Radio-opacity of core materials for all-ceramic restorations

The Dentist's Ability to Detect Different Restorative Procedures on Periapical Radiographs-Results from a Reliability Study

(1) Background: This in vitro reliability study aimed to determine the inter- and intra-examiner reliability for the detection of direct fillings, indirect crown restorations, root canal fillings and implants on periapical radiographs. (2) Methods: Fourteen dentists (<2 years of clinical experience = 11; >2 years of clinical experience = 3) participated in this diagnostic reliability study in which included a theoretical and practical educational training prior to data collection. The image set of periapical radiographs (N = 150) was examined in two evaluation rounds by all the dentists. Cohen's Kappa (CK) and a binary logistic regression model were computed. (3) Results: The inter- and intra-examiner reliability were found to be in almost perfect agreement: direct fillings (1st round 0.859/2nd round 0.844/intra 0.910), indirect crown restorations (0.932/0.926/0.955), root canal fillings (0.920/0.886/0.941) and dental implants (0.994/0.988/0.987). The binary logistic regression model revealed that the "evaluation round" and "dentist's clinical experience" had no significant influence, but for the "diagnostic category"; small, but statistically significant differences were documented. (4) Conclusions: The reliability for detecting direct and indirect restorations, root canal fillings or implants on periapical radiographs was found to be high in the present reliability study on periapical radiographs.

Alumina as a Computed Tomography Soft Material and Tissue Fiducial Marker

Background

The use of 3D imaging is becoming increasingly common, so too is the use of fiducial markers to identify/track regions of interest and assess material deformation. While many different materials have been used as fiducials, they are often used in isolation, with little comparison to one another.

Objective

In the current study, we aim to directly compare different Computed Tomography (CT and μCT) fiducial materials, both metallic and nonmetallic.

Methods

μCT imaging was performed on a soft-tissue structure, in this case heart valve tissue, with various markers attached. Additionally, we evaluated the same markers with DiceCT stained tissue in a fluid medium. Eight marker materials were tested in all.

Results

All of the metallic markers generated significant artifacts and were found unsuitable for soft-tissue μCT imaging, whereas alumina markers were found to perform the best, with excellent contrast and consistency.

Conclusions

These findings support the further use of alumina as fiducial markers for soft material and tissue studies that utilize CT and μCT imaging.

Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures

Various types of zirconia are widely used for the fabrication of dental implant superstructures and fixtures. Zirconia-alumina composites, such as ATZ and NanoZR, are adequate for implant fixtures because they have excellent mechanical strength in spite of insufficient esthetic properties. On the other hand, yttria-stabilized zirconia has been used for implant superstructures because of sufficient esthetic properties. They are classified to 12 types with yttria content, monochromatic/polychromatic, uniform/hybrid composition, and monolayer/multilayer. Zirconia with a higher yttria content has higher translucency and lower mechanical strength. Fracture strength of superstructures strongly depends on the strength on the occlusal contact region. It suggests that adequate zirconia should be selected as the superstructure crown, depending on whether strength or esthetics is prioritized. Low temperature degradation of zirconia decreases with yttria content, but even 3Y zirconia has a sufficient durability in oral condition. Although zirconia is the hardest dental materials, zirconia restorative rarely subjects the antagonist teeth to occlusal wear when it is mirror polished. Furthermore, zirconia has less bacterial adhesion and better soft tissue adhesion when it is mirror polished. This indicates that zirconia has advantageous for implant superstructures. As implant fixtures, zirconia is required for surface modification to obtain osseointegration to bone. Various surface treatments, such as roughening, surface activation, and coating, has been developed and improved. It is concluded that an adequately selected zirconia is a suitable material as implant superstructures and fixtures because of mechanically, esthetically, and biologically excellent properties.

Chemical durability of high translucent dental zirconia

This review describes low temperature degradation (LTD), discoloration, and erosion of high translucent dental zirconia and discusses its chemical durability in comparison with other CAD/CAM materials. The LTD of zirconia strongly depended on the firing temperature, yttria content, surface treatment, and heat treatment. Glass ceramics for CAD/CAM were remarkably etched in a lactic acid at 60°C, KOH solution at 60°C, and saline solution at 90°C, whereas zirconia showed no changes in these solutions. Glass ceramics and hybrid resins for CAD/CAM showed significant discoloration in a red wine and rhodamine B solution at 37°C, whereas zirconia showed no discolorations in either solution. It was concluded that high translucent dental zirconia has the highest chemical durability among dental CAD/CAM materials.

Nanostructured Zirconia-Based Ceramics and Composites in Dentistry: A State-of-the-Art Review

The objective of this paper is to review the current knowledge on the development of nanostructured zirconia-based ceramics and composites suitable for application in dentistry. Isi Web of Science, Science Direct, Scientific.net databases, and Google were searched electronically for the period of 1980 to the present, matching the keywords “nano” with the keywords: “Zirconia, ZrO₂, Y-TZP, and dental, dentistry”. A total of 74 papers were found, with the majority coming from Asia, indicating a more active scientific interest on the topic in this geographic area, followed by Europe, South America, and North America. The research shows, even though the scientific activity on nanostructured ceramics was intense in the last fifteen years, the development of fully dense zirconia-based nanoceramics is yet at an initial stage, most of all from the point of view of the clinical applications. It has been demonstrated that nanostructured ceramics can show improved properties because of the reduction of the grain size to the nanoscale. This is also true for zirconia-based nanoceramics, where some improvements in mechanical, optical, as well as resistance in low-temperature degradation have been observed. Potential applications of this class of material in the dental field are discussed, summarizing the results of the latest scientific research.

Evaluating ceramic crown margins with digital radiography

STATEMENT OF PROBLEM

Radiographs aid in clinically determining crown fit, specifically interproximal margins where tactile and visual methods may be limited. However, investigations of the utility of digital radiographs as a tool for evaluating the marginal openings of ceramic crowns are lacking.

PURPOSE

The purpose of this in vitro study was to assess whether marginal adaptation for ceramic crowns and for metal-ceramic crowns with a metal collar can be identified with digital radiographs.

MATERIAL AND METHODS

One lithium disilicate crown, 1 fluorapatite crown, and 1 metal-ceramic crown were fabricated for a maxillary premolar. The crowns were attached to a custom-designed device that allowed the marginal discrepancy to be changed. A total of 10 increments were measured starting at 0 to 20 μm and increasing every 20 μm to a maximum opening of 180 to 200 μm. At each increment, 2 radiographs were made of the crowns, using a digital sensor, 1 perpendicular to and 1 at 80 degrees to the long axis of the tooth. To test whether digital radiographs could be used to accurately identify "acceptable" and "unacceptable" margins, 21 dentists were asked to rate the radiographs as "acceptable" or "unacceptable." The chi square test was used to analyze differences between the dentists' evaluations and the actual marginal opening (α=.05). For the purposes of this study, a marginal discrepancy greater than 80 μm was considered "unacceptable."

RESULTS

Of all marginal discrepancies exceeding 80 μm, 78.6% of the metal-ceramic crown radiographs were incorrectly scored as "acceptable" (P<.001). These radiographs were identified as false positives. Lithium disilicate (66.1%) and fluorapatite (45.8%) crowns were more likely to be incorrectly evaluated as "unacceptable" (P<.001) and identified as false negatives.

CONCLUSIONS

Using digital radiographs to evaluate marginal adaptation without clinical examination is not by itself an accurate method of evaluating the marginal fit of complete coverage crowns. The marginal fit of the tested metal-ceramic crowns tended to be evaluated incorrectly as acceptable. The marginal fit of the tested ceramic crowns tended to be evaluated incorrectly as unacceptable.

Cone Beam Computed Tomography- An Effective Tool in Detecting Caries Under Fixed Dental Prostheses

INTRODUCTION

Caries under restorations is the most common reason for re-treatment and replacement in restorative failures. To avoid failures of fixed dental prostheses, it is important to diagnose caries under it earlier. Without image degradation and metal artifacts, Cone Beam Computed Tomography (CBCT) can be the solution to detect caries without removing fixed dental prostheses.

AIM

The aim of this study was to determine the efficacy of CBCT in detecting caries under fixed dental prostheses.

MATERIALS AND METHODS

Each specimen was scanned with CBCT for evaluation of secondary caries under fixed prostheses. Exposure parameters were 60 kVp and 3mA. Field of View (FOV) used was 8cm X 8cm. According to International Caries Detection and Assessment System (ICDAS) criteria, six Grade 6 carious extracted teeth were selected. All teeth were prepared with four different specimens - full metal, metal-ceramic, full ceramic and metal-acrylic crowns for each tooth. Each specimen was scanned by CBCT. T-test was performed for mean gray value differences between caries and noncaries regions of each material. Gray values were recorded and evaluated for different parameters using two-way analysis of variance.

RESULTS

Significant differences were found with respect to material (full metal, metal-ceramic, full ceramic and metal-acrylic) and situation (caries/noncaries) (p<0.001). There were no significant differences with respect to location (anterior or posterior). Mean gray values of caries and noncaries regions were found to be different for each material.

CONCLUSION

CBCT can be used as a post-treatment diagnostic technique for detecting caries under fixed prostheses without removing it.

The effects of sintering temperature and duration on the flexural strength and grain size of zirconia

Objective: This study investigated the effect of different sintering temperatures and times on the flexural strength and grain size of zirconia.

Material and methods: Zirconia specimens (In-Coris ZI, In-Coris TZI, 120 samples) were prepared in a partially sintered state. Subsequently, the specimens were randomly divided into three groups and sintered at different final sintering temperatures and for various durations: 1510 °C for 120 min, 1540 °C for 25 min and 1580 °C for 10 min. Three-point flexural strength (for 120 samples, 20 samples per group) was measured according to the ISO 6872: 2008 standards. The grain sizes were imaged by scanning electron microscopy (SEM) and the phase transitions were determined by X-ray diffraction (XRD). The data were analyzed using one-way ANOVA and Duncan tests (p < 0.05).

Results: The highest flexural strength was observed in ZI and TZI samples sintered at 1580 °C for 10 min. The differences between the ZI samples sintered at 1510 °C for 120 min and those sintered at 1540 °C for 25 min were statistically insignificant. Also, TZI samples sintered at 1510 °C for 120 min and those sintered at 1540 °C for 25 min also did not show any statistically significant differences. There were no visible differences in the grain sizes between the ZI and TZI specimens. The XRD patterns indicated similar crystalline structure for both materials subjected to the three different procedures.

Conclusions: The results of this study showed that experimented high sintering temperature and short sintering time combination increases the flexural strength of zirconia.

Is it possible to diagnose caries under fixed partial dentures with cone beam computed tomography?

OBJECTIVE

The goal of this study was to determine the possibility of detecting/diagnosing caries under fixed partial dentures using cone beam computed tomography.

STUDY DESIGN

A range of teeth with grade 3 to 6 caries, according to International Caries Detection and Assessment System criteria, were selected. All teeth were prepared, and three different specimens- zirconia full-ceramic, lithium disilicate full-ceramic, and metal-supported ceramic crowns-were built for each tooth. Each specimen underwent scanning by cone beam computed tomography. Opacity values were recorded and evaluated using two-way analysis of variance. The Tukey test was performed for material and slice differences, and the t test for mean gray value differences, between caries and noncaries regions of each material.

RESULTS

Significant differences were detected with respect to horizontal location (anterior/posterior), restoration type (crown/bridge), material (zirconia/lithium disilicate/metal), and situation (caries/noncaries) (P < .001). Mean gray values of caries and noncaries regions were found to differ for each material. There were no significant differences with respect to vertical position.

CONCLUSIONS

Cone beam computed tomography can be used as a posttreatment diagnostic technique for detecting caries under high-atomic-number fixed plate dentures. By combining high resolution and accuracy, cone beam computed tomography could provide the means for diagnosing caries without removing fixed plate dentures.

Posttreatment diagnosis of caries under fixed restorations: a pilot study

STATEMENT OF PROBLEM

Conventional radiographic techniques are insufficient for detecting caries under fixed restorations or for acquiring clear images of the disease. Advanced radiographic techniques such as cone beam computerized tomography may be a solution.

PURPOSE

The purpose of this study was to assess the viability of detecting and characterizing caries under complete-ceramic and metal-supported crowns by using cone beam computerized tomography.

MATERIAL AND METHODS

A grade 6 carious molar tooth according to the International Caries Detection and Assessment System criteria was selected. The tooth was prepared, and 3 different crowns were fabricated in a dental laboratory: yttria tetragonal zirconia polycrystal (Y-TZP) ceramic, lithium disilicate ceramic, and metal ceramic. The crowns were placed on the prepared tooth, and each specimen was subjected to cone beam computerized tomography. Opacity values were recorded and evaluated with 2-way ANOVA. Multivariate comparisons (Tukey was performed to assess the mean gray value differences of the materials between caries and dentin, and the Mann-Whitney U test was performed to assess the mean gray value differences between caries and dentin for each material (α=.05).

RESULTS

Carious borders and cavities were detected under the 3 ceramic crown specimens with a cone beam computerized tomography radiographic technique. The statistical analysis of the radiopacity mean gray value was at the borderline of significance for the specimen radiographies. Significant differences were found with respect to materials, location, and the interaction between these 2 factors (P<.001).

CONCLUSIONS

Cone beam computerized tomography can be used as a posttreatment diagnostic technique for detecting caries under high atomic numbered crowns and partial fixed dental prostheses.

Radiopacity evaluation of contemporary resin composites by digitization of images

OBJECTIVE

The aim of this study was to evaluate the radiopacity of different composite resins and compare the values to those of human enamel and dentine.

MATERIALS AND METHODS

Five specimens of each material with thicknesses of 2 mm were prepared and radiographed alongside aluminum step wedge and human enamel and dentin. Three occlusal radiographs for each material were taken and digitized using a desktop scanner. Mean gray values of the test materials were measured using Image J software. Then a conversion was performed according to establish the radiopacity of the test materials, in millimeters of equivalent Al. Data were analyzed using one-way analysis of variance and Duncan multiple range tests (P < 0.05).

RESULTS

The radiopacity values varied among the restorative materials (P < 0.05). The radiopacity values of the materials tested were, in decreasing order: Enamel Plus HRI > Z250 > Filtek Ultimate ≥ Z550 > Nexcomp ≥ Nanoceram Bright > enamel ≥ Estelite Sigma Quick > Clearfil Majesty Esthetic ≥ Reflexions XLS ≥ Aelite LS Posterior ≥ dentin ≥ 2 mm Al.

CONCLUSION

All resin composite materials investigated in this study presented different radiopacity values. However, all materials had radiopacity values greater than dentin and had sufficient radiopacity to meet International Organization for Standardization 4049 standard.

HRTEM observation of bonding interface between Ce-TZP/Al2O3 nanocomposite and porcelain

The surface of a ceria-stabilized tetragonal zirconia polycrystal (Ce-TZP/Al2O3) nanocomposite was sandblasted by alumina particles and veneered with feldspathic porcelain via a conventional condensation method. The part of each specimen containing the interface layer was sliced to ultrathin sections with an argon ion slicer, and these sliced sections were observed using high-resolution transmission electron microscopy (HRTEM). For both interfaces, Ce-TZP/porcelain and Al2O3/porcelain, no transition layers due to abrupt changes in atomic distributions were observed. Besides, the porcelain layers of both interfaces consisted of homogeneous amorphous phases. These results suggested that both Ce-TZP and Al2O3 could be directly bonded to porcelain by Van der Waals forces arising from the close contact between them.

Surface damages of zirconia by Nd:YAG dental laser irradiation

The purpose of this study was to characterize the surface damages of zirconia by Nd:YAG dental laser irradiation through a systematic evaluation of the associated microstructural changes. Disk specimens of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/Al₂O₃ nanocomposite) were irradiated by Nd:YAG dental laser. The specimens were characterized using scanning electron microscopy, X-ray diffractometry, and wavelength dispersive X-ray spectroscopy. Every single irradiated spot was indicated by a circular black pit surrounded by a circular raised rim with a sunken depression at the center. On surface changes, many cracks were formed inside each irradiated pit. On changes in elemental composition, the concentration of oxygen decreased while that of zirconium increased. After heating in air, the assembly of circular black pits turned white, although the depression and raised rim remained. This study showed that Nd:YAG dental laser irradiation induced cracking and reduced oxygen content on the surface of zirconia. Consequently, these phenomena reduced the mechanical strength of zirconia. Therefore, Nd:YAG dental laser welding should not be performed on tetragonal zirconia.