Effect of Er:YAG laser on debonding zirconia and lithium disilicate crowns bonded with 2- and 1-bottle adhesive resin cements.

INTRODUCTION: Erbium-doped yttrium-aluminum-garnet (Er:YAG) laser debonding of zirconia and lithium disilicate restorations is increasingly used for a range of clinical applications. Using rotary instruments to remove such restorations for any purpose has proven to be challenging. Erbium laser has been reported to be a conservative method for removing ceramic restorations. There is little data in the literature about the effect of adhesive resin cement type on the debonding time of the ceramic restoration using the Er:YAG laser. OBJECTIVES: To evaluate and compare the time required for the Er:YAG laser to debond zirconia and lithium disilicate crowns bonded with a 2- and 1-bottle adhesive resin cement systems. MATERIALS AND METHODS: Forty extracted premolar teeth were prepared and scanned for milled 40 CAD/CAM crowns. Teeth were randomly assigned into groups (n = 10 per group): 3 mol% yttria-partially stabilized zirconia crowns 3Y-PSZ (G1a) bonded with Panavia™ V5 (2-bottle adhesive resin cement), Zirconia 3Y-PSZ crowns (G1b) bonded with RelyX™ Ultimate (1-bottle adhesive resin cement), and for the lithium disilicate crowns bonded with the two types of cements (G2a, G2b). Each specimen was irradiated with an Er:YAG laser at 335 mJ, 15 Hz, 5.0 W, and 50-ms pulse duration (super short pulse mode). The irradiation time required for crowns to be successfully debonded was recorded for each specimen. Data were statistically analyzed using ANOVA and Tukey HSD post-hoc test (p < 0.05), at the 95 percent level of confidence. The intaglio surface of the debonded crown was analyzed using scanning electron microscopy (SEM). RESULTS: The mean ± standard deviation times needed for crown debonding were 5.75 ± 2.00 min for the G1a group, 4.79 ± 1.20 min for group G1b, 1.69 ± 0.49 min for group G2a, and 1.12 ± 0.17 for group G2b. There was no statistically significant difference in debonding time between the 2- and 1- bottle adhesive resin cement within the groups G1a and b (p = 0.2914), or between groups G2a b (p = 0.7116). A statistically significant difference (p < 0.05) was found between groups G1a and G2a and b and between groups G1b and G2a and b were SEM analysis showed no changes in the microstructure of the ceramic surface after Er:YAG laser irradiation. CONCLUSION: Zirconia and lithium disilicate restorations can be debonded using Er:YAG lasers in a safe and efficient manner. There is no significant difference in the debonding time between the 2- and 1- bottle adhesive resin cement systems used in this study. CLINICAL SIGNIFICANCE: Retrieving zirconia and lithium disilicate ceramics can be a challenging process when using diamond rotary instruments. ER:YAG lasers may efficiently debond these ceramics from the tooth structure, independent of the bonding process used for bonding them.

Surface roughness and optical characteristics evaluations after chairside adjustment of different zirconia types.

STATEMENT OF PROBLEM: Limited evidence is available for the effect of chairside adjustment using rotary cutting instruments on the surface roughness and optical properties of different zirconia types. PURPOSE: To evaluate the effect of simulated adjustments on surface roughness and optical properties of different zirconia types. MATERIALS AND METHODS: Three Partially Stabilized Zirconia (PSZ) types based on mole percent yttria (Y) concentration from the same manufacturer (Katana; Kuraray) were used: 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ. Thirty disk-shaped specimens (Ø14 × 1.2 mm) from different zirconia types (N = 90) were prepared. Specimens were either left without adjustment (NA), adjusted with Dialite ZR finishing and polishing system (Brasseler) (APol), or adjusted with course diamond instruments only (ADia). The specimens were distributed into 9 groups (n = 10): Group 3Y-PSZ/NA, Group 3Y-PSZ/APol, Group 3Y-PSZ/ADia, Group 4Y-PSZ/NA, Group 4Y-PSZ/APol, Group 4Y-PSZ/ADia, Group 5Y-PSZ/NA, Group 5Y-PSZ/APol, and Group 5Y-PSZ/ADia. The surface roughness of specimen was analyzed using an Atomic Force Microscope (AFM) (Bruker's Dimension Icon, Bruker) and Root Means Square (RMS) were recorded (nm). Surface Gloss (SG), Translucency Parameter (TP), and Contrast Ratio (CR) values of all groups were recorded using an integrating sphere spectrophotometer. Statistical analysis was performed using analysis of variance (ANOVA) and Tukey's multiple comparison tests for pairwise comparisons at p < 0.05 and 95% confidence interval. RESULTS: APol had no effect on the surface roughness (p = 0.88) while ADia had a significant negative effect (p < 0.05) despite the type of zirconia. Out of the three testes optical properties, only SG was negatively affected by ADia for all types of zirconia (p < 0.05). The two adjustment types did not affect the TP of all the tested zirconia (p = 0.91). The CR was not affected by the tested adjustments for all zirconia types (p = 0.726). CONCLUSION: Proper zirconia adjustment following a sequence of burs and polishers can maintain acceptable roughness and optical properties. Adjustment of zirconia with rough diamond can lead to deleterious effects and should be avoided. CLINICAL SIGNIFICANCE: Chairside adjustment of zirconia could lead to rougher surface and unpredictable changes of surface gloss. Therefore, zirconia adjustment should be minimized to the greatest extent possible and a proper protocol should be followed if had to be done.

Clinical and radiographical evaluation of CAD-CAM crowns with and without deep margin elevation: 10-year results.

STATEMENT OF PROBLEM: Current in vitro and short-term clinical studies suggest that deep margin elevation (DME) is a suitable approach to relocate subgingival margins to a supragingival position. However, long-term clinical results are lacking. PURPOSE: The purpose of this retrospective multicenter practice-based study was to assess the long-term clinical performance and periodontal health of teeth restored with computer-aided design and computer-aided manufacturing (CAD-CAM) crowns with or without DME. MATERIAL AND METHODS: Patients who had received CAD-CAM lithium disilicate (LD) crowns with or without DME in 2013 were invited for a follow-up appointment. When indicated, DME had been performed using resin-based restoration. A total of 275 LD crowns had been fabricated chairside, and 151 crowns had been laboratory milled. The crowns had been cemented with 3 different adhesive and self-adhesive resin cements. Clinical and radiographical assessment of the crowns and supporting periodontal structures were performed according to the modified United States Public Health Service (USPHS) criteria. Linear mixed effect models were used to assess the effect of the follow-up time on repeated measurements (α=.05). The Kaplan-Meier survival analyses were determined. RESULTS: A total of 380 patients with 426 crowns (153 with DME and 273 without DME) were examined with a follow-up period of 10 years. Overall, 15 teeth with secondary caries, 4 with loss of vitality, 4 crown fractures, and 3 crowns with lost retention were observed. The DME profile was rated good in 74%, acceptable in 17.5%, and poor in 8.5% of crowns. The periodontal parameters of teeth with DME were not significantly different from teeth without DME (P>.05). The 10-year survival rates for the DME and without DME groups were 95.8% and 94.7%, respectively, while the 10-year success rates for the DME and without DME groups were 94.1% and 93%, respectively. CONCLUSIONS: The use of DME and lithium disilicate crowns as well as adhesive bonding is considered a safe and reliable treatment option. The integrity of periodontal tissue was not affected by the DME or by the crowns.

Effect of surface finish and resin cement on the bond strength to CAD-CAM ceramics for interim resin-bonded prostheses.

STATEMENT OF PROBLEM: Resin-bonded prostheses, including interim resin-bonded prostheses, are effective in preserving tooth structure compared with other types of fixed dental prostheses for the replacement of missing teeth. However, loss of retention remains a notable concern with these types of prostheses. PURPOSE: The purpose of this in vitro study was to investigate the influence of glass-ceramic type, resin type, and surface finish on the shear bond strength (SBS) to the CAD-CAM ceramics used to fabricate interim resin-bonded prostheses. MATERIAL AND METHODS: Eighty 10×2-mm glass-ceramic disks were fabricated by using a diamond saw (IsoMet 1000), 40 from feldspathic porcelain blocks (Vita Mark II) and 40 from lithium disilicate blocks (IPS e.max CAD). Half of the specimens in each group were left with a dull or matte surface finish after cutting, while the other half were glazed with an add-on glaze (VitaAkzento Plus Glaze Spray and IPS e.max CAD Glaze Spray, respectively). The disks were mounted in acrylic resin, and each group was subdivided into 2, with 1 receiving a photopolymerized resin cement (RelyX Veneer) and the other receiving a flowable composite resin (Filtek Supreme Ultimate Flow) to form 2.38×2-mm cylinders. SBS was determined using a universal testing machine (Instron 4411) in accordance with the International Organization for Standardization (ISO) 29022:2013 standard, and failure modes were analyzed by using a stereomicroscope with ×40 magnification. The data were analyzed with a 3-way analysis of variance and Tukey post hoc analysis. The chi-squared test was used to analyze the failure mode (α=.05 for all tests). RESULTS: Ceramic type, resin type, and surface finish significantly impacted SBS (P<.001, P=.003, P<.001, respectively). Lithium disilicate showed higher SBS than feldspathic porcelain, and flowable composite resin exhibited higher SBS than resin cement. Glazed surfaces displayed lower SBS compared with the dull or matte surfaces. The combinations among the 3 materials also impacted SBS (P=.03). In addition, the combinations between ceramic type and surface finish affected SBS (P<.001), regardless of resin cement type. No other combinations affected the SBS (P>.05). The mode of failure was different among the groups (P<.001). In comparison with all other groups, cohesive failures were most prevalent in feldspathic porcelain with a dull or matte surface finish, regardless of the resin type used. CONCLUSIONS: The SBS to glass-ceramics was influenced by ceramic material, resin cement type, and surface finish. Flowable composite resin showed higher SBS than resin cement. A dull or matte surface finish exhibited greater bond strength than a glazed surface. Lithium disilicate had higher SBS than feldspathic porcelain.

Zirconia restoration types, properties, tooth preparation design, and bonding. A narrative review.

OBJECTIVE: The purpose of this review was to provide dental professionals with information regarding the various types of zirconia restorations, their mechanical and optical properties, tooth preparation design, and bonding protocol in an effort to enhance the longevity and durability of zirconia restorations. OVERVIEW: The yttria content of zirconia ceramics determines their classification. The mechanical and optical properties of each type are discussed, with an emphasis on the effect of yttria concentration on the properties of zirconia. The processing and sintering methods are also discussed as they have a direct impact on the properties of zirconia. The design of tooth preparation, specifically occlusal reduction, varies depending on the type of zirconia used in each case. Finally, a protocol for zirconia restoration bonding is described to ensure optimal bonding to the tooth structure. CONCLUSION: Not all zirconia restorations are the same. The selection of zirconia type based on yttria concentration, processing and sintering methods, tooth preparation design, and adherence to the bonding protocol are all critical to the success and longevity of zirconia restorations. CLINICAL SIGNIFICANCE: Zirconia restorations are the most commonly used indirect restorative material. The selection of the most appropriate zirconia type based on its yttria content, which determines its strength and translucency, is critical to the success and the longevity of the restoration. Tooth preparation design also influences the strength and translucency of the zirconia. Air-borne particle abrasion, followed by a ceramic primer and resin cement, can ensure a durable bond to the tooth structure.

Er:YAG laser debonding of zirconia and lithium disilicate restorations.

STATEMENT OF PROBLEM: Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations of different formulations are being used increasingly in monolithic form for a range of clinical applications. Using rotary instruments to remove such restorations for any purpose is challenging, but they can be removed conservatively with erbium lasers. However, studies on how a laser penetrates different zirconias to break the cement bond between the tooth surface and the zirconia are lacking. PURPOSE: The purpose of this in vitro study was to evaluate and compare the time required for an erbium-doped yttrium-aluminum-garnet (Er:YAG) laser to remove different types of zirconia and lithium disilicate crowns. MATERIAL AND METHODS: Forty extracted premolar teeth were prepared, scanned, designed, and milled to fabricate 40 computer-aided design and computer-aided manufacturing (CAD-CAM) crowns, which were assigned to 4 groups (n=10): 3 mol% Y-TZP, 4 mol% Y-TZP, 5 mol% Y-TZP, and lithium disilicate as a control. All crowns were bonded to the teeth with a self-adhesive resin cement (Panavia SA Cement Universal). Each specimen was irradiated with an Er:YAG laser with the following parameters: 300 mJ, 15 Hz, 5.0 W, and a 50-microsecond pulse duration (supershort pulse mode). The irradiation time required for crowns to be retrieved successfully was recorded for each specimen. Data were statistically analyzed using analysis of variance and the Tukey honestly significant difference post hoc test (α=.05). The intaglio surfaces of the restorations were analyzed using scanning electron microscopy (SEM). RESULTS: The mean ±standard deviation times in minutes needed for crown debonding were 12.46 ±4.17 for the 3 mol% Y-TZP group, 10.30 ±3.33 for the 4 mol% Y-TZP group, 4.03 ±1.62 for the 5 mol% Y-TZP group, and 2.08 ±0.92 for the lithium disilicate group. A statistically significant difference (P<.05) in the debonding time was found for all investigated groups, expect between the 3 mol% and 4 mol% Y-TZP groups and between the 5 mol% Y-TZP and lithium disilicate groups. SEM analysis of the ceramic surfaces showed no visual damage associated with Er:YAG laser irradiation. CONCLUSIONS: Zirconia crown retrieval time with the Er:YAG laser was influenced by the yttria content of the zirconia, with decreasing retrieval time with increasing yttria content. Er:YAG laser debonding of zirconia crowns is a noninvasive, efficient, and rapid approach to the removal of crowns and could be applied in clinical practice.

Fatigue resistance of 3D printed anatomic post-and-core after mastication simulation.

STATEMENT OF PROBLEM: Rigid post-and-core systems have traditionally been used in the restoration of endodontically treated teeth and are regarded by many as the standard treatment. Flexible materials, including nanoceramic resins, are being increasingly implemented as post-and-core systems, but data supporting their use are lacking. PURPOSE: The purpose of this in vitro study was to compare the fatigue resistance of conventional cast metal and nanoceramic 3-dimensionally (3D) printed resin post-and-core systems with teeth without posts. MATERIAL AND METHODS: Thirty freshly extracted human maxillary premolars were endodontically treated and divided into 3 subgroups (n=10) according to the restorative procedure: cast metal post-and-core (CM), nanoceramic 3D printed resin post-and-core (3DR), and without a post (0P). The CM post-and-core group was fabricated conventionally, while the 3DR group was printed using a 3D resin printing material. For the 0P group, the teeth were restored with a composite resin foundation after root canal obturation. Complete coverage 3-mol% monolithic zirconia restorations were cemented on all specimens. The specimens were exposed to simultaneous mastication simulation (1.2 million cycles) and thermocycling (10 000 cycles at 5 ºC to 55 ºC) and analyzed based on the failure of specimens. Data were analyzed using the Kruskal-Wallis survival analysis and the Wilcoxon rank sum test (α=.05). RESULTS: The Kruskal-Wallis test indicated statistically significant differences among the cycles needed to reach failure for each of the 3 groups (P<.001). At 1.2 million cycles, there were no CM failures. The 3DR group failed at a median value of 950 000 cycles, while the 0P group failed at a median value of 222 500 cycles (P<.001). CONCLUSIONS: All the endodontically treated teeth that received CM survived the 1 200 000 simulated mastication cycles. Both 3DR and 0P specimens fractured at the crown cervical third during mastication simulation.

Evaluation of surface roughness of differently manufactured denture base materials.

STATEMENT OF PROBLEM: The popularity of computer-aided design and computer-aided manufacturing (CAD-CAM) dentures has led to the introduction of new denture materials and resins. However, studies on the surface characteristics of these materials and how they compare to dentures fabricated by more traditional methods are lacking. PURPOSE: The purpose of this cross-sectional study was to determine whether the surface roughness (Ra) of denture base materials differed based on manufacturing technique. MATERIAL AND METHODS: Disks of Ø10×2-mm (n=10) were fabricated using 6 different manufacturing techniques, including compression molding (Lucitone 199), injection molding (Ivocap High Impact), Computer Numerical Control (CNC) milling (Ivotion Base), and additive manufacturing on the Carbon M2 (Lucitone Digital Print), the SprintRay Pro55 S (Dentca Denture Base II), and the Envision One (Flexcera Base) systems. An automatic, noncontact laser confocal microscope (VK-X1000 Series; KEYENCE) was used to analyze the Ra surface roughness of each specimen at ×5 magnification. The images were imported into a multifile analyzer, horizontal and vertical roughness profiles were inserted into each scan, and Ra values were calculated and averaged by following the International Organization for Standardization (ISO) 4287 standard. A 1-way analysis of variance (ANOVA) was performed to compare the effect of manufacturing technique on surface roughness, followed by the Tukey multiple comparisons test (α=.05). RESULTS: The additively manufactured Dentca Denture Base II (AM-DB) exhibited a statistically significantly higher Ra when compared with the other test groups (P<.001). The additively manufactured Flexcera Base (AM-FB) showed a higher Ra mean value when compared with injection molding (IM) (P=.036). No statistically significant difference in surface roughness was found among the other tested materials representing the different processing methods (P>.05). CONCLUSIONS: The manufacturing method influences the Ra of denture base materials with varying results. The injection molding method resulted in the smoothest surface compared with additively manufactured and CNC-milled denture base materials.

Effect of simulated toothbrushing on the surface roughness of LOCATOR abutments: An in vitro study.

STATEMENT OF PROBLEM: Studies evaluating the effect of toothbrushing and toothpaste abrasivity on the surface roughness of LOCATOR abutments are lacking. PURPOSE: The purpose of this in vitro study was to compare the surface roughness of LOCATOR abutments before and after simulated toothbrushing with different toothpastes to make recommendations for the home care of patients with LOCATOR abutments. MATERIAL AND METHODS: LOCATOR bone-level overdenture abutments (N=36) were analyzed with a confocal laser scanning microscope (Keyence VK-X1100) at ×5 magnification. Surface scans were made to determine the degree of surface roughness (Ra). Two toothpastes of different abrasivity (Colgate Total and Crest ProHealth) and deionized water were used as the brushing media (n=12). Each toothpaste was mixed with water in a 1:2 ratio. The abutments were brushed using soft nylon toothbrushes for 30 000 cycles in a ZM-3.12 toothbrushing simulator, which has been interpreted as 3 years of regular use. All specimens were then reanalyzed under the microscope. Changes in surface texture were compared by using a repeated measures analysis of variance (ANOVA) statistical test and a pairwise Sídák multiple comparisons test (α=.05). RESULTS: The mean surface roughness value of LOCATOR abutments at baseline ranged between 1.34 µm and 1.35 µm. After 30 000 cycles of toothbrushing simulation, the mean value increased to 1.62 µm (DI water, P=.001), 1.74 µm (Colgate Total, P<.001), and 2.03 µm (Crest ProHealth, P<.001). All brushing media resulted in a statistically significant increase in surface roughness (P<.001). CONCLUSIONS: LOCATOR abutments demonstrated significant increases in surface roughness after being subjected to toothbrushing, regardless of the brushing medium. Whitening toothpaste caused significantly more surface roughness than nonabrasive toothpaste and deionized water. Deionized water resulted in the lowest increase in surface roughness.

An Ex-Vivo Model for Investigating Bacterial Extrusion from Infected Root Canals during Masticatory Function.

INTRODUCTION: The extrusion of bacteria from infected root canals may lead to increase in symptoms, expansion of periapical lesions, and contribution to systemic diseases. The aim of this study is to investigate a potential proof-of-concept model to study the extent to which bacteria can escape from infected root canals under dynamic loading (simulated chewing). METHODS: The study was completed in 2 experiments performed at 2 institutions. Biofilms of Streptococcus intermedius in the first experiment and S. intermedius and Actinomyces naeslundii were allowed to grow in root canals of single-rooted extracted teeth for 3 weeks. The roots of the teeth were suspended in a small chamber containing dental transport medium and were mounted on a lower sample holder of a chewing simulator. In the experimental group, simulated chewing cycles equivalent to 1 year of function were conducted, and then bacterial migration was quantified and compared with stationary teeth. RESULTS: All experimental samples of the loading group revealed bacterial penetration in both experiments. Several of the unloaded samples revealed no bacterial penetration. In the first experiment, a significantly higher number of bacteria were able to escape into the periapex of the loaded group compared with the unloaded group (P = .017). In the second experiment, there was no significant difference between the 2 bacterial species used in the amount of extruded bacteria; however, there was a highly significant effect for occlusal loading (P = .0001). CONCLUSIONS: The potential for occlusal forces to enhance bacterial extrusion from infected root canals should be further explored.

Microcomputed tomography void analysis after cement cleanup methods.

STATEMENT OF PROBLEM: Cement at the restorative margin after implementation of the manufacturer's recommended procedure for cement cleanup has not been extensively evaluated. PURPOSE: The purpose of this in vitro study was to use microcomputed tomography (µCT) to evaluate the number, volume, and width of voids left at the margin when dental cement is cleaned during the cementation process as per 2 manufacturer-prescribed methods for cement cleanup by evaluating a self-adhesive resin cement and a resin-modified glass ionomer cement. MATERIAL AND METHODS: Twenty molar Ivorine Typodont prepared teeth were scanned, and lithium disilicate crowns were milled and cemented to the prepared teeth as per the manufacturer-recommended cementation process. Two methods of cement cleanup were performed: the excess cement was tack-polymerized with a polymerization light, or a delay of 3 minutes was used for the excess cement to reach partial polymerization, and the excess cement was removed with a sharp sickle scaler. These 2 methods of cement cleanup were performed with 2 cements: a resin-modified glass ionomer cement and a self-adhesive resin. Each specimen was then scanned with a µCT machine. The buccal margin of each specimen, from mesiobuccal line angle to distobuccal line angle, was examined, and the number, volume, and width of any voids remaining at the margin open to the environment were measured. For statistical analysis, the specimens were first grouped by method of cement cleanup and then grouped by cement type. The Wilcoxon ranked sum test was implemented because of the lack of a normal distribution and the heterogeneity of the data (α=.05). RESULTS: No statistically significant difference was found in the median number of voids, median volume of voids, or median width per void between the 2 cleanup methods, irrespective of cement type (P>.05). Significant differences were found in the median number of voids, median volume of voids, and median width per void when comparing cement types, irrespective of cement cleanup methods (P<.05). CONCLUSIONS: The choice of cement may be more important than the method of cement cleanup when considering voids left at the margin. Microcomputed tomography is an excellent nondestructive tool for volumetric measurements of voids at the margin.

Bromelain-based endodontic irrigant: preparation, properties, and biocompatibility: An in-vitro study.

The aim of the study was to determine the properties, efficacy and biocompatibility of combining bromelain enzyme, chlorohexidine and EDTA (BCE) to create a novel endodontic irrigant. Fourier transform infrared spectrometry was performed to confirm the stability of the BCE and direct contact inhibition test was performed to determine antibacterial action. Baseline pH and surface tension of irrigants was compared with determine stability. Subcutaneous injection to dorsal skin of rabbits was graded for presence of inflammation, oedema, granulation and fibrosis. BCE caused less overall irritation, less oedematous and was earlier to heal than 2.5% NaOCl. The pH stability of BCE was also superior to 2.5% NaOCl. A one-way ANOVA test was performed for the direct contact inhibition and microleakage test. A significant difference was determined (p ≤ 0.05) between BCE and 2.5% NaOCl for antibacterial action. BCE irrigant is effective in preparing dentinal surfaces for root canal without adverse effects and promising longevity.

Performance and efficacy of a recently introduced diamond rotary instrument: Cutting, surface preparation, and cleanability.

STATEMENT OF PROBLEM: Evaluation of the cutting efficiency and effectiveness, surface roughness, and cleanability of a novel rotary instrument is lacking. PURPOSE: The purpose of this in vitro study was to compare the cutting efficiency and effectiveness of a recently introduced diamond rotary instrument containing corundum microspheres with conventional instruments by evaluating the heat generated, surface roughness, and cleanability of each instrument after tooth preparations. MATERIAL AND METHODS: Sound molars (n=225) were used to evaluate cutting efficiency and effectiveness by measuring the heat generated by 3 diamond dental rotary instruments: test instrument (TI), reference instrument (RI), and NTI instrument (NI). Thirty cavity preparations (27 mm3) were prepared, and the thermal change (ΔT) was determined from a thermocouple inserted in the pulp chamber. The surface roughness of the dentin substrate was determined after veneer preparations using scanning white-light interferometry and scanning electron microscope imaging. The cleanability of TI and RI was also determined by comparing the efficacy of 3 conventional disinfection protocols after contaminating the instrument with Gram-positive or Gram-negative oral pathogens. The mean and standard deviation values for thermal change, surface roughness, and colony forming units were calculated at a 95% confidence level, and 1-way ANOVA was used to determine statistical significance (α=.05). RESULTS: The NI instrument had the lowest mean ΔT (1.47 °C). The TI (1.77 °C) and RI (1.85 °C) groups showed statistically similar means (P>.05). The TI presented the lowest surface roughness (1.68 µm), followed by the RI (1.87 µm) (P<.001). The NI resulted in the highest surface roughness (2.17 µm) (P<.001). The disinfection protocols used were more effective on the TI group than on the RI group regardless of organisms and time exposed to the cleaning solution (P<.001). CONCLUSIONS: The novel diamond instrument demonstrated similar cutting efficiency and effectiveness when compared with conventional diamond instruments. However, the novel instrument produced smoother tooth preparations and was easier to clean than the conventional diamond rotary instruments.

Anatomic CAD-CAM post-and-core systems: A mastication simulation study.

STATEMENT OF PROBLEM: Few studies have investigated the differences among various post-and-core systems under mastication simulation. Comparing these systems while simulating the clinical environment should provide a more accurate assessment of their performance. PURPOSE: The purpose of this in vitro study was to evaluate the fatigue resistance of conventional cast metal and prefabricated fiber post systems with computer-aided design and computer-aided manufacture (CAD-CAM) prefabricated nonmetal post-and-core systems. MATERIAL AND METHODS: Forty freshly extracted human maxillary premolars were endodontically treated and divided into 4 subgroups (n=10) according to the material: cast metal, zirconia, fiber-reinforced composite resin, prefabricated fiber post. The post-and-core materials were manufactured either conventionally or milled with CAD-CAM technology. All specimens were exposed to simultaneous mastication simulation (1.2 million cycles) and thermocycling (10 000 cycles at 5 °C to 55 °C) and analyzed based on failure of specimens. Data were analyzed by using the Kaplan-Meier survival analysis and Cox-regression (α=.05). RESULTS: Both cast metal and zirconia post-and-core groups had similar fatigue resistance (P>.05) but significantly higher fatigue resistance than the fiber-reinforced groups (P<.05). Fiber-reinforced composite resin and prefabricated fiber post did not survive the mastication simulation, fracturing between 504 000 and 752 000 cycles, with fractures occurring in the cervical portion of the tooth. CONCLUSIONS: Cast metal and zirconia post-and-core systems had improved physical properties with high resistance to fatigue when compared with fiber-reinforced post-and-core systems.

Strength and phase transformation of different zirconia types after chairside adjustment.

STATEMENT OF PROBLEM: Limited evidence is available for the effect of chairside adjustment using diamond instruments on different types of zirconia. PURPOSE: The purpose of this in vitro study was to evaluate the effect of simulated adjustments on the biaxial flexural strength and phase transformation of 3 different zirconia types. MATERIAL AND METHODS: Three zirconia types from the same manufacturer (Katana; Kuraray) were used: High Translucency (3Y-PSZ), Super Translucent Multi Layered (4Y-PSZ), and Ultra Translucent Multi Layered (5Y-PSZ). Thirty disk-shaped specimens (Ø14×1.2 mm) were fabricated according to the International Organization for Standardization (ISO) Standard 6872 from different zirconia types (N=90). Specimens were either left without adjustment (NA), adjusted with Dialite ZR finishing and polishing system (Brasseler) (APol), or adjusted with course diamond instruments only (ADia). The specimens were distributed into 9 groups (n=10): group 3Y-PSZ/NA, group 3Y-PSZ/APol, group 3Y-PSZ/ADia, group 4Y-PSZ/NA, group 4Y-PSZ/APol, group 4Y-PSZ/ADia, group 5Y-PSZ/NA, group 5Y-PSZ/APol, and group 5Y-PSZ/ADia. The biaxial flexural strength of each specimen was measured by using a universal testing machine (Model 4411; Instron) and according to ISO 6872. X-ray diffraction analysis was conducted to quantify the monoclinic phase transformation. Scanning electron microscopy images were obtained to evaluate the fracture pattern. Statistical analysis was performed by using analysis of variance (ANOVA) and Tukey multiple comparison tests for pairwise comparisons (α=.05). RESULTS: The mean biaxial flexural strengths ranked from the highest to the lowest were for 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ under any test condition (P=.007). Chairside adjustment with a diamond instrument significantly decreased the flexural strength of all zirconia types (P<.05). No statistically significant difference was found between the effect of APol and ADia on the strength of zirconia 3Y-PSZ (P=.603), 4Y-PSZ (P=.993), and 5Y-PSZ (P=.660). Phase transformation did not occur in the 5Y-PSZ groups. ADia groups had significantly higher phase transformation values regardless of zirconia type (P<.05). CONCLUSIONS: The biaxial flexural strength of zirconia decreased significantly after chairside adjustment with diamond instruments regardless of the yttria percentage. Adjustment with the Dialite ZR finishing and polishing system caused less tetragonal to monoclinic phase transformation than adjustment with a course-grit diamond instrument.

Survivability and fracture resistance of monolithic and multi-yttria-layered zirconia crowns as a function of yttria content: A mastication simulation study.

OBJECTIVE: To compare four different types of monolithic zirconia crowns in terms of survival rate and fracture resistance after thermocycling and/or thermo-mechanical loading in a chewing simulator. METHODS: Partially stabilized zirconia (PSZ) crowns with fiber-reinforced resin die assemblies (n = 80) were fabricated using: multi-yttria-layered 5Y-PSZ/3Y-PSZ, multi-yttria-layered 5Y-PSZ/4Y-PSZ, monolithic 4Y-PSZ, and monolithic 3Y-PSZ as control (n = 20). Half of the samples in each group were subjected to thermo-mechanical loading under 110 N, 1.4 Hz, 1.2 million cycles with simultaneous thermocycling (10,000 cycles, 5-55°C). The other half were subjected to thermocycling alone. The samples were loaded to failure to measure their fracture resistance. The data were analyzed using by two-way ANOVA and Tukey's HSD post-hoc test (α = 0.05). RESULTS: All specimens survived the aging protocols. The yttria content significantly affected the fracture resistance of the crowns (p < 0.0001). The mean fracture resistance, from highest to lowest: 3Y-PSZ, 4Y-PSZ, followed by the two multi-yttria-layered systems. The mean difference between the two multi-yttria-layered systems were not statistically significant (p = 0.98). The mechanical loading protocol did not affect the mean fracture resistance within each group (p = 0.18). CONCLUSIONS: Within each group, there was no difference in fracture resistance after thermocycling alone and thermo-mechanical loading. However, increasing the yttria concentration at the occlusal third of the crown decreased its fracture resistance. CLINICAL SIGNIFICANCE: The term "monolithic zirconia" alone without specifying the actual yttria content is misleading. This term represents different materials with different mechanical properties. The yttria content has an inverse relationship with the fracture resistance of zirconia crowns. The fracture resistance of multi-layer zirconia crowns is determined by the amount of the weaker zirconia phase at the occlusal part of the restoration rather than enforced by the stronger zirconia at the cervical part of the crown.

Linear and volumetric wear of conventional and milled denture teeth.

OBJECTIVE: The purpose of this study was to compare the linear and volumetric wear of conventional and milled double-cross-linked polymethyl methacrylate, nano-composite, and nano-ceramic infused resin posterior denture teeth. METHODS: Double-cross-linked polymethyl methacrylate (PMMA) premolar teeth were scanned and used to mill denture teeth from a double-cross-linked PMMA resin disc and a nano-composite with nano-ceramic infused resin disc. The specimens (n = 8: conventional double-cross-linked PMMA resin teeth-DCL, milled double-cross-linked PMMA resin teeth-DCL-CAM, conventional nano-composite infused resin teeth with four layers composed of composite and PMMA resin teeth-NC, and milled nano-composite and nano-ceramic infused resin teeth-NC-CAM) underwent chewing simulation in the biaxial fatigue testing machine at 1.53 Hz frequency, thermocycling between 5 and 55°C, and 49 N force against a Ø6mm steatite. After 250,000 cycles, the linear changes on the occlusal surfaces of the specimens were analyzed with pairwise comparison with Bonferroni post hoc test, and the volumetric changes of the specimens were analyzed with a one-way ANOVA with Bonferroni post hoc test (p < 0.05). RESULTS: The linear wear of the conventional and milled denture teeth was linearly correlated with the number of cycles between 50,000 and 250,000 cycles. After 250,000 cycles, NC had significantly more linear and volumetric wear (0.52 ± 0.10 mm and 4.29 ± 0.94 mm3 ) than DCL (0.18 ± 0.03 mm and 0.74 ± 0.14 mm3 ; p < 0.001) and NC-CAM (0.15 ± 0.03 mm and 0.35 ± 0.21 mm3 ; p < 0.001). DCL-CAM and NC-CAM had linearly and volumetrically equivalent wear to DCL (p > 0.05). NC-CAM had significantly less linear and volumetric wear (0.15 ± 0.03 mm and 0.35 ± 0.21 mm3 ) than DCL-CAM (0.24 ± 0.07 mm and 1.22 ± 0.61 mm3 ; p < 0.05). CONCLUSIONS: The conventional NC wore more than DCL, DCL-CAM, and NC-CAM. Both milled denture teeth wore an equivalent amount to conventional DCL. The wear between the conventional and milled DCL was equivalent. CLINICAL SIGNIFICANCE: Denture teeth selection can prolong the retreading process and decrease the occurrences of prosthetic complications. Milled denture teeth are good alternatives to conventional denture teeth with regards to their wear resistance.

Tooth-cusp preservation with lithium disilicate onlay restorations: A fatigue resistance study.

OBJECTIVES: This study examined the in vitro fatigue resistance of maxillary premolars with 2 mm or 3 mm preserved cusp thicknesses restored with lithium disilicate onlays. MATERIALS AND METHODS: Premolars(N = 48) were divided into six groups. Onlays for groups 1 to 4 preserved a 3 mm functional (G1), 2 mm functional (G2), 3 mm nonfunctional (G3), or 2 mm nonfunctional (G4) buccal-lingual cusp width. Onlays for group 5 (G5, control) replaced both cusps. Group 6 (G6) samples were identical to G1 with added retentive boxes. Lithium disilicate onlays were exposed to thermocycling (10 000 cycles, 5°C-55°C, 30s/cycle) and mechanical loading (1.2 million cycles at 1.4 Hz and 70 N). All samples were examined for onlay debonding or cusp or onlay fracture. RESULTS: Failure rates were 75%(G1), 0.0%(G2), 12.5%(G3), 0.0%(G4), 0.0%(G5), and 0.0%(G6). The difference in percent failure between the groups preserving the functional cusps (37.5%) and the groups preserving the nonfunctional cusps (6.3%) was statistically significant (P = .04; 95%CI:2.11-55.66). No cusp or restoration fractures were observed; all failures were due to debonding of the restoration. CONCLUSION: Teeth with thin remaining cusps that were restored with bonded lithium disilicate onlay restorations were not prone to fracture. Retentive preparation features that physically eliminated lateral displacement prevented onlay debonding even though the ceramic-enamel margin was directly at the occlusal contact. CLINICAL SIGNIFICANCE: The use of adhesively retained lithium disilicate ceramic onlays may be a viable alternative to full coverage restorations and may challenge traditionally accepted principals related to preparation resistance and retention form of ceramic partial coverage restorations.

Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions.

PURPOSE: To evaluate resin cement bond strength after removal of salivary contamination from a zirconia surface using different cleaning solutions and air-borne particle abrasion. MATERIALS AND METHODS: One-hundred and twenty zirconia specimens (KATANA STML, Noritake) were prepared and divided into 12 groups (n = 10). Groups were subjected to a notched-edge shear bond strength test (ISO 29022) to analyze the bonding efficiency of a resin cement (Panavia V5, Kuraray Noritake Dental Inc.) before and after contamination with saliva. Group 1 (control) was prepared and cemented without salivary contamination. Group 2 was coated with ceramic primer (Clearfil Ceramic Primer Plus, Kuraray Noritake Dental Inc.) then subjected to salivary contamination then tested. Group 3 was contaminated, cleaned by air-borne particle abrasion, ceramic primer and resin cement applied, and tested. Groups 4 to 12 were contaminated, and then different cleaning solutions (water, 4.5% hydrofluoric acid, 35% phosphoric acid, Ivoclean, KATANA cleaner, Zirclean, sodium hypochlorite 4%, and 7.5%) were used to decontaminate the zirconia surface, followed by ceramic primer, resin cement application, and tested. One-way ANOVA and Tukey post-hoc analysis was used to analyze the data. RESULTS: One-way ANOVA showed statistical differences among cleaning procedures (p < 0.001, F = 13.48). Air-borne particle abrasion was the only group which provided a bond strength (21 ± 2.8 MPa) that was not statistically different than the control group in which no contamination occurred (25.3 ± 3.3 MPa) (p = 0.247). The use of hydrofluoric acid and zirconia cleaning solutions resulted in bond strengths values which were not statistically different from each other (17.5-19.1 MPa). CONCLUSION: Air-borne particle, zirconia cleaning solutions and hydrofluoric acid are feasible to decontaminate the zirconia surface from saliva prior to bonding the restoration.

Optical properties of a novel glass-ceramic restorative material.

OBJECTIVE: To examine the optical properties of a dental restorative material manufactured from lithium aluminosilicate ceramic and reinforced with lithium disilicate. Translucency and the optical effects of various supporting materials on color were the primary focus. METHODS: Five 10 × 10 mm samples were prepared in thicknesses of 0.5, 1.0, 1.5, and 2.0 mm of both high translucency (HT) and low translucency (LT) versions of the material in shade A3. A spectrophotometer was used to measure the illuminance of the samples with black and white backings in order to calculate contrast ratio (CR) and relative translucency parameter (RTP). A baseline relationship between translucency and material thickness was examined and the effects of composite, titanium, and zirconia abutments on color change were studied. RESULTS: No significant findings were identified for RTP or CR between the HT and LT material, regardless of the material thickness (p = 0.39, p = 0.14, respectively). Regardless of material thickness (HT vs. LT), translucencies (RTP and CR) were significantly different with composite, titanium, and zirconia backings compared to baseline values (p < 0.0001). Titanium had the most significant decrease in translucency compared to composite and zirconia. There was no difference in ΔE00 between the HT and LT materials (p > 0.05) regardless of the backing. Titanium had the most significant effect on color of both materials followed by composite then zirconia (p < 0.0001). CONCLUSIONS: There is not a clinically significant difference in translucency between the high translucency and low translucency materials. Only zirconia supporting structures produced changes in color that are clinically acceptable. CLINICAL SIGNIFICANCE: Understanding the optical properties of glass-ceramic restorative materials aids providers in selecting appropriate materials for optimum esthetic outcomes. The lithium-aluminosilicate reinforced with lithium disilicate material does a poor job masking supporting structures and resisting color change.