Clinical Performance of Minimally Invasive Monolithic Ultratranslucent Zirconia Veneers: A Case Series up to Five Years of Follow-up.

There is a lack of reports in the literature on the long-term clinical performance of ultratranslucent zirconia, especially considering its use in manufacturing monolithic veneers. The purpose of this case series is to describe the aesthetic treatment steps of three patients with minimally invasive ultratranslucent zirconia veneers and to report the clinical findings up to five years. Three patients (woman: 2, man: 1; mean age: 30 years) unsatisfied with their dental aesthetics sought dental treatment. The treatment plan involved cementing ultratranslucent zirconia veneers. Air-abrasion was performed on the internal surface of zirconia with alumina particles coated by silica (silicatization), followed by silane and adhesive applications for the adhesive cementation. All veneers were adhesively cemented to enamel with resin cement (Variolink Esthetic, Ivoclar). The patients were clinically evaluated annually considering the Ryge modified/ California Dental Association criteria. After a mean follow-up of 4.33 years (4-5 years), a survival rate of 100% was detected for the 28 minimally invasive ultratranslucent zirconia veneers cemented in the 3 patients. There were no absolute failures such as debonding, veneer fracture, or secondary caries. Superficial marginal discoloration was observed in one element (maxillary left lateral incisor) of one patient. Ultratranslucent zirconia is a viable option for manufacturing veneers due to its excellent clinical performance and longevity. However, further long-term clinical studies are essential to consolidate this material as an option for esthetic restorations.

Two-Year Survival of Ceramic Endocrowns and Partial Coverage Ceramic Restorations with Fiber Post: A 2-Year Double-Blind Randomized Clinical Trial.

PURPOSE: This double-blind randomized clinical trial (RCT) aimed to evaluate the 2-year survival rates of endocrowns and partial coverage ceramic restorations (PCCR) with fiber posts. MATERIAL AND METHODS: Forty (40) participants fulfilled the elegibility criteria, and they were randomly allocated in 2 groups: Endocrown or PCCR+post. The survival rates were assessed based on USPHS modified and radiographic examinations. A Chi-square test was used to assess the distribution of characteristics between groups. Kaplan-Meier and Log-rank tests were used to estimate the survival rate. To evaluate the association between survival of the restorations and the explanatory variables, the Multivariate Cox regression model was used. Only variables presenting p⟨0.20 were maintained in final model (α= 0.05). RESULTS: The highest 2-year survival rates were recorded for the Endocrown group (100%), whereas the PCCR+post group exhibited the lowest performance (66.7%). Most of the restoration failures was due to lack of marginal adaption, fracture, and recurrent caries. Cox Regression unadjusted analysis showed that only type of restoration presented a significant effect (p⟨0.20). Thus, adjusted analysis was not performed. CONCLUSIONS: Endocrowns appear to be a promising conservative restorative option and to be feasible and reliable approach restoring endodontically.

Water as Veneering Modeling Liquid Affects Microhardness of Glassy Matrix Veneering Ceramic.

PURPOSE/AIM: To evaluate the effect of different veneering liquids used for modeling on microhardness, fracture toughness and biaxial flexural strength of a glass-veneering ceramic. MATERIAL AND METHODS: The manufacturer recommended modeling liquid (ML), distilled water (DW), isopropyl alcohol (IA), 0.5% (P05), 1% (P1), and 2% (P2) polyethylene glycol solutions were mixed with feldspathic ceramic powder to form disc-shaped samples (n=20, 15 mm × 1.2 mm). After sintering, samples were mirror-polished and subjected to Vickers indentation (n=5) for measurement of microhardness and fracture toughness. The remaining 15 samples from each group were subjected to biaxial flexural strength. Data were subjected to one-way ANOVA and Weibull analysis. RESULTS: The microhardness was affected by veneering liquid (p=0.002): DW promoted higher microhardness values than ML and IA. Fracture toughness (p=0.301) and flexural strength (p=0.930) were not affected by the veneering liquid but Weibull parameters were affected. All groups presented surface pores under high magnification. CONCLUSION: Even though the use of DW led to higher values of surface microhardness than the ML, all obtained values are inside the range of enamel microhardness values reported in the literature. Such parameters may affect antagonist wear and should be reported in clinical trials.

Digital Image Correlation and Finite Element Analysis of Bone Strain Generated by Implant-Retained Cantilever Fixed Prosthesis.

PURPOSE: The present study evaluated the displacement and strain generated in an implant- supported fixed prosthesis under axial and non-axial loads using two methods. MATERIALS AND METHODS: Three implants were inserted in a resin block. The Digital Image Correlation (DIC) was used to measure displacement and strain generated on the surface of the resin blocks for the different load applications (500N, 1 image/second). A 3-dimensional model was constructed and a load of 500 N was applied at an axial point and a non-axial point through finite element analysis (FEA). RESULTS: Both methods gave similar trends for the strains, and both gave slightly higher strains with non-axial loading. FEA predicted higher strain magnitude (±11%) in comparison with DIC, but with the same mechanical behavior. According to ANOVA, the loading influenced the strain concentration. Higher strain was generated for non-axial loading around the implant nearest to the loading. CONCLUSIONS: For implant-retained cantilever fixed prosthesis, the same load applied in the lever arm induces higher strain in the cervical area of the last implant, which suggests more damaging potential than a load applied at the center of the prosthesis.

Influence of Ceramic Materials on Biomechanical Behavior of Implant Supported Fixed Prosthesis with Hybrid Abutment.

PURPOSE: This study evaluated the stress distribution in different cement-retained implant-supported prostheses with a hybrid abutment. MATERIALS AND METHODS: Two factors were evaluated: restorative material for the crown and hybrid abutment - zirconia, lithium disilicate and hybrid ceramic, yielding 9 combinations. For finite element analysis, a monolithic crown cemented on a hybrid abutment was modeled and cemented on a titanium base (Ti base). An oblique load (45°, 300 N) was applied to the fossa bottom and system fixation occurred on the bone's base. RESULTS: Each structure was evaluated separately to find the possible weaknesses in geometry and failure criteria. In this context, results demonstrated a significant decrease of maximum principal and von-Mises stresses concentration when crowns with high elastic modulus are cemented onto a hybrid abutment with lower elastic modulus. CONCLUSIONS: Considering this theoretical study for a Morse taper implant, the association of a rigid crown with a more resilient hybrid abutment reduces the tensile stress concentration in the restoration cervical region.

Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y (n = 5,811 restorations) and were 91% at 10 y (n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.

Influence of acid-etching and ceramic primers on the repair of a glass ceramic.

The objective of this study was to evaluate the influence of different primers on the microtensile bond strength (µTBS) between a feldspathic ceramic and two composites. Forty blocks (6.0 x 6.0 x 5.0 mm³) were prepared from Vita Mark II . After polishing, they were randomly divided into 10 groups according to the surface treatment: Group 1, hydrofluoric acid 10% (HF) + silane; Group 2, CoJet + silane; Group 3, HF + Metal/Zirconia Primer; Group 4, HF + Clearfil Primer; Group 5, HF + Alloy Primer; Group 6, HF + V-Primer; Group 7, Metal/Zirconia Primer; Group 8, Clearfil Primer; Group 9, Alloy Primer; Group 10, V-Primer. After each surface treatment, an adhesive was applied and one of two composite resins was incrementally built up. The sticks obtained from each block (bonded area: 1.0 mm² ± 0.2 mm) were stored in distilled water at 37 degrees C for 30 days and submitted to thermocycling (7,000 cycles; 5 degrees C/55 degrees C ± 1 degree C). The µTBS test was carried out using a universal testing machine (1.0 mm/min). Data were analyzed using ANOVA and a Tukey test (a = 0.05). The surface treatments significantly affected the results (P < 0.05); no difference was observed between the composites (P > 0.05). The bond strength means (MPa) were as follows: Group 1a = 29.6; Group 1b = 33.7; Group 2a = 28.9; Group 2b = 27.1; Group 3a = 13.8; Group 3b = 14.9; Group 4a = 18.6; Group 4b = 19.4; Group 5a = 15.3; Group 5b = 16.5; Group 6a = 11; Group 6b = 18; Groups 7a to 10b = 0. While the use of primers alone was not sufficient for adequate bond strengths to feldspathic ceramic, HF etching followed by any silane delivered higher bond strength.

Silica coating on alumina ceramic: comparison of three chairside air-abrasion devices working for different times and distances.

AIM: This study evaluated, by scanning electron microscope (SEM) and EDS, the effect of different strategies for silica coating (sandblasters, time and distance) of a glass-infiltrated ceramic (In-Ceram Alumina). METHODS: Forty-one ceramic blocks were produced. For comparison of the three air-abrasion devices, 15 ceramic samples were divided in three groups (N.=5): Bioart, Microetcher and Ronvig (air-abrasion parameters: 20 s at a distance of 10 mm). For evaluation of the time and distance factors, ceramic samples (N.=5) were allocated in groups considering three applied times (5 s, 13 s and 20 s) and two distances (10 mm and 20 mm), using the Ronvig device. In a control sample, no surface treatment was performed. After that, the micro-morphologic analyzes of the ceramic surfaces were made using SEM. EDS analyzes were carried out to detect the % of silica on representative ceramic surface. ANOVA and Tukey tests were used to analyze the results. RESULTS: One-way ANOVA showed the silica deposition was different for different devices (P=0.0054). The Ronvig device promoted the highest silica coating compared to the other devices (Tukey test). Two-way ANOVA showed the distance and time factors did not affect significantly the silica deposition (application time and distance showed no statistical difference). CONCLUSION: The Ronvig device provided the most effective silica deposition on glass-infiltrated alumina ceramic surface and the studied time and distance for air-abrasion did not affect the silica coating.

A comparative study between cone-beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications.

AIM: To compare cone-beam computed tomography (CBCT) with periapical radiography for the identification of simulated endodontic complications. METHODOLOGY: Sixteen human teeth, in three mandibles, were submitted to the following simulated endodontic complications: G1) fractured endodontic file; G2) root perforation; G3) cast post with deviation; G4) external root resorption. Periapical radiographs were taken of each tooth at three different angles, and CBCT scan was taken. One calibrated examiner who was specialized in dental radiology interpreted the images. The results were analysed using the following scoring system: 0 - unidentified alteration; 1 - alteration identified with inaccurate diagnosis; and 2 - alteration identified with accurate diagnosis. Data were analysed using McNemar and Wilcoxon tests (alfa=0.05). RESULTS: In the overall assessment, CBCT was superior when compared with periapical radiographs (P<0.05). When individual results on each complication were evaluated, CBCT was superior only in the identification of external root resorption (100% Score 2) (P<0.05). CONCLUSION: Cone-beam computed tomography could be an alternative to periapical radiographs especially in the detection and assessment of external root resorption.

Durability of feldspathic veneering ceramic on glass-infiltrated alumina ceramics after long-term thermocycling.

AIM: This study compared the bond strength durability of a feldspathic veneering ceramic to glass-infiltrated reinforced ceramics in dry and aged conditions. METHODS: Disc shaped (thickness: 4 mm, diameter: 4 mm) of glass-infiltrated alumina (In-Ceram Alumina) and glass-infiltrated alumina reinforced by zirconia (In-Ceram Zirconia) core ceramic specimens (N=48, N=12 per groups) were constructed according to the manufacturers' recommendations. Veneering ceramic (VITA VM7) was fired onto the core ceramics using a mold. The core-veneering ceramic assemblies were randomly divided into two conditions and tested either immediately after specimen preparation (Dry) or following 30000 thermocycling (5-55 ºC±1; dwell time: 30 seconds). Shear bond strength test was performed in a universal testing machine (cross-head speed: 1 mm/min). Failure modes were analyzed using optical microscope (x20). The bond strength data (MPa) were analyzed using ANOVA (α=0.05). RESULTS: Thermocycling did not decrease the bond strength results for both In-Ceram Alumina (30.6±8.2 MPa; P=0.2053) and In-Ceram zirconia (32.6±9 MPa; P=0.3987) core ceramic-feldspathic veneering ceramic combinations when compared to non-aged conditions (28.1±6.4 MPa, 29.7±7.3 MPa, respectively). There were also no significant differences between adhesion of the veneering ceramic to either In-Ceram Alumina or In-Ceram Zirconia ceramics (P=0.3289). Failure types were predominantly a mixture of adhesive failure between the veneering and the core ceramic together with cohesive fracture of the veneering ceramic. CONCLUSION: Long-term thermocycling aging conditions did not impair the adhesion of the veneering ceramic to the glass-infiltrated alumina core ceramics tested.

Does the bonded cross-sectional surface area affect the microtensile bond strength of resin cement to glass-ceramic?

AIM: The aim of this study was to evaluate the effect of the bonded cross-sectional area on the bond strength of a resin cement to a glass ceramic. The hypothesis tested was that the decreased bonded surface area results in increased bond strength. METHODS: Twelve glass-ceramic blocks (6x6 x4 mm) (Vita VM7) were conditioned with 10% hydrofluoric acid for 1 min, washed and rinsed thoroughly and silanized. The resin cement was applied on the treated-surface and the cement-ceramic sets were sectioned to produce specimens with the bonded areas of about 0.7x0.7 mm (0.5 mm(2)-Gr1), 1x1 mm (1 mm(2)-Gr2), 1.4x1.4 mm (2 mm(2)-Gr3), which were submitted to the microtensile test. RESULTS: The results were affected significantly by bonded surface area (P<0.0001) with the highest mean value (MPa) obtained from Gr1 (26.3+/-8.2a), followed by Gr2 (20.8+/-6.5b) and Gr3 (16.1+/-5.7c) (ANOVA and Tukey's test, alpha=0.05). A negative correlation was found between the bonded surface area and the bond strength results (r=-0.5234; P<0.0001) (Pearson correlation test). Pre-test failures were more common when the bonded surface area was 0.5 mm(2). CONCLUSIONS: With the increased bonded surface area, the mean microtensile bond strength of the resin cement to the feldspathic ceramic decreased.

The use of the oregano (Origanum vulgare L.) essential oil and hydrosol in green olive fermentation

The effect of oregano the (Origanum vulgare L.) oil at the levels of 0.05, 0.1 and 0.3 percent and oregano hydrosol on the physicochemical, microbiological and sensory characteristics of the green olive (Edremit variety) fermentation was investigated. The initial pH of the oregano oil added samples were higher than the other treatments, which were above 5.8. The highest final acidity was observed in the hydrosol+brine combination (0.53 percent). The initial LAB population on the first day of the fermentation was high in the diluted hydrosol (8.89 log cfu ml-1) and control (8.47 log cfu ml-1) samples. But a significant difference was not observed between the LAB counts of the treatments on the 40th day of fermentation. The control and brine+oregano hydrosol samples had the highest sensory scores.