlusal. surfaces. von Mises and maximum principle values were evaluated Weibull risk-ofrupture. analysis was used to analyze the survival probability of the restorations and. tooth in the different models. RESULTS The highest von Mises were found in the butt joint design for FCZ, EX, and LU (45.3. MPa, 35.2 MPa, and 24.2 MPa, respectively) compared to the ferrule design for the. same materials (42.6 MPa, 31.2 MPa, and 23.6 MPa, respectively). For von Mises. stress distribution in the remaining part of tooth structure (dentin), the highest stresses. were found in LUFerrule which was closely similar to LUButt joint (135.4 MPa and. 134.7 MPa, respectively), followed by EXFerrule and FCZFerrule (132.2 MPa and. 131.7 MPa, respectively), while the lowest stresses were found in EXButt joint and. FCZButt joint (129.0 MPa and 128.4 MPa, respectively). Shear stresses within the. resin cement were the highest in FCZ and EX compared to LU. EX was found to be the. most reliable material with the highest survival probability, while FCZ showed the. lowest survival probability according to the Weibull risk-of-fracture results. SIGNIFICANCE Materials with high elastic modulus transfer more stresses to the endocrown and less. to the remaining tooth structure. Endocrown tooth preparation with ferrule design has. better stress distribution and magnitude compared to the butt joint design.
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Affiliation(s)
- Rewaa G AboElhassan
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - David C Watts
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rasha A Alamoush
- Department of Fixed and Removable Prosthodontics, School of Dentistry, the University of Jordan, Amman, Jordan
| | - Alaaeldin Elraggal
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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AlHelal AA. Biomechanical behavior of all-ceramic endocrowns fabricated using CAD/CAM: A systematic review. J Prosthodont Res 2024; 68:50-62. [PMID: 37286503 DOI: 10.2186/jpr.jpr_d_22_00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE This study performed a systematic review to assess the biomechanical behavior of all-ceramic endowcrowns fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) for the restoration of endodontically treated teeth. STUDY SELECTION Three electronic databases (PubMed, Web of Science, and Scopus) were searched by operators specializing in health sciences databases searches to answer the following focused question based on the Population, Intervention, Comparison, Outcome (PICO) format: "Whether all-ceramic CAD/CAM endocrowns (Intervention) used to restore human endodontically treated teeth (Population) exhibit superior fracture resistance (Outcome) compared to non-CAD/CAM all-ceramic or non-ceramic endocrowns (Comparison)." The methodological quality assessment was performed using previously conducted systematic reviews of in vitro studies. The outcomes were expressed as the mean ± the standard deviation (SD). RESULTS Seventeen in vitro studies were included. The materials used in these studies were lithium disilicate glass-ceramic, polymer-infiltrated ceramic, zirconia-reinforced lithium silicate glass-ceramic, resin/hybrid nanoceramics, zirconia-reinforced lithium silicate ceramics, and feldspathic ceramic. The fracture resistance of endocrowns using different ceramics varied as follows: (i) IPS e.max CAD (2863.62 ± 51.47 N), (ii) Vita Enamic (1952 ± 378 N), (iii) Vita Suprinity (1859 ± 588 N), (iv) Cerasmart (1981 ± 169.5 N), (v) LAVA Ultimate (2484 ± 464 N), (vi) Celtra Duo (1618.30 ± 585.00 N), and (vii) Cerec Blocs (236.29 ± 32.12 N). CONCLUSIONS CAD/CAM all-ceramic endocrowns can withstand occlusal forces in the posterior region. All-ceramic endocrowns improve the fracture strength of endodontically treated teeth. Lithium disilicate crowns were commonly and successfully used in the included studies. More in vitro investigations that implement uniformity in material and measurement approaches are required to strengthen the evidence currently available in the literature regarding the durability of all-ceramic endocrowns.
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Affiliation(s)
- Abdulaziz A AlHelal
- Department of Prosthetic Dental Sciences, King Saud University, College of Dentistry, Riyadh, Saudi Arabia
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10
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Geo TD, Gupta S, Gupta SG, Rana KS. Is Deep margin elevation a reliable tool for cervical margin relocation? - A comparative review. J Oral Biol Craniofac Res 2024; 14:33-38. [PMID: 38481655 PMCID: PMC10935500 DOI: 10.1016/j.jobcr.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 06/04/2024] Open
Abstract
The permanence of deep subgingival restorations are questionable both functionally and biologically. Crown lengthening is one of the traditionally performing procedures to visualize and relocate the deep margins, but the limitations of the invasive surgical procedure are anatomical complications like exposure of root concavities or furcation, violation of biological width, post operative discomfort because of sutures or periodontal packs; and less patient compliance. Other than crown lengthening, researchers tried some other techniques like modified matrix adaptation technique, using retraction cord, making holes in matrix band and flowing resin modified glass ionomer cement (RMGIC) to the root or cervical caries, orthodontic extrusion. But most of these procedures are failed to give adequate clinical success. Deep margin elevation (DME) is one of the minimally invasive and successful procedure performing in deep subgingival caries. But the evidences and knowledge in this technique is limited among practitioners. This review is to evaluate the applicability of DME, the current clinical concepts, techniques and materials for DME; and a comparison with traditionally used various techniques for cervical margin relocation also concluding that currently available various clinical parameters with this technique.
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Affiliation(s)
- T D Geo
- Department of Conservative Dentistry and Endodontics, Government College of Dentistry, 1 Sardar Patel Marg, Opp. M.Y. Hospital, Indore, Madhya Pradesh, 452001, India
| | - Saurabh Gupta
- Department of Conservative Dentistry and Endodontics, Government College of Dentistry, 1 Sardar Patel Marg, Opp. M.Y. Hospital, Indore, Madhya Pradesh, 452001, India
| | - Shilpi Gilra Gupta
- Department of Prosthodontics and Crown and Bridge, Government College of Dentistry, 1 Sardar Patel Marg, Opp. M.Y. Hospital, Indore, Madhya Pradesh, 452001, India
| | - Kuldeep Singh Rana
- Department of Conservative Dentistry and Endodontics, Government College of Dentistry, 1 Sardar Patel Marg, Opp. M.Y. Hospital, Indore, Madhya Pradesh, 452001, India
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Al Ahmari NM, Alshehri AH, Gadah TS, Alqahtani JA, Almushafi MA, Al Moaleem MM, Al Hatlan EN, Alqhatani AS, Alabydi SM. Comparison of color changes, fracture strengths, and failure modes of conventional endocrowns and endocrowns with different design modifications. Technol Health Care 2024; 32:2395-2408. [PMID: 38427513 DOI: 10.3233/thc-231175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND Endocrowns (ECs) are alternatives for rebuilding severely damaged teeth and show superior efficacy in molars over premolars. OBJECTIVE The objective of this in vitro study is to evaluate the effects of different preparation designs with short pulp chambers on the mean color change (ΔE), fracture resistance, and failure types of mandibular molar ECs. METHOD A total of 40 extracted mandibular molars were treated endodontically and divided into four groups. Samples in groups 1, 2, 3, and 4 had occlusal preparation depths of 5 mm, 3 mm, 3 mm with ferrule, and 3 mm with boxes, respectively. The samples were immersed in coffee and their ΔE values were measured by using the Commission Internationale de l'Eclairage color system. They were also subjected to a fracture test. Next, all specimens were examined visually under a stereomicroscope to evaluate their failure modes and identify their fracture origins. Data were entered and analyzed by using Statistical Package for Social Sciences. RESULTS Among all groups, group 4 (3 mm + boxes) presented the highest ΔE (4.15) after immersion in coffee. Moreover, ANOVA revealed that the ΔE of group 4 (occlusal preparation depth of 3 mm with boxes) was significantly different (p< 0.05) from that of group 2 (3 mm + ferrule, 3.07). The EC with a 3 mm chamfer and ferrule showed the highest maximum load of 2847.68 ± 693.27 N, whereas that with a 5 mm chamfer finish line had a marginally reduced load at fracture of 2831.52 ± 881.83 N. The EC with a 3 mm chamber and boxes had a slightly increased maximum load of 2700.75 ± 436.40 N, whereas that with the 3 mm chamber had the lowest maximum load at fracture of 2385.97 ± 465.61 N. One-way ANOVA showed that different EC preparation designs had no effect on maximum fracture load (F [3,16] = 0.550, p= 0.6). CONCLUSION The recorded ΔE values of ECs in all groups were equal or marginally higher than the acceptable values. The EC with a 3 mm chamfer and ferrule displayed the highest mean maximum load. The EC with a 5 mm chamfer finish line had a marginally lower maximum load at fracture than other ECs. Failures, such as ceramic fracture, split fracture, and ceramic and tooth splitting above the cemento-enamel junction (CEJ) or vertically were predominant in samples with occlusal preparation depths of 3 mm with ferrule and 5 mm.
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Affiliation(s)
| | - Abdulkarim H Alshehri
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Thrya S Gadah
- College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Jaber A Alqahtani
- Aseer Specialized Dental Center, Ministry of Health, Abha, Saudi Arabia
| | | | - Mohammed M Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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12
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Alammari MR, Alzahrani AA, Alaidarous AY, Alnasiri MM. Assessment of Level of Awareness, Current State of Knowledge, and Skills on Endocrown Technique Among Senior Saudi Dental Students and Interns. Cureus 2023; 15:e49897. [PMID: 38053991 PMCID: PMC10695002 DOI: 10.7759/cureus.49897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/07/2023] Open
Abstract
Background Awareness and knowledge about the endocrown technique contribute to the delivery of quality dental care and restorative long-term success. Dentists must be aware and knowledgeable about endocrowns as they offer a conservative approach, aid in maintaining tooth integrity, and have become a promising option in use recently. Aim This study evaluated the current state of knowledge, and the understanding of the endocrown technique as post-endodontic management among senior undergraduate dental students and interns who have studied the theoretical and laboratory procedures of endocrown as part of the curriculum. Materials and methods This cross-sectional investigation was conducted through an online questionnaire consisting of 21 questions in three parts. The first part consisted of demographic information; the second encompassed knowledge and attitude; and the third part evaluated skills regarding endocrown technique. A total of 164 voluntary dental students and dental intern questionnaires were evaluated. Factor analysis was used to identify the domains for knowledge and skill. Results In this study, the knowledge and skills of undergraduate dental students toward endocrowns were assessed. The reliability statistics showed favorable internal consistency (Cronbach's alpha values: 0.513 for knowledge and 0.729 for skill component 1). Significant correlations were noticed between knowledge component 1 and skill component 1 (r = 0.647, p < 0.001), knowledge component 1 and skill component 2 (r = 0.333, p < 0.001), and knowledge component 1 and skill component 3 (r = 0.260, p = 0.001). These findings emphasize the importance of evaluating students' understanding of endocrown. Significant differences were found among intern participants, fifth- and sixth-year dental students in component 1 of the knowledge (p-value<0.001), and all skills components. Conclusion Dental students have varying levels of knowledge and skills related to endocrown. Gaps in knowledge and skills have been detected, which dictates intervention actions, including curricular changes and training workshops.
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Affiliation(s)
- Manal R Alammari
- Oral and Maxillofacial Prosthodontics, King Abdulaziz University Faculty of Dentistry, Jeddah, SAU
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13
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Al Fodeh RS, Al-Johi OS, Alibrahim AN, Al-Dwairi ZN, Al-Haj Husain N, Özcan M. Fracture strength of endocrown maxillary restorations using different preparation designs and materials. J Mech Behav Biomed Mater 2023; 148:106184. [PMID: 37839334 DOI: 10.1016/j.jmbbm.2023.106184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging. MATERIALS AND METHODS Eighty two-rooted maxillary premolar crowns underwent endodontic treatment (N = 80, n = 10). The teeth were categorized into ten groups (4-mm deep with no intracanal extension lithium disilicate glass ceramic & multilayer zirconia endocrowns (LE0 & ZE0); 4-mm deep with 4-mm intracanal extension in one canal (LE1 & ZE1); 4-mm deep with 2-mm intracanal extensions in both canals (LE2 & ZE2); flat overlays with no endocore (LO & ZO); glass fiber reinforced post & core and crown (LC & ZC)). After cementation, all specimens were subjected to 1500 thermocycles and 1,200,000 chewing cycles with an axial occlusal load of 49 N. A static loading test was performed at a non-axial 45° loading using a universal testing machine and failure modes (Type I: restoration debonding; Type II: restoration fracture; Type III: restoration/tooth complex fracture above bone level; Type IV: restoration/tooth complex fracture below bone level) were evaluated using a stereoscope. Data were ananalzed using 2-way ANOVA and Tukey's tests (alpha = 0.05). RESULTS The endocrowns manufactured from multilayered zirconia and pressed lithium disilicate glass ceramic exhibited a fracture load ranging between 1334 ± 332 N and 756 ± 150 N, with ZC presenting the highest and LE2 the lowest values. The differences were not statistically significant (p > 0.05). CONCLUSION All endocrowns tested in this study performed similar considering the different designs and materials tested. The distribution of fracture modes did not differ significantly depending on the design of the restoration and the type of material used.
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Affiliation(s)
- Rami S Al Fodeh
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omer S Al-Johi
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Anas N Alibrahim
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad N Al-Dwairi
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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14
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Madfa AA, Almansour MI, Alshammari AF, Alenezi NM, Alrashidi EF, Aldhaban AA, Aljohani T, Alshammari FA. Knowledge and Awareness of Dental Practitioners About the Utilization of Endocrown in Post-endodontic Management. Cureus 2023; 15:e49838. [PMID: 38164301 PMCID: PMC10758257 DOI: 10.7759/cureus.49838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The objective of this study was to evaluate the knowledge, and awareness of dentists in Ha'il, Kingdom of Saudi Arabia, regarding the use of endocrown as post-endodontic restorations, utilizing an online questionnaire. METHODS A cross-sectional study was carried out among dental practitioners working in Ha'il, Kingdom of Saudi Arabia. Dentists who practice in the Ha'il were included in the current study. The survey study involved a sample size of 245 participants. The researchers employed the snowball sampling technique in this investigation. The validated, closed-ended questionnaires were disseminated to the entire sample of selected dental practitioners using electronic mail. The initial section of the survey encompassed inquiries pertaining to the demographic characteristics of the participants, encompassing variables such as gender, years of professional experience, and workplace. The subsequent section of the survey focused on assessing the participants' knowledge and opinions regarding the endocrown technique. The Chi-square test was employed to assess the associations between categorical variables. RESULTS The most of participants 228 (93.1%) had knowledge about endocrown and 94 (38.4%) of them received information from their educational institutions. Among the responses of the participants, 232 (94.7%) expressed their preference for utilizing endocrown restorations specifically for molar teeth. Moreover, 183 (74.7%) of respondents indicated that the endocrown is preferred when there is a restricted amount of inter-arch space available. A majority of respondents 152 (62.0%) indicated that the ferrule does not exert any influence on the endocrown. A majority of participants 135 (55.1%) expressed a preference for utilizing lithium disilicate ceramic in the fabrication of endocrown. The most of participants 209 (85.3%) opted to use resin cement for the purpose of cementation. The characteristics of gender, experience, and working place were found to have a significant relationship with the knowledge of the participants about endocrown (p <0.05). CONCLUSIONS The study participants need to enhance their knowledge and awareness pertaining to the utilization of endocrowns as a post-endodontic treatment.
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Affiliation(s)
- Ahmed A Madfa
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Moazzy I Almansour
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Asma F Alshammari
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, SAU
| | | | | | - Adel A Aldhaban
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, SAU
| | - Thoraya Aljohani
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, SAU
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15
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Zhu J, Li S, Wang D, Li D, Wang X, Rong Q. Effect of remaining pericervical dentin on biomechanical behavior of endocrown-restored molars with different materials: Three-dimensional finite element and Weibull analyses. Dent Mater J 2023; 42:683-691. [PMID: 37612061 DOI: 10.4012/dmj.2023-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
To evaluate the effect of remaining pericervical dentin (PCD) on the biomechanical behavior of endocrown-restored molars with different materials, six three-dimensional finite element (FE) models were reconstructed with different thicknesses and heights of pulp-chamber lateral dentinal wall (PCLDW). IPS Empress 2, In-Ceram Zirconia, and Lava Ultimate were selected as the materials. Compared with the Lava Ultimate FE models, the maximum tensile stress in the FE models using ceramics was higher in the endocrown and lower in the PCD surrounding it, and the overall failure probabilities with different PCLDW thicknesses and heights were similar, ranging from 9.8% to 12.9% under the normal lateral masticatory force, which were lower than the FE models using Lava Ultimate (ranging from 13.4% to 15.1%). Considering the bonding properties of ceramics, endocrown-restored molars using etchable lithium disilicate-reinforced glass ceramic exhibit superior longevity due to the stress shielding effect, regardless of the thickness and height of PCLDW.
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Affiliation(s)
- Junxin Zhu
- Second Dental Center, Peking University School and Hospital of Stomatology
| | - Shiying Li
- Second Dental Center, Peking University School and Hospital of Stomatology
| | - Dongmei Wang
- Second Dental Center, Peking University School and Hospital of Stomatology
| | - Deli Li
- Second Dental Center, Peking University School and Hospital of Stomatology
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University
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16
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Munoz-Sanchez ML, Gravier A, Francois O, Nicolas E, Hennequin M, Decerle N. In Vitro Resistance of Natural Molars vs. Additive-Manufactured Simulators Treated with Pulpotomy and Endocrown. J Funct Biomater 2023; 14:444. [PMID: 37754858 PMCID: PMC10531589 DOI: 10.3390/jfb14090444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
Endocrowns are designed to restore endodontically treated teeth with root canal treatment (Rct). Recently, endocrowns were proposed for teeth treated with full pulpotomy (FP). No data exist on in vitro evaluations for this combination. This study aimed to evaluate the mechanical behavior of pulpotomy-treated teeth with endocrowns according to different protocols for preparation design and materials and to assess whether 3D-printed resin simulators could be a reliable alternative for human teeth during in vitro strength tests. One hundred and ten extracted natural molars were randomized into 11 groups according to the type of endodontic treatment, the material used, and the design of peripheric preparation. One hundred and ten resin simulators were separated similarly. The samples were embedded in epoxy resin blocks before being subjected to oblique compressive load until failure. For natural teeth, the variance analysis separated two homogeneous groups, one regrouping the endodontically treated or pulpotomy-treated teeth without coronal restoration and the other one regrouping all the other samples, i.e., the untreated teeth (positive controls) and the treated and restored teeth. The strength resistance was lower for the resin simulators than for natural teeth in all groups. Within the limit of this study, strength resistance is not the most important criterion for choosing the type of material, preparation, or endodontic treatment for endocrowns. Resin simulators are not efficient for in vitro strength studies.
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Affiliation(s)
- Marie-Laure Munoz-Sanchez
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (O.F.); (M.H.); (N.D.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Alexis Gravier
- Institut Pascal UMR CNRS 6602, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Olivier Francois
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (O.F.); (M.H.); (N.D.)
| | - Emmanuel Nicolas
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (O.F.); (M.H.); (N.D.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (O.F.); (M.H.); (N.D.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Nicolas Decerle
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (O.F.); (M.H.); (N.D.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
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Veselinova M, Diamantopoulou S, Paximada C, Papazoglou E. In-Vitro Comparison of Fracture Strength of Endocrowns and Overlays in Endodontically Treated Teeth Manufactured with Monolithic Lithium Disilicate and Zirconia. J Funct Biomater 2023; 14:422. [PMID: 37623666 PMCID: PMC10455451 DOI: 10.3390/jfb14080422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
To evaluate the fracture strength and the failure mode of endodontically treated molars restored with monolithic lithium disilicate and zirconia endocrowns and overlays. A total of 48 extracted mandibular molars were endodontically treated, decoronated 2 mm above the cementoenamel junction and divided into four 12-specimen groups. Group ELD: lithium disilicate endocrowns. Group EZ: monolithic zirconia endocrowns. Group OLD: lithium disilicate overlays. Group OZ: monolithic zirconia overlays. Overlays did not extend in the pulp chamber and endocrowns extended in the pulp chamber 2 mm. After adhesive bonding of the restorations, the specimens were subjected to thermocycling (×5000 cycles) and then to fracture resistance testing at lateral static loading (1 mm/min) at a universal testing machine. The failure mode of the specimens was qualitatively evaluated. Differences in means were compared using with t-tests for independent samples or Mann-Whitney test (p < 0.05). Weibull distribution analysis was also performed. Group ELD showed significantly higher fracture strength than all other groups (p = 0.001), and the highest Weibull modulus. Conclusions: Lithium disilicate endocrowns exhibit higher fracture strength and are more reliable compared to the other types of restorations examined. Endocrowns had more catastrophic failures compared to overlays.
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Affiliation(s)
| | | | | | - Efstratios Papazoglou
- Department of Operative Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.V.); (S.D.); (C.P.)
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El-Farag SAA, Elerian FA, Elsherbiny AA, Abbas MH. Impact of different CAD/CAM materials on internal and marginal adaptations and fracture resistance of endocrown restorations with: 3D finite element analysis. BMC Oral Health 2023; 23:421. [PMID: 37357307 DOI: 10.1186/s12903-023-03114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/06/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To assess and compare the impact of various computers aided design/manufacturing (CAD/CAM) materials on internal and marginal discrepancies, fracture resistance and failure probability of Endocrown restorations with 3D Finite Element analysis. MATERIAL AND METHODS Forty devitalized human maxillary first molars were collected. After endodontic treatment, they classified into 4 groups (n = 10) based on the materials used for endocrown fabrication. Group V (Vita-Enamic), Group N (Nacera Hybrid), Group T (Translucent Prettau Zirconia) and Group P (Pekkton ivory). All samples were exposed to artificial aging method simulating one year of clinical service. Silicone replica technique and stereomicroscope (25X) utilized to evaluate the marginal and internal gaps of endocrowns at different areas. Fracture resistance test used for cemented specimens followed by qualitative investigation utilizing Stereomicroscopy. Four models representing four endocrown systems used for restoration of severely-damaged endodontically treated upper first molar were generated for finite element analysis (FEA). Axially and centrally static occlusal compressive load was applied. Modified Von Mises and maximum principal stress values on the remaining tooth structure, cement lines and restorative materials were assessed independently. Resulted data were statistically analyzed at P-value ≤ 0.05. RESULTS In the current study, the highest mean values of internal and marginal discrepancies (μm) among studied groups were reported for Zirconia group (100.300 and 102.650) respectively, while the lowest mean value of internal discrepancy (μm) was observed for Nacera group (69.275) and the lowest mean value of marginal discrepancy (μm) was observed for PEKK group (78.4750). Regarding internal discrepancy, Vita-Enamic and PEKK groups did not exhibit any statistically significant differences (P = 0.293), however zirconia and the other tested groups exhibited statistically significant differences in the mean values of the marginal gap region (p 0.05).On the other hand, PEKK group showed the highest mean value of fracture resistance (1845.20 N) and the lowest value was observed for Vita-Enamic group (946.50 N). Regarding to stress distributions through 3D FEA, and according to modified von Mises (mvM) analysis, the greatest possible stress values were noticed in PEKK model in relation to tooth structure, cement line, and flowable composite as the following: (93.1, 64.5, 58.4 MPa) respectively, while Zirconia revealed lower maximum stress values (11.4, 13.6, 11.6 MPa) respectively. CONCLUSIONS Statistically excellent marginal and internal fit was observed for PEKK in relation to other used endocrown materials. Also, PEKK material explained fracture resistance comparable to zirconia value while the lowest value was detected for Vita Enamic material.
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Affiliation(s)
- Shaimaa Ahmed Abo El-Farag
- Fixed Prosthodontics Department, Faculty of Dentistry, Mansoura University and Horus University (HUE), Mansoura, Egypt
| | - Fatma Abdallah Elerian
- Production and Mechanical Design Department, Faculty of Engineering, Mansoura University, Mansoura, 35516, Egypt
| | - Abdallah Ahmed Elsherbiny
- Production and Mechanical Design Department, Faculty of Engineering, Mansoura University, Mansoura, 35516, Egypt
| | - Mahy Hassouna Abbas
- Fixed Prosthodontics Department, Faculty of Dentistry, Mansoura University and Delta University for Science and Technology, Mansoura, Egypt.
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19
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Gouda A, Sherif A, Wahba M, Morsi T. Effect of veneering material type and thickness ratio on flexural strength of bi-layered PEEK restorations before and after thermal cycling. Clin Oral Investig 2023; 27:2629-2639. [PMID: 36602589 PMCID: PMC10264476 DOI: 10.1007/s00784-022-04829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/18/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was evaluating the biaxial strength of bi-layered PEEK restorations before and after aging using different veneering materials in different thickness ratios. MATERIAL AND METHODS Ninety specimens of thickness 1.5 mm were divided into three groups according to their veneering material. Group (CAD LD): BioHPP discs veneered with CAD milled lithium disilicate (n=30), group (CAD C): BioHPP discs veneered with CAD milled composite (n=30), and group (LC): BioHPP discs veneered with conventionally layered composite (n=30). Each group was subdivided into 3 subgroups (n=10) according to the different thickness ratios between the core and the veneering material (TC:TV). Subgroup 1: TC:TV=1:0.5, subgroup 2: TC:TV=0.7:0.8, and subgroup 3: TC:TV=0.5:1. Half of the specimens of each subgroup were subjected to thermocycling, and the bi-axial flexural strength of all specimens was tested before and after aging. Three-way ANOVA followed by Bonferroni's post hoc test were used for data analysis. The significance level was set at P ≤ 0.05. RESULTS Material, thickness ratio, and aging all had a significant effect on biaxial flexural strength. (LC) group had the highest biaxial flexural strength. TC:TV=0.5:1 showed the lowest biaxial flexural strength. All groups showed significant decrease in biaxial flexural strength after aging. CONCLUSIONS Veneering material for PEEK together with the thickness ratio between the core and veneering material greatly affect the flexural strength of bi-layered restorations. Thermocycling negatively impacts the flexural strength of PEEK bi-layered restorations. CLINICAL SIGNIFICANCE According to the results of that study, PEEK cores are best veneered with conventionally layered composite with core to veneering thickness ratio being 1:0.5.
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Affiliation(s)
- Ahmed Gouda
- Postgraduate Student, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
| | - Ashraf Sherif
- Fixed Prosthodontics Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
| | - Mennatallah Wahba
- Fixed Prosthodontics Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
| | - Tarek Morsi
- Fixed Prosthodontics Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
- Vice Dean Postgraduate Affairs. Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
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20
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Qamar Z, Alghamdi AMS, Haydarah NKB, Balateef AA, Alamoudi AA, Abumismar MA, Mathur A, Minervini G. In Vitro Evaluation of Lithium Disilicate Endocrowns and Post and Core Crowns-A Systematic Review. J Funct Biomater 2023; 14:jfb14050276. [PMID: 37233386 DOI: 10.3390/jfb14050276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
The aim of this systematic review was to summarize the results of the studies that have compared the physical and mechanical properties of lithium disilicate (LDS) endocrowns constructed for posterior teeth to those retained by post-and-core retention systems. The review was conducted following the PRISMA guidelines. The electronic search process was conducted on PubMed-Medline, Scopus, Embase and ISI Web of Knowledge (WoS) from the earliest available date till 31 January 2023. Additionally, the studies were assessed for their overall quality and risk of bias using the Quality Assessment Tool For In Vitro Studies (the QUIN). The initial search resulted in 291 articles, out of which, only 10 studies met the eligibility criteria. In all studies LDS endocrowns were compared with various kinds of endodontic posts and crowns made from other materials. There were no definite pattern or trends observed in the fracture strengths of tested specimens. There was no predilection observed in failure patters among the experimental specimens. No predilection was observed in the fracture strengths of LDS endocrowns when compared to post-and-core crowns. Furthermore, no differences in failure patterns could be observed when both types of restorations were compared. The authors propose standardized testing of endocrowns against post-and-core crowns in future studies. In conclusion, long-term clinical trials are advocated to compare the survival, failure and complication rates of LDS endocrowns and post-and-core restorations.
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Affiliation(s)
- Zeeshan Qamar
- Department of O&MFS and Diagnostic Sciences, Faculty of Dentistry, Riyadh Elm University, Riyadh 13244, Saudi Arabia
| | | | | | | | | | | | - Ankita Mathur
- STAT SENSE, Srushti 10, Sector 1 D, Amba Township Pvt. Ltd., Trimandir, Adalaj 382421, Gujarat, India
- Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
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Demachkia AM, Velho HC, Valandro LF, Dimashkieh MR, Samran A, Tribst JPM, de Melo RM. Endocrown restorations in premolars: influence of remaining axial walls of tooth structure and restorative materials on fatigue resistance. Clin Oral Investig 2023:10.1007/s00784-023-04895-6. [PMID: 36781479 DOI: 10.1007/s00784-023-04895-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To evaluate the effect of the remaining tooth structure and different CAD/CAM materials on the fatigue performance and failure mode of endodontically treated premolars restored with endocrowns. MATERIALS AND METHODS Ninety maxillary premolars were endodontically treated and assigned into 6 groups (n = 15) according to the number of remaining axial walls (four, three, and two) and restorative materials (ultra-translucent zirconia 5Y-PSZ [KATANA UTML] and lithium disilicate [IPS e.max-CAD]). The specimens were subjected to cyclic fatigue loading test (initial load 200 N; 20 Hz). An incremental step load of 100 N per 10,000 cycles was applied until failure. The fatigue failure load (FFL) and number of failure cycles (CFFs) data were statistically analyzed with two-way ANOVA and Kaplan-Meier test (α = 0.05). Failed specimens were examined under a stereomicroscope 25 × and failure modes were determined. RESULTS FFL and CFF were significantly influenced by restorative material (p < 0.05). 5Y-PSZ endocrowns showed significantly higher FFL when compared with lithium disilicate. The number of remaining walls did not affect the fatigue behavior or failure mode of the specimens. Of the lithium disilicate restorations, 51% had repairable failures, while 95% 5Y-PSZ restorations had non-repairable failures. CONCLUSIONS Zirconia endocrowns showed better FFL than lithium disilicate endocrowns, regardless of the number of remaining axis walls. Lithium disilicate and 5Y-PSZ endocrowns showed FFL higher than the normal masticatory loads. CLINICAL RELEVANCE Restoring endodontically treated premolars with endocrown could be a promising treatment, regardless of the remaining axial walls. However, precaution should be taken in material selection since it affects the fatigue resistance and failure mode.
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Affiliation(s)
- Amir Mohidin Demachkia
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo,777. 12245000, São José Dos Campos, São Paulo, Brazil.
| | - Helder Callegaro Velho
- Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul State, Brazil
| | - Luiz Felipe Valandro
- Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul State, Brazil
| | - Mohiddin Rida Dimashkieh
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Abdulaziz Samran
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - João Paulo Mendes Tribst
- Department of Oral Regenerative Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renata Marques de Melo
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo,777. 12245000, São José Dos Campos, São Paulo, Brazil
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Darwich MA, Aljareh A, Alhouri N, Szávai S, Nazha HM, Duvigneau F, Juhre D. Biomechanical Assessment of Endodontically Treated Molars Restored by Endocrowns Made from Different CAD/CAM Materials. MATERIALS (BASEL, SWITZERLAND) 2023; 16:764. [PMID: 36676500 PMCID: PMC9864025 DOI: 10.3390/ma16020764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/03/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
The aim of this study was to evaluate the deflection and stress distribution in endodontically treated molars restored by endocrowns from different materials available for the computer-aided design/computer-aided manufacturing (CAD/CAM) technique using three-dimensional finite element analysis. The models represented extensively damaged molars restored by endocrowns from the following materials: translucent zirconia; zirconia-reinforced glass ceramic; lithium disilicate glass ceramic; polymer-infiltrated ceramic network (PICN) and resin nanoceramic. Axial and oblique loadings were applied and the resulting stress distribution and deflection were analyzed. The Mohr-Coulomb (MC) ratio was also calculated in all models. The translucent zirconia endocrown showed the highest stress concentration within it and the least stress in dental structures. The resin nanoceramic model was associated with the greatest stress concentration in dental tissues, followed by the PICN model. Stress was also concentrated in the distal region of the cement layer. The MC ratio in the cement was higher than 1 in the resin nanoceramic model. Oblique loading caused higher stresses in all components and greater displacement than axial loading, whatever the material of the endocrown was. The translucent zirconia model recorded deflections of enamel and dentin (38.4 µm and 35.7 µm, respectively), while resin nanoceramic showed the highest stress concentration and displacement in the tooth-endocrown complex.
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Affiliation(s)
- Mhd Ayham Darwich
- Faculty of Biomedical Engineering, Al-Andalus University for Medical Sciences, Tartous, Syria
- Faculty of Technical Engineering, University of Tartous, Tartous, Syria
| | - Abeer Aljareh
- Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Nabil Alhouri
- Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Szabolcs Szávai
- Faculty of Mechanical Engineering and Informatics, University of Miskolc, 3515 Miskolc, Hungary
| | - Hasan Mhd Nazha
- Faculty of Mechanical Engineering, Institute of Mechanics, Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Fabian Duvigneau
- Faculty of Mechanical Engineering, Institute of Mechanics, Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Daniel Juhre
- Faculty of Mechanical Engineering, Institute of Mechanics, Otto Von Guericke University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
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Bozkurt DA, Buyukerkmen EB, Terlemez A. Comparison of the pull-out bond strength of endodontically treated anterior teeth with monolithic zirconia endocrown and post-and-core crown restorations. J Oral Sci 2023; 65:1-5. [PMID: 36385051 DOI: 10.2334/josnusd.22-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess the pull-out bond strength (PBS) of endodontically treated anterior teeth that had been restored with monolithic zirconia endocrowns using different extension depths (EDs) and post-and-core crowns after chewing simulation. METHODS Thirty-six maxillary central teeth were used (n = 12). Group I: Glass fiber post-and-core crown, Group II: Endocrown with 3-mm EDs, Group III: Endocrown with 5-mm EDs. Restorations were fabricated from monolithic zirconia blocks using a CAM (computer-aided manufacturing) device. For cementation, conventional resin luting agent (Multilink N) was used. All samples were aged with a chewing simulator and PBS tests were conducted at a speed of 1 mm/min using an electromechanical servo universal testing machine. The values were recorded in MPa by dividing the failure load by the bonding area. One-way ANOVA and the post-hoc Tukey test were used for statistical analysis (P = 0.05). RESULTS Group III demonstrated significantly greater PBS values than Groups I and II (P = 0.001). No significant difference was found between Groups I and II (P = 0.072). CONCLUSION Increasing the ED of an endocrown influences the PBS of endodontically treated anterior teeth restored with monolithic zirconia endocrowns.
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Affiliation(s)
- Durmus A Bozkurt
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University
| | - Emine B Buyukerkmen
- Department of Prosthodontics, Faculty of Dentistry, Necmettin Erbakan University
| | - Arslan Terlemez
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University
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Shafi MA, Rayyan MR. Failure loads of heat-pressed versus milled lithium disilicate endocrowns. Clin Oral Investig 2023; 27:339-344. [PMID: 36197546 DOI: 10.1007/s00784-022-04728-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/27/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aimed to compare the failure load of heat-pressed versus milled lithium disilicate endocrowns. MATERIALS AND METHODS Twenty extracted mandibular molars were sectioned 1.5 mm above the CEJ. Root canal treatment and endocrown preparation were done for all teeth. Samples were then divided into two groups: heat-pressed glass ceramic endocrowns (HP group) (n = 10) and milled endocrowns (CAD group) (n = 10). Cementation was done using self-adhesive resin cement, and a compressive load was applied on the occlusal surface of the specimens until failure occurred. RESULTS The mean failure loads were significantly higher in the HP group (2546.5 ± 339 N) compared to the CAD group (1759.9 ± 114.2) (p < 0.05), and majority of failures were due to fracture of the restoration. CONCLUSIONS Failure loads of heat-pressed lithium disilicate endocrown are superior to milled endocrown. CLINICAL RELEVANCE Molars restored with lithium disilicate endocrowns have higher failure loads than the maximum human bite force regardless of the fabrication method. Although heat-pressed endocrowns have superior failure loads to milled ones, both are indicated for restoring endodontically treated molar teeth.
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Affiliation(s)
- Mowaffq Abdulhamed Shafi
- Prosthdontic Department, College of Dentistry, Riyadh Elm University, P.O. Box: 84891, Riyadh, 11681, Saudi Arabia
| | - Mohammad Ramadan Rayyan
- Prosthdontic Department, College of Dentistry, Riyadh Elm University, P.O. Box: 84891, Riyadh, 11681, Saudi Arabia.
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Marginal Fit of Porcelain Laminate Veneer Materials under Thermocycling Condition: An In-Vitro Study. Dent J (Basel) 2023; 11:dj11010012. [PMID: 36661549 PMCID: PMC9858300 DOI: 10.3390/dj11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Objective: The purpose of this study was to evaluate the cervical marginal fit of porcelain laminate veneer (PLV) restorations made from two different types of CAD/CAM ceramic laminates: CEREC C PC and E.max (LD). Materials and Methods: This in-vitro experiment used a total of 32 human maxillary first premolars that were clean and free of any cracks or caries, extracted for orthodontic purposes. The samples were divided in a random way into two study groups: A and B (n = 16). Each sample was mounted on a dental surveyor and a silicon impression was made to create a silicone index for each tooth in both groups. Standardized preparation was carried out for all the samples by using preparation bur kit for the ceramic veneer system. Subsequently, digital impressions were made for all the samples by using Trios 3 shape intraoral camera (Sirona Dental Systems). The design of veneer restorations was made using Sirona inLab CAD SW 16.1 with CEREC inLab MC XL (Dentsply, Sirona Dental Systems, Bensheim, Germany). The veneer restorations were cemented using 3M RelyX veneer resin cement (3M ESPE, Seefeld, Germany) and the samples kept in distilled water for two weeks at 37 °C. All the specimens were subjected to thermocycling in a water bath with temperature varying between 5 °C and 55 °C for 500 cycles. The cervical marginal fit of veneers was evaluated by a digital microscope after sectioning the embedded teeth in acrylic resin. Results: The lowest mean of cervical marginal gap was recorded for Group A (91.59431 ± 1.626069) which was restored with CEREC CAD/CAM veneers, while the highest mean value of the gap was recorded for Group B (106.48863 ± 2.506684) which was restored with IPS E.max CAD. The t-test showed that the type of porcelain veneer restoration had a highly significant effect on the cervical marginal fit (p ≤ 0.01). Conclusions: CEREC CAD/CAM veneers showed smaller cervical marginal gaps, indicating a better fit compared to the IPS E.max CAD.
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Kaya Büyükbayram I, Güven ME, Ayman D, Şener Yamaner ID, Cakan EF. Fracture resistance of resin endocrowns with and without fiber reinforced composite base material: A preliminary study. J Appl Biomater Funct Mater 2023; 21:22808000231151832. [PMID: 36708253 DOI: 10.1177/22808000231151832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effects of fiber-reinforced composite base material on fracture resistance and fracture pattern of endodontically treated maxillary premolars restored with endocrowns using two different resin nanoceramic computer-aided design and computer-aided manufacturing (CAD/CAM) restorative material. METHODS Forty extracted sound maxillary premolars with an occlusal reduction of 2 mm above the cementoenamel junction (CEJ) was performed following root canal treatment. Mesial interproximal box was prepared for each tooth at the margin of the CEJ and randomly distributed into four groups (n = 10) as follows: Group A, no resin build-up in the pulp chamber; Group B, 2 mm of fiber-reinforced composite (FRC) build-up (EverX Posterior, GC).; Group C, no resin build-up in pulp chamber; Group D, 2 mm of FRC build-up. Groups A and B were prepared with resin nanoceramic (RNC) consisting ceramic nanofillers (Lava Ultimate 3 M ESPE), while Group C and D were prepared with RNC consisting ceramic nanohybrid fillers (Cerasmart GC Corp). All samples were subjected to 1,200,000 chewing cycles (1.6 Hz, 50 N) and 5000 thermal cycles (5°C-55°C) for artificial aging on a chewing simulator with thermal cycles (CSTC). Samples that survived the CSTC test without being damaged were subjected to a load-to-fracture test. RESULTS The highest mean fracture strength was found in Group D (936.0 ± 354.7) and lowest in Group A (684.2 ± 466.9). Fracture strength was higher in groups where FRC was used as a base material than plain restorations. However, there were no significant differences between the Lava and Cerasmart groups with and without FRC (p > 0.05). Most of the samples were irreparably fractured under CEJ. CONCLUSION Using short FRCs as a resin base material did not significantly improve fracture resistance. Cerasmart and Lava blocks had similar fracture resistance and fracture pattern.
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Affiliation(s)
- Işıl Kaya Büyükbayram
- Department of Endodontics, School of Dentistry, İstanbul Aydın University, Küçükçekmece, İstanbul, Turkey
| | - Mehmet Esad Güven
- Department of Prosthodontics, School of Dentistry, Necmettin Erbakan University, Konya, İstanbul, Turkey
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Gong Q, Huang L, Luo J, Zhang Y, Meng Q, Quan J, Tong Z. The practicability of different preparation of mandibular molar restored by modified endocrown with intracanal extension: Computational analysis using finite element models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107178. [PMID: 36242865 DOI: 10.1016/j.cmpb.2022.107178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Post-core-crown (PCC) and endocrown are two common restorative methods for severely damaged molars, but exhibit disadvantages. This study aimed to explore the practicability of modified endocrown with a 2 mm intracanal extension (MED) to restore defective teeth using finite element analysis (FEA). METHODS Five groups of numerical models of mandibular molars restored by three MEDs, a PCC, and a routine endocrown after root canal treatment were devised by FEA software. We constructed 4 mm, 3 mm, and 2 mm thickness of MED restorations to restore mandibular molars that were prepared to 1 mm, 2 mm, and 3 mm from the cemento-enamel junction (CEJ). Furthermore, PCC and routine endocrown were used to compare the stress distribution with MED. Lithium disilicate glass-ceramics (EMAX) and resin nanoceramics (LU) were considered restorative materials, and a vertical load of 600 N and an oblique load of 200 N were applied to the restorations. RESULTS In three MEDs by LU, 2 mm thickness of restoration generated the highest stress on prepared teeth, while the thickness of EMAX did not significantly influence the stress value. MED by LU generated higher stress around the CEJ, and reduced the stress on the middle and lower root compared to MEDs by EMAX, PCC by EMAX, and PCC by LU. MED by EMAX caused lower stress around the CEJ, and generated higher stress in the chamber walls after extended root canals compared with MED by LU, endocrowns by LU, and endocrowns by EMAX. There was an evident stress concentration at the last but one layer, which was a thin area of the tooth root in all restorative models. CONCLUSIONS The use of modified endocrown may be considered an effective restorative method to restore defective mandibular molar, but suitable restorative material must be selected based on the tooth preparation method and deficiencies in the tooth structure.
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Affiliation(s)
- Qimei Gong
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Luo Huang
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junpan Luo
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuejiao Zhang
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qingzhen Meng
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingjing Quan
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongchun Tong
- Hosiptal of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Çiriş GS, Altıntaş E. Comparison of Fracture Strength of Modified PEEK, Nanohybrid Ceramic, Monolithic Zirconium Endocrowns Produced with CAD/CAM System. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.23500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Deulkar PV, Bane SP, Rathi NV, Thosar NR. Rehabilitation of Traumatised Maxillary Anterior Teeth in Children Using Endocrown: A Case Series. Cureus 2022; 14:e28102. [PMID: 36127952 PMCID: PMC9480489 DOI: 10.7759/cureus.28102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022] Open
Abstract
Trauma to the anterior teeth has a great impact on the societal and psychosomatic well-being of an individual. Restoring such teeth with a minimally invasive approach is of utmost importance. Endocrown is a monolithic ceramic bonded structure that can be made at dental laboratories for the maintenance of tooth structures. This alternative for endodontically treated teeth turns out to be a viable option in restoring traumatic tooth structures. The steps in its preparation are easy and conservative when compared to conventional crowns with post and core. This article emphasizes two different cases of traumatic anterior teeth in children, successfully dealt with by means of endocrowns fabricated with composite and lithium disilicate prostheses with a 10-month follow-up period.
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Clinical Effect of Feldspar Glass Ceramics and Lithium Disilicate Reinforced Glass Ceramics. CONTRAST MEDIA & MOLECULAR IMAGING 2022. [DOI: 10.1155/2022/9691594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical effect of feldspar ceramics and lithium disilicate reinforced glass ceramics was studied. 57 affected teeth with complete root canal treatment and computer aided design/computer aided manufacturing (CAD/CAM) endocrown restoration were reviewed 24-36 months aftercompletion of the restoration. These dimensions including anatomical morphology, proximal contact , color matching, edge integrity, edge coloring, secondary caries, kinesthetic occlusion relationship, and periodontal health of the affected teeth by the modified clinical scoringcriteriafor United States Public Health Service (USPHS) were evaluated, and the patients’ satisfaction was recorded. The 57 affected teeth were divided into feldspar group and lithium disilicate reinforced ceramic group according to the different repair materials, and the statistical results are analyzed. The experimental results show medullary fixation crown can be used to repair a large area of dental defects after root canal treatment.
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Zhang Y, Lai H, Meng Q, Gong Q, Tong Z. The synergetic effect of pulp chamber extension depth and occlusal thickness on stress distribution of molar endocrowns: a 3-dimensional finite element analysis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:56. [PMID: 35723747 PMCID: PMC9209353 DOI: 10.1007/s10856-022-06677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate the effects of butt margin, occlusal thickness and pulp chamber extension depth on stress distributions on mandibular molar endodontically treated teeth (ETT) with EMAX endocrown restoration using 3-dimensional finite element analysis (FEA). The FEA models of endocrown with flat surface or curve surface of butt margin were firstly evaluated stress distributions, and then 9 FEA models of endocrown with 1-, 2- or 3-mm pulp chamber extension depth and 1-, 2- or 3-mm occlusal thickness were generated using curve surface of butt margin. In all of FEA models, a 200 N of vertical load or horizontal load was applied, and the von Mises stress (VMS) were evaluated. The results showed that curve surface of butt margin offered more adhesive area of enamel, though VMS on the prepared teeth was similar in flat surface and curve surface models. In 9 endocrown models, 2-mm occlusal thickness showed the lowest VMS on restorations, teeth tissue and root furcations, and 2-mm extension depth displayed the lowest VMS on root furcations under vertical load. Also, 2-mm extension depth exhibited the lowest VMS on restorations and teeth tissue under horizontal load. Within the limitations of this FEA study, the results of this study could be used as an aid for dentists to better devise endocrown restorations. Graphical abstract.
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Affiliation(s)
- Yuejiao Zhang
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongbin Lai
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qingzhen Meng
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qimei Gong
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongchun Tong
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
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李 智, 徐 永, 包 旭, 王 晓. [Effects of the resin base and retention depth on fracture resistance of molars restored with nano-ceramic endocrowns]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:95-99. [PMID: 35165474 PMCID: PMC8860635 DOI: 10.19723/j.issn.1671-167x.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the effects of resin base and different retention depth on the fracture resistance of mandibular molars restored with nano-ceramic endocrowns. METHODS Forty mandibular molars selected and randomly divided into 5 groups: ① The control group which was consisted of intact teeth, ② the non-resin base group, ③ the 2 mm retention depth group, ④ the 3 mm retention depth group, ⑤ the 4 mm retention depth group, respectively. After tooth preparation, in vitro root canal therapy was conducted, which was followed by endocrown design, production and adhesive of groups ②-⑤. All the samples were under load (N) of the universal mechanical testing machine after embedding. The fracture pattern of each sample was observed under stereomicroscope. Then the microstructure of the fracture surface was observed by scanning electron microscopy. RESULTS The fracture loads of each group were respectively: the control group fracture load was (3 069.34±939.50) N; experimental groups: fracture load of (2 438.04±774.40) N for the group without resin base; fracture load of (3 537.18±763.65) N for the group with 2 mm retention depth. The fracture load of the retention depth 3 mm group was (2 331.55±766.39) N; the fracture load of the retention depth 4 mm group was (2 786.98±709.24) N. There was statistical significance in the effect of resin base and different retention depth on the fracture loads of molars restored with nano-ceramic endocrown (P < 0.05). Repairable fractures in each group were as follows: control group 2/8, non-resin base group 1/8, retention depth of 2 mm group 1/8, retention depth of 3 mm group 2/8, and retention depth of 4 mm group 0/8. The effects of the retention depth and the presence of resin base on the fracture resistance of the resin nano-ceramic endocrowns were statistically significant (P < 0.05). Scanning electron microscopy showed more arrest lines and small twist hackles on the fracture surface of the restorations with resin base (retention depths of 2 mm, 3 mm, and 4 mm), with cracks extending towards the root. In addition to the characteristics above, more transverse cracks parallel to the occlusal surface, pointing outwards from the center of the pulp cavity retention, were also observed on the fracture surface of the non-resin base restorations. CONCLUSION When molar teeth with nano-ceramic endocrowns are restored, resin base and the retention depth of 2 mm help the teeth to obtain optimal fracture strength.
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Affiliation(s)
- 智 李
- 北京大学口腔医学院·口腔医院牙体牙髓科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digtal Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 永祥 徐
- 北京大学口腔医学院·口腔医院材料研究室,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Dental Materials, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digtal Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 旭东 包
- 北京大学口腔医学院·口腔医院牙体牙髓科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digtal Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 晓燕 王
- 北京大学口腔医学院·口腔医院牙体牙髓科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digtal Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
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Zheng Z, Sun J, Jiang L, Wu Y, He J, Ruan W, Yan W. Influence of margin design and restorative material on the stress distribution of endocrowns: a 3D finite element analysis. BMC Oral Health 2022; 22:30. [PMID: 35120525 PMCID: PMC8817586 DOI: 10.1186/s12903-022-02063-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the stress distributions in endocrown restorations as applied to endodontically treated teeth (ETT), according to the factors of “margin design” (four levels) and “restorative material” (six levels). Methods Four 3D-finite elements models were constructed for endocrown restored molars considering different margin designs. Model A was prepared with a flat butt joint margin and received an endocrown with a 2.0-mm occlusal thickness. Model B was prepared with a 20° bevel margin and received an endocrown with a 2.0-mm occlusal thickness. Model C was prepared with an axial reduction and 1-mm shoulder margin and received an endocrown with a 2.0-mm occlusal thickness. Model D was prepared with an anatomic margin and received an endocrown with a 2.0-mm occlusal thickness. The following endocrown materials were used: In-Ceram Zirconia (Zr), Vita Suprinity (VS), IPS Empress (IE), Grandio blocs (GR), VisCalor bulk (VS), and CopraPeek Light (CP). The Load application (600 N) was performed at the food bolus and tooth surface during the closing phase of the chewing cycle. The results for the endocrown and tooth remnants were determined according to the von Mises stress. The failure risk of the cement layer was also calculated based on the normal stress criterion. Results Model D (with an anatomic margin) showed the greatest stress concentrations, especially in the irregular and sharp angles of the restoration and tooth remnants. The stress concentrated on the dentin was significantly lower in Model B with a 20° bevel margin (20.86 MPa), i.e., 1.3 times lower than the other three margin designs (27.80 MPa). Restorative materials with higher elastic moduli present higher stress concentrations inside the endocrown and transmit less stress to the cement layer, resulting in lower bonding failure risks. In contrast, materials with an elastic modulus similar to that of dentin presented with a more homogeneous stress distribution on the whole structure. Conclusions An endocrown with a 20° bevel margin design could be a favorable preparation option for ETT. Composite resins (GR and VC) exhibit a more even stress distribution, and seem to be more promising materials for endocrown molars.
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Affiliation(s)
- Ziting Zheng
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jieli Sun
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Stomatology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Lifang Jiang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Wu
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiahui He
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenhao Ruan
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjuan Yan
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Barallat L, Arregui M, Fernandez-Villar S, Paniagua B, Pascual-La Rocca A. Fracture Resistance in Non-Vital Teeth: Absence of Interproximal Ferrule and Influence of Preparation Depth in CAD/CAM Endocrown Overlays-An In Vitro Study. MATERIALS 2022; 15:ma15020436. [PMID: 35057154 PMCID: PMC8778771 DOI: 10.3390/ma15020436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance.
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Affiliation(s)
- Lucía Barallat
- Department of Periodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, 08195 Sant Cugat del Valles, Spain; (L.B.); (B.P.); (A.P.-L.R.)
| | - María Arregui
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, 08195 Sant Cugat del Valles, Spain
- Correspondence: ; Tel.: +34-93504200
| | - Sandra Fernandez-Villar
- Department of Restorative Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, 08195 Sant Cugat del Valles, Spain;
| | - Blanca Paniagua
- Department of Periodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, 08195 Sant Cugat del Valles, Spain; (L.B.); (B.P.); (A.P.-L.R.)
| | - Andrés Pascual-La Rocca
- Department of Periodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, 08195 Sant Cugat del Valles, Spain; (L.B.); (B.P.); (A.P.-L.R.)
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Mezied M, Alhazmi A, Alhamad G, Alshammari N, Almukairin R, Aljabr N, Barakat A, Koppolu P. Endocrowns versus post-core retained crowns as a restoration of root canal treated molars - A review article. J Pharm Bioallied Sci 2022; 14:S39-S42. [PMID: 36110800 PMCID: PMC9469346 DOI: 10.4103/jpbs.jpbs_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/20/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
Normally root canal-treated teeth are covered with crowns to prevent fracture, which becomes challenging in cases where the tooth is extensively damaged. In such instances, various restorative methods such as post-core and endocrowns have been in use. The former methodology in recent times is being discouraged owing to impending tooth weakening. Due to this reason, an uncommon type of reconstruction, endocrowns are preferred. We carried out a comparative review of restorations for endodontically treated molars.
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Yildirim G, Demir C, Güven MÇ, Koç O, Dalkiliç EE. Influence of fiber insertion and different material type on stress distribution in endocrown restorations: a 3D-FEA study. Comput Methods Biomech Biomed Engin 2021; 25:1509-1519. [PMID: 34964689 DOI: 10.1080/10255842.2021.2019228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study aimed to evaluate the effects of fibers insertion and restorative material type on the stress distribution in endocrowns with finite element analysis. Five 3D models of first mandibular molars were created and restored as follows: (1) IN: intact tooth, (2) IPS-E: tooth restored with lithium disilicat ceramic endocrowns, (3) C-E: tooth restored with composite endocrowns, (4) IPS-E + F: lithium disilicate ceramic endocrowns + fiber, (5) C-E + F: composite endocrowns + fiber. Vertical masticatory load was imitated with finite element analysis. The equivalent stress of von Mises failure criterion (mvM) was calculated. The maximum mvM stress, enamel/crown, dentin and cement were compared among models and strength of the materials. Endocrowns presented a lower mvM stress level than intact tooth. In IPS-E, the mvM stress values in the crown and dentin were higher than C-E, while the mvM stress values in cement were higher in C-E group. Fibers insertion did not affect the stress level of IPS-E and C-E groups. In IPS model, fiber showed more stress absorption than C-E. The restorative material type changed the stress distribution of endocrown restorations. The fiber application did not affect the stress distribution in either endocrown group. But, more stress absorption was observed in fiber under IPS-E than C-E.
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Affiliation(s)
- Gulhan Yildirim
- Department of Prosthodontics, Beykent University, Istanbul, Turkey
| | - Cihan Demir
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
| | | | - Osman Koç
- Faculty of Mechanical Engineering, Yildiz Technical University, Istanbul, Turkey
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Comparison of Marginal and Internal Adaptation in Endocrowns Milled from Translucent Zirconia and Zirconium Lithium Silicate. Int J Dent 2021; 2021:1544067. [PMID: 34917150 PMCID: PMC8670910 DOI: 10.1155/2021/1544067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aimed to compare marginal and internal adaptation in endocrowns made from translucent zirconia and zirconium lithium silicate using CAD-CAM technology. Materials and Methods Twenty-eight freshly extracted upper molars were mounted in acrylic resin and underwent root canal therapy and endocrown preparation up to 2 mm above the cementoenamel junction. Endocrowns were CAD-CAM milled from zirconium lithium silicate (ZLS) and translucent zirconia (Zr). Internal and marginal adaptation was assessed by the replica technique before cementation. Marginal adaptation was evaluated by a stereomicroscope (×32) before and after cementation and also after thermomechanical aging. Results The ZLS group showed significantly higher internal adaptation compared to the Zr group (P = 0.028), while the marginal adaptation differences, at different times with different methods, were not statistically significant (P > 0.05). Axiomarginal angle had the highest and axiopulpal angle showed the lowest adaptation in both groups. The cementation process and thermomechanical aging increased the marginal gap in both groups significantly (P < 0.001). The marginal gap assessed by the replica technique before cementation was 7.11 µm higher than direct view under a stereomicroscope with intraclass correlation coefficient of 0.797. Conclusion Zirconia seems to be an acceptable material for endocrown with comparable internal and marginal adaptation to ZLS. Cementation and thermomechanical aging had significantly negative effects on marginal gap. The marginal gap assessed by the replica technique was higher than direct view under the stereomicroscope technique.
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Rehabilitation of severely-destructed endodontically treated premolar teeth with novel endocrown system: Biomechanical behavior assessment through 3D finite element and in vitro analyses. J Mech Behav Biomed Mater 2021; 126:105031. [PMID: 34922296 DOI: 10.1016/j.jmbbm.2021.105031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Rehabilitation of endodontically treated premolars with extensive coronal destruction through endocrown approach remains a controversial topic in reconstructive dentistry. There is no clear consensus in the literature which endocrown design with which material is the most effective restoration option for severely-destructed endodontically treated premolars. The aim of this study was to assess the biomechanical behavior of endodontically treated maxillary first premolars restored with a novel endocrown system compared to the conventional one varying the applied load type through finite element and in vitro analyses. MATERIALS AND METHODS For finite element analysis, two models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: Model C for the conventional monolithic IPS e.max CAD endocrown and Model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). Modified von Mises stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately under axial and oblique loading of 450 N. For in vitro analysis, forty sound human bifurcated maxillary first premolars were collected, endodontically-treated, and divided into 2 main groups (n = 20) according to the system used for endocrown fabrication; Group C: the conventional monolithic endocrowns and Group P: the novel bi-layered endocrowns. All specimens were subjected to an artificial thermomechanical aging protocol. Each main group was subdivided into two subgroups (n = 10) according to the loading type (axial and oblique) applied during the fracture resistance test. Qualitative analysis using Stereomicroscopy and Scanning Electron Microscopy was performed. Data were statistically analyzed at p-value ≤ 0.05. RESULTS Regarding stress distribution pattern of remaining tooth structure (enamel and dentin), both endocrown systems and cement lines under both axial and oblique load application, Model P resulted in lower stresses than Model C. The oblique stress values of all analyzed structures were higher than corresponding values resulted axially. Considering failure load, a significantly higher load was recorded for Group P when axial or oblique loading was applied (p = 0.00). A significantly higher failure load was recorded with axial loading for both main groups. With regard to failure mode, a statistically significant difference was observed between main groups (p = 0.033), with more favorable failures detected for Group P axially. CONCLUSIONS Compared to the conventional endocrown system, the studied novel system improved the biomechanical behavior within tooth/restoration complex of the restored severely-destructed endodontically treated maxillary first premolar teeth, whatever the applied load type. CLINICAL SIGNIFICANCE The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable promising option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. It can be considered as a conservative alternative option to the conventional treatment modalities not only for normal clinical conditions, but also for parafunctional cases.
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Soliman M, Alshamrani L, Yahya B, Alajlan G, Aldegheishem A, Eldwakhly E. Monolithic Endocrown Vs. Hybrid Intraradicular Post/Core/Crown Restorations for Endodontically Treated Teeth; Cross-sectional Study. Saudi J Biol Sci 2021; 28:6523-6531. [PMID: 34764768 PMCID: PMC8568831 DOI: 10.1016/j.sjbs.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/26/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
The gold standard for restoring Endodontically Treated Teeth (ETT) with successful clinical longevity requires having minimal invasive preparations and maximal tissue conservation. Many dentists still consider hybrid post/core/crown to be the first choice for restoring ETT. Endocrown is a viable alternative treatment modality to hybrid post/core/crown. This study aims to assess the proper judgment of dentists working in Riyadh, Saudi Arabia on the use of monolithic endocrown versus hybrid post/core/crown for restoring ETT. The IRB of Princess Nourah Bint Abdulrahman University (PNU) Institutional Review Board reviewed this study. The questionnaire was validated and electronically distributed. The participants were pre-informed that their responses are completely anonymous and used for professional purposes only. The questionnaire surveyed dentists working in Riyadh, Saudi Arabia, about their preference for different ETT restorative modalities at various clinical scenarios. Data were analyzed using One-way ANOVA and t-test. All P-values of < 0.05 were considered statistically significant. A total of 275 responses were collected; 61.45% were females and 38.55% males. 56% of them were general practitioners, while 16% were consultants. Prefabricated post/core was the most preferred technique among the participants (18.55%), followed by endocrown (12.36%), and lastly, cast post/core (8.73%). The amount of remaining tooth structure was the most influential in the treatment selection (30.18%), followed by the presence or absence of 1–2 mm ferrule (17.82%). Interocclusal space (12.36%) was the least influential factor. Endocrown recorded 63.27% as the most preferred line of treatment in case of insufficient inter-occlusal space. 40.36% preferred endocrown for patients with occlusal risk factors. The amount of the remaining tooth structure and the tooth position significantly affect the treatment options of the participants. Endocrown was the most preferred treatment modality for restoring ETT for patients with occlusal consideration.
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Affiliation(s)
- Mai Soliman
- Clinical Dental Science Department, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
| | - Lamar Alshamrani
- College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
| | - Basma Yahya
- College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
| | - Ghadah Alajlan
- College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
| | - Alhanoof Aldegheishem
- Clinical Dental Science Department, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
| | - Elzahraa Eldwakhly
- Clinical Dental Science Department, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11564, Saudi Arabia
- Department of Fixed Prosthodontics, Faculty of Dentistry, Cairo University, Cairo 12613, Egypt
- Corresponding author at: Clinical Dental Science Department, College of dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11426, Saudi Arabia. Tel.: +966547345731. (Elzahraa Eldwakhly)
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Meng Q, Zhang Y, Chi D, Gong Q, Tong Z. Resistance fracture of minimally prepared endocrowns made by three types of restorative materials: a 3D finite element analysis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:137. [PMID: 34716807 PMCID: PMC8557147 DOI: 10.1007/s10856-021-06610-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
A thin endocrown restoration was often applied in endodontically treated teeth with vertical bite height loss or inadequate clinical crown length. A model of mandibular molars made by endocrown restoration with 1 mm thickness and 2 mm depth of pulp chamber was constructed and imported into FEA ANSYS v18.0 software. The three CAD/CAM materials, feldspathic (Mark2), lithium disilicate (EMAX), and lava ultimate (LU), were assigned, and the five load indenters were loaded on the full occlusal (FO), occlusal center (OC), central fossa (CF), buccal groove (BG), and mesiobuccal cusp (MC) of restoration in the model. The MinPS and MaxPS of the thin endocrown were significantly higher than those of tooth tissue in five types of loads except for the LU endocrown loaded in the FO group. The smaller the contact surface of the load was, the higher MaxPS and MinPS were. MaxPS and MinPS of the MC were the highest, followed by the BG and CF in the restoration. In the stress distribution of tooth tissue, MaxPS in the LU endocrown accumulated at the external edge of enamel and was significantly higher than MaxPS in Mark2 and EMAX endocrown concentrated on the chamber wall of dentin under OC, CF and BG loads. Within the limitations of this FEA study, the LU endocrown transferred more stress to tooth tissue than Mark2 and EMAX, and the maximum principal stress on endocrown restoration and tooth tissue at the mesiobuccal cusp load was higher than that at the central fossa and buccal groove load.
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Affiliation(s)
- Qingzhen Meng
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuejiao Zhang
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Danlu Chi
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qimei Gong
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongchun Tong
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Biomechanical behavior of endodontically treated premolar teeth restored with novel endocrown system: 3D Finite Element and Weibull analyses. J Mech Behav Biomed Mater 2021; 124:104853. [PMID: 34600429 DOI: 10.1016/j.jmbbm.2021.104853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To date, there is no clear consensus in the literature which endocrown design with which material is the most effective treatment option to restore endodontically treated maxillary premolars with extensive loss of tooth structure. The aim of this study was to evaluate the stress distribution pattern and failure probability of maxillary first premolars restored with a novel endocrown system compared to the conventional one by means of Finite Element and Weibull analyses. MATERIALS AND METHODS Two finite element (FE) models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: model C for the conventional monolithic IPS e.max CAD endocrown and model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). A static occlusal compressive load was axially and centrally-applied. Modified von Mises and maximum principal stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately. Weibull function was incorporated with FE analysis to calculate the long term failure probability. RESULTS Regarding stresses occurred in the remaining tooth structure (enamel and dentin), model P transmitted less stresses than model C. The individual enamel of model C showed about 5% and 40% risk of failure at normal and maximum occlusal load values, respectively, while for model P, it had no failure risk at both values. For dentin, model C showed about 13% failure risk at the normal masticatory force, while model P showed only 2%. At clenching value, model C dentin showed about 44% failure risk, while only 9% was resulted for model P. CONCLUSIONS Compared to the conventional endocrown system, the positive impact of the studied novel endocrown system on the stress distribution pattern and also on the survival/failure probability of the restored severely-destructed endodontically treated maxillary first premolar teeth was reflected (more tooth-friendly), not only at normal masticatory forces but also at the maximum functional loads. CLINICAL SIGNIFICANCE The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. Despite the conventional endocrown system may benefit the durability of tooth bonding, it should not be selected for restoration of clenching cases because of the too high overall failure risk.
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Munoz-Sanchez ML, Bessadet M, Lance C, Bonnet G, Veyrune JL, Nicolas E, Hennequin M, Decerle N. Survival Rate of CAD-CAM Endocrowns Performed by Undergraduate Students. Oper Dent 2021; 46:505-515. [PMID: 35486509 DOI: 10.2341/20-126-c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to evaluate the success of computer-aided design-computer-aided manufacturing (CAD-CAM) endocrown restorations of endodontically treated teeth (ETT) performed by supervised undergraduate students. The study also intended to identify possible factors that may lead to failures. METHODS AND MATERIALS This observational open cohort study was based on clinical data from endocrown restorations performed by residents and undergraduate students in their 4th, 5th, and 6th year from July 2011 to May 2018. The presence of a tooth with an endocrown on the arch was the main criteria used to calculate the survival rate of restored teeth. The quality of the remaining endocrowns was evaluated referring to the FDI criteria. The cases of failure were categorized into either favorable or unfavorable. RESULTS A total of 343 ETT were restored with endocrowns in 315 patients. Among them, 199 patients encompassing 225 endocrowns were followed during a 56 ± 26 month period. The survival rate of restored teeth was found to be 81.8%, the estimated Kaplan-Meier survival rate being 71.8% at 9 years. Among the 41 failed cases, 32 were favorable (debonding and/or ceramic fractures) and 9 were unfavorable. CONCLUSION Endocrown restorations of posterior ETT using CAD-CAM technologies could be carried out by undergraduates with a low risk of failure. Teacher supervision could be reinforced, covering all steps of each endocrown procedure in order to avoid failures due to insufficient thickness or loss of retention.
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Affiliation(s)
- M L Munoz-Sanchez
- Marie Laure Munoz-Sanchez, DDS, University Clermont Auvergne CHU de Clermont-Ferrand, France
| | - M Bessadet
- Marion Bessadet, DDS, PhD, University Clermont Auvergne CHU de Clermont-Ferrand, France
| | - C Lance
- Cindy Lance, DDS, PhD, University Clermont Auvergne CHU de Clermont-Ferrand, France
| | - G Bonnet
- Guillaume Bonnet, DDS, PhD, University Clermont Auvergne CHU de Clermont-Ferrand, France
| | - J L Veyrune
- Jean Luc Veyrune, DDS, PhD, HDR, University Clermont Auvergne CHU de Clermont-Ferrand, France
| | - E Nicolas
- Emmanuel Nicolas, DDS, PhD, HDR, University Clermont Auvergne, CHU de Clermont-Ferrand, France
| | - M Hennequin
- *Martine Hennequin, DDS, PhD, HDR, University of Clermont Auvergne, Clermont-Ferrand, France
| | - N Decerle
- Nicolas Decerle, DDS, PhD, University Clermont Auvergne CHU de Clermont-Ferrand, France
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Beji Vijayakumar J, Varadan P, Balaji L, Rajan M, Kalaiselvam R, Saeralaathan S, Ganesh A. Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? - A systematic review of in-vitro studies. Biomater Investig Dent 2021; 8:104-111. [PMID: 34368777 PMCID: PMC8312589 DOI: 10.1080/26415275.2021.1932510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives: The primary objective of this systematic review is to compare the fracture resistance of lithium disilicate (LDS)-based endocrowns and resin-based (RB) endocrowns of in-vitro studies, and the secondary objective is to compare their catastrophic failures. Materials and Methods: The review protocol was registered in the P ROSP ERO database (CRD42020166201). A comprehensive literature search was done in PubMed, Cochrane, EBSCOhost and Google Scholar using key terms. Only in-vitro studies that compared fracture resistance of LDS-based endocrowns and indirect RB endocrowns in molars were included. Data extraction, risk of bias assessment and qualitative analysis of the included studies were performed. Results: Five studies were included in this systematic review. The overall risk of bias for the included studies was moderate. Under axial loading, RB endocrowns showed similar fracture resistance when compared with LDS endocrowns. However, they showed better fracture resistance when compared with zirconia reinforced lithium silicate (ZLS) endocrowns. Furthermore, RB endocrowns showed fewer catastrophic failures than LDS-based endocrowns. Conclusions: RB endocrowns have similar or better fracture resistance and fewer catastrophic failures when compared to LDS-based endocrowns.
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Affiliation(s)
- Joshna Beji Vijayakumar
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Preethi Varadan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Lakshmi Balaji
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Mathan Rajan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Rajeswari Kalaiselvam
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Sindhu Saeralaathan
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
| | - Arathi Ganesh
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra Faculty of Dental Sciences, SRIHER (DU), Chennai, India
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Ural Ç, Çağlayan E. A 3-dimensional finite element and in vitro analysis of endocrown restorations fabricated with different preparation designs and various restorative materials. J Prosthet Dent 2021; 126:586.e1-586.e9. [PMID: 34332775 DOI: 10.1016/j.prosdent.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM The preparation design and fabrication materials directly affect the clinical success of endocrown restorations, and yet, knowledge is lacking about the biomechanical impact of specific designs or materials on endocrown restorations. PURPOSE The purpose of this in vitro and finite element analysis study was to evaluate the biomechanical behavior of endocrown restorations. MATERIAL AND METHODS A total of 36 freshly extracted mandibular first molars were collected. The teeth were prepared as per 2 different preparation geometries: with the buccal wall intact (Class 2) and without the buccal wall (Class 3). Teeth were restored with endocrowns made from 3 different fabricating materials, Vita Enamic, GC Cerasmart, and Lava Ultimate. To analyze the in vitro fracture strength, cemented endocrowns were loaded in a universal test machine with a 200-N oblique force until the restoration fractured. Finite element analysis was used to evaluate the stress distribution on both the dentin tissue and the restorative materials. The data were analyzed with a 2-way ANOVA test and the Tukey post hoc test (α=.05). RESULTS No significant differences were found between the different preparation designs (Class 2 and Class 3) on fracture strength (P>.05). The highest mean ±standard deviation fracture strength values were found in the Lava Ultimate material (Class 2, 606.20 ±293; Class 3, 659.40 ±226 N) (P>.05), but the lowest fracture strength test values were obtained in the Vita Enamic material (Class 2, 439.60 ±136; Class 3, 340 ±98 N) (P>.05) for both preparation design test groups. CONCLUSIONS A statistically significant difference was not found between the 2 tooth preparation classifications. However, significant differences were observed among the test groups in the Class 2 preparation specimens. The Class 2 preparation design exhibited a higher number of irreparable failures.
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Affiliation(s)
- Çağrı Ural
- Professor, Department of Prosthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
| | - Esma Çağlayan
- Dentist, Oral and Dental Health Hospital, Samsun, Turkey
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Zhang H, Li H, Cong Q, Zhang Z, Du A, Wang Y. Effect of proximal box elevation on fracture resistance and microleakage of premolars restored with ceramic endocrowns. PLoS One 2021; 16:e0252269. [PMID: 34038489 PMCID: PMC8153463 DOI: 10.1371/journal.pone.0252269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background Restoration of endodontically treated premolar is in high risk for biomechanical failure, and often presents with subgingival margins. Proximal box elevation (PBE) has been used to relocate subgingival cavity outlines. Objective To evaluate the influence of PBE on fracture resistance and gingival microleakage of premolars with endodontic access cavities following ceramic endocrown. Methods Eighty sound maxillary premolars with standardized Class II cavities on mesial surfaces were randomly assigned to four groups (n = 20 in each group). Groups E1, E2 and E3, with proximal margins located in dentin/cementum, 2 mm below the cemento-enamel junction (CEJ), simulated subgingival location. Group E4 (supragingival group), with proximal margins located in enamel, 1 mm above the CEJ, was used as the positive control. For margin elevation of the proximal cavities, bulk-fill Smart Dentin Replacement (SDR), a visible light cured resin composite, was applied in group E1, and conventional resin composite (3M Z350 XT, a light-activated composite) was placed in group E2. Group E3 was only treated with a ceramic crown and served as the negative control. In all groups, computer-aided design (CAD) ceramic endocrowns were adhesively inserted, and fracture resistance, failure mode and microleakage were evaluated. Results A higher fracture resistance value was observed in PBE groups E1 and E2, regardless of the materials used (P = 0.038, and 0.010, respectively, vs E3), and fracture resistance in group E1 was higher than that in group E2. In teeth without PBE, the percentage of catastrophic failures reached 70%. Compared to group E3, a lower frequency distribution of microleakage was detected in supragingival group E4 (P = 0.031). No increased percentage of microleakage was observed in groups treated with PBE. Conclusion For endodontically treated maxillary premolars restored with ceramic endocrowns, PBE increases fracture resistance but not microleakage.
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Affiliation(s)
- Hong Zhang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - He Li
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - Qian Cong
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, P.R China
| | - Zhimin Zhang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
- * E-mail:
| | - Aobo Du
- Hospital of Stomatology, Jilin University, Changchun, P.R China
| | - Ying Wang
- Hospital of Stomatology, Jilin University, Changchun, P.R China
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Albelasy E, Hamama HH, Tsoi JKH, Mahmoud SH. Influence of material type, thickness and storage on fracture resistance of CAD/CAM occlusal veneers. J Mech Behav Biomed Mater 2021; 119:104485. [PMID: 33812289 DOI: 10.1016/j.jmbbm.2021.104485] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the effect of restoration thickness, CAD/CAM material, and 6 months of artificial saliva storage on the fracture resistance of occlusal veneers. MATERIALS AND METHODS A total of 84 intact maxillary molars were sectioned 4.0 mm occlusal to the cementoenamel junction to expose the dentine. The teeth were assigned into 3 main groups according to the type of restorative material (e.max CAD, Vita Enamic, and Lava Ultimate). In each group, the teeth were allocated into 2 subgroups (n = 14) according to restoration thickness (1.0 and 1.5 mm). The veneers were adhesively bonded using dual-cure self-adhesive luting agent. A total of 42 specimens comprising half the tested subgroups were stored in distilled water for 24-h before the test. The remaining half was stored in artificial saliva at 37 ± 1 °C in an incubator for 6 months. All specimens (n = 84) were subjected to 5000 thermal cycles between 5 and 55 °C ± 2 before the fracture resistance test. The maximum force at fracture was recorded in Newton. Failure mode was analyzed using a stereomicroscope. The results were analyzed using a parametric Three-way ANOVA test. RESULTS The results of the Three-way ANOVA test revealed that material type and restoration thickness significantly affected fracture resistance values (p < 0.5), while 6 months of storage in artificial saliva had no significant effect on mean fracture resistance values (p˃0.5). The most common failure patterns in CAD/CAM resin composite and polymer-infiltrated ceramics were scores I and score II. For glass ceramic groups, score IV and III were more dominant. CONCLUSIONS All the tested CAD/CAM restorations in both thicknesses exhibited fracture resistance values exceeding normal and parafunctional bite forces. Polymer-infiltrated ceramics and CAD/CAM resin composite veneers showed more favorable fracture patterns.
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Affiliation(s)
- Eman Albelasy
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Hamdi H Hamama
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt.
| | - James K H Tsoi
- Dental Material Science, Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Salah H Mahmoud
- Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Egypt
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Albelasy EH, Hamama HH, Tsoi JK, Mahmoud SH. Fracture resistance of CAD/CAM occlusal veneers: A systematic review of laboratory studies. J Mech Behav Biomed Mater 2020; 110:103948. [DOI: 10.1016/j.jmbbm.2020.103948] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 11/27/2022]
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Sağlam G, Cengiz S, Karacaer Ö. Marginal adaptation and fracture strength of endocrowns manufactured with different restorative materials: SEM and mechanical evaluation. Microsc Res Tech 2020; 84:284-290. [PMID: 32915479 DOI: 10.1002/jemt.23586] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022]
Abstract
Endocrowns were manufactured using different restorative materials to evaluate the marginal adaptation and fracture strength. Fifty endodontically treated mandibular first molar teeth were divided into five groups (n = 10). Endocrowns were obtained from lithium disilicate glass ceramic ingots by heat-press technique (Group e.max Press: GEP), and from feldspathic blocks (Group Cerec: GC), polymer infiltrated ceramic network blocks (Group Enamic: GE), lithium disilicate glass ceramic blocks (Group e.max CAD: GEC), and zirconia-reinforced glass ceramic blocks (Group Suprinity: GS) by CAD/CAM technique. After thermocycling, marginal adaptation was evaluated under scanning electron microscope at ×200 magnification. The specimens' fracture strengths were tested in universal test machine, and fracture types were evaluated. Statistical analyses were performed with Kruskal-Wallis test. The highest marginal gap value was found in GEP, but no significant differences were determined among the other four groups (p > .05). Significant differences were observed among the groups in terms of fracture strength (p = .019). The fracture strength values of GEC were significantly higher than GE, GC, and GS (p < .05). Values were not significantly different between the GEC and GEP groups (p > .05). CAD/CAM endocrowns showed better marginal adaptation than heat-pressed endocrowns. Clinically acceptable marginal gaps were seen in both endocrown types. Both CAD/CAM and heat-pressed lithium disilicate glass ceramic endocrowns showed higher fracture strength.
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Affiliation(s)
- Gaye Sağlam
- Department of Prosthodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Seda Cengiz
- Department of Prosthodontics, Faculty of Dentistry, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Özgül Karacaer
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Elashmawy Y, Elshahawy W, Seddik M, Aboushelib M. Influence of fatigue loading on fracture resistance of endodontically treated teeth restored with endocrowns. J Prosthodont Res 2020; 65:78-85. [PMID: 32938873 DOI: 10.2186/jpr.jpor_2019_485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This in vitro study aimed to evaluate the influence of fatigue loading on fracture resistance of endodontically treated molars restored with endocrowns using different machinable blocks. METHODS Endodontically treated mandibular first molars were prepared using a standardized method. Specimens were divided into 4 groups (n = 10).Anatomically shaped endocrowns groups were manufactured using VITA ENAMIC (VE) and KATANA Zirconia (KZ). Layered endocrowns groups were manufactured using IPS e.max CAD (EM) and BioHPP (BH). Half of the specimens of each group were subjected to fracture resistance test, while the other half were subjected to thermocycling and chewing simulation. After fatigue loading, specimens were loaded until failure. Specimens were examined using stereomicroscopy. Data were analyzed using ANOVA analysis of variance and Bonferroni post hoc test (α=0.05). RESULTS KZ group had the highest initial fracture resistance value (1810.20± 119.56 N) and BH had the lowest value (579.50± 76.15 N). The reduction of fracture resistance after fatigue loading was significant for KZ group (1588.30±216.25 N) and BH group (502.60±11.53 N) and non-significant to VE group (1101.70±77.05 N) and EM group (1112.10±74.12 N). Failure modes of KZ and EM groups showed high percentage of non-restorable fractures, while VE and BH groups showed high percentage of restorable fractures. CONCLUSIONS Within the limitations of this study, the following can be concluded: Poly infiltrated ceramics should be considered as a proper material to be used as an endocrown material because of its ability to be restorable if failure occurred.
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Affiliation(s)
- Yasmin Elashmawy
- Department of Fixed Prosthodontics, University of Tanta Faculty of dentistry, Tanta
| | - Waleed Elshahawy
- Department of Fixed Prosthodontics, University of Tanta Faculty of dentistry, Tanta
| | - Mohamed Seddik
- Department of Fixed Prosthodontics, University of Tanta Faculty of dentistry, Tanta
| | - Moustafa Aboushelib
- Department of Dental Materials, University of Alexandria Faculty of dentistry, Alexandria
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Hassouneh L, Jum’ah AA, Ferrari M, Wood DJ. Post-fatigue fracture resistance of premolar teeth restored with endocrowns: An in vitro investigation. J Dent 2020; 100:103426. [DOI: 10.1016/j.jdent.2020.103426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022] Open
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