Impact of different complete coverage onlay preparation designs and the intraoral scanner on the accuracy of digital scans.

STATEMENT OF PROBLEM: The trueness and precision of intraoral scanners (IOSs) and the effect of intracoronal restorations have been reported. However, studies addressing the accuracy of IOSs in reproducing different complete coverage onlay preparation designs are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the influence of complete coverage onlay preparation design and intraoral scanning devices on the accuracy of digital scans in terms of trueness and precision. MATERIAL AND METHODS: Three preparation designs on the mandibular first molar were considered: a traditional preparation design with isthmus reduction (IST), a traditional preparation design without isthmus reduction (wIST), and simplified nonretentive preparation (nRET). Digital scans of epoxy resin mandibular arch reference models of the preparations (containing second premolar, first molar, and second molar) were obtained by using 3 IOSs (iTero Element 2 [ELE], Trios 3 [TRI], and Primescan [PRI]) (n=10). Trueness (µm) and precision (µm) were analyzed by superimposing the digital scan on the digital reference models obtained with a high-accuracy industrial scanner (ATOS Core 80) in a tridimensional metrology software program. Accuracy was quantified by the absolute deviation (µm). Local and overall mean positive and negative deviations for trueness were also obtained. Data were analyzed by using the Kruskal-Wallis and Dunn tests with a statistical software program (α=.05). RESULTS: The nonretentive preparation groups obtained higher trueness (3.8 µm) and precision (2.7 µm) than the IST and wIST groups (trueness=7.5 to 6.3 µm, precision=5.5 to 4.6 µm). Trueness values were lower with ELE×IST (16 µm), followed by ELE×wIST (13 µm), and PRI×IST (7.8 µm). In general, no difference was found between PRI and TRI scanners (6.3 to 5.9 µm), with lower performance for ELE (13 µm). Positive deviations were higher on the proximal box of the IST and wIST preparation and on the occlusal box of the IST group. Negative deviation was higher on the ELE×IST occlusal box. CONCLUSIONS: Different intraoral scanners and preparation designs influenced the accuracy of digital scans. A more complex preparation such as IST and wIST showed higher deviation. The iTero Element 2 scanner exhibited higher deviation for both trueness and precision.

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)

Analysis of Digital Workflow in Implantology.

Digital workflow is increasingly accessible in daily dental practice. It has several benefits in implantology, such as the possibility of precise planning, which results in faster and safer surgery and, consequently, reduced prosthetic complications. There are also disadvantages that must be taken into consideration for successful treatment, such as deviations between the planned and placed implant position and intraoral scanning inaccuracies. We report a clinical case in implantology in which digital workflow was used throughout the process, pointing out its facilities and complications in the daily practice of dental surgeons. The patient had grade II mobility and external root resorption of tooth 11. After virtual planning, a surgical guide was fabricated by a CAD/CAM system, with immediate placement of a dental implant using the guided surgery technique. At the end of the osseointegration period, intraoral scanning was performed for fabrication of the final prosthesis also by a CAD/CAM system. After placement, the patient approved the aesthetic and functional results of the implant. We observed advantages such as simplification of clinical steps and safety of the proposed planning, but there were also disadvantages such as the complexity of digital tools, deviations of the placed implant, and inaccuracy in color selection. It was concluded that digital workflow is a reality that can be integrated into daily dental practice, resulting in greater safety, predictability of results, and ease of use in all clinical stages. However, it should be noted that there are still inaccuracies in digital tools and that a steep learning curve is needed in this area, which, if neglected, may lead to unsatisfactory results.

Does overlay preparation design affect polymerization shrinkage stress distribution? A 3D FEA study.

This study evaluated the polymerization shrinkage stress of three tooth preparation designs for indirect ceramic overlay by finite element analysis: isthmus preparation (IST); without isthmus preparation (wIST); and non-retentive preparation (nRET). The models were created based in prepared dental typodonts and were digitally impressed with an intraoral scanner. The interfaces in all models were considered perfectly bonded and all materials were considered homogeneous, linear, and isotropic. The polymerization shrinkage of the cement layer (100 µm) was simulated and evaluated by maximum principal stress criteria. The stress peaks followed this sequence: restoration = IST (13.4 MPa) > wIST (9.3 MPa) > nRET (9 MPa); cement layer = IST (16.9 MPa) > wIST (12.6 MPa) > nRET (10-7.5 MPa); and teeth = IST (10.7 MPa) > wIST (10.5 MPa) > (9 MPa). For the cement layer, the non-retentive preparation (nRET) had the lowest shrinkage stress from all the groups, obtaining a more homogeneous stress distribution on the cement surface. Regarding the abutment teeth, the IST generated a higher shrinkage stress area on the dental structure, concentrating higher stress magnitude at the axiopulpar and axiogingival angles. Non-retentive preparation seems to reduce polymerization shrinkage stress.

Microstructural analysis and reliability of monolithic zirconia after simulated adjustment protocols.

OBJECTIVE: To investigate the microstructural properties and reliability of zirconia partially stabilized by yttrium oxide (Y-TZP) for use in monolithic form (Vita YZ HT, Vita Zahnfabrik, Germany) after different clinical adjustment protocols simulation. One-hundred and sixty two Y-TZP discs of high translucency were divided into 6 groups (n=27), according to simulated adjustments: S-Y-TZP as sintered; G-glazed Y-TZP; DbG-Y-TZP with diamond bur adjustment simulation followed by glaze application; GDb-glazed Y-TZP adjusted with diamond bur; DbDrG-Y-TZP with adjustment simulation with diamond bur and polishing kit (diamond rubber), followed by glaze; GDbDr-glazed Y-TZP with adjustment simulation with diamond bur followed by polishing kit. METHODS: After monotonic testing under biaxial flexure (n=3), remaining specimens were distributed into 3:2:3 ratio and tested under step-stress accelerated life testing. Specimens were evaluated in a stereomicroscope and SEM. Microstructure was analyzed by X-ray diffraction and mean surface roughness (Ra). Survival data were used to calculate Weibull's beta value (ß) and reliability for missions of 300,000 and 600,000 cycles at 200N. Ra data were statistically analyzed by 1-way ANOVA and Tukey's test (both, a=5%). RESULTS: The untreated HT zirconia (S) presented a lower probability of survival after 600,000 cycles at 200N, compared to HT zirconia adjusted with diamond bur and glazed (DbG), and after final polishing with polishing kit (GDbDr). Final polishing with diamond rubber (GDbDr) resulted in a more homogeneous surface compared to glazed samples (G, DbG and DbDrG). SIGNIFICANCE: HT zirconia is more likely to present increased survival when glazed after diamond adjustments (DbG) or when it is finished with polishing kit (GDbDr).

Análise microestrutural e da resistência à fadiga de zircônia monolítica submetida a protocolos de ajuste simulado / MIcrostructural analysis and fatigue strength of monolithic zirconia simulating adjustment protocols

O objetivo deste trabalho foi investigar as propriedades microestruturais e a resistência à fadiga de amostras de zircônia parcialmente estabilizada por óxido de ítrio (Y-TZP) para uso em forma monolítica (Vita YZ HT, Vita Zahnfabrik, Alemanha) após diferentes protocolos de ajuste clínico simulado. 162 discos de Y-TZP HT (12 mm de diâmetro, 0,8 mm de altura) foram confeccionados e aleatoriamente divididos em 6 grupos de acordo com as simulações (n=27): S- YTZP sinterizada (sem desgaste, sem glaze); G- Y-TZP sinterizada (sem desgaste) e glazeada; PdG- ajuste simulado da Y-TZP com ponta diamantada seguido por aplicação de glaze; GPd- ajuste simulado com ponta diamantada da Y-TZP já glazeada; PdBdG- ajuste simulado com ponta diamantada, seguido por borracha diamantada e aplicação do glaze; GPdBd- ajuste simulado com ponta diamantada, seguido por borracha diamantada da Y-TZP já glazeada. Após teste monotônico sob flexão biaxial (n=3, célula de carga de 1000 kgf, velocidade de 1 mm/min), os espécimes restantes foram distribuídos na proporção 3:2:3 e testados sob fadiga acelerada (step stress) em três perfis de carregamento (leve, moderado e agressivo), variando-se os incrementos de carga e número de ciclos. Os espécimes representativos fraturados foram avaliados em estereomicroscopio e microscópio eletrônico de varredura (MEV) e as características microestruturais das superfícies obtidas com os diferentes protocolos foram analisadas quanto a difração de raios-X, rugosidade média (Ra), perfilometria e MEV. Os dados de sobrevivência ou fratura foram utilizados para cálculo do valor beta (ß) de Weibull e da confiabilidade para missões de 300.000 e 600.000 ciclos a 200 N. Os espectros obtidos pela difração foram comparados com espectros padrão de bancos de dados. Os dados de Ra foram analisados estatisticamente por ANOVA 1 fator e teste de Tukey (ambos, a=5%). As imagens foram analisadas qualitativamente e descritas. Não houve alteração significativa na cristalografia da zircônia após as simulações de ajuste clínico. A zircônia HT não tratada (S) apresentou menor probabilidade de sobrevivência, após 600.000 ciclos a 200 N, em comparação com a Y-TZP HT desgastada com ponta diamantada e glazeada (PdG) e após o polimento final com borracha diamantada (GPdBd). Apesar dos protocolos de ajuste simulado não alterarem a cristalografia da zircônia, o polimento final com borracha diamantada (GPdBd) resultou em uma superfície mais homogênea em comparação com amostras glazeadas (G, PdG e PdBdG). O glaze se acumulou em "ilhas" sobre todas as superfícies analisadas. Concluiu-se que a Y-TZP HT tem maior probabilidade de sobrevivência quando glazeada após desgaste com ponta diamantada (PdG) ou com polimento finalizado por borrachas diamantadas (GPdBd)(AU)

The objective of this study was to investigate the microstructural properties and fatigue resistance of zirconia partially stabilized by yttrium oxide (Y-TZP) for use in monolithic form (Vita YZ HT, Vita Zahnfabrik, Germany) after different clinical adjustment protocols simulation. 162 disc of Y-TZP HT (12 mm diameter, 0.8 mm high) were made and randomly divided into 6 groups according to the adjustment protocol (n = 27): S- Y-TZP as sintered (without adjustment and glaze); G- glazed Y-TZP (without adjustment); PdG- Y-TZP with adjustment simulation procedure with diamond bur followed by glaze application; GPd- glazed Y-TZP followed by adjustment simulation procedure with diamond bur; PdBdG- Y-TZP with adjustment simulation procedure with diamond bur and polishing kit, followed by glaze application; GPdBd- glazed Y-TZP with adjustment simulation procedure with bur followed by polishing kit. After monotonic testing under biaxial flexure (n=3, 1000 kgf load cell, 1 mm/min speed), the remaining specimens were distributed into 3:2:3 ratio and tested under step-stress in three profiles (light, moderate and aggressive), varying the load, increments and number of cycles. The fractured representative specimens were evaluated in a stereomicroscope and scanning electron microscope (SEM) and the microstructural characteristics of the surfaces obtained with different protocols were analyzed by X-ray diffraction, mean roughness (Ra), profilometry and SEM. Survival or fracture data were used to calculate Weibull's beta (ß) value and reliability for 300,000 and 600,000 cycles at 200 N. The spectra obtained by the diffraction were compared with standard spectra from databases. Ra data were statistically analyzed by 1-way ANOVA and Tukey's test (both, a=5%). The images were analyzed and qualitatively described. There was no significant change in zirconia crystallography after the simulations of clinical adjustment. The untreated Y-TZP HT (S) presented a lower probability of survival after 600,000 cycles at 200 N, compared to Y-TZP HT adjusted with diamond bur and glazed (PdG). and after final polishing with polishing kit (GPdBd). Although the simulated adjustment protocols did not alter the crystallography of the Y-TZP HT, the final polishing with diamond rubber (GPdBd) resulted in a more homogeneous surface compared to glazed samples (G, PdG and PdBdG). The glaze was accumulated in "islands" on all analyzed surfaces. It could be concluded that Y-TZP HT is more likely to survive when glazed after diamond adjustments (PdG) or when it is finished with polishing kit (GPdBd)(AU)