Clinical application of lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture in the restoration of single anterior tooth loss / 口腔疾病防治

Objective@#To investigate the clinical effect of lithium disilicate glass ceramic cantilever resin-bonded fixed partial dentures (CRBFPDs) on single anterior tooth loss to provide a reference for the selection of restoration methods for single anterior tooth loss.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-two patients with less than two anterior teeth with monomaxillary loss were included in this study. After 6 months, 1 year, 2 years, and 3 years, the aesthetic and functional effects of the restorations and the periodontal health status were evaluated, and the visual analog scale (VAS) was used to assess patient satisfaction.@*Results@#During the observation period, the connector fractured in one case within 3 months. One case had debonded within 2 years. The aesthetic restoration effect of all lithium disilicate glass ceramic CRBFPDs was categorized as Class A. The periodontal health was good, there was no clinical absorption in the soft and hard tissues of the abutment or subbridge, periodontal status according to the evaluation indices was classified as class A, and the total satisfaction rate of the patient was 100%.@*Conclusion@#For single anterior tooth loss patients, lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture can achieve the restoration effect of less invasion, better adhesion, aesthetics, comfort and good biocompatibility. With high patient satisfaction, it can be considered an ideal restoration method for replacing a single anterior tooth.

The removal of three kinds of occlusal veneers by Er: Yag laser / 华西口腔医学杂志

OBJECTIVES@#This study aimed to remove occlusal veneers of varied thicknesses and compositions by Er:Yag laser in vitro and analyze the interfacial microstructure between veneers and tooth that irradiated by laser, by which experimental evidence could be provided to support the non-invasive removal of occlusal veneerby laser.@*METHODS@#Fresh mandibular premolars extracted for orthodontic requirements were collected for tooth preparation. Three kinds of ceramic materials (Vita Suprinity, Vita Mark Ⅱ, and Upcera Hyramic) were selected to fabricate occlusal veneer with different thicknesses (1.0, 1.5, and 2.0 mm). One week later, Er:Yag laser (2.5 W and 3.5 W) was used to irradiate and remove the occlusal veneer and recorded the timespan. After the removal operation, the micro-morphologies of samples were examined by scanning electron microscope.@*RESULTS@#Upcera Hyramic veneer failed to be removed (>20 min); the operation span at 2.5 W, Vita Suprinity (96.0 s±16.0 s) was longer than Vita MarkⅡ(84.5 s±19.5 s) in the 1.0 mm group (P<0.05), and Vita Suprinity (246.5 s±13.5 s) was longer than Vita MarkⅡ(170.0 s±14.0 s) in the 1.5 mm group (P<0.05). At 3.5 W, Vita Suprinity (381.0 s±24.0 s) was longer than Vita MarkⅡ(341.5 s±26.5 s) in the 2.0 mm group.@*CONCLUSIONS@#Increasing laser power could shorten the operation span and facilitate the removal of occlusal veneers with the same thickness and composition. The occlusal veneer was sustained when insufficient laser power was applied. With the same laser power and ceramic thickness, laser penetration could interfere with the integral of the ceramic structure when the laser interacted with the bonding layer. With the same ceramic composition and laser power, the operation span and laser power increased with the thickness of the occlusal veneer. However, the laser was incapable of removing occlusal resin veneer directly.

Research progress on the application of Er: YAG laser removing all-ceramic restorations / 口腔疾病防治

@#All-ceramic restorations are widely used in oral restoration because of their beauty and high strength. Glass ceramics and zirconia all-ceramic materials are the two most widely used all-ceramic materials in the clinic. However, when all-ceramic restorations need to be removed due to marginal microleakage and secondary caries, its high strength and high bonding strength greatly increase the difficulty of removal. In recent years, clinicians have tried to use Er: YAG lasers to remove all-ceramic restorations. The Er: YAG laser can be safely and efficiently applied to the removal of glass restorations, and it can also play a role in thinner zirconia restorations. Various factors, such as the material and thickness of the all-ceramic restoration, the type of cement, and the laser power, can affect the speed of removal of the Er: YAG laser. However, the current research is limited to case reports and in vitro studies, lacking systematic clinical research. The specific mechanism of Er: YAG laser removal of all-ceramic restorations and the influence of laser frequency, adhesive type, and abutment on the removal speed need to be further demonstrated by follow-up research.

Research progress on tetrabutylammonium dihydrogen trifluoride as a substitute for hydrofluoric acid used for porcelain surface treatment / 口腔疾病防治

@#Hydrofluoric acid is a common surface treatment agent for glass ceramic restorations before bonding. However, the use of hydrofluoric acid has a high safety risk, so the search for hydrofluoric acid substitutes has been a research hotspot. Tetrabutylammonium dihydrogen trifluoride is a kind of fluoride, whose chemical activity is lower than that of hydrofluoric acid, so it’s safer, and the surface morphology changes on glass ceramics caused by it are smaller and more superficial. At present, the vast majority of laboratory studies and clinical case reports indicate that the mechanical strength and bonding strength of glass ceramics treated with tetrabutylammonium dihydrogen trifluoride can meet the clinical requirements. In the future, according to the research results, the performance of porcelain surface treatment agents containing tetrabutylammonium dihydrogen trifluoride can be further improved, and more hydrofluoric acid substitutes may be developed. In this review, the research progress of tetrabutylammonium dihydrogen trifluoride as a substitute for hydrofluoric acid is reviewed in terms of the influence of the surface morphology, mechanical strength, and bonding strength of glass ceramics.

Study of crystallization, microstructure and mechanical properties of lithium disilicate glass-ceramics as a function of the sintering temperature / Estudo da cristalização, microestrutura e propriedades mecânicas de uma vitrocerâmica de dissilicato de lítio em função da temperatura de sinterização

Objective: The purpose of the present study was to synthesize and characterize lithium disilicate glass-ceramics through the Li2O-SiO2system for determining the most satisfactory sintering parameter by evaluating the crystalline composition, microstructure and mechanical properties. Material and methods: The glass-ceramics were prepared from a glass precursor by means of the melting/cooling technique with a composition of 33.33 Li2O and 66.67 SiO2 (mol.%). The specimens were compressed by the uniaxial pressing technique and three different thermal treatments were used for sintering: 850 °C (Group 1), 900 °C (Group 2), and 950 °C (Group 3), which were determined based on the differential scanning calorimetry (DSC) result. The glass-ceramics were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), Archimedes method, microhardness and biaxial flexural strength analyses. Results: The results regarding XRD predominantly showed lithium disilicate phase for all the heat treatments performed. Moreover, grains with a needle form were more predominantly observed in the SEM images for Group 3, as well as a higher densification and consequently higher mechanical properties. In contrast, Group 1 presented the lowest mechanical properties and densification, as well as the highest porosity. Conclusion: The present study demonstrated how extremely important it is to follow the heat treatment recommended by the manufacturers of ceramics, including time and temperature, which possess direct effects in the crystalline phase formation, as well as in the material's microstructure and mechanical properties (AU)

Objetivo: O presente estudo teve como objetivo sintetizar e caracterizar uma vitrocerâmica de dissilicato de lítio através do sistema Li2O-SiO2para determinar o parâmetro de sinterização mais satisfatório através da avaliação da composição cristalina, microestrutura e propriedades mecânicas. Material e Métodos: As vitrocerâmicas foram preparadas a partir de um vidro precursor pelo método fusão/resfriamento utilizando a composição de 33.33 Li2O e 66.67 SiO2 (mol.%). As amostras foram prensadas utilizando uma técnica de prensagem uniaxial e três tratamentos térmicos diferentes foram utilizadas para sinterização: 850 °C (Grupo 1), 900 °C (Grupo 2), e 950 °C (Grupo 3), que foram determinados através do resultado da análise diferencial de calorimetria. As vitrocerâmicas foram caracterizadas através das análises de difração de raios X (DRX), microscopia eletrônica de varredura (MEV), métodos de Arquimedes, microdureza e ensaio de flexão biaxial. Resultados: Os resultados de DRX mostraram predominantemente a fase de dissilicato de lítio para todos os tratamentos realizados. Além disso, grãos com forma agulhada foram mais predominantemente observados por MEV no grupo 3, assim como uma densificação maior e consequentemente valores maiores das propriedades mecânicas. Em contraste, o grupo 1 apresentou os menores valores de propriedades mecânicas e densificação, e também a maior porosidade. Conclusão: O presente estudo demonstrou como é extremamente importante seguir o tratamento térmico recomendado pelos fabricantes de cerâmica, incluindo tempo e temperatura, que possuem efeitos diretos na formação da fase cristalina, assim como na microestrutura do material e propriedades mecânicas. (AU)

Machinability of Zirconia Toughened Mica Glass Ceramics for Dental Restorations / Usinabilidade de cerâmica de vidro de mica temperada com zircônia para restaurações dentárias

Objective: For a dental material to be machinable for CAD/CAM technology, it must offer convenient machining, under a given set of cutting conditions. Quantitative evaluation of machinability has been assessed in literature through various parameters such as tool wear, penetration rates, surface roughness, cutting force and power. A machinable ceramic will typically demonstrate a higher tool penetration rate with signs of reduced diamond tool wear and edge chipping. The purpose of this in vitro study was to evaluate the feasibility of machining an experimental ceramic, 20 wt.% zirconia reinforced mica glass ceramics (G20Z) for indirect dental restorations and compare the tool penetration rates of G20Z to commercially available dental ceramics, Presintered Zirconia (PSZ) and IPS emax CAD. Material and Methods: Precursors of base glass (SiO2 -Al2O3 -K2O -MgO-B2O3 -F) were melted at 15000C for 2 h in a platinum crucible and quenched in deionised water. The glass frit was ball milled with 20 wt. % YSZ (G20Z) and subject to two stage heat treatment in a muffle furnace. Specimens of G20Z (12 X 2 mm) were evaluated for their feasibility of machining under varying spindle speed, depth of cut, and feed rates. Influence of depth of cut, spindle speed and feed rate (vc=8000-16000 rpm, d=0.4-0.8 mm, f=0.1- 0.3 mm/tooth) on cutting forces, material response, surface roughness and tool wear were investigated. Tool penetration rates, tool wear and margin chipping were also evaluated and compared with Pre-sintered Zirconia (PSZ) and e.max CAD in a custom dental milling surveyor at 30,000 rpm with a load of 0.98 N under water lubrication for 6 min. Tool penetration rates were calculated as the ratio of length of cut and milling time with a measuring microscope and scanning electron microscope was used for tool wear and edge chipping. ANOVA and Tukey Kramer tests were used for statistically comparing the means of each group. Results: Spindle speed and feed rate play a significant role in influencing surface roughness, thrust force, cutting forces and tool wear. Penetration rates of G20Z (0.32 ±0.12 mm/min) was significantly greater than PSZ (0.26 ±0.06 mm/min) and IPS e.max CAD (0.21 ±0.05 mm/min). SEM observations reveal tool abrasion and edge chipping regardless of the ceramic type. Conclusion: High spindle speeds delivers low cutting forces with an average surface roughness of 1.61 µm, with abrasive wear of the tool insert and brittle fracture of zirconia mica glass ceramic composites. G20Z with its machinable nature demonstrates greater tool penetration rates than PSZ and IPS e.max CAD. Tool wear and edge chipping is seen in all the investigated ceramics. (AU)

Objetivo: Para que um material odontológico seja usinável para a tecnologia CAD / CAM, ele deve oferecer uma usinagem conveniente, sob um determinado conjunto de condições de corte. A avaliação quantitativa da usinabilidade tem sido avaliada na literatura por meio de vários parâmetros, como desgaste da ferramenta, taxas de penetração, rugosidade da superfície, força de corte e potência. Uma cerâmica usinável normalmente demonstrará uma maior taxa de penetração da ferramenta com sinais de desgaste reduzido da ferramenta de diamante e lascamento da borda. O objetivo deste estudo in vitro foi avaliar a viabilidade da usinagem de uma cerâmica experimental, 20% em peso de cerâmica de vidro de mica reforçada com zircônia (G20Z) para restaurações dentárias indiretas e comparar as taxas de penetração da ferramenta de G20Z com as cerâmicas dentais comercialmente disponíveis, Zircônia Presinterizada (PSZ) e IPS emax CAD. Material e Métodos: Precursores de vidro base (SiO2-Al2O3-K2O -MgO-B2O3 -F) foram fundidos a 15000C por 2 h em um cadinho de platina e temperados em água deionizada. A frita de vidro foi moída com 20% em peso de YSZ (G20Z) e submetida a tratamento térmico em duas fases em mufla. Amostras de G20Z (12 x 2 mm) foram avaliadas quanto à sua viabilidade de usinagem sob variação de velocidade do fuso, profundidade de corte e taxas de avanço. A influência da profundidade de corte, velocidade do fuso e taxa de avanço (vc = 8000-16000 rpm, d = 0,4-0,8 mm, f = 0,1- 0,3 mm / dente) nas forças de corte, resposta do material, rugosidade da superfície e desgaste da ferramenta foram investigadas. As taxas de penetração da ferramenta, o desgaste da ferramenta e o lascamento da margem também foram avaliados e comparados com Zircônia pré-sinterizada (PSZ) e e.max CAD em um topógrafo de fresamento dentário personalizado a 30.000 rpm com uma carga de 0,98 N de lubrificação subaquática por 6 min. As taxas de penetração da ferramenta foram calculadas como a razão entre o comprimento de corte e o tempo de fresamento com um microscópio de medição e um microscópio eletrônico de varredura foi usado para o desgaste da ferramenta e lascamento da borda. Os testes ANOVA e Tukey Kramer foram usados para comparar estatisticamente as médias de cada grupo. Resultados: a velocidade do fuso e a taxa de avanço desempenham um papel significativo em influenciar a rugosidade da superfície, força de impulso, forças de corte e desgaste da ferramenta. As taxas de penetração de G20Z (0,32 ± 0,12 mm / min) foram significativamente maiores do que PSZ (0,26 ± 0,06 mm / min) e IPS e.max CAD (0,21 ± 0,05 mm / min). As observações do SEM revelam a abrasão da ferramenta e o lascamento da borda, independentemente do tipo de cerâmica. Conclusão: As altas velocidades do fuso proporcionam baixas forças de corte com uma rugosidade superficial média de 1,61 µm, com desgaste abrasivo do inserto da ferramenta e fratura frágil de compósitos de cerâmica de vidro de zircônia. G20Z com sua natureza usinável demonstra maiores taxas de penetração da ferramenta do que PSZ e IPS e.max CAD. O desgaste da ferramenta e o lascamento da borda são vistos em todas as cerâmicas investigadas. (AU)

The Effect of Different Surface Treatment Protocols on the Shear Bond Strength to Repressed Lithium Disilicate Glass Ceramics / Efeito de diferentes protocolos de tratamento de superfície na resistência ao cisalhamento de vitrocerâmica de dissilicato de lítio reprensado

Objective: The present study aimed to evaluate the effect of repressing and different surface treatment protocols on the shear bond strength of lithium disilicate glass-ceramics. Material and Methods: A total of 52 lithium disilicate glass-ceramic discs (IPS emax Press, Ivoclar Vivadent) were fabricated using the heat-press technique. The discs were divided into two groups; group (P): discs fabricated from new e.max ingots (n=26), group (R): discs fabricated from reused e.max buttons (n=26). Each group was subdivided into subgroup (E): discs were etched with hydrofluoric acid (9.5%) (n=13), subgroup (S): discs were air-abraded with 110 µm alumina particles. All specimens were subjected to X-ray Diffraction analysis, Scanning Electron Microscope, Energy Dispersive X-Ray, Thermo-Cycling, and Shear Bond Strength Testing. Results: Repressed Etched subgroup (RE) recorded the statistically highest shear bond strength value, followed by the Pressed Etched subgroup (PE), while the statistically lowest shear bond strength value was recorded for the Pressed Air-Abraded subgroup (PS) and Repressed Air-Abraded subgroup (RS). Conclusion: Repressing the leftover buttons for the construction of new lithium disilicate glass-ceramic restorations has no adverse effect on the bond strength of the resin cement to the ceramic. Hydrofluoric acid surface treatment improves the shear bond strength and durability of resin cement bond to both pressed and repressed lithium disilicate glass-ceramic. Air-abrasion cannot be considered as a reliable surface treatment when bonding to lithium disilicate glass-ceramics. (AU)

Objetivo: O presente estudo teve como objetivo avaliar o efeito da reprensagem e de diferentes protocolos de tratamento de superfície na resistência ao cisalhamento de vitrocerâmica de dissilicato de lítio. Materiais e Métodos: Um total de 52 discos de vitrocerâmica de dissilicato de lítio (IPS emax Press, Ivoclar Vivadent) foram fabricadas usando a técnica de prensagem quente. Os discos foram divididos em dois grupos: grupo (P): discos fabricados a partir de novo lingotes de e-max (n=26), grupo (R): discos fabricados a partir de botões de emax reutilizados (n=26). Cada grupo foi subdividido em subgrupo (E): discos condicionados com ácido fluorídrico (9,5%) (n=13), subgrupo (S) discos foram abrasivos com partícula 110 µm de alumínio. Todos os espécimes foram submetidos a analise de difração de raio-x, microscópio eletrônico de varredura, raio-x de energia dispersiva, termociclagem e teste de resistência de cisalhamento. Resultados: O subgrupo Reprensado-condicionado (RE) registrou o valor estatisticamente mais alta em relação a resistência ao cisalhamento, seguido pelo subgrupo Prensado-condicionado (PE), enquanto o valor estatisticamente mais baixo de resistência ao cisalhamento foi o subgrupo Prensado-Jateado (OS) e o subgrupo Reprensado-Jateado (RS). Conclusão: A reprensagem dos botões restantes para a construção de novas restaurações vitrocarâmicas de dissilicato de lítio não apresentou efeitos adversos na resistência de unicãp do cimento resinoso à cerâmica. O tratamento de superfície com ácido fluorídrico melhora a resistência ao cisalhamento e a durabilidade do cimento resinoso para vitrocerâmica de dissilicato de lítio prensada e reprimida. A abrasão por ar não pode ser considerada um tratamento de superfície confiável quanto a colagem da vitrocerâmica de dissilicato de lítio (AU)

Wear behavior of monolithic zirconia against natural teeth in comparison to two glass ceramics with two surface finishing protocols: an in-vitro study / Comportamento do desgaste da zircônia monolítica frente a dentes naturais em comparação com duas cerâmicas de vidro com diferentes protocolos de acabamento superficial: um estudo in vitro

Objective: To evaluate and compare the wear behavior of three different ceramic systems; monolithic zirconia, lithium di-silicate and nano-fluorapatite glass ceramic with two finishing procedures polishing and glazing, and their effect on the wear of natural tooth antagonists. Material and Methods: Forty two ceramic disc specimens (10mm x3mm) and forty two natural tooth antagonists were used. Samples were divided according to ceramic materials into 3 groups (n = 14). Group I: nano-fluorapatite glass ceramic (FLU) (IPS e.max Ceram), Group II: lithium disilicate (LD) (IPS e.max CAD) and group III: monolithic zirconia (ZIR) (ZirkoZahn Prettau). Each group was further subdivided into two subgroups (n = 7), according to the surface finish: Polishing (P) and glazing (G). Specimens were subjected to a custom designed two-body wear simulator. Quantitative wear assessment was carried out using weight loss measurements. Scanning electron microscope was used for characterization of wear patterns. Kruscal Wallis and Dunn's tests were used to compare between weight loss of the three ceramic materials. Whitney U test was used to compare the weight loss between the two surface finish protocols. Wilcoxon Signed rank test was used to compare the weight loss between ceramic specimens and antagonist teeth (p ≤ 0.05). Paired t-test was used to compare weight loss before and after wear test. Results: After wear, LD and FLU had the highest weight loss values compared to ZIR (p < 0.05). For teeth, there was no significant difference between the weight loss values with the three materials (p > 0.05). P and G specimens showed no significant difference in weight loss values. SEM images of the wear patterns verified the previous analysis. Conclusion: ZIR is more wear resistant than LD and FLU. However, the surface treatment had no impact on the wear behavior. (AU)

Objetivo: Avaliar e comparar o comportamento ao desgaste de três diferentes sistemas cerâmicos; zircônia monolítica, di-silicato de lítio e vitrocerâmica de nano-fluorapatita com dois procedimentos de polimento e glaze, e seu efeito no desgaste de dentes naturais antagonistas. Material e Métodos: Foram utilizadas quarenta e duas amostras de discos cerâmicos (10 mm x 3 mm) e quarenta e dois dentes naturais como antagonistas. As amostras foram divididas de acordo com o material cerâmico em 3 grupos (n = 14). Grupo I: vitrocerâmica nano-fluorapatita (FLU) (IPS e.max Ceram), Grupo II: dissilicato de lítio (LD) (IPS e.max CAD) e grupo III: zircônia monolítica (ZIR) (ZirkoZahn Prettau). Cada grupo foi subdividido em dois subgrupos (n = 7), de acordo com o acabamento da superfície: Polimento (P) e Glaze (G). As amostras foram submetidas a um simulador de desgaste de dois corpos projetado. A avaliação quantitativa do desgaste foi realizada usando medidas de perda de massa. Microscópio eletrônico de varredura foi utilizado para caracterização de padrões de desgaste. Os testes de Kruscal Wallis e Dunn foram usados para comparar a perda de massa dos três materiais cerâmicos. O teste U de Whitney foi utilizado para comparar a perda de massa entre os dois protocolos de acabamento superficial. O teste de Wilcoxon Signed Rank foi utilizado para comparar a perda de massa entre amostras de cerâmica e os dentes antagonistas (p ≤ 0,05). O teste t pareado foi utilizado para comparar a perda de massa antes e depois do teste de desgaste. Resultados: Após o desgaste, LD e FLU apresentaram os maiores valores de perda de massa em comparação ao ZIR (p < 0,05). Para os dentes, não houve diferença significativa entre os valores de perda de massa com os três materiais (p > 0,05). As amostras de P e G não mostraram diferença significativa nos valores de perda de massa. Imagens SEM dos padrões de desgaste confirmaram a análise anterior. Conclusão: O ZIR é mais resistente ao desgaste do que LD e FLU. No entanto, o tratamento de superfície não teve impacto no comportamento do desgaste. (AU)

Effect of two aging methods on the bonding interface between glass ceramics and dentin / 口腔疾病防治

Objective@#To study the effects of bacterial invasion and artificial saliva immersion on the bond strength and nanoleakage between healthy dentin and glass ceramics-bonded specimens using three types of resin cements and provide a reference for the selection of clinical bonding materials.@*Methods @#One hundred eight dentin blocks were selected to prepare bonded specimens with Variolink N, Multilink N, RelyX Unicem and glass ceramics blocks. The adhesive specimens of each type of resin cements were divided into three groups according to the aging method: bacterial invasiveness group (the specimens were cultured under anaerobic conditions for 14 days after inoculation with Streptococcus mutans), artificial saliva immersion group (the specimens were immersed in artificial saliva for 6 months), and control group (the immediate test group). Each group comprised 12 specimens: 6 were selected to test the bonding strength, and 6 were observed by scanning field emission scanning electron microscopy (FESEM). @*Results @#The bond strength of Variolink N in the immediate test group was significantly higher than that of Multilink N and RelyX Unicem, and the difference was statistically significant (P < 0.05). However, no significant difference was found in the bacterial invasiveness group and artificial saliva immersion group (P > 0.05). In the bacterial invasion group, the difference in the nanoleakage of the three adhesives was statistically significant (P < 0.05), with a trend of Variolink N > Multilink N > RelyX Unicem, and pairwise comparison was statistically significant (P < 0.05). The nanoleakage of the three resin adhesives showed an increasing trend in the bacterial invasion group and artificial saliva group compared with that of the immediate test group. @* Conclusion@#Both artificial saliva soaking and bacterial invasion can reduce the sealing property of the adhesive interface of 3 types of resin cements to different degrees. The presence of Streptococcus mutans in the oral cavity may reduce the sealing performance of the resin dentine adhesive interface.

Alternativas de tratamientos de superficie para adhesión de cerámica de disilicado de litio / Alternatives of surface treatments for adhesion of lithium disilicate ceramics

Introduction: the clinical success of a restoration is strongly associated with the quality and durability of the ceramic-cement resin interface. In order to obtain an adequate union between these materials of different nature surface treatments are used and achieve mechanical retention or chemical interaction. Objectives: to check if any method promotes a true chemical bond between lithium disilicate ceramics and resin cement. As well as determineif there is any treatment that reports bonding values comparable to hydrofluoric acid and silane (gold standard). Methods: a systematic literature review was developed based on the PRISMA strategy, where the databases were searched: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO with MeSH and free terms from 2005 to November 2016 for articles in English and Spanish on surface treatments for lithium disilicate. Results: from 58 publications selected a sample of 21 articles. Two articles reported high risk of bias. Conclusions: hydrofluoric acid and silane continue to be the method with the highest and most reliable adhesion values in the literature. Universal adhesives are an alternative to promote chemical adhesion additional to the silane. Diamond burs, Nd: YAG and Er: YAG laser are not recommended as surface treatments(AU)

Introducción: el éxito clínico de una restauración se asocia fuertemente a la calidad y duración de la interface cerámica-cemento resinoso. Para que exista una adecuada unión entre estos materiales de distinta naturaleza se emplean tratamientos de superficie para lograr una buena retención mecánica o interacción química. Objetivos: revisar si algún método promueve una verdadera adhesión química entre la cerámica de disilicato de litio y el cemento resinoso, así como determinar si existe algún tratamiento que reporte valores de unión comparables al ácido fluorhídrico y silano (patrón de oro). Métodos: se desarrolló una revisión sistemática de literatura basada en la estrategia PRISMA, donde se buscó en las bases de datos: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO con términos MeSH y libres desde el 2005 a noviembre de 2016 para artículos en inglés y español sobre tratamientos de superficie para disilicato de litio. Resultados: de 58 publicaciones, se seleccionó una muestra de 21 artículos. Dos artículos reportaron riesgo de sesgo alto. Conclusiones: el ácido fluorhídrico y silano continúan siendo el método con los valores de adhesión más altos y confiables de la literatura. Los adhesivos universales son una alternativa para promover adhesión química adicional al silano. Fresas diamantadas, laser Nd: YAG y Er:YAG no se recomienda como tratamientos de superficie(AU)

Crystal Modification on Lithium Disilicate Glass Ceramics Sintered Using Microwaves / Modificación de Cristales de Cerémicas de Vidrio de Disilicato de Litio Sinterizadas con Microondas

ABSTRACT: Microwaves are an interesting alternative to process dental ceramics. It is well documented that Microwave Hybrid Sintering (MHS) allows important savings in time and energy consumption. However, little is known about its effect on lithium disilicate glass ceramics, a popular material in dentistry today. We analyzed the microstructure of lithium disilicate glass ceramics sintered with MHS compared with conventional sintering. We sintered lithium disilicate glass ceramics using MHS and conventional furnaces, and we analyzed the samples using X-Ray diffraction and SEM. Samples sintered with MHS showed an increased crystalline phase, with an increased number of crystals. These crystals have larger perimeters compared with samples sintered in conventional furnaces. MHS produced a different crystallization pattern and crystal/ matrix ration in lithium disilicate glass ceramics when compared to conventional sintering. This can be associated with the improved mechanical properties of these materials reported previously.

RESUMEN: Las microondas son una interesante alternativa para procesar cerámicas dentales. Está bien documentado que el Sinterizado Híbrido por Microondas (MHS) permite ahorros importantes de tiempo y energía. Sin embargo, poco se ha publicado respecto a sus efectos en cerámicas de disilicato de litio, un material bastante popular en odontología en estos días. En este artículo analizamos la micro estructura de cerámicas de disilicato de litio sinterizada con MHS comparada con el sinterizado convencional. Sinterizamos muestras de cerámicas de disilicato de litio usando MHS y hornos convencionales, y analizamos las muestras usando difracción de rayos X y SEM. Las muestras sintetizadas usando MHS tienen una mayor fase cristalina, con mayor número de cristales. Estos cristales tienen además perímetros mayores, comparados con las muestras sinterizadas en hornos convencionales. MHS produce patrones de cristalización y proporción de cristal/matrix diferentes a las producidos por sinterizado convencional. Esto puede asociarse a las mejoras en propiedades mecánicas reportadas previamente.

Effect of Different Silane Treatments on Long-Term Bonding Between Non-Etched Glass-Ceramic and Resin Cement

he present study evaluated the bond strength between glass-ceramic and resin cement, using different silane treatments, performing no previous hydrofluoric acid (HF) etching on ceramic surface, after short- and long- term storage. One hundred and eighty glass-ceramic plaques (IPS e.max CAD®) were polished and divided into six groups (n=30) to receive different silane treatments: (1) RCP-RelyX Ceramic Primer® (one-bottle silane), (2) RCP+SB-RelyX Ceramic Primer and Adper Singlebond2® (silane plus separated adhesive), (3) SBU-Scotchbond Universal® (silane-containing universal adhesive), (4) CP-Clearfil Ceramic Primer® (silane/MDP primer), (5) NC-no-silane (negative control) and (6) PC-Previous HF etching (5%, 20s) plus RelyX Ceramic Primer® (positive control). Two resin cement cylinders (Rely X Ultimate®) were built on each plaque. Each group was divided into two sub-groups to be stored for 24 hours (24h) or 6 months (6mo) in distilled water at 37°C (n=15). Then microshear (µSBS) testing was performed. Failure mode was analyzed using scanning electron microscopy (SEM). Data were statistically analyzed by two-way ANOVA and Tukey´s test (α=0.05). Both factors and their interaction resulted statistically significant (p≤0.05). PC obtained the highest µSBS values (in MPa) at both storage times (24h: 28.11±2.44; 6mo: 19.10±3.85). After 24h storage, groups RCP+SB (10.86±3.62), SBU (8.37±4.33) and CP (8.05±3.62) were not statistically different from NC (8.00±2.51); only RCP (19.73±4.63) and PC obtained higher values. After 6 months, only PC showed higher values than NC (0.04±0.01). Cohesive failure in resin cement was more prevalent for RCP-24h and PC, while adhesive failure was more frequent among all other groups. Clinical relevance: None of the commercially available silane primers tested, improve long- term ceramic/cement bonding without performing HF etching on ceramic surface. Combination of HF acid and silane, remain as a gold standard treatment for glass-ceramic materials.

ste estudio evaluó la resistencia de unión entre cerámica vítrea y cemento resinoso, utilizando diferentes tratamientos de silano, sin realizar condicionamiento previo de la cerámica con ácido fluorhídrico (HF), después de almacenamiento en corto y largo plazo. Ciento ochenta placas de cerámica (IPS e.max CAD®) fueron pulidas y divididas en 6 grupos (n=30) para ser tratadas como sigue: (1) RCPRelyX Ceramic Primer® (silano de 1 frasco), (2) RCP+SB-RelyX Ceramic Primer y Adper Singlebond2® (silano más adhesivo separado), (3) SBU-Scotchbond Universal® (adhesivo universal conteniendo silano), (4) CP-Clearfil Ceramic Primer® (primer cerámico conteniendo silano y MDP), (5) NC-ningún silano (control negativo) y (6) PC-Condicionamiento con HF previo (5%, 20s) y silano (RelyX Ceramic Primer®) (control positivo). Dos cilindros de cemento resinoso (Rely X Ultimate®) fueron construidos en cada placa. Cada grupo fue dividido en 2 sub-grupos para ser almacenados por 24 horas (24h) y 6 meses (6mo) en agua destilada a 37°C (n=15). Luego fue realizada la prueba de microcizallamiento (µSBS). El tipo de fractura fue analizado con microscopio electrónico de barrido (SEM) y los datos analizados con las pruebas estadísticas ANOVA de dos factores y Tukey (α=0.05). Ambos factores y su interacción resultaron estadísticamente significativos (p≤0.05). PC presentó los valores más altos de µSBS (MPa) para ambos tiempos de almacenamiento (24h: 28.11±2.44; 6mo: 19.10±3.85). Luego de 24h, los grupos RCP+SB (10.86±3.62), SBU (8.37±4.33) y CP (8.05±3.62) no fueron estadísticamente diferentes del grupo control negativo (NC: 8.00±2.51); sólo RCP (19.73±4.63) y PC obtuvieron resultados mayores. Después de 6 meses de almacenaje, sólo el grupo PC obtuvo valores estadísticamente mayores que NC (0.04±0.01). Fractura cohesiva en el cemento fue más prevalente para RCP-24h y PC, mientras que el tipo adhesivo fue el más frecuente para todos los demás grupos. Relevancia Clínica: Ninguno de los tratamientos de silano evaluados, mejoró significativamente la adhesión a largo plazo entre cerámica vítrea no condicionada y cemento resinoso. La combinación de HF y silano, continúa siendo el tratamiento de preferencia para cerámica vítrea durante el proceso de cementación.

LED and Halogen Light Transmission through a CAD/CAM Lithium Disilicate Glass-Ceramic

The effect of thickness, shade and translucency of CAD/CAM lithium disilicate glass-ceramic on light transmission of light-emitting diode (LED) and quartz-tungsten-halogen units (QTH) were evaluated. Ceramic IPS e.max CAD shades A1, A2, A3, A3.5, high (HT) and low (LT) translucency were cut (1, 2, 3, 4 and 5 mm). Light sources emission spectra were determined. Light intensity incident and transmitted through each ceramic sample was measured to determine light transmission percentage (TP). Statistical analysis used a linear regression model. There was significant interaction between light source and ceramic translucency (p=0.008) and strong negative correlation (R=-0.845, p<0.001) between ceramic thickness and TP. Increasing one unit in thickness led to 3.17 reduction in TP. There was no significant difference in TP (p=0.124) between shades A1 (ß1=0) and A2 (ß1=-0.45) but significant reduction occurred for A3 (ß1=-0.83) and A3.5 (ß1=-2.18). The interaction QTH/HT provided higher TP (ß1=0) than LED/HT (ß1=-2.92), QTH/LT (ß1=-3.75) and LED/LT (ß1=-5.58). Light transmission was more effective using halogen source and high-translucency ceramics, decreased as the ceramic thickness increased and was higher for the lighter shades, A1 and A2. From the regression model (R2=0.85), an equation was obtained to estimate TP value using each variable ß1 found. A maximum TP of 25% for QTH and 20% for LED was found, suggesting that ceramic light attenuation could compromise light cured and dual cure resin cements polymerization.

Resumo Avaliou-se o efeito da espessura, cor e translucidez de uma cerâmica vítrea a base de dissilicato de lítio para CAD / CAM sobre a transmissão da luz de unidades de diodos emissores de luz (LED) e de quartzo-tungstênio-halogênio (QTH). Cerâmica IPS e.max CAD nas cores A1, A2, A3, A3.5 de translucidez alta (HT) e baixa (LT) foram cortadas (1, 2, 3, 4, 5 mm). Os espectros de emissão das fontes de luz foram determinados. A intensidade da luz incidente e transmitida através de cada espécime de cerâmica foi medida para determinar a percentagem de transmissão de luz (TP). Um modelo de regressão linear foi utilizado para a análise estatística. Houve interação significativa entre a fonte de luz e translucidez cerâmica (p = 0.008) e forte correlação negativa (r = -0.845, p <0.001) entre a espessura da cerâmica e TP. O aumento da espessura em uma unidade levou a uma redução média de 3.17 em TP. Não houve diferença significativa em TP (p = 0.124) entre as cores A1 (ß1 = 0) e A2 (ß1 = -0.45), mas ocorreu redução significativa para as cores A3 (ß1 = -0.83) e A3.5 (ß1 = -2.18). A interação QTH/HT proporcionou maior TP (ß1 = 0) do que LED/HT (ß1 = -2.92), QTH/LT (ß1 = -3.75) e LED/LT (ß1 = -5.58). A transmissão de luz foi mais eficaz utilizando QTH e cerâmica de alta translucidez, diminuiu à medida que a espessura de cerâmica aumentou, e foi maior para as cores A1 e A2. A partir do modelo de regressão (R2 = 0.85), obteve-se uma equação para estimar o valor de TP utilizando os valores de ß1 encontrado. Foi observada TP máxima de 25% para QTH e 20% para LED, sugerindo que a atenuação promovida pela cerâmica pode comprometer a ativação de um cimento resinoso fotoativado e de ativação dupla.

Negative Effect of Rapidly Resorbing Properties of Bioactive Glass-Ceramics as Bone Graft Substitute in a Rabbit Lumbar Fusion Model

BACKGROUND: Bioactive glass-ceramics have the ability to directly bind to bones and have been widely used as bone graft substitutes due to their high osteoconductivity and biocompatibility. CaO-SiO2-P2O5-B2O3 glass-ceramics are known to have good osteoconductivity and are used as bone graft extenders. METHODS: This study aimed to evaluate the effects of the resorbing properties of glass-ceramics in bone fusion after producing and analyzing three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with high osteoconductivity that had enhanced resorption by having an increased B2O3 content. The three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with B2O3 contents of 8.0, 9.0, and 9.5 weight % were designated and grouped as P20B80, P10B90, and P5B95, respectively. Glass-ceramic types were tested for fusion rates and bone formation by employing the lumbar 5-6 intertransverse process fusion model in 51 New Zealand male rabbits. Bioactivity was assessed by soaking in simulated body fluid (SBF). RESULTS: In vitro study results showed sufficient hydroxycarbonate apatite layer formation occurred for P20B80 in1 day, for P10B90 in 3 days, and for P5B95 in 5 days after soaking in SBF. For the rabbit lumbar spine posterolateral fusion model, the autograft group recorded a 100% fusion rate with levels significantly higher than those of P20B80 (29.4%), P10B90 (0%), and P5B95 (14.3%), with high resorbing properties. Resorbing property differences among the three glass-ceramic groups were not significant. Histological results showed new bone formation confirming osteoconductivity in all three types of glass-ceramics. Radiomorphometric results also confirmed the resorbing properties of the three glass-ceramic types. CONCLUSIONS: The high resorbing properties and osteoconductivity of porous glass-ceramics can be advantageous as no glass-ceramics remain in the body. However, their relatively fast rate of resorption in the body negatively affects their role as an osteoconductive scaffold as glass-ceramics are resorbed before bony fusion.

Solución estética a un dilema en las restauraciones indirectas con corona y carillas simultáneas: Reporte de un caso / Dental restoration with laminate veneers and ceramic crown, aesthetic solution to a routine dilemma. Case Report

El presente artículo presenta una alternativa de solución ante la necesidad de resolver el sector anterior con combinaciones de carillas y corona. Se confeccionó una infraestructura que simula a un diente natural tallado para carilla y luego la cementación de las carillas sobre dientes preparados y sobre la infraestructura adhoc.Esta es una alternativa ante la imposibilidad de coincidir estéticamente de manera adecuada una situación clínica en la cual la coincidencia estética sea un reto; el manejo del caso estuvo basado en una planificación precisa que inicia con un diseño digital personalizado, recogiendo las expectativas estéticas de la paciente y luego en una traducción a modelos encerados, para transitoriamente pre visualizar el diseño en un ensayo restaurador en boca, el cual sirvió también como guía precisa para las preparaciones dentarias de las carillas a manera de pre-provisionales, finalmente para confeccionar los provisionales y orientar el formato de las futuras cerámicas. La predictibilidad de los resultados conseguidos fue gracias a una adecuada planificación y las cualidades estéticas y mecánicas de los materiales dentales restauradores indirectos empleados en este caso.

The following article presents an alternative to resolve the esthetic zone with a combined treatment, consisting of laminate veneers and full coverage crown. A substructure that simulates natural tooth structure prepared for veneer was built, and then laminate veneers were fabricated and cemented over these adhoc substructures. The case was based in a meticulous treatment planning, which starts with custom smile design, gathering the patients´ expectations and appropriate principles in dental esthetics. The result is then rendered in a diagnostic wax up, so the final outcome can be pre-visualized in the mouth by a mock-up. This mock-up will be later on used as a precise guide for the reduction required for the veneers, and serving as pre-provisionals. Predictability of the excellent results obtained is due to an adequate planning and of course quality and good handling of the dental materials used in the present case.

Evaluation of Osteosynthesis in CaO-SiO2-P2O5-B2O3 Glass-ceramics by Posterolateral Fusion of Rabbit Lumbar vertebrae / 대한척추외과학회지

STUDY DESIGN: A comparative in vivo study between ceramics with different compositions. OBJECTIVES: To compare the biodegradation and osteoconduction properties of CaO-SiO2- P2O5- B2O3 glass-ceramics and Cerabone(R)-AW. Summary of Literature Review: Bioglass ceramics can be used as bone graft substitutes. However, no study has been undertaken to investigate the possibility of CaO-S i O2-P2O5-B2O3 glass-ceramics as a bone graft substitute. MATERIALS AND METHODS: Porous CSPB2 implants (44.07% CaO, 40.28% SiO2, 8.1% P2O5 and 5.0% B2O3), porous CSPB3 implants (43.76% CaO, 43.41% SiO2, 4.05% P2O5 and 7.5% B2O3) and porous Cerabone(R)-AW were prepared by the polymer sponge method. Single-level posterolateral spinal fusions were performed on sixty New Zealand white male rabbits. The animals were divided into four groups (9 of autograft, 17 per 3 kind of porous implant group) according to the implant material used: autograft, CSPB2, CSPB3 and Cerabone(R)-AW. Radiographs were performed every two weeks. All animals were sacrificed 12 weeks after surgery. Manual palpation and uniaxial tensile strength were determined. The proportion of the area occupied by the ceramics in the final compared to the initial radiographs was calculated. Decalcified and undecalcified histological sections were evaluated by light microscopy. RESULTS: Fifty one rabbits were evaluated. The union rates were 100 (9 out of 9), 80 (8 out of 8), 81.1 (9 out of 11) and 90.9% (10 out of 11) in the autograft, Cerabone(R)-AW, CSPB2 and CSPB3 groups, respectively. The proportion of the area occupied by Cerabone(R)-AW (90.8 % +/- 14.0) was significantly higher than for CSPB2 (73.1% +/- 11.5) and CSPB3 (73.5% +/- 10.0)(p=0.0011). The mean values of the tensile strengths of Cerabone(R)-AW (214. +/- 57.3N), CSPB2 (214. +/- 57.3 N) and CSPB3 (217 +/- 70.1 N) were not significantly different (p>0.05). CONCLUSION: CSPB2 and CSPB3 had similar tensile strengths and fusion rates of the fusion masses as those of Cerabone(R)-AW; however, they degraded more rapidly than Cerabone(R)-AW. These findings suggest that CSPB2 and CSPB3 grafts can be used as a more ideal new bone graft substitutes than Cerabone(R)-AW.

Evaluation of Biodegradation and Osteosynthesis in CaO-SiO2-B2O3 Glass-ceramics by Posterolateral Fusion of Rabbit Lumbar vertebrae / 대한정형외과학회잡지

PURPOSE: To compare the biodegradation and osteoconduction properties of CaO-SiO2-B2O3 glass-ceramics (CS10B), hydroxyapatite(HA), and tricalcium phosphate (TCP). MATERIALS AND METHODS: Porous CS10B implants were prepared by the polymer sponge method. Single-level posterolateral spinal fusions were performed on thirty rabbits. The animals were divided into three groups by implant material: HA, TCP and CS10B. Radiographs were performed every two weeks. All animals were sacrificed 12 weeks after surgery. The proportion of the area occupied by the ceramicsin the final over the initial radiographs was calculated. Uniaxial tensile strength was determined from 7 cases in each group. RESULTS: The proportion of the area occupied by HA (88.7+/-16.1%) was significantly higher than the others (p<0.05), and the proportion of the area occupied by CS10B (28.2+/-9.3%) was significantly lower than those of HA and TCP (37+/-9.6%) (p<0.05). The mean values of the tensile strengths of HA (191.4+/-33.5 N) and CS10B (182.7+/-19.9 N) were significantly higher (p<0.05) than those of TCP (141.1+/-28.2 N). CONCLUSION: CS10B had similar tensile strengths of the fusion masses as HA, however, it degraded more rapidly than HA or TCP. These findings suggest CS10B grafts as possible bone replacement materials.

Evaluation of Osseointegration in Dense Ceramics Using Rabbit's External Fixation Model / 대한정형외과연구학회지

PURPOSE: To evaluate the osseointegration of different dense ceramics. MATERIALS AND METHODS: Twenty-eight New Zealand white male rabbits were divided into 4 groups by implant materials: Cerabone(R)-AW, CaO-SiO2- B2O3 glass ceramics (CS10B), CaO-SiO2- B2O3 glass (CS5B glass) and Cerabone(R)- A W + A l2O3 glass ceramics. We implanted the dense ceramics into the tibia of rabbits with external fixator and checked the radiographs every 4 weeks. The union rate, histology and SEM were evaluated 8 weeks after surgery. RESULTS: The union rates were 85.7% (6 of 7) in Cerabone(R)-AW, 85.7% (6 of 7) in CS10B, 71.4% (5 of 7) in CS5B glass and 28.6% (2 of 7) in Cerabone(R)-AW+Al2O3 by simple radiographs. The union rates of Cerabone (R)-AW and CS10B were statistically higher than that of Cerabone(R)-AW+Al2O3 (p=0.031). Histologically, the Cerabone(R)-AW had fused with tibia without biodegradation, CS10B, CS5B glass had fused with tibia in some portion but resorbed in others. Cerabone(R)-AW+Al2O3 had not fused with bony tissue. CONCLUSION: We confirmed the osseointegration and insolubility of Cerabone(R)-AW. We also confirmed the osseointegration and partial solubility of CaO-SiO2-B2O3 glass ceramics. These findings suggest that Cerabone (R)-AW can be used as an insoluble artificial bone and CaO-SiO2-B2O3 glass ceramics as biodegradable bone replacement materials.

Mechanical Properties Of Reused Lithium Disilicate Glass-Ceramic Of Ips Empress 2 System / 대한치과보철학회지

This investigation was designed to estimate the biaxial flexure strength and fracture toughness of lithium disilicate glass-ceramics of IPS Empress 2 system pressed with as-received ingots and their sprue buttons. Two groups of the lithium disilicate glass-ceramics were prepared as follows: group 1 is ingot-pressed group; group 2 is sprue button-pressed group. A ball-on-three-ball test was used to determine biaxial flexure strength (BFS) of disks in wet environment. Scanning electron microscopy(SEM) analysis was conducted to observe the microstructure of the ceramics. Unpaired t-test showed that there were no differences in the mean biaxial flexure strength (BFS) and KIC values between group 1 and 2 (p>0.05). Two groups showed similar values in the KIC and the strength at 5% failure probability. The SEM micrographs of the IPS Empress 2 glass-ceramic showed a closely packed, multi-directionally interlocking pattern of numerous lithium disilicate crystals protruding from the glass matrix. The lithium orthophosphate crystals could not be observed on the fracture surface etched. There was no a marked difference of the microstructure between group 1 and 2. Although there were no tests including color stability, casting accuracy, etc., the results of this study implied that we could reuse the sprue button of the pressed lithium disilicate glass-ceramic of IPS Empress 2 system.

The Affinitty of Human Osteoblast to A-W Glass Ceramics / 대한정형외과연구학회지

The purpose of this study was to evaluate the biocompatibility of polystyrene, titanium, and A-W ceramic focusing on the affinity of osteoblasts to the metals. Human osteoblasts were cultivated with each material (group I : polystyrene; group II :titanium; and group III:A-W ceramic) for seven days. Serial scanning electromicroscopic (SEM) examination and quantitative analysis of cellular protein synthesis were performed in each group of material. SEM examination showed that at the first day, the osteoblasts in group II and group III had longer and abundant cytoplasmic spindles than those in group 1. At the seventh day, the particulate networks (diameter 1-2 urn) were observed on the surfaces of osteoblasts in group I and group II but not in group III. In all groups, the amount of protein synthesis tended to increase with days of culture. Furthermore the actual amount was significantly larger in the orders of group III, group II, and group I (p<0.05, in all comparisons). This in vitro study suggests that when other factors are controlled, the superior affinity of human osteoblast to A-W ceramic might be attributable to the better biocompatibility than that of titanium and polystyrene.