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Musapoor N, Neshandar Asli H, Mokhtari S, Babaee Hemmati Y, Falahchai M. In Vitro Effect of the Length of Relocated Cervical Margin with Casting Post and Core, Prefabricated Fiber Post, and Polyethylene Fiber with a Composite Core on Fracture Resistance and Marginal Integrity. Int J Dent 2024; 2024:9274141. [PMID: 39229333 PMCID: PMC11371451 DOI: 10.1155/2024/9274141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
Objective This study aimed to assess the effect of length of the relocated cervical margin with casting post and core (CP), prefabricated fiber post and composite core (PFP), and polyethylene fiber-reinforced composite (PEFRC) on fracture resistance and marginal integrity. Materials and Methods In this in vitro study, 70 sound human maxillary premolars were divided into seven groups according to the type of post and core system and length of the relocated cervical margin (n = 10): control (no preparation), PFP-3, PEFRC-3, CP-3 with 3 mm of cervical margin relocation (CMR), PFP-6, PEFRC-6, and CP-6 (with 6 mm of CMR). The samples were restored with zirconia crowns (except the control group). Epoxy resin replicas were fabricated before and after thermomechanical loading. Marginal integrity was assessed at the luting cement-core, core-tooth, and luting cement-enamel interfaces under a scanning electron microscope (SEM) (×200). Fracture resistance and failure mode were subsequently assessed. Data were analyzed by independent t-test, paired t-test, ANOVA, Tukey-Games Howell, Mann-Whitney, Kruskal-Wallis, Wilcoxon, Mann-Whitney with Bonferroni correction, and Fisher-Freeman-Halton tests (α = 0.05). Results The marginal integrity of the groups with 3 mm of CMR followed the following order: PEFRC > PFP > CP at all interfaces (P < 0.05). In 6-mm CMR groups, this order was CP < PFP = PEFRC at the luting cement-core and (CP < PEFRC) = PFP at the core-tooth interface. No significant difference was found in fracture resistance when comparing the 3-mm CMR groups with each other (P > 0.05). PFP-6 showed higher FR than CP-6 (P < 0.001). PEFRC-6 had no significant difference with PFP-6 and CP-6 (P > 0.05). In each post and core system, 3-mm CMR groups showed higher marginal integrity and fracture resistance (P < 0.05). Conclusion Increasing the length of the relocated cervical margin decreased the marginal integrity and fracture resistance of all three systems of CP, PFP, and PEFRC.
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Affiliation(s)
- Naghmeh Musapoor
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryQazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Neshandar Asli
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
| | - Soroosh Mokhtari
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryArak University of Medical Sciences, Arak, Iran
| | - Yasamin Babaee Hemmati
- Department of OrthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
| | - Mehran Falahchai
- Department of ProsthodonticsDental Sciences Research CenterSchool of DentistryGuilan University of Medical Sciences, Rasht, Iran
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Taylor A, Burns L. Deep margin elevation in restorative dentistry: A scoping review. J Dent 2024; 146:105066. [PMID: 38740249 DOI: 10.1016/j.jdent.2024.105066] [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: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Deep margin elevation (DME) is a restorative approach offering the possibility of performing stepwise elevation of deep proximal cavities to create more favourable margins for direct or indirect restorations. The objectives of this scoping review were to explore what is known or unknown about DME by describing a wide ranging evidence base including peer reviewed literature and non-traditionally published information on the web. DATA Data were extracted from the included evidence in order to describe the following: the extent and nature of the evidence base; the situations which are appropriate for DME; the materials and techniques which are used; the outcomes which have been measured in empirical studies; the risks which have been reported; and the findings which have been reported in studies which compared DME to surgical crown lengthening. SOURCES This scoping review included a wide range of published evidence and extensive web searching for grey literature, including CPD, training and multimedia information. STUDY SELECTION The findings revealed a range of published literature as well as freely available, online information advising practitioners about DME. Most empirical evidence was based on in vitro studies, and there were few clinical studies comparing DME to crown lengthening. Online information included recent, multimedia sources. CONCLUSIONS DME is a technique that can be used with motivated patients with good oral hygiene if rubber dam isolation is achieved, if there is no invasion of the connective tissue space, and if a strict restorative protocol is adhered to. CLINICAL SIGNIFICANCE With phasing out of amalgam and adhesive dentistry increasing in popularity, DME addresses multiple clinical problems associated with sub-gingival margins prior to restoration.
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Affiliation(s)
- Anna Taylor
- The Treatment Centre, Tinner's Court, Back Quay, Truro, Cornwall TR1 2LL, UK
| | - Lorna Burns
- Peninsula Dental School, John Bull Building, Research Way, Plymouth, Devon PL6 8BU, UK.
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Adel M, Hamdy A, Sabet A, Ebeid K. Effect of cervical margin relocation on marginal adaptation and microleakage of indirect ceramic restorations. J Prosthodont 2024; 33:374-381. [PMID: 37186493 DOI: 10.1111/jopr.13696] [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: 12/06/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE This study evaluated the effect of cervical margin relocation (CMR) with two different materials and contamination with hemostatic agents on the margin adaptation and microleakage of ceramic restorations. MATERIALS AND METHODS Mesial-occlusal-distal cavities were prepared in 60 human first molars and distributed to 3 groups (n = 20) according to the margin relocation procedure. The groups were: group F; flowable composite applied in two 2 mm increments, group B; bulk-fill flowable composite applied as a bulk increment of 4 mm thickness and group C (control); no CMR was done. Each group was subdivided into two subgroups (subgroup N; no hemostatic agent applied and subgroup H; hemostatic agent was applied). In all groups, ceramic inlays were prepared and cemented. The samples were subjected to thermocycling (10,000 cycles). The adaptation of the cervical margin was evaluated with scanning electron microscopy (200×). Samples were then assessed for microleakage analysis with the dye penetration method. Marginal adaptation data were normally distributed and analyzed using two-way ANOVA followed by Tukey's post hoc test. Ordinal microleakage score data were analyzed using cumulative link models followed by the analysis of deviance using Wald chi-square tests. RESULTS Both CMR and contamination with a hemostatic agent had significant effects on the margin adaptation of the cervical margin. Group C showed the highest adaptation with no significant difference from group F. The lowest adaptation was revealed in group B with a significant difference from group C. Subgroup N (in all groups) showed a statistically higher adaptation than subgroup H. Regarding microleakage assessment, CMR had no significant effect but hemostatic agent application showed a significantly higher microleakage score for all groups. CONCLUSIONS Both the CMR procedure and contamination with AlCl3 hemostatic agent had a negative effect on marginal adaptation. For microleakage assessment, only contamination with hemostatic agent negatively affected the microleakage with no effect on the margin relocation procedure.
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Affiliation(s)
- Marwa Adel
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Amina Hamdy
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ahmed Sabet
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
- Department of Fixed Prosthodontics, Faculty of Dentistry, British University in Egypt, Cairo, Egypt
| | - Kamal Ebeid
- Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Baltacioğlu İH, Demirel G, Öztürk B, Aydin F, Orhan K. Marginal adaptation of bulk-fill resin composites with different viscosities in class II restorations: a micro-CT evaluation. BMC Oral Health 2024; 24:228. [PMID: 38350901 PMCID: PMC10863248 DOI: 10.1186/s12903-024-03975-7] [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: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the marginal adaptation of bulk-fill resin composites with different viscosities (paste-like and flowable) in Class II restorations using micro-CT imaging. METHODS Forty extracted human molars were used. Mesial and distal Class II box cavities (approximately 3 mm x 3 mm x 4 mm) were prepared for each tooth, with cavity floors located 1 mm below the enamel-cementum junction. Following adhesive application, teeth were restored using eight different groups: Group XB: X-tra Base Bulk-fill Flowable (VOCO), Group XF: X-tra Fill Bulk-fill (VOCO), Group FB: Filtek Bulk-fill Posterior (3 M ESPE), Group FF: Filtek Bulk-fill Flowable (3 M ESPE), Group BB: Beautifil-Bulk (SHOFU), Group BF: Beautifil-Bulk Flowable (SHOFU), and Group CO: "as a control group", Clearfil Majesty Posterior (KURARAY) and Group CF: "as a control group", Clearfil Majesty Flow + Clearfil Majesty Posterior (KURARAY). The restored teeth underwent an aging protocol involving 1000 cycles in a water bath fluctuating between 5 ± 1.0 °C and 55 ± 1.0 °C. Post-aging, teeth were immersed in 50% silver nitrate solution for 24 h and then in a film developer solution for 8 h. Microleakage analysis was performed using micro-CT, evaluated with 3D Slicer software. A two-way ANOVA was employed for statistical analysis. RESULTS Two-way ANOVA results indicated significant effects of both viscosity (p < 0.0001) and composite type (p < 0.0001) on marginal adaptation. Viscosity analysis (comparing flowable and paste-like) revealed no significant differences in the FB-FF, XB-XF and BB-BF groups but significant differences in the and CO-CF group, with flowable type exhibiting less microleakage than paste-like type. CONCLUSIONS The study suggests that while the viscosity of bulk-fill composites did not significantly affect marginal adaptation, the brand of bulk-fill composite did influence it.
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Affiliation(s)
| | - Gülbike Demirel
- Department of Restorative Dentistry, Faculty of Dentistry, Ankara University, Ankara, Turkey.
| | - Burcu Öztürk
- Department of Restorative Dentistry, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Fulya Aydin
- Department of Restorative Dentistry, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Kaan Orhan
- Department of Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Theisen CER, Amato J, Krastl G, Attin T, Blatz MB, Weiger R, Eggmann F. Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study. Clin Oral Investig 2023; 27:2691-2703. [PMID: 36622446 PMCID: PMC10264514 DOI: 10.1007/s00784-022-04841-y] [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: 09/03/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME.
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Affiliation(s)
- Catherine E R Theisen
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Julia Amato
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Attin
- Department of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland Weiger
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland
| | - Florin Eggmann
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, CH-4058, Basel, Switzerland.
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Şenol AA, Karabulut Gençer B, Tarçın B, Kahramanoğlu E, Yılmaz Atalı P. Microleakage and Marginal Integrity of Ormocer/Methacrylate-Based Bulk-Fill Resin Restorations in MOD Cavities: SEM and Stereomicroscopic Evaluation. Polymers (Basel) 2023; 15:polym15071716. [PMID: 37050330 PMCID: PMC10096632 DOI: 10.3390/polym15071716] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
This in vitro study aimed to compare the microleakage and marginal integrity of methacrylate/ormocer-based bulk-fill composite (BFC) restorations used in cervical marginal relocation with two different layering thicknesses in mesio-occlusal-distal (MOD) cavities exposed to thermo-mechanical loading. Standard MOD cavities were prepared in 60 mandibular molars and assigned into three groups: x-tra fil/AF + x-tra base/XB, Tetric N-Ceram Bulk Fill/TNB + Tetric N-Flow Bulk Fill/TFB, and Admira Fusion x-tra/AFX + Admira Fusion x-base/AFB. Each group was further divided into two subgroups (2 mm and 4 mm) based on the thickness of flowable BFCs (n = 10). The specimens were subjected to thermo-mechanical loading (240,000 cycles) and immersed in 0.2% methylene blue. Following mesiodistal sectioning, the specimens were examined under stereomicroscope (×25) and scored (0-3) for microleakage. Marginal integrity was examined using a scanning electron microscope (SEM). Descriptive statistical methods and the chi-square test were used to evaluate the data (p < 0.05). While there was no statistically significant difference in gingival cement microleakage in the XB and AFB specimens with a 4 mm thickness, microleakage was significantly increased in the TFB specimen (p = 0.604, 0.481, 0.018 respectively). A significantly higher amount of score 0 coronal microleakage was detected in the AFX2 mm + AFB4 mm compared to the TNB2 mm + TFB4 mm (p = 0.039). The SEM examination demonstrated better marginal integrity in groups with 2 mm thick flowable BFCs. Ormocer and methacrylate-based materials can be used in marginal relocation with thin layers.
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Affiliation(s)
- Aslı A Şenol
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Büşra Karabulut Gençer
- Department of Restorative Dentistry, Faculty of Dentistry, Nişantaşı University, Istanbul 34398, Turkey
| | - Bilge Tarçın
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Erkut Kahramanoğlu
- Department of Prosthodontic Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
| | - Pınar Yılmaz Atalı
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey
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Robaian A, Alqahtani A, Alanazi K, Alanazi A, Almalki M, Aljarad A, Albaijan R, Maawadh A, Sufyan A, Mirza MB. Different Designs of Deep Marginal Elevation and Its Influence on Fracture Resistance of Teeth with Monolith Zirconia Full-Contour Crowns. Medicina (B Aires) 2023; 59:medicina59040661. [PMID: 37109619 PMCID: PMC10144512 DOI: 10.3390/medicina59040661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.
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Eggmann F, Ayub JM, Conejo J, Blatz MB. Deep margin elevation-Present status and future directions. J ESTHET RESTOR DENT 2023; 35:26-47. [PMID: 36602272 DOI: 10.1111/jerd.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. OVERVIEW The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal. CONCLUSIONS Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence. CLINICAL SIGNIFICANCE Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.
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Affiliation(s)
- Florin Eggmann
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Jose M Ayub
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julián Conejo
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Deger C, Özduman ZC, Oglakci B, Eliguzeloglu Dalkilic E. The Effect of Different Intermediary Layer Materials Under Resin Composite Restorations on Volumetric Cuspal Deflection, Gap Formation, and Fracture Strength. Oper Dent 2023; 48:108-116. [PMID: 36445957 DOI: 10.2341/21-211-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/02/2022]
Abstract
This study investigated the effect of different intermediary layer materials under class II mesio-occluso-distal (MOD) resin composite restorations on volumetric cuspal deflection, gap formation, and fracture strength. In total, 32 sound human maxillary premolars were used. After large, standardized Class II MOD cavities were prepared, a universal adhesive (Clearfil Universal Bond Quick, Kuraray) was applied. The premolars were randomly allocated into four groups according to different intermediary layer materials (n=8): Group Z250 (control)/micro-hybrid composite (Filtek Z250, 3M ESPE); Group EST/low-viscosity bulk-fill resin composite (Estelite Bulk Fill Flow, Tokuyama Dental Corp) + micro-hybrid composite; Group NOV/nanofiber-reinforced low-viscosity composite (NovaPro Flow, Nanova) + micro-hybrid composite; and Group RIB/polyethylene fiber [Ribbond, Ribbond Inc] + micro-hybrid composite. Distilled water was used for storage for 24 hours. Using microcomputed tomography (micro-CT), the teeth were scanned immediately after cavity preparation (T0), then 24 hours after restorative procedures (T1). Volumetric cuspal deflection in cubic millimeters (mm3) was analyzed on the palatal and buccal regions of each restoration individually at T0 and T1 scans. Gap formation (mm3) was evaluated to quantify the volume of black spaces at the tooth-resin interface on the T1 scan. After these scans, using a universal testing machine, the teeth were subjected to a fracture strength test (0.5 millimeters/minute [mm/min]). The fracture surfaces were analyzed with a stereomicroscope. The data were analyzed using the Kruskal-Wallis, one-way analysis of variance (ANOVA), and Dunn's tests (p< 0.05). No significant differences in volumetric cuspal deflection and fracture strength were detected for all tested groups (p>0.05). Group RIB exhibited significantly higher gap formation values in comparison with all other groups (p<0.05). Predominant failure mode was favorable.
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Affiliation(s)
- C Deger
- Ceren Deger, restorative dentistry specialist, Department of Restorative Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Z C Özduman
- Zümrüt Ceren Özduman, assistant professor, Department of Restorative Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - B Oglakci
- *Burcu Oglakci, associate professor, Department of Restorative Dentistry, Bezmialem Vakif University, Istanbul, Turkey
| | - E Eliguzeloglu Dalkilic
- Evrim Eliguzeloglu Dalkilic, professor, Department of Restorative Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Post-Fatigue Fracture Resistance of Lithium Disilicate and Polymer-Infiltrated Ceramic Network Indirect Restorations over Endodontically-Treated Molars with Different Preparation Designs: An In-Vitro Study. Polymers (Basel) 2022; 14:polym14235084. [PMID: 36501478 PMCID: PMC9739407 DOI: 10.3390/polym14235084] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to evaluate the fatigue to cyclic and static resistance of indirect restorations with different preparation designs made either of lithium disilicate (LS) or polymer-infiltrated ceramic network (PICN). Eighty-four (n = 84) molars were chosen, endodontically treated, and prepared with standardized MOD cavities. The molars were randomly divided into 6 study groups (n = 14) taking into account the "preparation design'' (occlusal veneer with 1.2 mm occlusal thickness; overlay with 1.6 mm occlusal thickness; adhesive crown with 2 mm occlusal thickness) and the "CAD/CAM material'' (E-max CAD, Ivoclar vivadent; Vita Enamic, Vita). A fatigue test was conducted with a chewing simulator set at 50 N for 1,500,000 cycles. Fracture resistance was assessed using a universal testing machine with a 6 mm diameter steel sphere applied to the specimens at a constant speed of 1 mm/min. A SEM analysis before the fracture test was performed to visually analyze the tooth-restoration margins. A statistical analysis was performed with a two-way ANOVA and a post-hoc pairwise comparison was performed using the Tukey test. The two-way ANOVA test showed that both the preparation design factor (p = 0.0429) and the CAD/CAM material factor (p = 0.0002) had a significant influence on the fracture resistance of the adhesive indirect restorations. The interaction between the two variables did not show any significance (p = 0.8218). The occlusal veneer had a lower fracture resistance than the adhesive crown (p = 0.042) but not lower than the overlay preparation (p = 0.095). LS was more resistant than PICN (p = 0.002). In conclusion, in the case of endodontically treated teeth, overlay preparation seems to be a valid alternative to the traditional full crown preparation, while occlusal veneers should be avoided in restoring non-vital molars with a high loss of residual tooth structure. LS material is more resistant compared to PICN.
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Resin Cement Residue Removal Techniques: In Vitro Analysis of Marginal Defects and Discoloration Intensity Using Micro-CT and Stereomicroscopy. Dent J (Basel) 2022; 10:dj10040055. [PMID: 35448050 PMCID: PMC9027873 DOI: 10.3390/dj10040055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] Open
Abstract
The objective was to compare marginal defects and evaluate discoloration for adhesively cemented veneers in vitro when using two cement removal techniques. Twenty premolars were prepared with chamfer and borders in enamel. IPS e.max CAD veneers were cemented using Panavia V5 and divided in two groups (n = 10): cement excess removed with a probe after tack-curing for 3–5 s, or cement excess removed with a brush, then completely polymerized. All teeth were stored in alginate gel until micro-CT examination. Scanning was performed twice: directly after cementation and after thermocycling (5000 cycles, between 5 and 55 °C). To analyze discoloration, teeth were colored using 0.5% basic fuchsine and examined under a stereomicroscope. Depth of dye infiltration was scored 0 (no discoloration) to 5 (discoloration along the entire margin). Statistically significant differences of cement defects before thermocycling were reported, where brushing showed more defects than probing (p = 0.0161). After thermocycling, the defects increased for both groups. Extensive discoloration was the most common (55.56%) when removing excess by probing; by brushing, 90% of the specimens exhibited slight discoloration (p = 0.008). Regression analysis showed no relationship between type of defect and degree of discoloration. Removing cement with a brush causes more marginal defects, however less discoloration after thermocycling.
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Deep Margin Elevation: A Literature Review. Dent J (Basel) 2022; 10:dj10030048. [PMID: 35323250 PMCID: PMC8947734 DOI: 10.3390/dj10030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
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Baldi A, Scattina A, Ferrero G, Comba A, Alovisi M, Pasqualini D, Peroni L, Muggeo M, Germanetti F, Scotti N. Highly-filled flowable composite in deep margin elevation: FEA study obtained from a microCT real model. Dent Mater 2022; 38:e94-e107. [DOI: 10.1016/j.dental.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/15/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
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Baldi A, Comba A, Ferrero G, Italia E, Michelotto Tempesta R, Paolone G, Mazzoni A, Breschi L, Scotti N. External gap progression after cyclic fatigue of adhesive overlays and crowns made with high translucency zirconia or lithium silicate. J ESTHET RESTOR DENT 2021; 34:557-564. [PMID: 34783440 PMCID: PMC9298883 DOI: 10.1111/jerd.12837] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate three-dimensional external gap progression after chewing simulation of high translucency zirconia (HTZ) and zirconia-reinforced lithium silicate (ZLS) applied on endodontically treated teeth with different preparation designs. MATERIALS AND METHOD Endodontically treated molars were prepared with low-retentive (adhesive overlay) and high-retentive (full crown) designs above cementum-enamel junction and restored with HTZ and ZLS. Micro-computed tomography analysis was assessed before and after chewing simulation to evaluate three-dimensionally the external gap progression. Results were statistically analyzed with two-way ANOVA and post-hoc Tukey test. RESULTS High-retentive preparation design had a significantly inferior gap progression compared to the overlay preparation (p < 0.01); ZLS exhibited a significant inferior gap progression compared to HTZ (p < 0.01). CONCLUSIONS High-retentive preparations restored with ZLS seem to better perform in maintaining the sealing of the external margin after cyclic fatigue. CLINICAL SIGNIFICANCE The clinician should pay attention to the proper combination of preparation designs and ceramic material selection for an endodontically treated molar restoration. HTZ seems to perform worse than lithium silicate in terms of marginal sealing, still showing lacks in resistance to cyclic fatigue when adhesive preparations are performed.
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Affiliation(s)
- Andrea Baldi
- Department of Surgical Sciences, Dental School Lingotto, Turin
| | - Allegra Comba
- Department of Surgical Sciences, Dental School Lingotto, Turin
| | - Giorgio Ferrero
- Department of Surgical Sciences, Dental School Lingotto, Turin
| | - Edoardo Italia
- Department of Surgical Sciences, Dental School Lingotto, Turin
| | | | - Gaetano Paolone
- Department of Dentistry, IRCCS San Raffaele Hospital and Dental School, Vita Salute University, Milan, Italy
| | - Annalisa Mazzoni
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Alma Mater Studiorum, Bologna, Italy
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Alma Mater Studiorum, Bologna, Italy
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School Lingotto, Turin
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Baldi A, Comba A, Michelotto Tempesta R, Carossa M, Pereira GKR, Valandro LF, Paolone G, Vichi A, Goracci C, Scotti N. External Marginal Gap Variation and Residual Fracture Resistance of Composite and Lithium-Silicate CAD/CAM Overlays after Cyclic Fatigue over Endodontically-Treated Molars. Polymers (Basel) 2021; 13:polym13173002. [PMID: 34503042 PMCID: PMC8434150 DOI: 10.3390/polym13173002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this in vitro study was to evaluate the external marginal gap variation with a 3D quantitative method and the residual fracture resistance after cyclic fatigue in endodontically treated molars restored with overlays of different materials, with and without fiber posts-supported buildups. Forty-eight human maxillary molars were selected, endodontically treated, prepared with standardized MOD cavities and randomly allocated into 6 study groups considering the "core strategy" (build-up with composite resin; build-up with composite resin supported by a fiber post); and the "restorative material" of the indirect adhesive overlay (GrandioBlocks, Voco; Cerasmart, GC; CeltraDuo, Dentsply). All procedures were executed according with manufacturers guidelines. Micro-CT analysis prior and after cyclic fatigue were executed, followed by scanning electron microscope analysis and fracture resistance test. The Two-Way ANOVA analysis showed that interfacial gap progression was significantly influenced by the "core strategy" (p < 0.01) but not of "restorative material" (p = 0.59). Concerning fracture resistance, "restorative material" was statistically significant (p < 0.01), while "core strategy" (p = 0.63) and the interaction (p = 0.84) were not. In conclusion, the fiber post presence within the build-up promoted a lower interfacial gap opening after fatigue, evaluated through micro-CT scans. In terms of fracture resistance, teeth restored with Cerasmart and Celtra Duo were statistically similar, but superior to GrandioBlocks.
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Affiliation(s)
- Andrea Baldi
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, 10126 Turin, Italy; (A.B.); (A.C.); (R.M.T.); (M.C.)
| | - Allegra Comba
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, 10126 Turin, Italy; (A.B.); (A.C.); (R.M.T.); (M.C.)
| | - Riccardo Michelotto Tempesta
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, 10126 Turin, Italy; (A.B.); (A.C.); (R.M.T.); (M.C.)
| | - Massimo Carossa
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, 10126 Turin, Italy; (A.B.); (A.C.); (R.M.T.); (M.C.)
| | - Gabriel Kalil Rocha Pereira
- Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria, Santa Maria 97105-900, Brazil; (G.K.R.P.); (L.F.V.)
| | - Luiz Felipe Valandro
- Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria, Santa Maria 97105-900, Brazil; (G.K.R.P.); (L.F.V.)
| | - Gaetano Paolone
- Department of Dentistry, IRCCS San Raffaele Hospital and Dental School, Vita Salute University, 20158 Milan, Italy;
| | - Alessandro Vichi
- Dental Academy, University of Portsmouth, William Beatty Building, Hampshire Terrace, Portsmouth PO1 2QG, UK;
| | - Cecilia Goracci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, 10126 Turin, Italy; (A.B.); (A.C.); (R.M.T.); (M.C.)
- Correspondence: ; Tel.: +39-340-2861-799
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Comba A, Baldi A, Saratti CM, Rocca GT, Torres CRG, Pereira GKR, Valandro FL, Scotti N. Could different direct restoration techniques affect interfacial gap and fracture resistance of endodontically treated anterior teeth? Clin Oral Investig 2021; 25:5967-5975. [PMID: 33860368 PMCID: PMC8443477 DOI: 10.1007/s00784-021-03902-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/19/2021] [Indexed: 01/11/2023]
Abstract
Objectives To evaluate different direct restoration techniques on various cavity designs in anterior endodontically treated teeth (ETT). Materials and methods Ninety upper central incisors (n = 90) were selected, endodontically treated, and divided into three groups (n = 30) accordingly to the cavity design: minimal endodontic cavity access (group A), endodontic access + mesial class III cavity (group B), and endodontic access + two class III cavities (group C). Three subgroups (n = 10) were then created accordingly to the restoration technique: nano hybrid composite restoration (subgroup a), glass fiber post + dual-cure luting cement (subgroup b), and bundled glass fiber + dual-cure luting cement (subgroup c). Samples underwent micro-CT scan, chewing simulation, and a second micro-CT scan. 3D quantification (mm3) of interfacial gap progression was performed; then, samples underwent fracture resistance test. Data were statistically analyzed setting significance at p < 0.05. Results Groups A and B showed significantly lower interfacial gap progression compared with group C. Subgroup b performed significantly better compared with subgroups a and c. Improved fracture strength was reported for group C compared with group A, while both subgroups b and c performed better than subgroup a. Conclusions Cavity design significantly influenced interfacial gap progression and fracture resistance. Fiber posts significantly lowered gap progression and improved fracture resistance while bundled fibers only increased fracture resistance. A significant reduction of non-repairable fractures was recorded when fibers were applied. Clinical relevance A minimally invasive approach, conserving marginal crests, should be applied whenever possible. Inserting a fiber post is indicated when restoring anterior ETT, in order to reduce gap progression, improve fracture resistance, and avoid catastrophic failures.
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Affiliation(s)
- Allegra Comba
- Department Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - Andrea Baldi
- Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy
| | - Carlo Massimo Saratti
- Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland
| | - Giovanni Tommaso Rocca
- Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland
| | - Carlos Rocha Gomes Torres
- Institute of Science and Technology, Department of Restorative Dentistry, São Paulo State University-UNESP, São José dos Campos, SP, Brazil
| | - Gabriel Kalil Rocha Pereira
- Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria, Santa Maria, Brazil
| | - Felipe Luiz Valandro
- Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria, Santa Maria, Brazil
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School, University of Turin, Turin, Italy.
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Oğuz Eİ, Kılıçarslan MA, Özcan M, Ocak M, Bilecenoğlu B, Orhan K. Evaluation of Denture Base Adaptation Fabricated Using Conventional, Subtractive, and Additive Technologies: A Volumetric Micro‐Computed Tomography Analysis. J Prosthodont 2021; 30:257-263. [DOI: 10.1111/jopr.13326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ece İrem Oğuz
- Department of Prosthodontics Faculty of Dentistry Ankara University Ankara Turkey
| | | | - Mutlu Özcan
- Center for Dental and Oral Medicine University of Zürich Zürich Switzerland
| | - Mert Ocak
- Department of Anatomy Faculty of Dentistry Ankara University Ankara Turkey
| | - Burak Bilecenoğlu
- Department of Anatomy Faculty of Medicine Medipol University Ankara Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology Faculty of Dentistry Ankara University Ankara Turkey
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