Fracture Rates and Lifetime Estimations of CAD/CAM All-ceramic Restorations.

The gathering of clinical data on fractures of dental restorations through prospective clinical trials is a labor- and time-consuming enterprise. Here, we propose an unconventional approach for collecting large datasets, from which clinical information on indirect restorations can be retrospectively analyzed. The authors accessed the database of an industry-scale machining center in Germany and obtained information on 34,911 computer-aided design (CAD)/computer-aided manufacturing (CAM) all-ceramic posterior restorations. The fractures of bridges, crowns, onlays, and inlays fabricated from different all-ceramic systems over a period of 3.5 y were reported by dentists and entered in the database. Survival analyses and estimations of future life revealed differences in performance among ZrO2-based restorations and lithium disilicate and leucite-reinforced glass-ceramics.

Dental materials for primary dentition: are they suitable for occlusal restorations? A two-body wear study.

AIM: This was to evaluate the wear resistance of different materials, compomers, resin-modified glass ionomer cements (RMGICs), glass ionomer cements (GICs), used for posterior restorations in primary teeth and to compare the results with the reference material, amalgam. STUDY DESIGN: Eight specimens of each material were subjected to two-body wear test, using a chewing simulator. The wear region of each material was examined under a profilometer, measuring the vertical loss (µm) and the volume loss (mm(3)) of the materials. RESULTS: The results showed significant differences of vertical loss and volume loss of the test materials (p < 0.001). Amalgam had the highest wear resistance. Twinky Star (compomer) had the lowest vertical loss and volume loss. There was no significant difference of vertical loss among compomers, Dyract Extra, Dyract Flow and Dyract Posterior. Riva Self Cure (GIC) had no statistically significant difference compared with the compomers (except Twinky Star). No statistically significant difference was found also between Equia (GIC) and Ketac Moral (GIC) with Dyract Extra (Compomer). RMGICs were found to have the lowest wear resistance. STATISTICS: For the statistical analysis, the PASW 20.0 (SPSS Statistics, IBM, Chicago) package was used. Means and standard deviations were measured with descriptive statistics and analyzed using one-way ANOVA. CONCLUSION: Compomers and some GICs, that have moderate wear resistance, may be sufficient for occlusal restorations in primary dentitions.

Effect of double-layer application on dentin bond durability of one-step self-etch adhesives.

PURPOSE: The aim of this in vitro study was 1) to analyze the influence of a double-layer application technique of four one-step self-etch adhesive systems on dentin and 2) to determine its effect on the stability of the adhesive interfaces stored under different conditions. MATERIALS AND METHODS: Four different one-step self-etch adhesives were selected for the study (iBondSE, Clearfil S(3) Bond, XenoV(+), and Scotchbond Universal). Adhesives were applied according to manufacturers' instructions or with a double-layer application technique (without light curing of the first layer). After bonding, resin-dentin specimens were sectioned for microtensile bond strength testing in accordance with the nontrimming technique and divided into 3 subgroups of storage: a) 24 hours (immediate bond strength, T0), b) six months (T6) in artificial saliva at 37°C, or c) five hours in 10 % NaOCl at room temperature. After storage, specimens were stressed to failure. Fracture mode was assessed under a light microscope. RESULTS: At T0, iBond SE showed a significant increase in microtensile bond strength when the double-application technique was applied. All adhesive systems showed reduced bond strengths after six months of storage in artificial saliva and after storage in 10% NaOCl for five hours; however at T6, iBond SE, Clearfil S(3) Bond, and XenoV(+) showed significantly higher microtensile bond strength results for the double-application technique compared with the single-application technique. Scotchbond Universal showed no difference between single- or double-application, irrespective of the storage conditions. CONCLUSION: The results of this study show that improvements in bond strength of one-step self-etch adhesives by using the double-application technique are adhesive dependent.

A photoelastic assessment of residual stresses in zirconia-veneer crowns.

Residual stresses within the veneer are linked to the high prevalence of veneer chipping observed in clinical trials of zirconia prostheses. We hypothesized that the thermal mismatch between the zirconia infrastructure and the veneer porcelain, as well as the rate used for cooling zirconia-veneer crowns, would be directly proportional to the magnitude of residual stresses built within the veneer layer. Two porcelains with different coefficients of thermal expansion were used to veneer zirconia copings, to create high or low thermal mismatches. The crowns were cooled according to a fast- or a slow-cooling protocol. The retardation of polarized light waves was used to calculate the residual stress magnitude and distribution across the veneer, according to the photoelasticity principle, in 1.0-mm-thick crown sections. While thermal mismatch was an important factor influencing the maximum stress development in the veneer, cooling rate had a minor role. Curved surfaces were preferential sites for stress concentration regardless of thermal mismatch or cooling rate.

Antimicrobial activity of various 'active' gutta-percha points against Enterococcus faecalis in simulated root canals.

AIM: To test the antimicrobial activity of various gutta-percha points against Enterococcus faecalis in simulated root canals. METHODOLOGY: Root canals were simulated by inoculated glass capillaries. A 2.5 microL increment of a suspension of E. faecalis was placed into 10 simulated root canals together with Calcium Hydroxide(R) points (CHP), Calcium Hydroxide Plus(R) points (CH+P), active points(R) (AP), conventional gutta-percha points (CP) (Coltène Whaledent, Langenau, Germany) or no points (NP) (control) (each n = 2). The points and simulated root canals were flushed with 2 mL of sterile saline solution after 10 min or after 5 h of anaerobic incubation (37 degrees C, 100% humidity). Dilution sequences until 10(-3) and 10(-4) were prepared and plated on agar plates. The original suspension, diluted until 10(-6) and 10(-7), served as another control. The numbers of colony forming units were counted after 24 h. This experimental procedure was repeated 15 times. RESULTS: Without gutta-percha points, bacteria grew threefold in number within 5 h. With CHP and CH+P bacterial counts at 10 min and 5 h were approximately 50% compared with the control. AP killed all bacteria within 5 h. With CP, bacteria proliferated more than without points (counts at 5 h 177% of NP). Except for CHP versus CH+P differences between groups were statistically significant (Mann-Whitney test, P < 0.01). CONCLUSIONS: In this experimental model, the potential of CHP and CH+P to kill E. faecalis was limited. CP stimulated bacterial growth. AP killed all bacteria after 5 h.

Influence of tooth age and root section on root dentine dye penetration.

AIM: To investigate dye permeability of root dentine according to patients' age, root section and dye penetration time. METHODOLOGY: A total of 96 extracted human single-rooted teeth, assigned to four age groups (<30, 30-45, 45-60 and >60 years) were separated at the cemento-enamel junction and root canals were enlarged. The root surfaces were coated with cyanocrylate to prevent external dye penetration and centrifuged in distilled water to eliminate air. For dye penetration the root canals were filled with methylene blue 5%. After 1, 30 and 60 days eight roots per age group were cross-sectioned in 1 mm slices. Dye penetrated areas and the complete dentine areas were digitized and measured. Differences between groups were judged with anova and LSD, P < 0.05 or P < 0.01. RESULTS: The root section, the patients' age and the penetration time influenced significantly the penetrated areas (P < 0.05). After 1 and 30 days significant differences could be found only in the apical root sections between all age groups (P < 0.05). Dye penetration areas systematically decreased with increasing age and also from coronal to apical (P < 0.01). CONCLUSIONS: Age influenced dye penetration significantly. Dye penetration also depended on the location (coronal, middle and apical) within the root canal. These findings indicate that there may be a correlation between the tooth age and permeability of root dentine, which may influence the distribution and effectiveness of drugs used for root canal disinfection.

[Study of biomimetic apatite formation on dentine surface].

The aim of this study was investigation of the opportunity of biomimetic growth of apatite on a dentine surface at various methods of its processing. Artificial blood human plasma--simulated body fluid (SBF)--was used as a source of ions. According to the scanning electronic microscope (SEM) and confocal laser scanning microscope (CLSM) and energy dispersive X-ray analysis (EDX) they have revealed the growth of crystals of calcium--deficient apatite. The structure of the formed apatite layer differed depending on a kind of processing of a dentine surface. After acid etching the globules of the apatite are located chaotically and the part of a dentine surface remains free. The removal of the collagen fibres by NaClO promotes uniform, controllable growth of crystals, forming a monolithic layer. The hypermineralisated areas of a tooth create the best conditions for growth. The transformation hydroxyl apatite in a superficial dentine layer can be caused by increasing of pressure at preparing with diamond bur. The growth of crystals of brushite in the smear layer is possible at a storage in water at 37 degrees capital ES, Cyrillic. The crystals have lamellar form and are well integrated in a dentin surface.

Calcium release and pH-characteristics of calcium hydroxide plus points.

AIM: To evaluate calcium ion release and pH-characteristics of calcium hydroxide plus points (CHPP), conventional calcium hydroxide points (CHP, both Coltène/Whaledent, Langenau, Germany) and aqueous calcium hydroxide suspension (CHS) (Calxyl, OCO, Dirmstein, Germany). METHODOLOGY: Ten CHPP or CHP of size 50 were immersed into 5 mL isotonic sodium chloride solution. Conventional Ca(OH)2-free gutta-percha points served as negative control. Calcium release was measured up to 44 days by means of complexometric titration. Time dependent pH behaviour of all points in comparison with CHS was determined immersing 30 points of size 50 into 2.3 mL 0.9% wt NaCl-solution at time intervals of 0.5-72 h by a microelectrode measuring chain and a pH-meter. The surface morphologies of new and used gutta-percha points were evaluated qualitatively under a scanning electron microscope. Statistical evaluation was carried out using Kolmogorov-Smirnov-tests, Mann-Whitney-tests and multifactorial anova. RESULTS: For CHPP, a threefold greater calcium release was measured compared with CHP. Both types of points as well as CHS showed a maximum pH of approximately 12. Differences between groups were statistically significant for calcium release and pH (multifactorial anova; P < 0.001). Both types of points showed porous surfaces after usage, with a rougher surface for CHPP. CONCLUSIONS: CHPP and CHP increased the pH of isotonic sodium chloride >11 within 3 min. CHPP had a greater release of Ca2+ compared with CHP.

Ceramic inserts do not generally improve resin composite margins.

summary Ceramic inserts are reported to possibly reduce polymerization shrinkage for posterior resin composite fillings. The aim of the present investigation was to evaluate the effect of different insert systems before and after thermomechanical loading. Sixty sound human third molars received occlusomesial Class II cavities, 40 with proximal margins 2 mm above and 20 with proximal margins 1 mm below the cementum-enamel junction. The specimens were randomly assigned to one of the six experimental groups (n = 10). The enamel-bordered cavities were restored with Syntac classic and Tetric Ceram (ST), Syntac classic, Tetric Ceram and beta-quartz inserts (TB), Syntac classic, Tetric Ceram and Cerana inserts (TC), Syntac classic, Tetric flow and SonicSys approx inserts (TS). The dentin-limited cavities were filled with Syntac classic and Tetic Ceram (DT), Syntac classic, Tetric flow and SonicSys approx inserts (DS). Before and after thermomechanical loading (100 000 x 50 N, 2500 x 5 degrees C/55 degrees C), replicas were made and both interfaces tooth/composite and insert/composite were examined under a scanning electron microscope at 200x. The Cerana and SonicSys insert groups showed significantly less gaps in enamel (P < 0.05). With beta-quartz inserts, no reduction of gaps was found (P > 0.05). Marginal integrity in dentine-bordered specimens could not be improved with SonicSys inserts (P > 0.05). The bonding performance insert/composite was promising for all IPS Empress inserts (Cerana, SonicSys enamel) but worse for beta-quartz inserts. Regarding gap formation between resin composite and tooth, Cerana and SonicSys inserts significantly reduced gaps. The use of SonicSys inserts in deep proximal cavities cannot be recommended.

Effect of preparation mode on Class II resin composite repair.

Complete removal of failed posterior resin composite fillings is time-expensive and involves the risk of removing sound tooth substance. In any case of failure within the composite material, intra-oral repair would be favourable. This in vitro study was conducted to examine the effect of different preparation and bonding modes on integrity of repaired restorations. Forty-eight direct Class II resin composite restorations (Syntac Classic/Tetric Ceram) were placed in extracted human third molars. The specimens were stored for 365 days and then replaced partially by removing the central part of the proximal box with all margins located in composite. The partial repairs were placed with the same materials after pre-treatment with a silicon carbide bur and Syntac Classic (n = 8). Preparation modes have been (i) box-only parallel, (ii) box-only with undercuts, (iii) box with undercuts and additional occlusal retention. The repairs were performed either with (i) Tetric Ceram or with (ii) Tetric Flow as thin lining covered with Tetric Ceram. Before and after thermomechanical loading (100 000 cycles of 50 N and 2500 cycles between +5 and +55 degrees C in an artificial mouth), marginal quality between aged and freshly applied composite was evaluated by SEM at x200 magnification and microleakage was observed by light microscopy at x50 magnification. Box-only preparations exhibited a better fatigue resistance than preparations with additional occlusal retention. This observation was independent from the presence of undercuts (P < 0.05). An intermediary layer of flowable resin composite tended to result in better marginal quality, however, not being statistically significant.

Effect of surface treatment on fatigue behaviour between Tetric Ceram inlays and Variolink luting composite.

The effect of pre-treatment of composite inlays on bonding performance between a resin composite inlay and a luting composite has not been fully studied. The aim of the present study was to evaluate the influence of three different pre-treatment modes on fatigue bond strength and marginal adaptation. One hundred twenty resin composite discs (Tetric Ceram) were made as simulated inlays and randomly assigned to four groups (n=30): Without treatment (WT), hydrofluoric acid etching for 15 s + silanating (HF), roughening with a silicon carbide bur (SC), and silica coating + silanating (CO). Luting composite cylinders (Variolink II low) were bonded to the discs using Heliobond, and after 24 h in water at 37 degrees C, quasistatic shear bond strengths (n=l) and fatigue bond strengths (n=20; 5,000 cycles) were measured. Thirty-two third molars received occlusomesial Class II cavities (n=8), and direct resin composite inlays were luted with identical methods and materials. Before and after thermomechanical loading (100,000x50 N, 2,500 x +5 degrees C/+55 degrees C), replicas were made and examined (SEM, x200). CO and SC exhibited significantly higher bond strengths and adhesive fatigue limits than HF and WT (P<0.05). After thermomechanical loading, CO (98% continuous margin) and SC (95% continuous margin) demonstrated that they provide significantly more fatigue resistance than HF (88%).

A new screening test for toxicity testing of dental materials.

OBJECTIVES: The development of a micro plate assay for cytotoxicity testing of dental materials based on a bioassay using brine shrimp larvae (artemia salina) as sensitive organisms. METHODS: Brine shrimp larvae are commonly used for cytotoxicity assays in pharmacology. These larvae are sensitive to toxic substances. The ratio between dead larvae (no motility) and living larvae (high motility) in comparison to a control without any toxic substances is used to estimate the toxicity of the test solutions. The test materials (Arabesk((R)), Solitaire((R)), Pertac((R)) II, Tetric((R)), Herculite((R)) and the compomer materials Dyract((R)), Hytac((R)), Compoglass((R))) were polymerized and consecutively milled. After incubation of 1g in 4ml distilled water at 37 degrees C for 48h, the solid materials were separated by centrifugation. The solutions were equibrilated with NaCl to a salt content of 25g/l. Aliquots of 200microl were distributed in eight micro wells and 50microl of a artemia salina containing (n=8-14) solution were added to each well. As controls eight wells with 250microl salt solution containing a comparable number of brine shrimp were used. At baseline, after 2, 5, 24 and 48h, the dead shrimp were counted using a stereo microscope. Finally all shrimps were sacrificed using Na-acid (5%) and counted to get the number of shrimps per well. RESULTS: All compomers and Solitaire caused 100% brine shrimp lethality after 24h and showed significantly (p<0.01, signed rank test) higher toxicities than the remaining composites. With the exception of Pertac II, all composites showed significantly higher toxic values than the control. Pertac II did not show any differences from the controls used. CONCLUSIONS: This new technique has some advantages for toxicity testing of restorative materials, because it can quickly be carried out at low costs. The disadvantage is the high quantity of material used and the low sensitivity.

Long-term effect of dentin primers on enamel bond strength and marginal adaptation.

Contamination of etched enamel with dentin adhesive systems is unavoidable in clinical situations. The aim of this in vitro study was to evaluate the long-term effect of dentin adhesives and application technique on resin composite bond strength and marginal adaptation to enamel. Six hundred freshly extracted mandibular bovine incisors were used. Three hundred teeth were flat ground, and the enamel was etched for 30 seconds with 32% phosphoric acid. The etched surface was treated by different dentin adhesive systems with and without intensive rubbing by use of application brushes. As a control, only the enamel adhesive resin was applied and air thinned. Furthermore, contamination with saliva was performed after the etching process. Etched and silanated CEREC blocks were bonded onto the enamel specimens with different adhesive resins and stored for 1 and 365 days (37 degrees C, aqua dest). After storage, the specimens were thermocycled for 24 hours (1150 cycles between 5 degrees C and 55 degrees C), and subjected to shear bond testing. Three hundred box-shaped cavities were prepared on buccal surfaces of the incisors and filled with one resin composite using the same pretreatment modes as in the shear bond test groups. After 1 and 365 days of storage, a margin analysis was performed using a SEM (X200 magnification). Dentin adhesive systems did not show an adverse effect on long-term enamel bond strength and marginal adaptation. Rubbing application of the primers decreased the bond strength by values of approximately 20% after 24 hours and approximately 40% after 1 year of storage. Marginal adaptation showed 94-98% gap-free margins in the control and dentin adhesive system-only groups; however, after rubbing of primers, the proportion of gap-free margins decreased significantly to 85-88%. The lowest bond strength (8-10 MPa) and margin quality (49-69% gap-free margins) were recorded for the groups with saliva contamination.

Dentin bond strength and marginal adaption after NaOCl pre-treatment.

The aim of this in vitro study was to compare the dentin bond strength and marginal adaptation of direct composite resins with and without additional NaOCl treatment after the etching process. A total of 150 cavities were prepared into disks of freshly extracted human third molars and filled with direct composite resins. Dentin adhesives of the fourth (with total etching: Scotchbond Multi-Purpose Plus, EBS, and Solid Bond), and fifth generation (one-bottle adhesives: Prime&Bond 2.1, Syntac Sprint) were used in combination with corresponding composite resin materials. Dentin disks without cavity preparation treatment served as controls. After 24 hours of storage and 24 hours of thermocycling (1150 cycles), replicas were made and push-out testing was performed. Replicas were examined regarding marginal adaptation using SEM (X200 magnification). In general, fourth-generation dentin adhesives produced better results in bond strength and marginal adaptation than fifth-generation one-bottle systems (P < 0.05). Within the fourth generation, Scotchbond Multi-Purpose Plus and EBS achieved significantly higher push-out values and percentages of gap-free margins than Solid Bond (P < 0.05). After hypochlorite treatment, dentin bond strength (-25%) and marginal adaptation (-30%) decreased significantly (P < 0.05) in all groups.

Technique sensitivity of dentin bonding: effect of application mistakes on bond strength and marginal adaptation.

This in vitro study evaluated dentin bond strength and marginal adaptation of direct resin composites according to the manufacturers' instructions and with simulated application errors. One hundred and forty cavities were prepared into disks of freshly extracted human third molars and filled with one resin composite. Dentin adhesives of the third (with self-etching primer: Syntac Classic), fourth (with total etching: Scotchbond Multi-Purpose Plus) and fifth generation (one-bottle adhesive: Prime&Bond 2.1) were used for bonding. Simulated application mistakes were as follows: 1) prolonged etching; 2) excessive drying after conditioning; 3) drying primers immediately after application and 4) drying primers excessively. After 21 days of storage and 24 hours thermocycling (1150 cycles), replicas were made and push-out testing was performed. Replicas were examined for marginal adaptation using SEM (X200 magnification). Compared with values of the control groups, application errors resulted in dramatically decreased bond strengths and reduced percentages of gap-free margins for all products tested (p < 0.05). Excessive drying after conditioning exhibited significantly less effect for the third generation adhesive than for products requiring total etching/wet bonding.

Leucite-reinforced glass ceramic inlays and onlays after six years: clinical behavior.

Ceramic inlays are an esthetic substitute for large amalgam and other metallic restorations. This controlled clinical study evaluated the performance of IPS Empress inlays and onlays with cuspal replacements and proximal margins below the cementoenamel junction over six years of clinical service. Six dentists placed 96 ceramic restorations in 34 patients. Luting was accomplished using the enamel-etch-technique, a dentin bonding system (Syntac Classic) and four different composite systems. The restorations were assessed by two calibrated investigators using modified USPHS criteria at baseline (96 restorations), one (96), two (95), four (89) and six years (67). Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier): Five inlays suffered cohesive bulk fractures and two teeth required endodontic treatment. After six years of clinical service, significant deterioration (Friedman 2-way ANOVA; p < 0.05) was found for marginal adaptation of the remaining restorations. Ninety-four percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the quality of the restorations.

Fatigue behaviour of different dentin adhesives.

The aim of this in vitro study was to compare quasistatic and cyclic fatigue dentin bond strength of modern adhesive systems representing different generations. One hundred and fifty cavities were made in discs of freshly extracted human third molars and filled with direct resin composite restorations. Dentin adhesives of different generations (SY = Syntac Classic, multi-step system with self-etching primer; SE = Syntac Classic with additional phosphoric acid etching prior to application of the self-etching primer; SB = Scotchbond Multi-Purpose Plus, multi-step system with total etching; PE = Prime & Bond 2.1, single-step system with and without [PB] total etching) were used in combination with one hybrid composite. After 21 days of storage, 10 specimens for each adhesive system were subjected to thermocycling (1150 cycles) for 24 h and were afterwards debonded in a push-out test. Another 20 specimens were tested with cyclic fatigue according to the staircase method with 5000 cycles for each specimen. Static and cyclic push-out bond strengths, respectively, for each group were (MPa): SY 16.9 +/- 0.9 and 14.2 +/- 1.7, SE 17.5 +/- 1.8 and 14.8 +/- 3.4, SB 18.5 +/- 1.7 and 13.9 +/- 2.1, PB 14.6 +/- 2.2 and 7.2 +/- 2.4, PE 13.4 +/- 2.2 and 6.8 +/- 1.8. Both quasistatic and dynamic bond strengths revealed better values for the multi-step systems (P < 0.05). All adhesive systems tested revealed a significant fatigue behaviour which was more pronounced for the one-bottle system with a decrease of about 50% independent of additional dentin etching.

Dentin bond strength and marginal adaptation: direct composite resins vs ceramic inlays.

The aim of this in vitro study was to compare the dentin bond strength and marginal adaptation of directly and indirectly inserted restorations. A conically modified push-out test was designed to consider polymerization shrinkage and facilitate inlay placement. A total of 260 cavities were prepared into disks of freshly extracted human third molars and filled with direct composite resins or with adhesively luted ceramic inlays. Dentin adhesives of the third--(with self-etching primer: ART Bond, Syntac Classic), fourth--(with total etching: Scotchbond Multi-Purpose Plus), and fifth-generation (one-bottle adhesives: Syntac Single Component, Prime & Bond 2.1) were used in combination with one hybrid composite (Tetric) or luting composite (Variolink Low). Control groups did not use an adhesive. Polymerization of the bonding agent was carried out prior to insertion of the filling/inlay or afterwards simultaneously with the composite/luting composite. The thickness of the adhesive layer and luting composite was recorded, and after 7 days of storage and 24 hours of thermocycling (1150 cycles) replicas were made and extrusion testing performed. Fracture modes were determined and replicas were examined regarding marginal adaptation using SEM (X200 magnification). Precuring of the bonding resin increased dentin bond strength independent of the material combination or insertion mode (P < 0.05). In general, third- and fourth-generation dentin adhesives produced better results in bond strength and marginal adaptation than one-bottle systems (P < 0.05). In the third generation, ART Bond achieved significantly higher push-out values than Syntac (P < 0.05), but no better marginal adaptation. Cohesive fractures within the dentin were only observed in the inlay groups with precured resin. Precuring of the bonding resin is an important factor for both direct and indirect restorations. Nevertheless, precuring of the bonding resin prior to insertion of adhesive inlays cannot be recommended clinically, because the 120-micron luting spaces were too large. In simulated cavities, direct composite fillings with precuring achieved bond strengths similar to inlays without precuring. One-bottle adhesive systems performed poorly compared with multi-step adhesives of the third and fourth generation.

IPS Empress inlays and onlays after four years--a clinical study.

OBJECTIVE: Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined. MATERIALS AND METHODS: Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear. RESULTS: Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p < 0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations. CONCLUSION: After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

Crack formation of all-ceramic crowns dependent on different core build-up and luting materials.

OBJECTIVES: The aim of this in vitro study was to evaluate various core build-up and luting materials regarding their effect on crack formation of all-ceramic crowns. METHODS: Fifty-six freshly extracted sound human third molars were prepared according to a standardized procedure obtaining a circular shoulder of 1.5 mm with all margins located in dentin. Sixty percent of the dentin volume were removed and restored with totally bonded build-up composite resins or resin-modified glass ionomer cements (RMGIC) or compomers. Cast IPS-Empress caps were manufactured and luted with the different materials. For each material group, the volumes of the core build-ups and of the luting cements were determined. The caps were examined for cracks after 1, 3, 6, 9 and 12 months storage in 0.9% saline solution at 37 degrees C. RESULTS: The tested groups revealed no major differences in the percentage of the core build-ups and in the volume of the luting cements. After 12 months only the group with composite resin build-up and luting showed no crack formation. RMGIC/compomer build-up or RMGIC/compomer luting always resulted in cracking of the caps. CONCLUSIONS: Within the limits of this study it can be concluded that the hygroscopic expansion of RMGIC/compomer materials led to failure of all-ceramic crowns, when the materials are used for both core build-up or adhesive bonding.