A clinical evaluation of zirconia reinforced lithium silicate glass-ceramic CAD/CAM onlay: a two-year case report / Avaliação clínica de onlay cerâmica do tipo CAD / CAM de silicato de lítio reforçado com zircônia: um relato de caso de dois anos

ABSTRACT The CAD/CAM technology arose from the need to develop materials with better mechanical and optical properties that could be used for making monolithic restorations. Several materials have been used for milling indirect restorations in prefabricated blocks. Among them, lithium silicate reinforced with zirconia. Due to its recent introduction in the market, this case report aimed to present a detailed clinical protocol for the execution of a ceramic onlay of this material using CAD/CAM technology. A 57-year-old female patient sought care with extensive restoration in composite resin (BOMD) of tooth 15 maintained for almost two years. However, due to bruxism, constant dental tightening, the extension of the direct restoration and the need for improved esthetics, it was proposed to replace it with an indirect ceramic onlay restoration. Prophylaxis and choice of the color of the patient's dental substrate were performed. Afterwards, the dental preparation was made and polished. Subsequently, the molding was made with addition silicone and the provisional restoration confectioned. Once the stone model was obtained, it was scanned and the ceramic onlay restoration was milled using CAD/CAM technology. Finally, the restoration was stained and cemented over the preparation. After 2 years, the restoration remained stable, with no evidence of color mismatch, marginal discoloration, marginal cleft, caries or fracture, proving the effectiveness of the treatment in this time interval. The correct indication of the ceramic material combined with the use of CAD/CAM technology facilitated the restorative process, restoring function and the esthetics desired by the patient.

RESUMO A tecnologia CAD/CAM surgiu da necessidade de desenvolvimento de materiais com melhores propriedades mecânicas e ópticas que pudessem ser utilizados para confecção de restaurações monolíticas. Diversos materiais têm sido utilizados para fresagem de restaurações indiretas em blocos pré-fabricados. Dentre eles, o silicato de lítio reforçado com zircônia. Devido a sua recente introdução no mercado, este relato de caso objetivou apresentar um protocolo clínico detalhado para a execução de uma onlay cerâmica desse material utilizando a tecnologia CAD/CAM. Paciente, 57 anos, sexo feminino, procurou atendimento com extensa restauração em resina composta envolvendo as faces (MODV) do dente 15 mantida por quase dois anos. Contudo, em virtude do bruxismo, do apertamento dental constante, da extensão da restauração direta e da necessidade de melhora na estética, foi proposto a substituição por uma restauração indireta em cerâmica do tipo onlay. Foi realizada a profilaxia e escolha da cor do substrato dental da paciente. Em seguida o preparo dental foi confeccionado e polido. Posteriormente foi feita a moldagem com silicone de adição e a confecção do provisório. Com a obtenção do modelo, este foi escaneado e fresada a onlay cerâmica pela tecnologia CAD/CAM, que posteriormente foi maquiada e cimentada sobre o preparo. Após 2 anos, a restauração permaneceu estável, sem evidência de incompatibilidade de cor, descoloração marginal, fenda marginal, cárie ou fratura, comprovando a eficácia do tratamento neste intervalo de tempo. A correta indicação do material cerâmico aliada ao uso da tecnologia CAD-CAM facilitou o processo restaurador devolvendo função e a estética desejada pela paciente.

Influence of restorative materials on occlusal and internal adaptation of CAD-CAM inlays

Aim: To evaluate the occlusal and internal marginal adaptation of inlay restorations made of different materials, using CAD-CAM. Methods: Preparations were made for MOD inlays of one-third intercuspal width and 4 mm depth in 30 third human molars. The teeth were restored using CAD-CAM materials (n=10) of nanoceramic resin (Lava Ultimate), polymer-infiltrated ceramic network (VITA ENAMIC), or lithium disilicate glass-ceramic (IPS e.max CAD). The specimens were cemented with dual resin cement and sectioned at the center of the restoration, after which the two halves were evaluated, and photographed The occlusal and internal discrepancy (µm) was determined at five points: cavosurface angle of the occlusal-facial wall (CA-O); center of the facial wall (FW); faciopulpal angle (FPA); center of the pulpal wall (PW); and center of the lingual wall (LW). The data were submitted to the Kruskal-Wallis and the Dunn tests (α=0.05). Results: No difference was observed among the materials regarding the occlusal discrepancy at the CA-O, FPA, or PW internal points. The e.max CAD measurement at FW showed larger internal discrepancy than that of Lava (p=0.02). The internal discrepancy at LW was greater for e.max CAD than VITA ENAMIC (p=0.02). Conclusion: Lithium disilicate glass-ceramic presented greater internal discrepancy in relation to the surrounding walls of the inlay preparations

Biomechanical, operative and biological aspects of the cervical margin relocation: a case report / Aspectos biomecânicos, operatórios e biológicos da recolocação da margem cervical com resina composta em cavidades classe II com margens profundas: um relato de caso

The clinical success of tooth-colored indirect restorations has been confirmed in several studies. However, inlays and onlays restorations in Class II cavities with deep gingival margins can still be considered a clinical challenge. With the purpose of facilitating the execution of the operative procedures in intrasulcular margins and reducing the risk of restorative failures, the technique of cervical margin relocation has been explored as a noninvasive alternative to surgical crown lengthening. This work aims at discussing through a case report the biomechanical, operative and biological aspects in the treatment of teeth with deep gingival margins. Therefore, given the therapy applied in the clinical case presented, it is concluded that the cervical margin relocation with composite resin is advantageous since it eliminates the need for surgery, allowing the implementation of indirect restorations in fewer clinical sessions, not causing damage to periodontal tissues once it provided good finishing and polishing with the establishment of a correct emergence profile, allowing flawless maintenance of gingival health after one year. (AU)

Sucesso clínico das restaurações indiretas livres de metal tem sido confirmado em diversos estudos. No entanto, restaurações parciais indiretas em cavidades do tipo classe II com margens profundas ainda podem ser consideradas um desafio clínico. Com a proposta de facilitar a execução dos procedimentos operatórios em margens intra-sulculares e reduzir a ocorrência de falhas, a técnica de elevação da margem gengival em resina composta tem sido explorada como alternativa não invasiva à cirurgia de aumento de coroa clínica. Este trabalho tem a intenção de discutir através de um relato de caso clínico os aspectos biomecânicos, operatórios e biológicos no tratamento de dentes com margens cervicais profundas. Sendo assim, conclui-se que a técnica de elevação da margem gengival com resina composta é vantajosa, pois elimina a necessidade de cirurgia permitindo a execução de restaurações indiretas em menos sessões clínicas, não gerando danos aos tecidos periodontais, desde que haja um bom acabamento e polimento, com estabelecimento de um correto perfil de emergência. (AU)

Resistencia flexural y estabilidad de color en resinas híbridas y cerómeros empleadas en restauraciones indirectas / Flexural strength and color stability in hybrid resins and ceromers used in indirect restorations

Las restauraciones dentales con técnica indirecta fueron concebidas con el propósito de optimizar las propiedades mecánicas, físicas y químicas de los materiales polimerizados. En tal sentido, se realizó una investigación cuyo objetivo fue comparar restauraciones mediante la técnica indirecta utilizando resina híbrida (P60/3M) y un cerómero (Ceramage-Shofu), a través de la resistencia flexural y la estabilidad del color. Se realizó un estudio observacional comparativo en 30 muestras estructuradas en forma de bloques, distribuidas en 2 grupos, ambos con 15 piezas, en el primero (G1) se utilizó resina Filtek P60/3M; mientras que, en el segundo (G2) se empleó cerómero marca Ceramage-Shofu. el 80,00% de las piezas del grupo 1 evolucionó de A1 a B1; sin embargo, en el grupo 2 (piezas de resina), la transformación resultó desfavorable, más del 50% alcanzó una categoría imprecisa entre los valores B3 y B4. A través de la prueba U Mann Whitney se determinó la existencia de una diferencia significativa entre ambos grupos, así como entre los estados inicial y final del color de las piezas en ambos grupos (p<0,001). La prueba t de Student permitió comparar los valores medios, obteniéndose diferencias significativas (p<0,001), en cuanto a la resistencia observada en ambos materiales odontológicos. Los resultados relativos a la resistencia flexural y la estabilidad del color entre los dos biomateriales odontológicos analizados, permitió establecer una diferencia estadísticamente significativa entre estos.

Dental restorations using indirect technique were developed to optimize the mechanical, physical and chemical properties of the polymerized materials. In this sense, this research was carried out in order to compare restorations by the indirect technique using hybrid resin (P60 / 3M) and a ceromer (Ceramage-Shofu) through flexural resistance and color stability. A comparative and observational study was carried out in 30 samples structured in the form of blocks, distributed in 2 groups, 15 pieces each one; in the first (G1) Filtek P60 / 3M resin were analyzed; while, in the second (G2), Ceramage-Shofu brand ceromer was used. 80.00% of the pieces in group 1 evolved from A1 to B1; however, in group 2 (resin pieces), the transformation was unfavorable, more than 50% selecting an imprecise category between the B3 and B4 values. The U Mann Whitney test determined the existence of a significant difference between both groups, as well as between the initial and final states of the color of the pieces in both groups (p <0.001). The Student's t-test compares the mean values, obtaining different differences (p <0.001), regarding the resistance observed in both dental materials. The results related to flexural resistance and color stability between the two dental biomaterials analyzed establish a statistically significant difference between them.

A three-dimensional finite element model of mesio-occluso-distal cavity zirconium dioxide inlay and its bonding interface:a stress analysis / 中国组织工程研究

BACKGROUND: Zirconia inlays have good mechanical, biocompatible and aesthetic properties in the field of dental prosthodontics, but there is no consensus on the standards of zirconia inlays for clinical cavity design, dental preparation and selection of bonding materials. OBJECTIVE: To investigate the stress distribution and characteristics of the bonding interface, tooth and periodontal tissues of the zirconia inlay model after 3 M RelyX Unicem or vario-link resin adhesive bonding. METHODS: Micro-CT was used to scan the right mandibular third molars. A three-dimensional finite element model of MOD zirconia inlay with different adhesives (3 M RelyX Unicem resin binder, vario-link resin binder) and cavity types (2, 3, 4 mm in the depth of the joint cavity) was constructed by software Mimics, Goemagic Studio and NX 10.0. Using ANSYS Workbench mesh generation, the stress distribution of each model was analyzed after loading 10 N·mm torque, 45° 175 N, 90° 600 N. RESULTS AND CONCLUSION: (1) After loading 10 N·mm torque, the bonding agent equivalent stress and root surface equivalent stress of the model with 3 mm cavity depth were largest, so the stress on the bonding interface, crown and root was largest. (2) After loading 175 N at 45° lingual direction, the bonding interface of the model with 4 mm cavity depth undertook a higher stress. The stress values of the root and periodontal tissue of 3 M RelyX Unicem resin bonding agent model with the same cavity depth were higher. (3) After loading 600 N at 90°, the root force of the model with 3 mm cavity depth was largest. The crown, root and periodontal tissue of the 3 M RelyX Unicem resin bonding agent model with the same cavity depth undertook a higher stress. The bonding interface of the vario-link resin bonding agent model was under greater stress. (4) The regions of stress concentration areas included the bifurcation zone of the root, the inlay edge line, the roof of pulp chamber, the gingival wall, 1/3 mesial part of the buccal surface near the neck, and 1/3 mesial part of the lingual surface near the neck. (5) All these findings indicate that vario-link resin adhesive and 3 M RelyX Unicem resin adhesive are suitable for the bonding of zirconia inlay, but the vario-link adhesive strength is larger and the bonding interface stress is larger. The factors such as cavity design, residual tooth tissue resistance, retention shape, and periodontal support should be considered comprehensively. The optimization of cavity design, tooth preparation, cushion bottom and high inlay should be adopted, in order to improve the long-term repair effect of zirconia inlay. However, further clinical trials are needed to verify the results of three-dimensional finite element model.

Surgical treatment of presbyopia I

Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.

Microfiltración marginal en incrustaciones de cerómero tipo table top cementadas con cementos resinosos: autograbantes, universales y resina termoplastificada / Margin microfiltration in cerometer incrustations type ta-ble top cemented with resin cements: self-recruitors, universal and thermoplastified resin / Microfiltração marginal em incrustações de cerómero tipo "table top" cimentadas com cimentos de resina: autoadesivos, universais e resina termoplastificada

Luego del procedimiento de cementación de incrustaciones de cerómero puede presentarse microfiltración en la inter-fase diente-restauración, el gap en la interfase puede ser influenciado por las características del agente cementante y el proceso de cementación. Objetivo: Evaluar la microfiltración en incrustaciones de cerómero tipo table top cementadas con tres diferentes cementos. Materiales y métodos: En 36 terceros molares divididos en 3 grupos (n= 12), se realizaron preparaciones estandarizadas tipo table top y se fabricaron incrustaciones con CERAMAGE® (SHOFU, Japón) que fueron cementadas con 3 biomateriales diferentes, Grupo A: cemento de autograbado RelyX® U200 (3M). Grupo B: cemento uni-versal RelyX Ultimate® (3M, USA). Grupo C: resina termo plastificada a 55oC Enamel Plus HRI® (Micerium). Cada muestra se sometió a termociclado (3300 ciclos) y se colocaron en una solución de azul de metileno durante 24 horas. Para el aná-lisis se realizó un corte longitudinal en la zona media en sentido meso-distal de las muestras y se evaluó la microfiltración marginal en la cara mesial y distal con la ayuda de un estéreo microscopio Olympus. Los resultados se almacenaron en una base de datos en Excel, posteriormente los valores experimentales se archivaron y fueron codificados utilizando el software BioEstat (Brasil). El análisis se realizó mediante la prueba no paramétrica de Kruskal Wallis, con una significancia del 95%. Resultados: la resina termo plastificada presentó los valores más bajos en el grado de microfiltración con una media de 0,4mm; con el cemento universal se obtuvo los valores más altos con una media de 1,33mm, que no fue signi-ficativa en relación al cemento de autograbado que tuvo una media de 0,88mm. Conclusiones: se logró determinar que en restauraciones tipo table top el grado de microfiltración fue menor cuando se cementaron con resina termo plastificada (p= < 0,05) con una diferencia estadísticamente significativa respecto a los otros cementos. No existió diferencia en la microfiltración entre los cementos de resina de autograbado en relación al cemento de resina universal.

After the process of cementation of cerometer encrustations, microfiltration can occur in the tooth-restoration interface, the gap in the interface can be influenced by the characteristics of the cementing agent and the cementation process. Objec-tive: To evaluate the microfiltration in inlays of ceramics type table top cemented with three different cements. Materials and methods: In 36 third molars divided into 3 groups (n = 12), standardized table top preparations were made and inlays made with CERAMAGE® (SHOFU, Japan) that were cemented with 3 different biomaterials, Group A: cement RelyX® U200 self-etch (3M). Group B: RelyX Ultimate® universal cement (3M, USA). Group C: thermoplastic resin at 55oC. Each sample was subjected to thermocycling (3300 cycles) and placed in a solution of methylene blue for 24 hours. For the analysis, a longitudinal cutting was made in the middle area in the meso-distal direction of the samples and the marginal microfiltration on the mesial and distal side was evaluated with the help of an Olympus stereo microscope. The results were stored in a database in Excel, then the experimental values were archived and coded using the BioEstat software (Brazil). The analysis was performed using the non-parametric Kruskal Wallis test, with a significance of 95%. Results: the thermoplastic resin had the lowest values in the degree of microfiltration with an average of 0.4mm; with the universal cement the highest val-ues were obtained with an average of 1.33mm, which was not significant in relation to the self-etched cement that had an average of 0.88mm. Conclusions: it was possible to determine that in table type restorations the degree of microfiltration was lower when they were cemented with thermoplasticized resin (p = <0.05) with a statistically significant difference with respect to the other cements. There was no difference in microfiltration between self-etched resin cements in relation to universal resin cement.

Após o processo de cimentação das incrustações de cerômero, pode ocorrer microfiltração na interface dente-restau-ração, o espaço na interface pode ser influenciado pelas características do agente cimentante e do processo de ci-mentação. Objetivo: Avaliar a microfiltração em incrustações tipo "table top" de cerómero cimentada com três cimentos diferentes. Materiais e métodos: Em 36 terceiros molares divididos em 3 grupos (n = 12), foram preparadas restaurações padronizadas tipo "table top", após, incrustações foram confeccionadas com CERAMAGE® (SHOFU, Japão) e cimenta-das com 3 biomateriais diferentes, Grupo A: cimento Autocondicionante RelyX® U200 (3M). Grupo B: cimento universal RelyX Ultimate® (3M, EUA). Grupo C: Resina termoplástificada Enamel Plus HRI® 55 ° C (Micerium). Cada espécime foi submetido a termociclagem (3300 ciclos) e colocado em uma solução de azul de metileno por 24 horas. Para a análise, foi feita uma seção longitudinal na área do meio na direção meso-distal das amostras e avaliada a microfiltração marginal em mesial e distal com a ajuda de um estéreo microscópio Olympus. Os resultados foram armazenados em um banco de dados em Excel, e os valores experimentais foram arquivados e codificados no software BioEstat (Brasil). A análise foi realizada pelo teste não paramétrico de Kruskal Wallis, com significância de 95%. Resultados: a resina termoplástificada apresentou os menores valores no grau de microfiltração com média de 0,4mm; com o cimento universal, os valores mais altos foram obtidos com média de 1,33mm, o que não foi significativo em relação ao cimento autocondicionado, com média de 0,88mm. Conclusões: foi possível determinar que nas restaurações tipo "table top" o grau de microfiltração foi menor quando cimentadas com resina termoplástica (p = <0,05), com diferença estatisticamente significante em relação aos demais cimentos. Não houve diferença na microfiltração entre os cimentos resinosos autocondicionantes em relação ao cimento resinoso universal.

Allogeneic corneal small incision intrastromal lenticule inlays for moderate and high hyperopia :one year follow-up / 中华实验眼科杂志

Objective This study was to evaluate the long-term clinical efficiency of allogeneic corneal intrastromal lenticule inlay for correction of moderate and high hyperopia.Methods A prospective self-controlled case series study was adopted.Twenty-nine hyperopic patients (53 eyes) were performed with allogeneic corneal intrastromal lenticule inlays.The range of preoperative spherical equivalent was +3.75 to + 10 D,with the mean value of (+6.84±2.95)D.All the cases were followed up for 1 year.Uncorrected and best corrected visual acuity and refraction were compared between before and after operation.Corneal topography and optical coherence topography were used to examine corneal topography.Ocular response analyzer was used to evaluate the shifts of corneal hysteresis.This study followed the Helsinki declaration,and the research process was approved by the Ethic Committee of Beijing Tongren Hospital,and informed consent was signed by each donor and receptor.Results Compared with the before surgery,the uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) were obviously improved and the spherical equivalent (SE) was obviously decresed in 3 months,6 months and 1 year after surgery,with significant differences between them (all at P＜0.05),but no significant differences were found between each postoperative time points (all at P＞0.05).One year after surgery,14 eyes (26.4％) gained one line of best corrected distance visual acuity (BCDVA),and 12 eyes (22.6％) gained two lines of BCDVA.Only 2 patients (5.66％) lost lines due to opaque lenticules,and no eye lost lines after changing the opaque lenticules.There was no obvious hyperopic fallback phenomenon.Compared with the before surgery,the average corneal curvature value (Avek) was obviously improved,the surface regularity index (SRI),surface asymmetry index (SAI) and central corneal thickness (CCT) were obviously increased in 3 months,6 months and 1 year after surgery,with significant differences between them (all at P＜0.05),but no significant differences were found between each postoperative time points (all at P ＞ 0.05).The cornea optical coherence tomography (OCT) examination showed that,after the operation,the corneal stromal implant was in place and clear.One year after surgery,the dividing line of corneal graft was still clearly visible.No significant changes of corneal hysteresis (CH) and corneal resistance factor (CRF) were seen among different time points before and after surgeries (F =1.443,P =0.216;F =1.744,P =0.128).Conclusions Allogeneic corneal small incision intrastromal lenticule inlays can be used to correct moderate and high hyperopic eye with good safety,effectiveness and predictability.It provides a new choice for hyperopic patients.

Effect of different hydrofluoric acid etching methods on the surface and adhesion strength of two ceramic inlays / 口腔疾病防治

Objective@#o study the effect of cleaning treatment with hydrofluoric acid (HF) on the surface and bonding strength of IPS e.max and Vita Mark II ceramic inlays. @*Methods@#Fifty pieces of IPS e.max and Vita Mark II ceramic inlay specimens were made separately using CAD/CAM. After uniformly bonding surfaces using 9% HF etching, they were randomly divided into an untreated control group (group A) and the following experimental groups: neutralizing powder (B group), 37% phosphoric acid (group C), ultrasonic cleaning (group D) and neutralizing powder + 37% phosphoric acid + ultrasonic cleaning (group E). Each set of 8 specimens was bonded to Variolink N resin adhesive under standard conditions. The shear adhesive strength was measured after exposure to a constant-temperature water bath at 37 ℃ for 24 h. The location of the fracture and the type of adhesion failure were recorded. The shear adhesion and the average strength of the connection were analyzed. The remaining 2 specimens were used for scanning electron microscopy (SEM) to observe the surface morphology, including the crystal structure, pore pattern, and residue.@*Results @# The results were similar for the IPS e.max and Vita Mark II inlays. The maximum bond strength was observed in the IPS e.max ceramic inlays in group E, with an average bond strength 11.96 MPa higher than that in group A. Among the Vita Mark II porcelain inlays, the maximum bond strength was observed in group E. The average bond strength was 9.74 MPa higher than that in group A. The results of the statistical analysis were similar for the IPS e.max and Vita Mark II porcelain inlays, with significant differences in the bond strengths between groups C, D, and E and the control group (P < 0.05). There was no significant difference in the adhesive strength between groups B and A. At the same time, there was no significant difference in the bond strength between the treatment groups B, C, D, and E (P > 0.05). SEM revealed that the pores on the surface of ceramics subjected to the acid etching treatment were broadened and uniform, with less residue than observed in the control group. The effects of treatments D and E were the best. @*Conclusion@#The HF etching treatment can enhance the bonding strength of IPS e.max and Vita Mark Ⅱ ceramic inlays while leaving little residue, and the joint strength is highest when the joints are treated together.

Evaluation of adaptation of ceramic inlays using optical coherence tomography and replica technique

Abstract Optical coherence tomography (OCT) has generally been used as a nondestructive technique to evaluate integrities of composite restorations. We investigated marginal and internal adaptations of ceramic inlay restorations with OCT and compared them to results with the silicone replica technique. Round-shaped class I cavities were prepared on 16 human maxillary first premolar teeth. Ceramic inlays were fabricated. Silicone replicas from inlays were obtained and sectioned to measure marginal and internal adaptations with a stereomicroscope (Leica Dfc 295, Bensheim, Germany). Inlays were cemented on respective teeth. Marginal and internal adaptations were then measured with the OCT system (Thorlabs, New Jersey, USA) in 200- μm intervals. Replica and OCT measurements were compared with independent samples t-tests. A paired t-test was used to evaluate the marginal and internal adaptations of each group (p < 0.05). Marginal and internal adaptations were 100.97 ± 31.36 and 113.94 ± 39.75 μm, respectively, using the replica technique and 28.97 ± 17.86 and 97.87 ± 21.83 μm, respectively, using OCT. The differences between the techniques were significant (p = 0.00 and p = 0.01, respectively). On evaluation within the groups, internal adaptation values were found to be significantly higher than the marginal adaptation values for the replica technique (p = 0.00) and OCT (p = 0.00). Therefore, the replica and OCT techniques showed different results, with higher values of marginal and internal adaptation found with the replica technique. Marginal and internal adaptation values of ceramic inlays, whether measured by replica or OCT techniques, were within clinically acceptable limits.

Restaurações indiretas inlay-onlay em resina nanocerâmica com a tecnologia CAD/CAM: relato de caso / Inlay-onlay indirect restorations in nanoceramic resin with CAD / CAM technology: a case report

Restaurações indiretas inlay/onlay utilizando materiais estéticos vem sendo utilizadas crescentemente em dentes posteriores, resultando em um aumento do uso de cerâmicas dentais antes restrita apenas ao tratamento em regiões anteriores. Uma nova opção restauradora são as resinas nanocerâmicas, intitulada de Lava Ultimate™, produto desenvolvido pela empresa 3M™ ESPE™ (Irvine, Califórnia, EUA). Desenvolvido especialmente para o CAD/CAM, o Lava™ Ultimate foi criado com a exclusiva nanotecnologia. Este trabalho tem por finalidade apresentar dois casos de restaurações indiretas em região posterior utilizando o material Lava Ultimate™ (3M™ ESPE™) e a tecnologia CAD/CAM(AU)

Indirect inlay / onlay restorations using aesthetic materials have been increasingly used in posterior teeth, resulting in an increase in the use of dental ceramics previously restricted only to treatment in previous regions. A new restorative option is the nanoceramic resins, titled Lava Ultimate™, a product developed by 3M™ ESPE™ (Irvine, Califórnia, USA). Developed especially for CAD / CAM, Lava™ Ultimate was created with exclusive nanotechnology. The aim of this study was to present two cases of indirect posterior restorations using the Lava Ultimate™ material (3M™ ESPE™) and CAD / CAM(AU)

Profundidad de curado e interfaces en medios cementantes para incrustaciones de resina / Curing depth and interphases in luting agents for resin inlays

Los medios de fijación a base de resinas compuestas para cementado, no son más que una resina compuesta fluida, que contiene un menor porcentaje de relleno inorgánico. Es por esto que en la actualidad, algunos autores plantean el uso de resina compuesta de restauración como medio de fijación de restauraciones indirectas (inlay fabricado en cerómero). Dicha resina debe ser fluidificada con calor (50ºC), para posteriormente ser fotoactivada por un tiempo adecuado. Asimismo, como se trata de un material cuya reacción de polimerización sólo es activada por luz, surge la pregunta de si será capaz de ser fotoactivada eficazmente como para polimerizar correctamente, en especial en las zonas más profundas de la preparación cavitaria. El presente estudio busca analizar si existen diferencias en el grado de sellado marginal y en la profundidad de curado de restauraciones cementadas con un medio de fijación a base de resina, previa técnica de grabado y colocación de adhesivo y con una resina compuesta a través de la técnica fluidificada.

The fixing means based on composite resins for cementing, are nothing more than a fluid composite resin, which contains a lower percentage of inorganic filler. This is why, at present, some authors propose the use of composite resin restoration as a means of fixing indirect restorations (inlay made of ceramics). Said resin must be fluidized with heat (50 ° C), to be photoactivated for a suitable time. Also, since it is a material whose polymerization reaction is only activated by light, the question arises whether it will be able to be effectively photoactivated to properly polymerize, especially in the deeper areas of the cavity preparation. The present study aims to analyze if there are differences in the degree of marginal sealing and in the depth of cure of cemented restorations with a resin-based fixing medium, prior to etching and adhesive placement and with a composite resin through the fluidized technique.

Comparison of the marginal adaptation of direct and indirect composite inlay restorations with optical coherence tomography

ABSTRACT Objective The purpose of the study was to use the photonic imaging modality of optical coherence tomography (OCT) to compare the marginal adaptation of composite inlays fabricated by direct and indirect techniques. Material and Methods Class II cavities were prepared on 34 extracted human molar teeth. The cavities were randomly divided into two groups according to the inlay fabrication technique. The first group was directly restored on cavities with a composite (Esthet X HD, Dentsply, Germany) after isolating. The second group was indirectly restored with the same composite material. Marginal adaptations were scanned before cementation with an invisible infrared light beam of OCT (Thorlabs), allowing measurement in 200 µm intervals. Restorations were cemented with a self-adhesive cement resin (SmartCem2, Dentsply), and then marginal adaptations were again measured with OCT. Mean values were statistically compared by using independent-samples t-test and paired samples t-test (p<0.05), before and after cementation. Results Direct inlays presented statistically smaller marginal discrepancy values than indirect inlays, before (p=0.00001442) and after (p=0.00001466) cementation. Marginal discrepancy values were increased for all restorations after cementation (p=0.00008839, p=0.000000952 for direct and indirect inlays, respectively). The mean marginal discrepancy value of the direct group increased from 56.88±20.04 µm to 91.88±31.7 µm, whereas the indirect group increased from 107.54±35.63 µm to 170.29±54.83 µm. Different techniques are available to detect marginal adaptation of restorations, but the OCT system can give quantitative information about resin cement thickness and its interaction between tooth and restoration in a nondestructive manner. Conclusions Direct inlays presented smaller marginal discrepancy than indirect inlays. The marginal discrepancy values were increased for all restorations that refer to cement thickness after cementation.

Resistencia a la fractura in vitro de incrustaciones cerámicas usando dos materiales como bases cavitarias / in vitro fractures strength of ceramic inlays, using two types of cavity bases

Las bases cavitarias son usadas en odontología restauradora,varios materiales se recomiendan como base cavitaria en incrustaciones cerámicas. Objetivo: Comparar la resistencia a la fractura in vitro de una cerámica (disilicato de litio) como material restaurativo usando diferentes bases cavitarias en inlays en premolares. Material y métodos: Se elaboraron cavidades estandarizadas para inlays cerámicas MOD en 30 premolares. Se asignaron aleatoriamente tres grupos (n = 10): grupo 1: sin base cavitaria; grupo 2: base ionómero de vidrio reforzado con resina (VitrebondTM, 3M); grupo 3: base resina compuesta (FiltekTM Z350 XT, 3M). Las incrustaciones fueron fabricadas con disilicato de litio (IPS e.max®, Ivoclar) cementadas con (RelyXTM, 3M) y almacenadas en agua bidestilada (37 oC por 24 horas). Semidió la resistencia a la fractura en una máquina universal de pruebas mecánicas (MTS® Alliance RT/30) a una velocidad de 0.5 mm/minuto,fracturadas las muestras se registró bajo microscopia estereoscópica elmodo de fallo. Los datos se analizaron usando ANOVA de una vía y comparaciones post hoc con la prueba Scheffé. (Programa IBM SPSS STATISTICS 21.0). Resultados: El grupo control (sin base) obtuvo la media más alta (105.16 Kgf ± 11.41) siendo estadísticamente significativa con relación al grupo 2 (77.04 ± 19.69). El grupo 3 obtuvo una media (94.81 ± 10.65) siendo estadísticamente diferente del grupo 2 (p = .001). El modo de fallo más común fue el patrón IV (60 por ciento). Conclusiones: La resistencia a la fractura de inlays cerámicas de disilicato de litio es mayor en cavidades sin base cavitaria...

Effect of Ceramic Thickness and Composite Bases on Stress Distribution of Inlays - A Finite Element Analysis

The purpose of this study was to determine the effect of cavity depth, ceramic thickness, and resin bases with different elastic modulus on von Mises stress patterns of ceramic inlays. Tridimensional geometric models were developed with SolidWorks image software. The differences between the models were: depth of pulpal wall, ceramic thickness, and presence of composite bases with different thickness and elastic modulus. The geometric models were constrained at the proximal surfaces and base of maxillary bone. A load of 100 N was applied. The stress distribution pattern was analyzed with von Mises stress diagrams. The maximum von Mises stress values ranged from 176 MPa to 263 MPa and varied among the 3D-models. The highest von Mises stress value was found on models with 1-mm-thick composite resin base and 1-mm-thick ceramic inlay. Intermediate values (249-250 MPa) occurred on models with 2-mm-thick composite resin base and 1-mm-thick ceramic inlay and 1-mm-thick composite resin base and 2-mm-thick ceramic inlay. The lowest values were observed on models restored exclusively with ceramic inlay (176 MPa to 182 MPa). It was found that thicker inlays distribute stress more favorably and bases with low elastic modulus increase stress concentrations on the internal surface of the ceramic inlay. The increase of ceramic thickness tends to present more favorable stress distribution, especially when bonded directly onto the cavity without the use of supporting materials. When the use of a composite base is required, composite resin with high elastic modulus and reduced thickness should be preferred.

O objetivo do estudo foi avaliar o efeito da profundidade da cavidade, da espessura da cerâmica e da presença de bases de resina, com os diferentes módulos de elasticidade na distribuição de tensões de von Mises em inlays cerâmicos. Modelos geométricos tridimensionais foram desenvolvidos com o software SolidWorks. As diferenças entre os modelos foram: a profundidade da parede pulpar, a espessura da cerâmica e a presença de bases de resina composta com diferentes espessuras e módulos de elasticidade. Os modelos geométricos foram engastados nas superfícies proximais e base do osso maxilar e uma carga de 100 Newton foi aplicada. O padrão de distribuição de tensões foi analisado com diagramas de tensão de von Mises. O valor de tensão máxima de von Mises foi variável entre os modelos e situou-se na faixa entre 176 e 263 MPa. O maior valor foi encontrado nos modelos restaurados com bases de resina composta de 1 mm e inlay cerâmico de 1 mm de espessura. Valores intermediários (249-250 MPa) ocorreram nos modelos com bases de resina composta de 2 mm e inlays de 1 mm de espessura e nos modelos com bases de resina composta de 1 mm e inlays de 2 mm. Os menores valores foram observados nos modelos restaurados exclusivamente com inlay cerâmico (176-182 MPa). Verificou-se que inlays com maior espessura distribuem o estresse de forma mais favorável e bases com baixo módulo de elasticidade aumentam a concentração de tensões na superfície interna do inlay de cerâmica. O aumento da espessura do material cerâmico tende a apresentar uma distribuição de tensões mais favorável, principalmente quando cimentadas diretamente sobre o preparo cavitário, sem a existência de materiais intermediários. Em situações em que o emprego de materiais de base é necessária, deve-se preferir resinas compostas com alto módulo de elasticidade e espessura reduzida.

Comparison of the marginal microleakage of three cavity restoration methods / 实用口腔医学杂志

Objective:To compare the marginal microleakage of class V cavity restored with composite resin by 3 different methods. Methods:Class Ⅴ cavity was prepared in 36 human third molars,the teeth were randomly divided into 3 groups(n =1 2)and were repaired with common Z350 resin,pre-heated Z350 resin and Z350 resin inlay,respectively.After thermal cycling for 500 times the teeth were immersed in fuchsin solution for 24 h.Then the samples were sectioned longitudinally and examined for leakage under stereomicroscope.Results:The microleakage of cavity restoration by pre-heated Z350 resin and Z350 resin inlay was significantly low-er than that of the direct restoration with Z350 resin(P≤0.05).No significant difference was found between the groups of pre-heated Z350 resin and Z350 resin inlay.Conclusion:Marginal microleakage of Z350 resin restoration can be decreased by preheating of the resin.

Bonding values of two contemporary ceramic inlay materials to dentin following simulated aging

PURPOSE: To compare the push-out bond strength of feldspar and zirconia-based ceramic inlays bonded to dentin with different resin cements following simulated aging. MATERIALS AND METHODS: Occlusal cavities in 80 extracted molars were restored in 2 groups (n=40) with CAD/CAM feldspar (Vitablocs Trilux forte) (FP) and zirconia-based (Ceramill Zi) (ZR) ceramic inlays. The fabricated inlays were luted in 2 subgroups (n=20) with either etch-and-bond (RelyX Ultimate Clicker) (EB) or self-adhesive (RelyX Unicem Aplicap) (SA) resin cement. Ten inlays in each subgroup were subjected to 3,500 thermal cycles and 24,000 loading cycles, while the other 10 served as control. Horizontal 3 mm thick specimens were cut out of the restored teeth for push out bond strength testing. Bond strength data were statistically analyzed using 1-way ANOVA and Tukey's comparisons at alpha=.05. The mode of ceramic-cement-dentin bond failure for each specimen was also assessed. RESULTS: No statistically significant differences were noticed between FP and ZR bond strength to dentin in all subgroups (ANOVA, P=.05113). No differences were noticed between EB and SA (Tukey's, P>.05) bonded to either type of ceramics. Both adhesive and mixed modes of bond failure were dominant for non-aged inlays. Simulated aging had no significant effect on bond strength values (Tukey's, P>.05) of all ceramic-cement combinations although the adhesive mode of bond failure became more common (60-80%) in aged inlays. CONCLUSION: The suggested cement-ceramic combinations offer comparable bonding performance to dentin substrate either before or after simulated aging that seems to have no adverse effect on the achieved bond.

Computer Aided Designing-Computer Aided Milling in Prosthodontics: A Promising Technology for Future.

Computer aided designing-computer aided milling (CAD-CAM) technology was introduced to dentistry way back in 1971. Over the years there has been a constant upgradation in the quality and popularity of its application to dentistry. CAD-CAM fabricated prosthesis though initially were considered costly and technique sensitive, nowadays they are being extensively used because of advancements in various CAD-CAM systems that have gained popularity. Th e ease of work and reduced chair side time makes them a boon while providing prosthodontics treatment. Dental CAD-CAM systems are being used not only for crowns and bridges, inlays and onlays but also for fabrication of removable prosthesis, stents, and implant components. Th is article reviews the evolution of the CAD-CAM system and its applications in the fi eld of dentistry over the past two and a half decades.

Clinical study of onlay treatment of cracked teeth with vital pulp / 重庆医学

Objective To investigate the effect of cobalt chromium alloy onlay on the direct repair of cracked vital pulp teeth with the resin compostie filling and porcelain-fused-to-metal (PFM ) crown repair as the control .Methods 201 cracked vital pulp teeth from 201 cases were randomly divided into 3 groups according to the clinical symptoms :mild discomfort at occlusion (group A) ,pain at occlusion accompanied with transient pain to cold or hot stimulation (group B) and pain at occlusion accompanied with continuous pain to cold or hot stimulation(group C) .The cracked teeth directly were restored by the resin composite filling ,cobalt chromium alloy onlay and PFM crown repair and the effective rate in each group was observed after 2-year follow up .Results The effective rate of the group A ,B and C were statistically significant different from each other (P<0 .05) .The effective rate of the co-balt chromium alloy onlay and the PFM crown was statistically significant higher than that of resin composite (P<0 .05) .Conclusion The direct repair with cobalt chromium alloy onlay is an effective repair method for the cracked vital pulp teeth with mild discomfort at occlusion and mild pain accompanied with transient pain to cold or hot stimulation .

Type of resin cement influences microleakage in ceromer inlays? / Tipo de cimento resinoso influencia a micorinfiltração em inlays de cerômero?

Objective: To evaluate the influence of two resin cements on microleakage of ceromer inlays. Methods: Twenty recently extracted human third molars were selected. Standard inlay mesio-occluso-distal cavities were prepared, with cervical margin in enamel (mesial) or dentin (distal). The specimens were randomly divided into two groups (n=10) and indirect restorations were made with Belleglass HP system (Kerr, Romulus, MI, USA). The cavities in the first group were treated with adhesive system Single Bond and restorations were cemented with dual curing cement RelyX ARC (3M ESPE, St. Paul, MN, USA). In the second group, the ED Primer (Kuraray, Tokyo, Japan) was applied and indirect restorations were cemented with Panavia 21 EX (Kuraray, Tokyo, Japan). The specimens were coated with varnish, except for the restorations and 1 mm around them and submitted to thermal cycling and then immersed in 2% basic fuchsine solution for 24 hours. Teeth were sectioned longitudinally and leakage scores were evaluated using a stereomicroscope at 40x magnification. Data were submitted to statistical analysis (Mann-Whitney test). Results: Enamel showed lower dye penetration than dentin (p<0.05). Statistical difference between cements was only observed in enamel, with RelyX exhibiting less leakage (p<0.05). Conclusion: Within the limitations of the study, the substrate had a significant effect for sealing ability and RelyX ARC performed better than Panavia 21 EX only in enamel.

Objetivo: Avaliar a influência de dois cimentos resinosos sobre a microinfiltração de inlays de cerômero. Métodos: Vinte coroas de terceiros molars recentemente extraídos foram selecionadas.Cavidades do tipo Inlay padronizadas foram preparadas com a margem cervical em esmalte (mesial) ou dentina (distal). Os espécimes foram randomicamente distribuídos em dois grupos (n=10) e restaurações indiretas foram confeccionadas com o sistema Belleglass HP (Kerr, Romulus, MI, EUA). As cavidades do primeiro grupo foram tratadas com sistema adesivo Single Bond (3M ESPE, St. Paul, MN, USA) e as restaurações foram cimentadas com um cimento resinoso de cura dual (RelyX ARC, (3M ESPE, St. Paul, MN, EUA).No segundo grupo, ED Primer(Kuraray, Tokio, Japão)foi aplicado e as restaurações indiretas foram cimentadas com Panavia 21 EX (Kuraray, Tokio, Japão). Os espécimes foram pintados com verniz, exceto as restaurações e em torno de 1mm em volta destas,sendo então submetidos à termociclagem e imersos em solução de fucsina básica a 2% por 24 horas. Os dentes foram seccionados longitudinalmente e os escores de infiltração foram avaliados utilizando-se um estereomicroscópio com aumento de 40x. Os dados foram submetidos à análise estatística (teste de Mann-Whitney). Resultados: O esmalte apresentou menor infiltração de corante que a dentina (p<0.05). Diferenças estatística entre cimentos foram observadas apenas em esmalte, com o cimento RelyX ARC exibindo menor infiltração (p<0.05).Conclusão: Dentro das limitações deste estudo, observou-se que o substrato dentário apresentou um efeito significante para o selamento cavitário e o cimento RelyX ARC mostrou-se melhor que o Panavia 21 EX apenas em esmalte.