Evaluation of shear bond strength based on substructure materials and ceramic veneering techniques.

PURPOSE: Bilayered restorations have both the strength of the substructure material and the esthetics of the veneer material; however, they should have appropriate bonding between the two materials. This study aimed to evaluate the shear bond strength (SBS) according to the substructure material and veneering technique used in bilayered restorations. MATERIALS AND METHODS: The experimental group was divided into four groups (n = 15 per group) based on the substructure materials (cobalt-chromium [Co-Cr] alloy and 3 mol% yttrium-stabilized tetragonal zirconia polycrystal [3Y-TZP]) and veneering techniques (pressing and layering). Veneering was performed with disk shape (diameter: 5 mm, height: 2 mm) on a substructure using each veneering technique. Shear stress was applied to the interface of the substructure and the veneering ceramic using a universal testing machine. The shear bond strength, according to the substructure and veneering technique, was analyzed using a two-way analysis of variance with a post-hoc Tukey's honestly significant difference test. The failure mode was observed, and the surface was analyzed using a scanning electron microscope and energy-dispersive spectroscopy. RESULTS: The shSBS of the Co-Cr alloy and 3Y-TZP substructure was not different (p > 0.05); however, the pressing technique showed a higher SBS than the layering technique (p < 0.05). The SBS did not differ depending on the veneering technique in the Co-Cr alloys (p > 0.05), whereas the SBS in the pressing technique was higher than that in the layering technique for 3Y-TZP (p < 0.05). In the layering technique, the Co-Cr alloy showed a higher SBS than 3Y-TZP (p < 0.05). In the failure mode, mixed failure occurred most frequently in all groups. Extensive elemental interdiffusion was observed through the opaque layer in the Co-Cr alloy, regardless of the veneering technique. In 3Y-TZP, a wider range of elemental interdiffusion was observed in the pressing technique than in the layering technique. CONCLUSIONS: In bilayered restorations with a 3Y-TZP substructure, the pressing technique yielded higher bonding strength than layering. Using the layering technique, 3Y-TZP showed a lower SBS than the Co-Cr alloy. In bilayered restorations using 3Y-TZP as a substructure, the veneering technique and thermal compatibility of the materials must be considered.

Complete mouth rehabilitation in a patient with condylar fracture malunion: A clinical report.

Mandibular condyle fracture malunion and tooth loss can cause functional and esthetic problems. A patient with restricted mouth opening associated with muscle atrophy required prosthetic rehabilitation. Since the remaining teeth had a poor prognosis and the patient had difficulty adapting to the interim denture, complete mouth rehabilitation with implants was chosen. The implants were placed by using nerve lateralization and an autogenous bone graft. Prosthetic rehabilitation combines digital diagnosis and conventional prosthetic restorations. The definitive prosthesis was fabricated to ensure adequate oral hygiene and functional adaptation of the orofacial structures. Treatment resulted in stable masticatory function, occlusion, and esthetics and restored the function of the atrophied lips and restricted mouth opening.

Chewing Side Preference Related to Food Texture and Occlusal Contact Area.

PURPOSE: To determine whether food texture affects chewing side preference (CSP) and to investigate the relationship between CSP and masticatory factors such as occlusal contact area, bite force, and masticatory performance. MATERIALS AND METHODS: Forty-seven adults (20 women and 27 men; mean age, 24 years) participated in this study. Three types of food (chewing gum, beef jerky, and peanuts) were provided to assess CSP. Occlusal contact area was measured at various ranges of interocclusal distance, and the bite force was measured. Masticatory performance was assessed according to the median particle size. Asymmetry indices of each measurement were calculated and analyzed using Pearson's correlation coefficient (α = .05). RESULTS: The CSP for beef jerky and peanuts were significantly correlated with each other, whereas the CSP for chewing gum was not correlated with other food. The proportion of participants who chewed equally on both sides was higher for chewing gum than for beef jerky. There was a significant correlation between the CSP for beef jerky and occlusal contact area, especially at interocclusal distance ranges of 0-89 and 0-109 µm (r = 0.41). Bite force and masticatory performance were not significantly correlated with CSP. CONCLUSION: Food texture seemed to affect chewing side preference and masticatory laterality was greater for tough foods. Moreover, CSP for tough food was closely related to the occlusal contact area at about 0.1mm interocclusal distance level.

Flexural strength and translucency of barium-silicate-filled resin nanoceramics for additive manufacturing.

OBJECTIVE: This in vitro study aimed to evaluate the flexural strength (FS) and translucency parameter (TP) of resin nanoceramics (RNCs) with barium silicate for additive manufacturing. MATERIALS AND METHODS: An RNC slurry was prepared by mixing a barium silicate filler and resin monomer. For the FS tests, specimens with three filler contents (0, 50, and 63 wt%) were designed according to ISO6872 for dental ceramics and ISO10477 for dental polymers. These specimens were then formed into discs with thicknesses of 1 and 2 mm for TP measurement. RESULTS: In the specimens prepared according to ISO6872, the FS increased significantly depending on the filler content. However, in the case of ISO10477, there was no significant difference between the FSs of the specimens with 0 and 50 wt% filler contents. The increase in thickness affected translucency, and the lowest translucency was obtained at a filler content of 63 wt%. The filler distribution was dense in the specimen with 63 wt% filler and uniform but relatively sparse in the specimen with 50 wt% filler. More voids were observed in the specimen with 63 wt% filler. The thickness and filler content of the specimen affected its TP. The TP of the specimen with 63 wt% filler was similar to that of human enamel. CONCLUSION: The FS was significantly higher at a filler content of 63 wt%. The lowest translucency was obtained at a filler content of 63 wt% for all tested thicknesses. CLINICAL SIGNIFICANCE: Increasing the filler content was advantageous for the mechanical properties of the RNCs. A high filler content led to low translucency in the RNCs. Therefore, the esthetics of human teeth can be reproduced if layering according to the filler content is performed in areas where esthetic characteristics are required.

Tensile bond strength of CAD-CAM all ceramic crowns before and after thermomechanical aging.

PURPOSE: The purpose of this in vitro study was to compare the tensile bond strength (TBS) of resin nanoceramics (RNC), zirconia, and lithium disilicate (LS2) restorations cemented to titanium abutments before and after thermomechanical aging. MATERIALS AND METHODS: Twelve specimens per group were fabricated to determine the TBS between a titanium abutment and four types of crown materials (2 RNCs, LS2, and translucent zirconia crowns for the maxillary molar). After milling, the abutments and crowns were cemented with resin cement after air-particle abrasion. In addition, thermomechanical aging (200,000 cycles, 50 N, 2 Hz) was applied to half of the specimens by using a mastication simulator. TBS was measured by using a universal testing machine. The interface between the crown and the cement was observed by using scanning electron microscopy (SEM). Two-way ANOVA was performed to analyze the effects of crown materials and thermomechanical aging. Failure-mode and interface analyses were also conducted. RESULTS: After thermomechanical aging, the TBS decreased in the LS2 specimens and increased in RNCs (p < 0.001). The ratio of mixed failure and debonding with the hole-sealing resin increased in the RNC group. SEM images showed the reduced gap between the crown and the resin cement after thermomechanical aging in the RNC group. CONCLUSIONS: Differences in TBS were affected by the crown materials after thermomechanical aging. After thermomechanical aging, the RNC crowns showed increased TBS, whereas LS2 and zirconia crowns exhibited decreased or similar TBS.

Fatigue resistance of anterior monolithic crowns produced from CAD-CAM materials: An in vitro study.

STATEMENT OF PROBLEM: Lithium disilicate and 5 mol% yttria partially stabilized zirconia (5Y-PSZ) are commonly used for anterior restorations. However, studies comparing the durability of 5Y-PSZ and lithium disilicates are sparse. PURPOSE: The purpose of this in vitro study was to investigate the fracture load of anterior monolithic crowns made of 2 lithium disilicates and a 5Y-PSZ under dynamic loading. MATERIAL AND METHODS: Titanium abutments of the maxillary incisors were prepared (N=48, 8 for each group). Monolithic anterior crowns were made from the lithium disilicates (e.max CAD, Rosetta SM) and 5Y-PSZ (Katana UTML). After cementation, the specimens were stored in water for 24 hours and then thermocycled 10 000 times. Dynamic loading (70 N, 200 000 cycles, 1 Hz) was applied to half the specimens. The fracture load was measured by using a universal testing machine. The fracture patterns were analyzed and fractography applied. Two-way ANOVA and the Fisher exact test were used for statistical analysis (α=.05). RESULTS: The material and dynamic loading affected the fracture load of the anterior monolithic crowns (P<.05). However, there was no interaction between the material and the dynamic loading (P=.079). Both lithium disilicates had higher fracture loads than 5Y-PSZ (P<.05). The fracture load of each specimen was reduced after dynamic loading (P<.05). Lithium disilicate showed marginal and bulk fractures, and 5Y-PSZ presented catastrophic fractures (P<.001). CONCLUSIONS: 5Y-PSZ materials with large grains and low flexural strength may be less resistant to fractures under dynamic loading than lithium disilicates.

Degree of conversion of light-polymerized composite resin in implant prosthesis screw access opening.

PURPOSE: The mechanical and physical properties of implant screw access opening deteriorate if composite resin is not polymerized properly. Therefore, this study aimed to analyze the effect of using composite resin in implant access opening on the degree of conversion (DC). MATERIALS AND METHODS: Two prosthetic materials (Co-Cr and zirconia), two types of composite resin (low and high viscosity), two light-cured resin depths (2 and 3 mm), and two polymerization methods (max-mode 10 s and mid-mode 20 s: 16 and 22 J/cm2 , respectively) were considered (n = 192). The DC of the polymerized composite resin was measured through Fourier-transform infrared spectroscopy. The top and bottom surfaces of the polymerized composite resin body were observed through scanning electron microscopy. Multiple linear regression analysis and analysis of variance were used to identify significant differences in DC (α = 0.05). RESULTS: The DC was lower when the low-viscosity composite resin (ß = -0.431), light-polymerized resin depth of 2 mm (ß = -0.430), zirconia prosthesis (ß = -0.191), and mid-mode polymerization method (ß = -0.164) were used. The resin type, depth of resin to be light-cured, prosthesis material, and polymerization method had an effect on the DC. CONCLUSIONS: Low-viscosity composite resin should be polymerized at a low irradiance and long polymerization time (such that the light-cured resin depth does not exceed 2 mm) to ensure proper composite resin polymerization in implant screw access opening.

Effect of barium silicate filler content on mechanical properties of resin nanoceramics for additive manufacturing.

PURPOSE: The purpose of this study was to investigate the effect of barium silicate filler contents on mechanical properties of resin nanoceramics (RNCs) for additive manufacturing (AM). MATERIALS AND METHODS: Additively manufactured RNC specimens were divided into 4 groups depending on the content of ceramic fillers and polymers: 0% barium silicate and 100% polymer (B0/P10, control group); 50% barium silicate and 50% polymer (B5/P5); 60% barium silicate and 40% polymer (B6/P4); 67% barium silicate and 33% polymer (B6.7/P3.3). The compressive strength (n = 15) and fracture toughness (n = 12) of the specimens were measured, and scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS) analyses were performed. Independent sample Kruskal-Wallis tests were performed on the compressive strength and fracture toughness test results, and the significance of each group was analyzed at the 95% confidence interval through post-tests using the Bonferroni's method. RESULTS: B6/P4 and B6.7/P3.3 exhibited much higher yield strength than B0/P10 and B5/P5 (P < .05). Compared to the control group (B0/P10), the other three groups exhibited higher ultimate strength (P < .05). The fracture toughness of B6/P4 and B6.7/P3.3 were similar (P > .05). The content of barium silicate and fracture toughness showed a positive correlation coefficient (R = 0.582). SEM and EDS analyses revealed the presence of an oval-shaped ceramic aggregate in B6/P4 specimens, whereas the ceramic filler and polymer substrate were homogeneously mixed in B6.7/P3.3. CONCLUSION: Increasing the ceramic filler content improves the mechanical properties, but it can be accompanied by a decrease in the flowability and the homogeneity of the slurry.

Connector design effects on the in vitro fracture resistance of 3-unit monolithic prostheses produced from 4 CAD-CAM materials.

STATEMENT OF PROBLEM: Studies that compared the fracture strength of monolithic lithium disilicate and 5-mol% yttria partially stabilized zirconia multiunit fixed dental prostheses are sparse. PURPOSE: As the connector is the weakest part of a fixed dental prosthesis, the purpose of this in vitro study was to investigate the effect of connector designs and material on the fracture strength of 3-unit monolithic fixed dental prostheses. MATERIAL AND METHODS: Resin-ceramic canine and premolar teeth (N=144) were prepared for fixed dental prosthesis abutments. Prostheses with 3 connector designs (width=height, widthheight) were made from 2 types of lithium disilicate (IPS e.max CAD and Amber Mill) and 5-mol% yttria partially stabilized zirconia (3M Lava Esthetic and Katana Zirconia UTML). Fracture strengths were measured after 200 000 cycles of dynamic loading of 50 N and thermocycling at 5 °C and 55 °C, and the fracture patterns were analyzed. Two-way analysis of variance and the Fisher exact test were used for statistical analysis (α=.05). RESULTS: The material and connector design affected the fracture strength of fixed dental prostheses (P<.05), and a significant interaction was found between the material and connector design (P<.05). The IPS e.max CAD material had significantly lower fracture strength than Amber Mill, 3M Lava Esthetic, or Katana Zirconia UTML (P<.05). Connector designs with a greater width versus height showed significantly lower fracture strengths than other designs (P<.05). CONCLUSIONS: The connector design of 3-unit fixed dental prostheses, particularly the connector height, may affect fracture strength depending on the prosthesis material.

Effect of different ceramic materials and substructure designs on fracture resistance in anterior restorations.

STATEMENT OF PROBLEM: Materials have been developed to reduce the chipping of ceramic veneer and improve the esthetics of anterior ceramic veneered restorations. However, studies of the effects of material and substructure design on fracture resistance are sparse. PURPOSE: The purpose of this in vitro study was to investigate the fracture resistance of metal-ceramic (MC), zirconia-feldspathic porcelain (ZC), and zirconia-lithium disilicate (ZL) anterior restorations and evaluate the effect of material and substructure design. MATERIAL AND METHODS: After preparing and scanning artificial maxillary central incisor teeth, titanium abutments and restoration specimens (n=90) were fabricated. MC, ZC, and ZL materials were prepared with substructure designs A (two-third coverage of the palatal surface) and B (one-third coverage of the palatal surface). After cementation, the specimens were thermocycled (10 000 cycles, 5 and 55 °C). Fracture load measurements, failure mode analysis, energy dispersive X-ray spectroscopy (EDS), line scan analysis, fractography, finite element analysis (FEA), and Weibull analysis were performed. Two-way ANOVA was used to identify the effects of material and substructure design on fracture load. One-way ANOVA was used to identify significant differences of fracture load (α=.05). RESULTS: MC and ZL showed significantly higher fracture load than ZC (P<.05). MC_A showed a significantly higher fracture load than MC_B (P<.05). ZC_A exhibited the lowest Weibull modulus. FEA revealed that the maximum principal stress occurred near the loading area of the veneer. ZL displayed the lowest maximum principal stress among all the materials. CONCLUSIONS: ZL and MC_A exhibited more favorable fracture resistance. The substructure design of MC, with increased metal coverage of the palatal surface, improved fracture resistance significantly.

Effect of materials on axial displacement and internal discrepancy of cement-retained implant-supported prostheses.

STATEMENT OF PROBLEM: How axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear. PURPOSE: The purpose of this in vitro study was to assess the difference in internal discrepancy and axial displacement according to the prosthesis material in cement-retained prostheses splinting nonparallel implants. MATERIAL AND METHODS: Computer-aided design and computer-aided manufacture (CAD-CAM) titanium abutments were fabricated for a vertically placed implant and a 15-degree tilted implant. Three types of prostheses, in zirconia, cobalt-chromium (Co-Cr) alloy, and polymethylmethacrylate resin (PMMA), were fabricated (n=10). The internal discrepancy between the CAD-CAM titanium abutment and the prosthesis was measured by using the replica technique. After luting with an interim cement, they were mounted in Type IV gypsum. The specimens were cyclic loaded, and axial displacement of the prosthesis was measured after 3, 10, 100, and 106 cycles. The internal discrepancy and cumulative axial displacement were assessed by using a 3-way analysis of variance and repeated measures analysis of variance (α=.05). RESULTS: The internal discrepancy of the prosthesis did not differ based on the prosthesis material (P=.869); however, it was significantly different based on the measurement location, with the occlusal discrepancy (224 ±29 µm) being greater than the axial discrepancy (21 ±10 µm) (P<.05). Implants with an angled placement exhibited less axial displacement than implants with vertical placement (P<.05). The PMMA prosthesis demonstrated significantly greater axial displacement than the zirconia or Co-Cr prostheses (P<.05), which were similar (P=.623). CONCLUSIONS: Prostheses made with high-elastic moduli materials exhibited less axial displacement than PMMA prostheses, even though the internal discrepancy was not different. Moreover, vertically placed implants presented a greater axial displacement of the prosthesis than implants with angled placement.

Correlation between occlusal contact area at various levels of interocclusal thicknesses and masticatory performance.

BACKGROUND: This study aimed to determine the correlation between occlusal contact area and masticatory performance using BiteEye® , a photo occlusal analysis device and the multiple sieve method. OBJECTIVES: To calculate the occlusal contact area at various levels of interocclusal thicknesses and to measure masticatory performance with peanuts as the test material. METHODS: Fifty-two adults (30 men and 22 women) were enrolled according to specific exclusion/inclusion criteria. The occlusal contact area was measured by obtaining the interocclusal record of the maximum intercuspal position (MIP) using silicone impression material. Occlusal contact area measurements were performed in the ranges of 0-149, 0-89, 0-59, 0-29 and 0-9 µm. Masticatory performance was measured by obtaining the median particle size (X 50 ) after converting the weight of comminuted peanuts into size using the multiple sieve method. Statistical analysis was performed at 95% significance level. RESULTS: Interocclusal thickness comparison revealed the highest correlation with X 50 in the 0-149 µm range. Stronger correlations between the occlusal contact area and X 50 were observed in cases of 20 strokes of mastication (r = -.451) than in cases of 10 strokes (r = -.383), in the posterior occlusal contact area (r = -.456) than in the full arch occlusal contact area (r = -.451) and the molar area (r = -.478) than in the premolar area (r = -.296). CONCLUSIONS: The larger the occlusal contact area, the higher the masticatory performance; this correlation was statistically significant. Regarding interocclusal thickness, the highest correlation between the occlusal contact area and masticatory performance was observed in the 0-149 µm range. CLINICAL TRIAL REGISTRATION NUMBER: GWNUDH IRB 2020-A001.

Effects of heat treatment on the microstructure, residual stress, and mechanical properties of Co-Cr alloy fabricated by selective laser melting.

The mechanical properties and residual stress of dental Co-Cr-Mo (CCM) alloy depend on the manufacturing and post-processing methods, which affect the prognosis of dental prostheses. Two CCM alloys manufactured by casting and selective laser melting (SLM) were compared, and the effect of heat treatment temperature for CCM alloys manufactured by SLM method was evaluated. Specimens were fabricated by casting (Cast Co-Cr) and SLM (SLM Co-Cr). SLM Co-Cr specimens were heat treated at 750, 950, and 1150 °C to compare their properties. Microstructures were analyzed via scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and electron backscattered diffraction (EBSD), and the residual stress was measured via x-ray diffraction (XRD). Mechanical properties were evaluated by a Vickers hardness test and a tensile test; fractography was performed after this. The SLM Co-Cr group exhibited a decrease in porosity, grain size, increase in solid solution limit, and high residual stress compared to Cast Co-Cr; the ultimate tensile strength, yield strength, and hardness were also higher. The microstructures, residual stresses, and mechanical properties differed significantly depending on the heat treatment, and the strength and hardness showed a tendency inverse to that of the elongation. Type I residual stresses mostly decreased after 750 °C heat treatment, however type II and III residual stresses remained even after 1150 °C heat treatment. SLM presented superior mechanical properties to casting. Considering the reduction of tensile residual stress and increased ductility, CCM alloys should be heat treated at a temperature of 950 °C or higher.

Initial Change in the Occlusal Force and Occlusal Contact Area Following Single Molar Implant Restoration.

PURPOSE: The occlusal force and occlusal contact area may be used to evaluate oral function following restoration of a missing tooth. This study aimed to monitor the initial changes in these factors after single molar implant restoration. MATERIALS AND METHODS: Patients who underwent single implant restoration between December 2018 and September 2019 were recruited for this study. Occlusal force was measured before, immediately after, and 1 month after prosthesis placement. The occlusal contact area was evaluated immediately and 1 month after the placement. Data were grouped by sex, restored tooth, and restored side for analysis. RESULTS: In most groups, occlusal force was significantly increased 1 month after the placement compared with that before placement (P < .05), and the change was more significant in the first molar group than in the second molar group. There was a significant difference in the occlusal contact area of the implant prosthesis immediately and 1 month after placement when a thickness of 9 µm was used. The occlusal contact area of the natural tooth in the mesial side was significantly increased 1 month after placement (P < .05). CONCLUSION: Occlusal force was significantly increased 1 month after implant restoration, and restoration of the first molar had the most significant effect on the occlusal force. Occlusal contact areas may differ according to the occlusal indicator used in the clinical setting because the changes were significant with only 0 to 9 µm.

Composite Cement Components Stabilize the Bond between a Lithium-Disilicate Glass-Ceramic and the Titanium Abutment.

PURPOSE: To evaluate the effect of composite cement components and thermocycling on the bond strength of monolithic lithium-disilicate (LS2) glass-ceramic implant-supported restorations bonded to titanium (Ti) abutments. MATERIALS AND METHODS: Eighty LS2 blocks were treated with five types of composite cement and primer, then divided accordingly into groups: M (Multilink hybrid abutment), G (G-CEM LinkAce), GP (G-CEM LinkAce with G-Multi PRIMER), P (Panavia F2.0), and U (RelyX U200). Half of the 16 specimens from each group were subjected to thermocycling (groups T-M, T-G, T-GP, T-P, and T-U). The tensile bond strength (TBS) of all specimens was measured using a pull-off test. The cross section of the LS2 block from which the Ti abutment was removed was examined for mode of failure. Two-way ANOVA and Tukey's HSD test (significance level = 0.05) were used to determine the effect of composite cement composition and thermocycling on TBS. RESULTS: There was no difference in TBS between the five groups before thermocycling (p = 0.16). However, groups M (p < 0.001) and G (p = 0.014) showed significantly lower TBS than the corresponding thermocycled groups. Groups T-GP, T-P, and T-U did not show significant changes in TBS after thermocycling (p > 0.05). All failures occurred at the interface between the composite cement and Ti abutment and not between the cement and the LS2 block. CONCLUSION: Thermocycling can reduce the bond strength between the composite cements and Ti abutment. The composite cements containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) or methacrylate phosphate ester monomers stabilize bonding.

Effect of core design on fracture resistance of zirconia-lithium disilicate anterior bilayered crowns.

PURPOSE: The effect of core design on the fracture resistance of zirconia-lithium disilicate (LS2) bilayered crowns for anterior teeth is evaluated by comparing with that of metal-ceramic crowns. MATERIALS AND METHODS: Forty customized titanium abutments for maxillary central incisor were prepared. Each group of 10 units was constructed using the same veneer form of designs A and B, which covered labial surface to approximately one third of the incisal and cervical palatal surface, respectively. LS2 pressed-on-zirconia (POZ) and porcelain-fused-to-metal (PFM) crowns were divided into "POZ_A," "POZ_B," "PFM_A," and "PFM_B" groups, and 6000 thermal cycles (5/55℃) were performed after 24 h storage in distilled water at 37℃. All specimens were prepared using a single type of self-adhesive resin cement. The fracture resistance was measured using a universal testing machine. Failure mode and elemental analyses of the bonding interface were performed. The data were analyzed using Welch's t-test and the Games-Howell exact test. RESULTS: The PFM_B (1376. 8 ± 93.3 N) group demonstrated significantly higher fracture strength than the PFM_A (915.8 ± 206.3 N) and POZ_B (963.8 ± 316.2 N) groups (P<.05). There was no statistically significant difference in fracture resistance between the POZ_A (1184.4 ± 319.6 N) and POZ_B groups (P>.05). Regardless of the design differences of the zirconia cores, fractures involving cores occurred in all specimens of the POZ groups. CONCLUSION: The bilayered anterior POZ crowns showed different fracture resistance and fracture pattern according to the core design compared to PFM.

Effects of the Thickness Ratio of Zirconia-Lithium Disilicate Bilayered Ceramics on the Translucency and Flexural Strength.

PURPOSE: To determine the effects of the total thickness and core/veneer thickness ratio of bilayered ceramics on their three-point flexural strength and translucency. MATERIALS AND METHODS: Two groups of specimens were prepared with two different total thicknesses, 1.0 mm and 0.6 mm. These groups were divided into five and three subgroups with ten specimens each, respectively, having different core/veneer thickness ratios. Lithium disilicate was pressed on the zirconia surface using the "lost-wax technique." The translucency and three-point flexural strength were measured, and a one-way analysis of variance test (p < 0.05) was performed to determine whether the translucency and three-point flexural strength were affected by the total thickness and core/veneer thickness ratio of the specimens. RESULTS: For the same total thickness, translucency decreased with a increase in the zirconia core proportion (p < 0.001). For the same core/veneer ratio, the translucency decreased with an increase in the total thickness (p < 0.001). If the zirconia thickness was less than half of the total thickness, the bilayered ceramic specimens containing zirconia cores and monolithic lithium disilicate specimens exhibited a similar translucency. The three-point flexural strength increased with the increasing proportion of zirconia; however, it did not change significantly with the total thickness. However, for the same total thickness, the flexural strengths of the bilayered ceramics were higher than those of the monolithic specimens. CONCLUSIONS: At the same total thickness, increasing the zirconia core thickness decreased the translucency and increased the three-point flexural strength. Bilayered ceramic specimens with low zirconia ratios exhibited translucency similar to that of monolithic lithium disilicate ceramic but a higher flexural strength.

Axial displacement in cement-retained prostheses with different implant-abutment connections.

PURPOSE: The purpose of this study was to evaluate axial displacement in cement-retained prostheses using computer-aided design/computer-aided manufacturing (CAD/CAM) abutments with three different types of implant-abutment connections. MATERIALS AND METHODS: CAD/CAM abutments made with two types of titanium blocks (made by the same manufacturer as the implant manufacturer and by a manufacturer with a patent for CAD/CAM abutment fabrication) were connected with three types of implant connections: external, internal butt, and internal conical connection. Titanium custom abutments and zirconia prostheses were fabricated using the CAD/CAM system for each specimen. The geometries and surface morphologies of CAD/CAM abutments and ready-made abutments were comparatively evaluated using scanning electron microscopy. Cemented prostheses on abutments were mounted on a universal testing machine and subjected to 250-N sine wave cyclic loads. Cumulative axial displacement was measured at loading cycles of 3, 10, 100, and 106 and analyzed by repeated measures analysis of variance (ANOVA). RESULTS: Surface geometries and morphologies of CAD/CAM abutments varied according to the implant-abutment connection and manufacturers of the titanium block. The internal conical connection exhibited the greatest axial displacement, while the external connection showed the lowest axial displacement. The CAD/CAM abutment made with a compatible titanium block exhibited a greater axial displacement than that exhibited by the abutment fabricated using a titanium block made by the implant manufacturer. CONCLUSION: In implant connections with a vertical stop, axial displacement occurred primarily in the early loading period and was self-limited. However, long-term axial displacement can occur with internal conical connection implants. Therefore, in internal conical connection implants, axial displacement should be managed more carefully using a provisional restoration, with consideration of the abutment fabrication method.

Displacement of Simulated Flabby Tissue by Different Tray Designs and Impression Materials.

PURPOSE: To compare the effect of 3 tray designs and 3 commonly used impression materials on the displacement of flabby tissue during maxillary edentulous impression by superimposition of 3D digital models. MATERIALS AND METHODS: Fifteen maxillary edentulous casts with simulated flabby tissue were fabricated by modifying a standard maxillary edentulous acrylic resin cast. Three types of impression trays were fabricated: trays with conventional relief, trays with additional relief, and trays with an open window. Three impression materials were tested: light-body polysulfide, light-body vinylpolysiloxane, and zinc oxide eugenol paste. For the analysis of tissue displacement during impression making, the test and control stone casts were scanned using a 3D laser scanner, and the 3D digital models were superimposed using metrology software. Statistical analyses were performed with an α = 0.05. RESULTS: Negative deviations were recorded at the areas of the alveolar crest, posterior part of flabby tissue, and middle of the palate. On the other hand, a positive deviation was recorded at the area of the anterior part of flabby tissue. A significant difference in the displacement of flabby tissue was found when using different tray designs (p < 0.0001). The tray with the open window showed significantly low tissue displacement at the flabby tissue region. Depending on sites, the amount of flabby tissue displacement showed different significances by the different impression materials used (anterior part: p < 0.0001; alveolar crest: p = 0.097; posterior part: p < 0.0001). Conventionally relieved trays showed significantly higher values of displacement at the anterior part of flabby tissue (p < 0.0001), while trays with open windows showed similar values of displacement at all measuring points, and no significant differences among different impression materials were found (p = 0.104). CONCLUSIONS: There were significant differences in the displacement of flabby tissue with different tray designs, especially with displacement occurring at the anterior and posterior parts of flabby tissue. Tray designs should be considered in order to make proper impressions when flabby tissue is present.