Retreatment of 6 ceramic restorations in a single session - the application of Er:YAG laser and CAD/CAM technology: an 1 year follow up clinical evaluation / Retratamento de 6 restaurações de cerâmica em uma única sessão ­ Utilizando o Laser ER: YAG e a tecnologia CAD/CAM com Acompanhamento de 1 ano

Background: To present the benefits of high power lasers (Er: YAG and Nd: YAG) over the use of the high speed turbine for the extraction of ceramics restorations, without damaging the surfaces of the teeth; being a relatively easier and faster procedure without the use of anesthetic agents, and the preparation of the ceramic restorations and cementing in the single session; with a follow-up of 1 year. Objective: The benefits of lasers over high-speed turbine mechanical instrumentation for crown removal encompass efficient restoration recovery without damage to tooth surfaces; and a relatively easier and faster procedure without the use of anesthetic agents. Methods: The Er: YAG laser (no contact; 3.2-4.0 W, 20 Hz) was used to extract the porcelain prosthesis, followed by a gingivectomy with the Nd: YAG laser on tooth 12 to improve the gingival contour. The dental surfaces where the ceramic prosthesis will be cemented were scanned. Then, CAD / CAM technology was used to make the ceramic veneers that were cemented in the same session. Results: The efficacy the Er:YAG laser energy was observed by the decreased of the time to remove all-ceramic materials through ablation of bonding cements, reducing working time by 75% compared to a high-speed turbine. Conclusions: An Er: YAG laser can safely remove lithium disilicate crowns with the settings used in this study. Laser-assisted removal of all ceramic PDFs is a promising treatment protocol. The use of the Nd: YAG (2.0 W power, short 20Hz, 320 µm optical fiber, in contact) laser allowed gingivoplasty to be performed, automatically cauterizing avoiding post-operative bleeding, and facilitating the preparation of ceramic restorations the same day. The use of high-power lasers and the use of accompanying CAD / CAM technology allowed this clinical case to be completed in a single visit without the use of temporary restorations, achieving absolute patient satisfaction. (AU)

Antecedentes: Apresentar os benefícios dos lasers de alta potência (Er: YAG e Nd:YAG) sobre o uso da turbina de alta velocidade para a remoção de restaurações cerâmicas, sem danificar as superfícies dos dentes; sendo um procedimento relativamente mais fácil e rápido evitando o uso de agentes anestésicos, conseguindo fazer o preparo das restaurações de cerâmica e cimentação em uma única sessão; com seguimento de 1 ano. Objetivo: Os benefícios dos lasers sobre a instrumentação mecânica com turbina de alta velocidade para a remoção da coroa abrangem a recuperação eficiente da restauração sem danos às superfícies dos dentes; e um procedimento relativamente mais fácil e rápido sem o uso de agentes anestésicos. Métodos: O laser Er: YAG (sem contato; 3,2-4,0 W, 20 Hz) foi utilizado para remover a prótese de porcelana, seguido de gengivectomia com o laser Nd: YAG no dente 12 para melhorar o contorno gengival. As superfícies dentais onde a prótese de cerâmica será cimentada foram escaneadas. Em seguida, a tecnologia CAD / CAM foi utilizada para confeccionar as facetas de cerâmicas que foram cimentadas na mesma sessão. Resultados: A eficácia da energia do laser Er: YAG foi observada pela diminuição do tempo na remoção dos materiais cerâmicos por meio da ablação dos cimentos de ligação, reduzindo o tempo de trabalho em 75% em relação a uma turbina de alta velocidade. Conclusão: Um laser Er: YAG pode remover com segurança as coroas de dissilicato de lítio com as configurações usadas neste estudo. A remoção assistida por laser de todos os PDFs de cerâmica é um protocolo de tratamento promissor. O uso do laser Nd: YAG (2,0 W potência, curta 20Hz, 320 µm fibra ótica, em contato) permitiu a realização da gengivoplastia, cauterizando automaticamente evitando sangramento pós-operatório e facilitando o preparo das restaurações cerâmicas no mesmo dia. O uso de lasers de alta potência e o uso da tecnologia CAD / CAM que o acompanha permitiram que este caso clínico fosse concluído em uma única visita, sem o uso de restaurações temporárias, alcançando a satisfação absoluta do paciente (AU)

Effect of occlusal thickness design on the fracture resistance of endocrowns restored with lithium disilicate ceramic and zirconia / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the effect of occlusal thickness design on fracture resistance of endocrowns restored with lithium disilicate ceramic and zirconia.@*METHODS@#A total of 24 artificial first mandibular molars were randomly divided into four groups with six teeth in each group as follows: group lithium disilicate ceramic-2 mm (lithium disilicate ceramic, with an occlusal thickness of 2 mm and a retainer length of 4 mm); group lithium disilicate ceramic-4 mm (lithium disilicate ceramic, with an occlusal thickness of 4 mm and a retainer length of 2 mm); group zirconia-2 mm (zirconia, with an occlusal thickness of 2 mm and a retainer length of 4 mm); and group zirconia-4 mm (zirconia, with an occlusal thickness of 4 mm and a retainer length of 2 mm). After adhesive cementation (RelyX Ultimate Clicker), all specimens were subjected to thermocycling (10 000 cycles). The specimens were subjected to fracture resistance testing at a 135° angle to the teeth at a crosshead speed of 0.5 mm·min⁻¹ in a universal testing machine. Data were analyzed with ANOVA and Tukey's HSD test by SPSS 15.0. The failure modes were classified.@*RESULTS@#The fracture resistances of groups lithium disilicate ceramic-
2 mm, lithium disilicate ceramic-4 mm, zirconia-2 mm, and zirconia-4 mm were (890.54±83.41), (2 320.87±728.57), 
(2 258.05±557.66), and (3 847.70±495.99) N respectively. Group zirconia-4 mm had the highest fracture resistance, whereas group lithium disilicate ceramic-2 mm had the lowest.@*CONCLUSIONS@#The fracture resistance of molar endocrown with zirconia is higher than that with lithium disilicate ceramic. Increasing the occlusal thickness can improve the fracture resistance but increase the risk of fracture of abutment.

Comparative evaluation of lithium disilicate ceramic surface and bond strength to dentin surface after treatment with hydrofluoric acid and acidulated phosphate fluoride gel: An In Vitro study

Long-term retention of the restoration depends on strength and durability of the bond of the luting composite resin to the tooth and the porcelain substrates. Aims: This in vitro study was conducted to compare and evaluate the influence of hydrofluoric acid (HF) and acidulate phosphate fluoride (APF) gel-etched treatments on surface roughness and bond strength to dentin of a commercially available lithium disilicate ceramic (E-Max). Subjects and Methods: Sixty lithium disilicate ceramic disks measuring 5 mm in diameter and 2 mm thick were fabricated and divided into three groups: Group A (n = 24), Group B (n = 24), and Group C (n = 12) and were subdivided to Group A1, A2, and A3which were surface treated with 1.23% APF gel (pH = 3–4) at different time intervals 4, 7, and 10 min, respectively. Group B1, B2, and B3 were surface treated with 1% APF gel (pH = 1–2) at different time intervals 4, 7, and 10 min, respectively. Group C were surface treated with 9.6% HF (pH = 1–2) for 1 min. Morphological changes obtained with the surface treatments were analyzed using a surface profilometer. Statistical Analysis: All specimens were subjected to a tensile bond strength test using a tensometer, and the obtained data were statistically analyzed using Kruskal–Wallis test. Results: The surface roughness (μm) and bond strength (MPa) of lithium disilicate discs (samples) etched with 1.23% APF gel and 1% APF gel for 10 min and etched with 9.6% HF for 1 min showed no statistical significant difference among them. Conclusions: In this study, the lithium disilicate discs etched with 1.23% APF gel and 1% APF gel for 10 min showed similar surface roughness and bond strength to those etched with 9.6% HF for a minute.

Effect of Surface Pretreatments on the Microtensile Bond Strength of Lithium-Disilicate Ceramic Repaired with Composite Resin

The aim of this study was to evaluate the influence of ceramic surface treatments and silane drying temperature on the microtensile bond strength (µTBS) of a resin composite to a lithium disilicate ceramic. Twenty blocks (7x7x5 mm) of lithium disilicate-based hotpressed ceramic were fabricated and randomly divided into 4 groups: G1: acid etching with 9.5% hydrofluoric acid for 20 s and drying silane with room-temperature air; G2: acid etching with 9.5% hydrofluoric acid for 20 s and drying silane with 45 ± 5 °C warm air; G3: airborne-particle abrasion with 50 µm aluminum oxide particles and drying silane with 45 ± 5 °C warm air; G4: airborne-particle abrasion with 50 µm aluminum oxide particles and drying silane with air at room-temperature. After treatments, an adhesive system (Single Bond 2) was applied, light-cured and direct restorations were built up with a resin composite (Filtek Z250). Each specimen was stored in distilled water at 37 °C for 24 h and cut into ceramic-composite beams with 1 mm2 of cross-sectional area for µTBS testing. Statistical analysis was performed with one-way ANOVA and Student-Newman-Keuls test (α=0.05). µTBS means (S.D.) in MPa were: G1: 32.14 (7.98), G2: 35.00 (7.77) and G3: 18.36 (6.17). All specimens of G4 failed during the cutting. G1 and G2 presented significantly higher µTBS than G3 (p<0.05). There was no statistically significant difference between G1 and G2 (p>0.05). As far as the bond strength is concerned, surface pretreatment of lithium-disilicate ceramic with hydrofluoric acid and silane application can be used as an alternative to repair ceramic restorations with composite resin, while surface pretreatment with sandblasting should be avoided.

O objetivo deste estudo foi avaliar a influência dos tratamentos de superfícies e a temperatura de secagem do silano na resistência de união de resina composta à cerâmica de disilicato de lítio. Vinte blocos (7x7x5 mm) de cerâmica à base de disilicato de lítio foram fabricados e aleatoriamente divididos em quatro grupos: G1: condicionamento com ácido fluorídrico a 9,5% por 20 s e secagem do silano com ar à temperatura ambiente; G2: condicionamento com ácido fluorídrico a 9,5% por 20 s e secagem do silano com ar aquecido a 45± 5 °C; G3: jateamento com partículas de óxido de alumínio de 50 µm e secagem do silano com ar aquecido a 45 ± 5 °C; G4: jateamento com partículas de óxido de alumínio de 50 µm e secagem do silano com ar à temperatura ambiente. Após os tratamentos, o adesivo Adper Single Bond 2 foi aplicado, fotoativado e foi construído um platô de resina composta (Filtek Z250). Cada espécime foi armazenado em água destilada a 37 °C por 24 h e cortados em forma de palito de área adesiva de 1 mm2 para a realização do teste de microtração. Os dados foram submetidos à ANOVA e ao teste de Student-Newman-Keuls (α=0,05). As médias (D.P.) dos valores de resistência de união em MPa foram: G1: 32,14 (7,98), G2: 35,00 (7,77) e G3: 18,36 (6,17). G1 e G2 apresentaram maiores valores de resistência de união que G3 (p<0,05). Não houve diferença estatística entre as médias dos valores dos grupos G1 e G2 (p>0,05). Levando-se em consideração a resistência de união, o pré-tratamento de cerâmica de disilicato de lítio com ácido fluorídrico e aplicação de silano pode ser uma alternativa para o reparo de restaurações de cerâmicas com resinas compostas, enquanto que o pré-tratamento de superfície com o jateamento deve ser evitado.

Effects of hydrofluoric acid concentration and etching time on the shear bond strength between lithium disilicate ceramic and resin cement / 대한치과보철학회지

PURPOSE: The objective of this study was to evaluate the effects of hydrofluoric acid concentration & etching time on the shear bond strength between IPS Empress 2 ceramic and resin cement. MATERIAL AND METHODS: Thirty three rectangular shape ceramic specimens(20x12x5mm size, IPS Empress 2 core materials) were used for this study. The ceramic specimens divided into ten experimental groups with three specimens in each group and were etched with hydrofluoric acid(4%, 9%) according to different etching times(30s, 60s, 90s, 120s, 180s). Etched surfaces of ceramic specimens were bonded with resin cement(Rely X Unicem) using acrylic glass tube. All cemented specimens were tested under shear loading until fracture on universal testing machine at a crosshead speed of 0.5mm/min and the maximum load at fracture(kg) was recorded. Collected shear bond strength data were analyzed with one way ANOVA and Duncan tests. All etched ceramic surfaces were examined morphologically using SEM(scanning electron microscopy). RESULTS: Shear bond strength of etching group(35.89~68.01 MPa) had four to seven times greater than no-etching group(9.53+/-2.29 MPa). The ceramic specimen etched with 4% hydrofluoric acid for 60s showed the maximum shear bond strength(68.01+/-11.78 MPa). Ceramic surface etched with 4% hydrofluoric acid for 60s showed most retentive surface texture. CONCLUSION: It is considered that 60s etching with 4% hydrofluoric acid is optimal etching methods for IPS Empress 2 ceramic bonding.