EPA Consensus Project Paper: Failure Rates of Direct Versus Indirect Single-Tooth Restorations. A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this systematic review and meta-analysis was to evaluate and compare the failure rates of direct and indirect restorations for single-tooth restorations. METHODS: A literature search was conducted by using electronic databases and relevant references for clinical studies on direct and indirect dental restorations with a follow-up of at least 3 years. The risk of bias was assessed with the ROB2 and the ROBINS- I tools. The I2 statistic was used for the assessment of heterogeneity. The authors reported summary estimates of annual failure rates of single-tooth restorations using a random-effects model. RESULTS: Of 1415 screened articles, 52 (18 RCTs, 30 prospective, 4 retrospective) met the inclusion criteria. No articles with direct comparisons were identified. No significant difference was found in the annual failure rates of single teeth restored with either direct or indirect restorations, which were calculated as 1% using a random-effects model. High heterogeneity was found, ranging from 80% (P⟨0.01) for studies on direct restorations to 91% (P⟨0.01) for studies on indirect restorations. Most of the studies presented some risk of bias. CONCLUSIONS: Annual failure rates were similar for direct and indirect single-tooth restorations. Further randomized clinical trials are needed to draw more definitive conclusions.

The Effect of Surface Pretreatment and Water Storage on the Bonding Strength of a Resin Composite Cement to Modified PEEK.

The bonding quality of bonding to polyether ether ketone (PEEK) after different surface treatments and adhesive regimens was assessed through shear bond strength. MATERIALS AND METHODS: Sixty modified PEEK disks were cut out of BioHPP round blanks using CAD-CAM procedures. Disks were subjected to the following surface pretreatments: (A) Sandblasting with alumina (Rocatec) and application of adhesive bonding agent visiolink (control group) (B) Sandblasting with silica-modified alumina (Cojet), application of silane agent Espe Sil, followed by application of adhesive bonding agent Visio-Bond (C) Sandblasting with silica-modified alumina (Cojet), application of silane containing primer-adhesive Clearfil Ceramic Primer, followed by application of adhesive bonding agent visiolink. A dual-curing resin composite cement (combolign) was luted to all treated surfaces. Each group was further divided to subgroups of 10 specimens which were stored in distilled water at 37°C for 150 days without further thermocycling. Specimens were then submitted to shear bond strength testing. RESULTS: Group (B) was statistically significant different from group (A) (control group). Water storage condition had no significant influence on final bond strength. CONCLUSIONS: Use of different conditioning protocols had a significant effect on the final bond strength of composite resin cement to PEEK surface. Water storage did not significantly influence bonding.

Digital data management for CAD/CAM technology. An update of current systems.

Abstract - Computer-aided design/computer-aided manufacturing (CAD/CAM) technology continues to rapidly evolve in the dental community. This review article provides an overview of the operational components and methodologies used with some of the CAD/CAM systems. Future trends are also discussed. While these systems show great promise, the quality of performance varies among systems. No single system currently acquires data directly in the oral cavity and produces restorations using all materials available. Further refinements of these CAD/CAM technologies may increase their capabilities, but further special training will be required for effective use.

Predictions of cement microfracture under crowns using 3D-FEA.

PURPOSE: The objective of this research study was to test the effects of (1) crown margin type, (2) cement type, (3) cement thickness, (4) loading direction, and (5) loading magnitude on stress levels and distributions within luting cement that might lead to cement microfracture using three-dimensional Finite Element Analysis techniques. MATERIALS AND METHODS: Thirty-two three-dimensional computer models, as well as models for standards, were generated for a mandibular first premolar. Crown preparations exhibited shoulder or chamfer margin configurations, and zinc phosphate, zinc polycarboxylate, glass ionomer, and resin cements were used in thicknesses of 25 or 100 microm. Modeled crowns were loaded axially or obliquely at 10 and 100 MPa. Areas and levels of stress concentrations within the cement were determined. RESULTS: Stresses in the cement were low for all situations except 100 MPa oblique stressing. Stresses at the margins of crowns with chamfer marginal configuration were higher than those with shoulder margins. Stresses under oblique stressing were 10 to 150 times higher than under axial stressing. Except for Zn phosphate cement, cement thickness minimally affected stress levels and distributions. Greater stresses were found in cements with the greater Young's modulus. CONCLUSIONS: Although the chamfer margin design could lead to greater stresses near the margins that places the cement at risk for microfracture and possible crown failure, glass-ionomer and composite resin cements have more favorable mechanical properties for resisting microfracture.

3D-FEA of osseointegration percentages and patterns on implant-bone interfacial stresses.

OBJECTIVES: The degree of osseointegration and its patterns are important for the success of implants. 3D-FEA was used to determine interfacial stresses on a single tooth implant (IMZ) for four degrees of osseointegration (100, 75, 50 and 25%), and five patterns at 50% osseointegration (locally alternating, coronal only, apical only, facial only and lingual only). METHODS: The implant was restored with a metal-ceramic crown and subjected to 10 MPa axial or oblique applied stress. Resolved stresses were examined at four heights along the implant-bone interface. RESULTS: The degree of osseointegration did not affect resolved stress levels or distributions. Oblique loads elevated interfacial stresses 5 to 20 times. Stresses were always higher at the bone crest. CONCLUSIONS: Osseointegration patterns with crestal bone reduced both crestal and apical stresses. Apical only osseointegration produced much higher apical stresses. Crestal osseointegration and axial loads minimized overall stress.

Three-dimensional finite element analysis of stress-distribution around single tooth implants as a function of bony support, prosthesis type, and loading during function.

The elastic limit of bone surrounding implants may be surpassed and thus produce microfractures in bone. The purpose of this study was to use computer simulations to examine clinical situations with IMZ implants in edentulous mandibles and to identify loading conditions that could lead to bone microfractures. Three-dimensional finite element analysis models were used to examine effects of: (1) types of edentulous mandibles, (2) veneering materials, (3) the absence of cortical bone, (4) different intramobile elements, (5) loading directions, and (6) loading levels. Stress distribution patterns were compared and interfacial stresses were monitored specifically at four heights along the bone-implant interface. Stresses were concentrated toward cortical bone (0.8 to 15.0 MPa). There were no differences between types of veneering materials and the absence of cortical bone increased interfacial stresses. The use of a titanium intramobile element decreased stresses. Minor stress increases were associated with smaller mandibles. Oblique loads increased stresses 15 times, and 200 N loads increased stresses 10 times. Conditions for bone microfracturing were associated with oblique loads, high occlusal stress magnitudes, and the absence of cortical bone.

Stress concentration in all-ceramic posterior fixed partial dentures.

Two-dimensional finite-element analysis was used to study levels and distribution patterns of stress within three-unit fixed partial dentures (mandibular first premolar to first molar) constructed of different materials (Type III gold alloy, Dicor, and In-Ceram) and with different connector heights (3.0 mm versus 4.0 mm). In the computer models, 10 MPa of stress was applied centrally to the prosthesis. Resultant von Mises stresses were concentrated within the connectors; the greatest stress occurred at the axial location of the connector. Stresses were 40% to 50% lower for 4.0-mm connectors. Patterns of stress distribution were similar for premolar and molar connectors. Stress levels within In-Ceram models were lower than for the other two materials and represented a lower percentage of the ultimate strength of the material. Based on a two-dimensional finite-element analysis model, In-Ceram would appear to be the best choice for posterior fixed partial dentures.

Finite element analysis of ceramic abutment-restoration combinations for osseointegrated implants.

All-ceramic restorations can solve many esthetic problems associated with implant-supported prostheses. This study evaluated stress concentration and distribution in implant abutments under normal masticatory forces using computer simulations. Two-dimensional finite element analysis was used to study four different abutment-restoration combinations using Brånemark implants. The models considered two positions of the fastening screw, two positions of the crown margins, cemented versus screw-retained prostheses, and clinical loads of 200 N. Models having screws on top of abutments had the lowest stresses (3.1 to 4.8 MPa) and best stress distribution. Screw-retained prostheses and short crown margins increased overall stresses (9.9 to 11.4 MPa).

Finite element analysis estimates of cement microfracture under complete veneer crowns.

Long-term clinical failures of complete veneer crowns are commonly attributed to microleakage of the cement. Excessive stress or fatigue cycling may create cement microfractures and promote microleakage. Two-dimensional (2D) finite element analysis (FEA) was selected to determine stress levels and distributions on dental cements resulting from 10 MPa occlusal loads on single-unit complete artificial veneer crowns during various clinical conditions. Sixteen 2D-FEA computer models were generated for a mandibular first premolar to study the effects of (1) marginal configuration (shoulder for all-ceramic crown versus chamfer for type III gold alloy crown), (2) four types of cement (zinc phosphate, polycarboxylate, glass ionomer and composite resin), and (3) two thicknesses of cement (25 and 100 microns) for single-cycle loads and fatigue loading. There was almost no difference between a chamfer and shoulder marginal configuration except at the edge of the margin where the chamfer finish lines reached 2 to 8 times greater stresses. There were minimal effects for thickness of cement and marginal configurations. Stresses were slightly less for thicker cement. Fatigue analysis was based on estimated stress versus number of cycle curves for cements and resulted in stresses below the estimated endurance limit. If the average occlusal loading levels were 10 MPa, there did not appear to be a risk of microfracture in dental cement because of mechanical loading.