The effect of a fiber reinforced cavity configuration on load bearing capacity and failure mode of endodontically treated molars restored with CAD/CAM resin composite overlay restorations.

OBJECTIVES: To evaluate the fracture strength and the mode of failure of endodontically treated molars restored with CAD/CAM overlays with fiber reinforced composite build-up of the pulp chamber. METHODS: 40 Devitalized molars were cut over the CEJ and divided into five groups (n=8). The pulp chamber area was filled with: group 0 (control), no resin build-up; group 1, hybrid composite build-up (G-aenial posterior, GC); group 2, as in group 1 but covered with 3 nets of bi-directional E-glass fibers (EverStickNET, Stick Tech Ltd.); group 3, a FRC resin (EverX posterior, GC); group 4, as in group 3 but covered by the bi-directional fibers. The crowns were restored with CAD-CAM composite restorations (Lava Ultimate, 3M ESPE). Maximum fracture loads were recorded in Newton and data were analyzed using Kruskal-Wallis test (p<0.05). Fragments were analyzed using SEM. RESULTS: The mean static loads in Newton were: group 0: 2448 (546); group 1: 2817 (873); group 2: 2128 (952); group 3: 2429 (1091); group 4: 2577 (833). No significant differences were found between the groups (p>0.05). All specimens fractured in a catastrophic way, under the CEJ. The main crack evolved in the corono-apical direction. In groups 2 and 4 secondary fracture paths with apico-coronal direction were detected close to the bi-directional fibers' layer. CONCLUSIONS: For the restoration of endodontically treated molars, the incorporation of FRCs did not influence the load-bearing capacity of the tooth-restoration complex. The SEM analysis showed a low ability of the bi-directional fibers net in deviating the fracture but this effect was not sufficient to lead more favorable fracture patterns, over the CEJ. CLINICAL SIGNIFICANCE: The use of FRCs to reinforce the "core" of devitalized molars against vertical fractures under static loads seems useless when the thickness of the CAD/CAM composite overlay restoration is high.

Effect of different surface treatments on the hydrothermal degradation of a 3Y-TZP ceramic for dental implants.

OBJECTIVES: Implant surface modifications are intended to enhance bone integration. The objective of this study was to assess the effect of different surface treatments on the resistance to hydrothermal degradation, hardness and elastic modulus of a 3Y-TZP ceramic used for dental implants. METHODS: Samples grouped according to their surface morphologies (AS, as-sintered; C, coated; P, dry-polished; R, roughened; PA, polished and annealed; RA, roughened and annealed) were subjected to accelerated hydrothermal degradation (LTD) by exposure to water steam (134°C, 2bars) for 100h. The t-m phase transformation was quantified by grazing incidence X-ray diffraction (GIXDR) and by combined focused ion beam and scanning electron microscopy (FIB-SEM). Elastic modulus and hardness before- and after prolonged aging (100h) were assessed by nanoindentation. RESULTS: AS and C specimens presented a better resistance to hydrothermal degradation than P and R samples. After prolonged aging, the depth of the monoclinic transformed layer ranged from 11µm to 14µm. Hydrothermal degradation led to a significant decrease of elastic modulus and hardness. SIGNIFICANCE: Surface treatments affected the resistance to hydrothermal degradation of the 3Y-TZP ceramic. Dry mechanical surface modifications should be avoided since a high t-m transformation rate associated to the initial monoclinic content was observed. Annealing was useful to reverse the initial t-m transformation, but did not improve the resistance to hydrothermal degradation.

Post-hot isostatic pressing: a healing treatment for process related defects and laboratory grinding damage of dental zirconia?

OBJECTIVE: Processing parameters (powder granulation, compaction, debinding, greenbody shaping, sintering) and post-sinter rough, even fine grinding are influencing the final mechanical properties of 3Y-TZP. The hypothesis of this study was that post-sinter hot isostatic pressing (post-HIP) would be beneficial for improving reliability and strength of both sintered and coarse ground sintered zirconia by closing or reducing surface and/or small volume defects. METHODS: 75 sintered bars of an experimental 3Y-TZP (3mm×4mm×45mm) with chamfered edges and 15µm diamond surface finish were provided by the manufacturer (Ivoclar Vivadent) and randomly distributed in five groups of N=15 each. G1 served as control (as received); G2 was post-HIPed at 1400°C and G3 at 1350°C, both using a pressure of 195MPa in Ar for 1h; G4 was coarse ground with 120µm diamond disk grain size; G5 was ground 120µm and post-HIPed at 1350°C at 195MPa, 1h in Ar. The specimens were fractured in air in 4 point-bending. Weibull characteristic strength (σ0) in MPa, m parameter (reliability) and confidence intervals (CI) at 90% confidence level are reported. Identification of the critical flaw was performed by SEM on the fractured surface of all specimens and XRD performed in all groups. RESULTS: G1: σ0=973 (932-1016), m=10.6 (7.45-15.1); G2: σ0=930 (871-995), m=6.9 (4.87-9.9); G3: σ0=898 (848-952), m=7.94 (5.6-11.4); G4: σ0=921 (857-991), m=6.35 (4.48-9.11); G5: σ0=881 (847-918), m=11.4 (8.03-16.3). G5 had a significantly lower σ0 than G1. No significant differences were seen in the reliability (m) among the groups. Fractography revealed critical intrinsic subsurface flaws of 10-60µm present in all groups resulting from the processing parameters. No "healing" (i.e. closing of defects by densification) resulted after post-HIP. Grinding sintered zirconia with 120µm diamond disks induced radial cracks of 10-20µm and an important pseudo-cubic phase transformation (56wt%) that was not completely removed after post-HIP. Post-HIP increased slightly the relative density by 0.1% but without improving the strength and reliability. SIGNIFICANCE: Post-HIP was not efficient in closing large (10-60µm) subsurface (volume) processing defects.

Titanium nitride oxide coating on rough titanium stimulates the proliferation of human primary osteoblasts.

OBJECTIVES: Titanium is widely used in contemporary endosseous implantology and there is considerable thrust to further promote osseointegration by implant surface modifications. The aim of this study was to evaluate the effect of a titanium-nitride-oxide (TiNOx) coating on commercially pure microroughened titanium by assessing the proliferation and differentiation of human primary osteoblasts. MATERIALS AND METHODS: Cell proliferation, gene expression, alkaline phosphatase activity, osteoprotegerin and osteocalcin secretion were analyzed for a time course of 3 weeks, with or without additional stimulation by 1.25(OH)(2) vitamin D(3) 100 nM. RESULTS: A 1.5-fold increase in the proliferation rate of cells grown on TiNOx-coated titanium as compared with uncoated surfaces was observed. SEM views indicated that the cells' normal morphology with their numerous extensions was maintained. The differentiation process on the TiNOx surface was only affected to a minor degree and translated into a slight delay in osteoblast maturation when compared to uncoated titanium. CONCLUSION: Pending confirmation of these results in vivo, TiNOx coatings could potentially accelerate and enhance osseointegration.

Comparative study of the physical properties of a polyacid-modified composite resin and a resin-modified glass ionomer cement.

OBJECTIVES: The physical properties of the resin-modified composite resin Dyract (Detrey Dentsply) and the resin-modified glass ionomer cement Fuji II LC (GC) were compared, and the effect of water sorption on these properties was studied. METHODS: Compressive, diametral compressive and flexural strengths were measured using specimens aged up to three months. The Vickers hardness and the water erosion were also determined. The specimens were stored at 37 degrees C under five different conditions, chosen to vary the water sorption of the samples. The results were analyzed using a multi-factor analysis of variance. RESULTS: Dry specimens of Dyract and Fuji II LC showed similar properties. However, the two materials behaved differently when stored in presence of water. In contrast to Fuji II LC, Dyract showed very little expansion for the first 24 h (1.5 +/- 0.3 and 0.03 +/- 0.01%, respectively), leached small quantities of ions and retained its mechanical strength. Those differences are related to their chemical composition. Fuji II LC is hydrophilic, as it contains polyHEMA. In the presence of water, Fuji II LC behaves like a hydrogel, but the network resulting from the copolymerization of acidic and UDMA monomers is less hydrophilic, and the effect of water on Dyract is retarded. SIGNIFICANCE: The significant properties of Dyract are determined by its composite character. This certainly represents some advantages, for instance, a higher mechanical strength, a better protection against initial dehydration and subsequent water effects. However, Dyract shows some disadvantages over Fuji II LC, like a lower amount of fluoride release or the interference of oxygen during polymerization.

Effect of water on the physical properties of resin-modified glass ionomer cements.

OBJECTIVES: Resin-modified glass ionomer cements (GIC) are available for clinical use as restorative materials or as liners and bases. This work was conducted to study the effect of water sorption on the physical properties of several resin-modified GIC, by changing the samples' storage conditions. METHODS: The water sorption, the flexural strength, the flexural elastic modulus, the Vickers hardness and the dimensional changes of five resin-modified GICs were measured using specimens aged for 24 h to 3 mon. The specimens were stored at 37 degrees C, either in a dry environment (A), immersed in water (B), stored in a humid environment (C), stored in a humid environment for 1 h and then immersed in water (D), or immersed in water and subsequently dried (B + A). An analysis of variance was used to compare the results. RESULTS: The resin-modified GIC absorb during the first 24 h large amounts of water (114-172 mg/cm3) compared to the conventional GIC (30-63 mg/cm3). Water alters the physical properties of resin-modified GICs: With regard to dry specimens, a decrease in the flexural strength of 20 to 80% was observed for samples immersed in water. Decreases in their flexural elastic modulus (50 to 80%) and in their hardness (approximately 50%) were also observed. Water sorption also provoked an expansion in volume of the immersed specimens, ranging from 3.4 to 11.3% after 24 h. SIGNIFICANCE: The flexural strength and Vickers hardness of the resin-modified GICs are sensitive to the water contained in the tested specimens. A correlation was established between the decrease in their physical properties and the water uptake. However, it should not be concluded that these materials are not adequate for use in applications in direct contact with oral fluids. Probably, resin-modified GIC placed in oral cavities would not be affected to the same extent as in in vitro tests. In an oral environment, the constituents of saliva will certainly decrease the rate of water sorption and will hence delay its effects.

Compomers: between glass-ionomer cements and composites.

The term 'compomer' was crafted by the producers of the first commercial material of this kind: a polyacid-modified composite resin, sold as a filling material for some specific applications. This term should recall the composite resins and glass-ionomer cements, since some features of these two generic materials are found in the compomers. Compomers contain a bifunctional monomer, which should be able to react with the pendant methacrylate groups of other monomers, as well as with the cations liberated by the glass particles. Several products of this kind are now available, and the purpose of this paper is to describe some of their specificities and to compare their influence on the mechanical properties, water uptake and fluoride release.

Mechanical behavior of glass ionomer cements affected by long-term storage in water.

OBJECTIVES: The early strength of glass ionomer cements was investigated previously (Cattani et al., 1993). Using the same set of glass ionomer cements, this study was designed to determine if mechanical property degradation occurred after an extended period of storage in water. METHODS: In the present study, the effect of aging in water on the compressive, tensile and flexural strengths of twelve commercial glass ionomer cements was evaluated at different time intervals after the beginning of the setting reaction. The aging periods varied from 24 h to 12 mon. RESULTS: The results show that the mechanical properties of the tested materials are in some cases affected by long-term aging in water. The evolution of strength follows distinct patterns of change. It has been established that the glass ionomer cements are neither characterized by a continuous increase nor a continuous decrease in strength. Most of the materials tested maintained a constant strength. However, several of them first display an improvement of the mechanical strength followed by a reduction. In this case, the 24h and the 12 mon strengths are usually similar. SIGNIFICANCE: The aging mechanisms of glass ionomers are complex. Strengthening probably results from additional crosslinking and build-up of a silica gel phase, whereas weakening may result from erosion and plasticizing effect of water.

Early strength of glass ionomer cements.

The present study compared the compressive, tensile and flexural strengths of 26 commercial glass ionomer cements, which were evaluated 24 h after the beginning of the setting reaction. In order to give a global estimation of their overall strength, a coefficient was attributed to each glass ionomer cement. This strength coefficient provided a ranking of the tested materials. The highest scores were obtained by the restorative glass ionomers; however, these materials exhibited lower mechanical properties than the more classic restorative materials such as amalgams or composites. The results also showed a large scattering of the mechanical properties among the luting and lining glass ionomer cements. The creep behavior of the glass ionomer cements was also investigated.