Peri-implant complications for posterior endosteal implants.

OBJECTIVES: (1) To assess whether there is evidence of an association between the number of peri-implant tissue complications and patient characteristics such as gender, diabetes status, smoking status, and bite force; (2) To assess whether there is evidence of an association between the number of peri-implant tissue complications and location of the implant, surgical technique used, bone graft status and sinus lift status. MATERIALS AND METHODS: This randomized, controlled clinical trial included a total of 176 implants (OsseoSpeed, DENTSPLY) in 67 participants with 88 fixed dental prostheses. Information was obtained from health histories, a baseline exam, surgical notes, and post-operative exams. The data were analyzed using Fisher's exact and Mann-Whitney tests and generalized estimating equations using logistic regression with a significance level set at 0.05. RESULTS: All 176 implants survived within a recall period of 3 years, but 11 implants demonstrated peri-implant tissue complications. Ten sites showed dehiscence and one case exhibited vertical bone loss. There was a statistically significant association between surgical technique used (1-stage or 2-stage) and the presence of soft tissue complications (P = 0.005), where 2-stage surgery was associated with a higher frequency of peri-implant soft tissue complications. A correlation, although not statistically significant (P = 0.077), was noted, between peri-implant tissue complications and bone grafting, suggesting a possible role for this factor as well. CONCLUSIONS: Participants who did not require any second-stage surgery at the implant sites experienced fewer complications. Therefore, additional surgical procedures should be performed judiciously considering their possible effects on peri-implant tissue health. CLINICAL SIGNIFICANCE: The clinical implication of this research study is that secondary surgery should be considered with caution during implant placement and it should be performed only when other options have been exhausted, as it has been shown to have a direct adverse effect on the long-term peri-implant tissue health.

Fracture analysis of randomized implant-supported fixed dental prostheses.

OBJECTIVE: Fractures of posterior fixed dental all-ceramic prostheses can be caused by one or more factors including prosthesis design, flaw distribution, direction and magnitude of occlusal loading, nature of supporting infrastructure (tooth root/implant), and presence of adjacent teeth. This clinical study of implant-supported, all-ceramic fixed dental prostheses, determined the effects of (1) presence of a tooth distal to the most distal retainer; (2) prosthesis loading either along the non-load bearing or load bearing areas; (3) presence of excursive contacts or maximum intercuspation contacts in the prosthesis; and (4) magnitude of bite force on the occurrence of veneer ceramic fracture. METHODS: 89 implant-supported FDPs were randomized as either a three-unit posterior metal-ceramic (Au-Pd-Ag alloy and InLine POM, Ivoclar, Vivadent) FDP or a ceramic-ceramic (ZirCAD and ZirPress, Ivoclar, Vivadent) FDP. Two implants (Osseospeed, Dentsply) and custom abutments (Atlantis, Dentsply) supported these FDPs, which were cemented with resin cement (RelyX Universal Cement). Baseline photographs were made with markings of teeth from maximum intercuspation (MI) and excursive function. Patients were recalled at 6 months and 1-3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts. CONCLUSION: No significant relationship existed between the occurrence of fracture and: (1) the magnitude of bite force; (2) a tooth distal to the most distal retainer; and (3) contacts in load-bearing or non-load-bearing areas. However, there was a significantly higher likelihood of fracture in areas with MI contacts only. CLINICAL SIGNIFICANCE: Because of the absence of a periodontal ligament, this clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses. Implant supported prostheses should have minimal occlusion and lighter contacts than those supported by natural dentition. CLINICAL TRIALSGOV NO: K23 D2007-46.

Cytotoxicity of alloying elements and experimental titanium alloys by WST-1 and agar overlay tests.

OBJECTIVE: This study was performed to evaluate the biocompatibility of nine types of pure metals using 36 experimental prosthetic titanium-based alloys containing 5, 10, 15, and 20wt% of each substituted metal. METHODS: The cell viabilities for pure metals on Ti alloys that contain these elements were compared with that of commercially pure (CP) Ti using the WST-1 test and agar overlay test. RESULTS: The ranking of pure metal cytotoxicity from most potent to least potent was: Co>Cu>In>Ag>Cr>Sn>Au>Pd>Pt>CP Ti. The cell viability ratios for pure Co, Cu, In, and Ag were 13.9±4.6%, 21.7±10.4%, 24.1±5.7%, and 24.8±6.0%, respectively, which were significantly lower than that for the control group (p<0.05). Pure Pd and Pt demonstrated good biocompatibility with cell viabilities of 93.8±9.6% and 97.2±7.1%, respectively. The Ti-5Pd alloy exhibited the highest cell viability (128.4±21.4%), which was greater than that of CP Ti. By alloying pure Co or Cu with Ti, the cell viabilities for the Ti-xCo and Ti-xCu alloys increased significantly up to 10wt% of the alloying element followed by a gradual decrease with a further increase in the concentration of the alloying element. Based on the agar overlay test, pure Ag, Co, Cr, Cu, and In were ranked as 'moderately cytotoxic', whereas all Ti alloys were ranked as 'noncytotoxic'. SIGNIFICANCE: The cytotoxicity of pure Ag, Co, Cr, Cu, and In suggests a need for attention in alloy design. The cytotoxicity of alloying elements became more biocompatible when they were alloyed with titanium. However, the cytotoxicity of titanium alloys was observed when the concentration of the alloying element exceeded its respective allowable limit. The results obtained in this study can serve as a guide for the development of new Ti-based alloy systems.

Influence of substructure design and occlusal reduction on the stress distribution in metal ceramic complete crowns: 3D finite element analysis.

PURPOSE: Occlusal reduction is considered a fundamental step for providing adequate and uniform space for the ceramic prosthesis; however, a flat occlusal surface is usually found. The prosthesis design influences the resistance to deformation and the stress state within the ceramic. This finite element (FE) study analyzes the influence of changing the substructure design on the stress distribution of a metal-ceramic crown in a premolar tooth with three types of occlusal reduction. MATERIALS AND METHODS: Each part of three-dimensional metal ceramic complete crown models was designed according to the space provided by different levels of occlusal reduction and the same external morphology of the tooth. Three models were designed: (1) correct occlusal reduction with a uniform thickness of the substructure (0.3 mm) and the veneering porcelain (1.5 mm); (2) flat occlusal reduction with different thicknesses of veneering porcelain to produce a uniform substructure; and (3) a flat occlusal reduction with different thicknesses of substructure for a uniform thickness of veneering porcelain. RESULTS: Stress distributions were very similar in the three models. The highest tensile stresses were concentrated immediately below the midline fissure in both the veneering porcelain and the metal alloy substructure. Although models with flat occlusal reduction had lower stress values, this preparation results from a reduction that removes a greater amount of sound tissue, which may increase the probability of dental pulp injury. CONCLUSIONS: Occlusal reduction must be anatomic; however, when a flat occlusal reduction already exists, the substructure must reproduce the correct anatomic form to allow a uniform thickness of the veneering porcelain.

Randomized clinical trial of implant-supported ceramic-ceramic and metal-ceramic fixed dental prostheses: preliminary results.

PURPOSE: The aim of this study was to determine the survival rates over time of implant-supported ceramic-ceramic and metal-ceramic prostheses as a function of core-veneer thickness ratio, gingival connector embrasure design, and connector height. MATERIALS AND METHODS: An IRB-approved, randomized, controlled clinical trial was conducted as a single-blind pilot study involving 55 patients missing three teeth in either one or two posterior areas. These patients (34 women; 21 men; age range 52-75 years) were recruited for the study to receive a three-unit implant-supported fixed dental prosthesis (FDP). Two implants were placed for each of the 72 FDPs in the study. The implants (Osseospeed, Astra Tech), which were made of titanium, were grit blasted. A gold-shaded, custom-milled titanium abutment (Atlantis, Astra Tech), was secured to each implant body. Each of the 72 FDPs in 55 patients were randomly assigned based on one of the following options: (1) A. MATERIAL: ceramic-ceramic (Yttria-stabilized zirconia core, pressable fluorapatite glass-ceramic, IPS e.max ZirCAD, and ZirPress, Ivoclar Vivadent) B. metal-ceramic (palladium-based noble alloy, Capricorn, Ivoclar Vivadent, with press-on leucite-reinforced glass-ceramic veneer, IPS InLine POM, Ivoclar Vivadent); (2) occlusal veneer thickness (0.5, 1.0, and 1.5 mm); (3) curvature of gingival embrasure (0.25, 0.5, and 0.75 mm diameter); and (4) connector height (3, 4, and 5 mm). FDPs were fabricated and cemented with dual-cure resin cement (RelyX, Universal Cement, 3M ESPE). Patients were recalled at 6 months, 1 year, and 2 years. FDPs were examined for cracks, fracture, and general surface quality. RESULTS: Recall exams of 72 prostheses revealed 10 chipping fractures. No fractures occurred within the connector or embrasure areas. Two-sided Fisher's exact tests showed no significant correlation between fractures and type of material system (p = 0.51), veneer thickness (p = 0.75), radius of curvature of gingival embrasure (p = 0.68), and connector height (p = 0.91). CONCLUSIONS: Although there were no significant associations between connector height, curvature of gingival embrasure, core/veneer thickness ratio, and material system and the survival probability of implant-supported FDPs with zirconia as a core material, the small number of fractures precludes a definitive conclusion on the dominant controlling factor.

Time-dependent fracture probability of bilayer, lithium-disilicate-based, glass-ceramic, molar crowns as a function of core/veneer thickness ratio and load orientation.

UNLABELLED: Recent reports on bilayer ceramic crown prostheses suggest that fractures of the veneering ceramic represent the most common reason for prosthesis failure. OBJECTIVE: The aims of this study were to test the hypotheses that: (1) an increase in core ceramic/veneer ceramic thickness ratio for a crown thickness of 1.6mm reduces the time-dependent fracture probability (Pf) of bilayer crowns with a lithium-disilicate-based glass-ceramic core, and (2) oblique loading, within the central fossa, increases Pf for 1.6-mm-thick crowns compared with vertical loading. MATERIALS AND METHODS: Time-dependent fracture probabilities were calculated for 1.6-mm-thick, veneered lithium-disilicate-based glass-ceramic molar crowns as a function of core/veneer thickness ratio and load orientation in the central fossa area. Time-dependent fracture probability analyses were computed by CARES/Life software and finite element analysis, using dynamic fatigue strength data for monolithic discs of a lithium-disilicate glass-ceramic core (Empress 2), and ceramic veneer (Empress 2 Veneer Ceramic). RESULTS: Predicted fracture probabilities (Pf) for centrally loaded 1.6-mm-thick bilayer crowns over periods of 1, 5, and 10 years are 1.2%, 2.7%, and 3.5%, respectively, for a core/veneer thickness ratio of 1.0 (0.8mm/0.8mm), and 2.5%, 5.1%, and 7.0%, respectively, for a core/veneer thickness ratio of 0.33 (0.4mm/1.2mm). CONCLUSION: CARES/Life results support the proposed crown design and load orientation hypotheses. SIGNIFICANCE: The application of dynamic fatigue data, finite element stress analysis, and CARES/Life analysis represent an optimal approach to optimize fixed dental prosthesis designs produced from dental ceramics and to predict time-dependent fracture probabilities of ceramic-based fixed dental prostheses that can minimize the risk for clinical failures.

Cytocompatibility of pure metals and experimental binary titanium alloys for implant materials.

OBJECTIVE: This study was performed to evaluate the biocompatibility of nine types of pure metal ingots (Ag, Al, Cr, Cu, Mn, Mo, Nb, V, Zr) and 36 experimental titanium (Ti) alloys containing 5, 10, 15, and 20 wt% of each alloying element. METHODS: The cell viabilities for each test group were compared with that of CP-Ti using the WST-1 test and agar overlay test. RESULTS: The ranking of pure metal cytotoxicity from most potent to least potent was as follows: Cu>Al>Ag>V>Mn>Cr>Zr>Nb>Mo>CP-Ti. The mean cell viabilities for pure Cu, Al, Ag, V, and Mn were 21.6%, 25.3%, 31.7%, 31.7%, and 32.7%, respectively, which were significantly lower than that for the control group (p<0.05). The mean cell viabilities for pure Zr and Cr were 74.1% and 60.6%, respectively (p<0.05). Pure Mo and Nb demonstrated good biocompatibility with mean cell viabilities of 93.3% and 93.0%, respectively. The mean cell viabilities for all the Ti-based alloy groups were higher than 80% except for Ti-20 Nb (79.6%) and Ti-10 V (66.9%). The Ti-10 Nb alloy exhibited the highest cell viability (124.8%), which was higher than that of CP-Ti. Based on agar overlay test, pure Ag, Cr, Cu, Mn, and V were ranked as 'moderately cytotoxic', whereas the rest of the tested pure metals and all Ti alloys, except Ti-10 V (mild cytotoxicity), were ranked as 'noncytotoxic'. SIGNIFICANCE: The results obtained in this study can serve as a guide for the development of new Ti-based alloy implant systems.

Randomized, controlled clinical trial of bilayer ceramic and metal-ceramic crown performance.

PURPOSE: Analyzing the clinical performance of restorative materials is important, as there is an expectation that these materials and procedures will restore teeth and do no harm. The objective of this research study was to characterize the clinical performance of metal-ceramic crowns, core ceramic crowns, and core ceramic/veneer ceramic crowns based on 11 clinical criteria. MATERIALS AND METHODS: An IRB-approved, randomized, controlled clinical trial was conducted as a single-blind pilot study. The following three types of full crowns were fabricated: (1) metal-ceramic crown (MC) made from a Pd-Au-Ag-Sn-In alloy (Argedent 62) and a glass-ceramic veneer (IPS d.SIGN veneer); (2) non-veneered (glazed) lithium disilicate glass-ceramic crown (LDC) (IPS e.max Press core and e.max Ceram Glaze); and (3) veneered lithia disilicate glass-ceramic crown (LDC/V) with glass-ceramic veneer (IPS Empress 2 core and IPS Eris). Single-unit crowns were randomly assigned. Patients were recalled for each of 3 years and were evaluated by two calibrated clinicians. Thirty-six crowns were placed in 31 patients. A total of 12 crowns of each of the three crown types were studied. Eleven criteria were evaluated: tissue health, marginal integrity, secondary caries, proximal contact, anatomic contour, occlusion, surface texture, cracks/chips (fractures), color match, tooth sensitivity, and wear (of crowns and opposing enamel). Numerical rankings ranged from 1 to 4, with 4 being excellent, and 1 indicating a need for immediate replacement. Statistical analysis of the numerical rankings was performed using a Fisher's exact test. RESULTS: There was no statistically significant difference between performance of the core ceramic crowns and the two veneered crowns at year 1 and year 2 (p > 0.05). All crowns were rated either as excellent or good for each of the clinical criteria; however, between years 2 and 3, gradual roughening of the occlusal surface occurred in some of the ceramic-ceramic crowns, possibly caused by dissolution and wear of the glaze. Statistically significant differences in surface texture (p= 0.0013) and crown wear (p= 0.0078) were found at year 3 between the metal-ceramic crowns and the lithium-disilicate-based crowns. CONCLUSION: Based on the 11 criteria, the clinical performance of ceramic-ceramic crowns was comparable to that of the metal-ceramic crowns after 2 years; however, gradual roughening occurred between years 2 and 3, which resulted in differences in surface texture and wear.

Effectiveness of bonding resin-based composite to healthy and fluorotic enamel using total-etch and two self-etch adhesive systems.

The aim of this study was to evaluate the bond strength of three adhesive systems: Excite™, Adper Prompt L-Pop™ and AdheSE One™ to varying degrees of fluorotic enamel using micro-tensile bond strength (µTBS) tests. Human enamel was classified according to the Thylstrup and Fejerskov Index. The interface resin-enamel was observed using stereoscopic and electron microscopy. The Excite™, achieved the highest µTBS when bonded to healthy enamel and decreased as the degree of fluorosis increased (p<0.05). The Prompt L-Pop™ improved the bonding on moderate and severe fluorosis. The µTBS of the AdheSE One™, was significantly lower in all degrees of fluorotic enamel (p<0.05) indicating a very poor bonding ability to enamel. These results will provide clinicians with preliminary data to assist them in the selection of the most effective adhesive systems for treatment of fluorosis enamel, resulting in more successful restorative care.

Analysis of the molecular structure of human enamel with fluorosis using micro-Raman spectroscopy.

The aim of this study was to analyze the molecular structure of enamel with fluorosis using micro-Raman spectroscopy and compare it with that of healthy enamel. Eighty extracted human molars were classified into four fluorosis groups according to the Thylstrup-Fejerskov Index (TFI) [TFI: 0, Healthy enamel; 1-3, mild; 4-5, moderate; 6-9, severe fluorosis]. All samples were analyzed by micro-Raman spectroscopy. The integral areas of ν(1) (960 cm(-1)) phosphate peak as well as B-type carbonate peak (1070 cm(-1)) were obtained to analyze structural differences among the specimens. Although the differences were not statistically significant (P > 0.05), the mean of integral areas of ν(1) phosphate peak among groups indicated greater mineralization in the severe fluorosis group. However, there were statistically significant differences in the intensities, and the integral areas of B-type carbonate peak among groups (P < 0.05). Therefore, mineralization of the carbonate peak at 1070 cm(-1) decreased significantly in fluorotic groups, suggesting that carbonate ions are easily dissolved in the presence of fluoride. Although structurally fluorotic teeth are not more susceptible to dental caries, serious alteration in its surface topography may cause retention of bacterial plaque and formation of enamel caries. Micro-Raman spectroscopy is a useful tool for analyzing the molecular structure of healthy and fluorotic human enamel.

Three years in vivo wear: core-ceramic, veneers, and enamel antagonists.

OBJECTIVES: Test the hypotheses that there are equivalent wear rates for enamel-versus-enamel and ceramic-versus-enamel, analyzing the in vivo wear of crown ceramics, their natural enamel antagonists, and the corresponding two contralateral teeth; and, that bite force does not correlate with the wear. METHODS: A controlled, clinical trial was conducted involving patients needing full coverage crowns opposing enamel antagonists. Bite forces were measured using a bilateral gnathodynamometer. Single-unit restorations of metal/ceramic (Argedent 62, Argen Corp/IPS d.SIGN veneer); or, core-ceramic/veneer from either, Empress2/Eris, or e.max Press core/e.max Ceram glaze (ceramics: Ivoclar Vivadent, USA) were randomly assigned, fabricated and cemented. Impressions were made of the ceramic crowns, as well as each maxillary and mandibular quadrant at one week (baseline) and one, two and three years. Resulting models were scanned (3D laser scanner). Maximum wear was calculated by superimposing baseline with annual images. RESULTS: There were a total of thirty-six crowns required for thirty-one patients. Each restoration had three associated enamel teeth: crown, (1) antagonist, (2) contralateral and (3) contralateral-antagonist. SAS PROC MIXED (α=0.05) indicated no statistical significance for mean maximum wear among crown ceramics, enamel antagonists and contralaterals. However, enamel wear was statistically significant in relation to intraoral location (p=0.04) and among years (p<0.02). Analyzed alone, the enamel contralateral-antagonist exhibited significantly greater wear (p<0.001). Considering all wear sites, there was no correlation with bite force (p=0.15). SIGNIFICANCE: The ceramics and their antagonists exhibited in vivo wear rates within the range of normal enamel. Future studies should examine the wear implications of the contralateral-antagonist enamel.

Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses.

UNLABELLED: The recent increase in reports from clinical studies of ceramic chipping has raised the question of which criteria should constitute success or failure of total-ceramic prostheses. Terminologies such as minor chipping [1], partial chipping, technical complications [2,3], and biological complications have crept into the dental terminology and they have complicated our classification of success and failure of these crown and bridge restorations. Some journals have permitted the reporting of fractures as "complications" and they are not necessarily classified as failures in the study. One study has attempted to classify chipping fractures according to their severity and subsequent treatment [4]. This is a promising approach to resolve the challenges to the classification of chipping fracture. The term 'chipping fracture' is more descriptive than 'chipping' since the latter term tends to imply an event of minor consequence. Two types of statistics are reported routinely in these studies, i.e., percent success, which is a measure of restorations that survive without any adverse effects, and percent survival, which is a measure of all restorations that survive even though they may have exhibited chipping fracture or they may have been repaired. Why has this scenario occurred? One possible explanation is that many of these types of fractures are very small and do not affect function or esthetics. Another reason is that corporate sponsors prefer to use the term chipping since it does not connote failure in the sense that the term fracture does. In any event, we need to be more precise in our scientific observations of fracture and classifications of the various types of fracture including details on the location of fracture and the prosthesis design configuration. Because of the lack of standardized methods for describing chipping fractures, materials scientists are unable to properly analyze the effect of material properties and design factors on the time-dependent survival probability of ceramic fixed dental prostheses (FDPs). Based on the review of clinical trials and systematic reviews of these trials, the present study was designed to develop guidelines for classifying the functional performance, success, survival, and susceptibility to chipping fracture, and subsequent treatment of ceramic and metal-ceramic restorations. OBJECTIVE: To develop comprehensive descriptive guidelines and a clinical reporting form to assist dental scientists in their analyses of chipping fracture behavior of metal-ceramic and all-ceramic prostheses with particular emphasis on veneered-zirconia restorations. These guidelines are required to optimize the recording of fracture features that can be used to differentiate ceramic chipping fracture from bulk fracture and to assist dentists in identifying subsequent treatment that may minimize the need to replace affected restorations. A recording form for clinical fracture observations must be sufficiently clear and complete so that dental health professionals can translate the most relevant information in a context that allows their patients to fully understand the potential risks and benefits of treatment with ceramic restorations. It should clearly allow a clinician to determine whether or not a ceramic fracture constitutes a failure, which requires replacement of the prosthesis, or whether the fracture surface is relatively small or located in a nonfunctional area, i.e., one that is not contribute to occlusion, esthetics, proximal contacts, or food impaction. To accomplish this task, a review of the relevant publications of clinical trials was necessary to identify the variability in reporting of fracture events. The reviews were focused on clinical research studies of zirconia-based FDPs and PFM FDPs, which had been monitored through recall exams for three years or more. These reports and systematic reviews of all relevant publications were published in English dental journals between 2004 and 2010.The primary focus in this review was on the susceptibility to chipping fracture or bulk fracture of veneered zirconia-based fixed dental prostheses (FDPs) and metal-ceramic FDPs, which are also referred to in this paper as porcelain-fused-to-metal (PFM) FDPs.

A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation.

OBJECTIVE: The purpose of this study was to compare 2 irrigation techniques by evaluating canal cleanliness and obturation of lateral/accessory canals. STUDY DESIGN: Seventy-five extracted canines were instrumented to a size #40/0.06 taper. The EndoActivator (EA) was compared with an ultrasonic unit for final irrigation. Each unit was used for 1 minute each with 6.15% NaOCl and 17% EDTA. A control group received syringe irrigation. Thirty teeth were sectioned and evaluated for debris removal and open dentinal tubules at 3/5 mm from the apical foramen with a scanning electron microscope. Forty-five teeth were examined for obturation of lateral canals. RESULTS: The EA was significantly better in removing debris at all levels when compared with other treatment groups (P < .05) and resulted in obturation of significantly more numbers of lateral canals (P < .01.) CONCLUSIONS: The EA provided better obturation of lateral and accessory canals and resulted in less remaining debris.

Nanostructure evaluation of healthy and fluorotic dentin by atomic force microscopy before and after phosphoric acid etching.

The aim was to characterize by atomic force microscopy (AFM) the nanostructure of human dentin surfaces affected by dental fluorosis (DF) before and after phosphoric acid etching. This study included 240 human dentin samples classified according to the severity of DF, which were divided into four groups using the Thylstrup-Fejerskov Index (TFI). Samples were analyzed by AFM before and after acid etching for 15, 30, and 60 s. The roughness (R(a)) for healthy dentin, and dentin with mild, moderate, and severe fluorosis were 440 nm, 442 nm, 445 nm, and 449 nm, respectively. After 15, 30, and 60 s of acid etching, all healthy and fluorotic dentin samples increased in roughness (p<0.05). The diameter of dentinal tubule orifices (D(t)) in healthy human dentin increased after acid etching for 60 s. We conclude that effective etching times are 15 s for healthy and mild dentin fluorosis, 30-s for moderately fluorosed dentin, and 45-60 s for severe fluorotic dentin.

Characterization of healthy and fluorotic enamel by atomic force microscopy.

The aim was to characterize the external structure, roughness, and absolute depth profile (ADP) of fluorotic enamel compared with healthy enamel. Eighty extracted human molars were classified into four groups [TFI: 0, control (C); 1-3, mild (MI); 4-5, moderate (MO); 6-9, severe fluorosis (S)] according to the Thylstrup-Fejerskov Index (TFI). All samples were analyzed by atomic force microscopy.The mean values of enamel surface roughness (ESR) in nm were: Group C, 92.6; Group MI, 188.8; Group MO, 246.9; and Group S, 532.2. The mean values of absolute depth profile in nm were: C, 1,065.7; MI, 2,360.7; MO, 2,536.7; and S, 6,146.2. The differences between mean ESR and mean ADP among groups were statistically significant (p < 0.05). This structural study confirms at the nanometer level that there is a positive association between fluorosis severity, ESR, and ADP, and there is an association with the clinical findings of fluorosis measured by TFI as well.

Interfacial toughness of bilayer dental ceramics based on a short-bar, chevron-notch test.

OBJECTIVE: The objective of this study was to test the null hypothesis that the interfacial toughness of each of two types of bonded core-veneer bilayer ceramics is not significantly different from the apparent fracture toughness of the control monolithic glass veneer. METHODS: T-shaped short-bars of a lithia-disilicate glass-ceramic core (LC) and yttria-stabilized polycrystalline zirconia core ceramic (ZC) were prepared according to the manufacturer's recommendations. V-shaped notches were prepared by using 25-mum-thick palladium foil, leaving the chevron-notch area exposed, and the bars were veneered with a thermally compatible glass veneer (LC/GV and ZC/GV). Additionally, we also bonded the glass veneer to itself as a control group (GV/GV). Specimens were kept in distilled water for 30 days before testing in tension. Eight glass veneer bars were prepared for the analysis of fracture toughness test using the indentation-strength technique. RESULTS: The mean interfacial toughness of the LC/GV group was 0.69 MPam(1/2) (0.11), and did not significantly differ from that of the GV/GV control group, 0.74 MPam(1/2) (0.17) (p>0.05). However, the difference between the mean interfacial toughness of the ZC/GV group, 0.13 MPam(1/2) (0.07), and the LC/GV and the GV/GV groups was statistically significant (p<0.05). SIGNIFICANCE: For bilayer all-ceramic restorations with high-strength core materials, the veneering ceramics are the weakest link in the design of the structure. Since all-ceramic restorations often fail from chipping of veneer layers or crack initiation at the interface, the protective effects of thermal mismatch stresses oral prosthesis design should be investigated.

Atomic force microscopy observation of the enamel roughness and depth profile after phosphoric acid etching.

The aim was to compare the enamel surface roughness (ESR) and absolute depth profile (ADP) (mean peak-to-valley height) by atomic force microscopy (AFM) before and after using four different phosphoric acids. A total of 160 enamel samples from 40 upper premolars were prepared. The inclusion criterion was that the teeth have healthy enamel. Exclusion criteria included any of the following conditions: facial restorations, caries lesions, enamel hypoplasia and dental fluorosis. Evaluations of the ESR and ADP were carried out by AFM. The Mann-Whitney U-test was used to compare continuous variables and the Wilcoxon test was used to analyze the differences between before and after etching. There were statistically significant differences (P

Residual stress in glass: indentation crack and fractography approaches.

OBJECTIVE: To test the hypothesis that the indentation crack technique can determine surface residual stresses that are not statistically significantly different from those determined from the analytical procedure using surface cracks, the four-point flexure test, and fracture surface analysis. METHODS: Soda-lime-silica glass bar specimens (4 mm x 2.3 mm x 28 mm) were prepared and annealed at 650 degrees C for 30 min before testing. The fracture toughness values of the glass bars were determined from 12 specimens based on induced surface cracks, four-point flexure, and fractographic analysis. To determine the residual stress from the indentation technique, 18 specimens were indented under 19.6N load using a Vickers microhardness indenter. Crack lengths were measured within 1 min and 24h after indentation, and the measured crack lengths were compared with the mean crack lengths of annealed specimens. Residual stress was calculated from an equation developed for the indentation technique. All specimens were fractured in a four-point flexure fixture and the residual stress was calculated from the strength and measured crack sizes on the fracture surfaces. RESULTS: The results show that there was no significant difference between the residual stresses calculated from the two techniques. However, the differences in mean residual stresses calculated within 1 min compared with those calculated after 24h were statistically significant (p=0.003). SIGNIFICANCE: This study compared the indentation technique with the fractographic analysis method for determining the residual stress in the surface of soda-lime-silica glass. The indentation method may be useful for estimating residual stress in glass.

Viscoelastic finite element stress analysis of the thermal compatibility of dental bilayer ceramic systems.

PURPOSE: The aim of this study was to test the hypothesis that viscoelastic finite element analyses can reliably predict the effect of geometry on maximum tensile stresses in bilayer screening tests that are used to determine thermal compatibility. MATERIALS AND METHODS: Three-dimensional viscoelastic finite element models of a beam, cylinder, disk, sphere, central incisor crown, molar crown, and posterior three-unit fixed partial denture (FPD) were used to calculate residual stresses after simulated bench cooling. Four compatible and four incompatible systems were evaluated. RESULT: The highest residual tensile stresses for all material combinations were associated with the three-unit FPD. Residual tensile stresses ranged from 5.4 MPa in the disk for a compatible combination to 262 MPa in the three-unit FPD for an incompatible system. Residual tensile stresses in the three-unit FPD ranged from 16.8 MPa to 44.0 MPa for the compatible systems and from 175 MPa to 262 MPa for the incompatible systems. CONCLUSION: Based on finite element calculations, it is predicted that all-ceramic dental prostheses with an average thermal contraction mismatch (500 degrees C to 25 degrees C) greater than +/- 1.0 ppm/K will likely exhibit a relatively high percentage of failures in clinical use compared with systems having smaller thermal contraction mismatch between core and veneering ceramics.

Four-year clinical performance of a lithia disilicate-based core ceramic for posterior fixed partial dentures.

PURPOSE: The objective of this research was to test the hypothesis that 3-unit fixed partial dentures (FPDs) made from a moderately high-strength core ceramic will adequately resist fracture in posterior regions if fabricated with a minimal connector size of 4 mm. MATERIALS AND METHODS: Thirty ceramic FPD core frameworks were prepared using a hot-pressing technique and a lithia disilicate-based core ceramic. The maximum occlusal force was measured for each patient prior to tooth preparation. Connector heights and widths were measured for each FPD. Patients were recalled annually after cementation for 4 years and evaluated using 11 clinical criteria. All FPDs were examined by 2 independent clinicians, and rankings for each criterion were made from 1 to 4 (4 = excellent; 1 = unacceptable). RESULTS: The fracture rate was approximately 3% per year, and the proportion of good overall ratings in the nonfractured FPDs was reduced by more than 6% per year, where a good overall rating was defined to be a rank of 3 or 4 in all 11 criteria. There was little evidence that the use of either resin-reinforced glass-ionomer cement (Protec CEM) or dual-cure resin cement (Variolink II) made any difference in terms of fracture rate or overall rating (P= .30, .63, .97, and .71 for the 4 years, respectively). From a fracture resistance perspective, 4 of the 30 ceramic FPDs fractured within the 4-year evaluation period, representing an 86.7% success rate. Another FPD was replaced because of a caries lesion on 1 abutment tooth away from the margin. One FPD fracture was associated with the subject having the greatest occlusal force (1,031 N). The other 2 fractures were associated with FPDs that exhibited connector heights of less than 3 mm. All criteria were ranked good to excellent during the 4-year period for the remaining FPDs. CONCLUSION: Fractured FPDs were associated with a connector height of less than 4 mm; thus, the hypothesis was accepted.