Fracture strength, pull-out bond strength, and volume of luting agent of tooth-colored CAD-CAM post-and-cores.

STATEMENT OF PROBLEM: Little is known about the fracture strength, retention, and adaptation of post-and-cores fabricated with novel tooth-colored materials by computer-aided design and computer-aided manufacturing (CAD-CAM). PURPOSE: The purpose of this in vitro study was to investigate the fracture strength, pull-out bond strength (POBS), and volume of luting agent of endodontically treated premolars restored with post-and-cores milled from different CAD-CAM materials. MATERIAL AND METHODS: Post spaces were prepared in 80 human premolars in which post-and-cores fabricated with polyetheretherketone (PK; Ceramill PEEK), nanohybrid composite resin (BB; Brava Block), polymer-infiltrated ceramic (EN; VITA Enamic), and fiber-reinforced epoxy resin (GF; Fiber Cad Post & Core) CAD-CAM materials were luted (n=20). All specimens were subjected to thermal aging (3000 cycles at 5 °C and 55 °C with a 20-second dwell time). Half of the specimens were subjected to mechanical fatigue (250 000 cycles at 5 Hz) before fracture strength testing, while the other half was submitted to POBS testing and volume of luting agent measurement. Fracture strength data were analyzed by 1-way ANOVA, while POBS and volume of luting agent data were submitted to Kruskal-Wallis followed by the Bonferroni-Dunn multiple comparison tests. The correlation between POBS and the volume of luting agent was determined by the Spearman test (α=.05). RESULTS: POBS of GF was significantly higher than that for PK (P<.001); however, failure load (P=.160) and volume of luting agent (P=.390) values did not differ. EN showed the highest percentage of catastrophic failures (20%), while PK exhibited only core deformations. POBS and cement film volume were not significantly correlated (P>.05). CONCLUSIONS: Different CAD-CAM materials did not influence the fracture strength and volume of luting agent of post-and-cores. Post-and-cores made with PEEK blocks showed lower bond strength to intracanal dentin than those made with fiber-reinforced epoxy resin blocks. No significant correlation was found between bond strength and the volume of luting agent.

Effect of half-digital workflows on the adaptation of custom CAD-CAM composite post-and-cores.

STATEMENT OF PROBLEM: Even without the use of an intraoral scanner, post-and-cores can be obtained by using a part-digital fabrication workflow that requires pattern modeling (direct, indirect, or impression); however, studies on the adaptation of computer-aided design and computer-aided manufacturing (CAD-CAM) composite resin post-and-cores in comparison with metal cast post-and-cores are sparse. PURPOSE: The purpose of this in vitro study was to analyze the adaptation of CAD-CAM composite resin post-and-cores fabricated through a part-digital fabrication workflow and to compare it with that of metal cast post-and-cores fabricated through conventional methods. METHOD AND MATERIALS: Eight extracted human premolars were endodontically treated and prepared for custom post-and-cores. Metal cast post-and-cores were fabricated with Ni-Cr alloy (Fit Cast-Sb Plus; Talmax) and conventional resin pattern modeling methods directly in the root canal (conventional direct modeling) or indirectly in a stone cast (conventional indirect modeling). Composite resin post-and-cores were milled from nanohybrid glass-ceramic composite resin CAD-CAM blocks (Brava Block; FGM) by using the part-digital workflow. A laboratory scanner was used to digitalize polyvinyl siloxane impressions (part-digital scanned impression direct CAD-CAM [PSC]) of the root canals and resin patterns fabricated directly (part-digital direct CAD-CAM [PDC]) or indirectly (part-digital indirect CAD-CAM [PIC]). All post-and-cores were placed in the respectively prepared root canals, scanned with microcomputed tomography, and measured in terms of volume of the cementation space, the luting cement film thickness in each root third, and the apical gap between the apical end of the post-and-cores and remaining gutta percha (apical gap). The groups were compared for each adaptation parameter by using 2-way (volume of the cementation space and apical gap) and 3-way (film thickness) ANOVA, and the Games-Howell multicomparison post hoc test (α=.05). RESULTS: The conventional direct modeling group had lower mean volume of the cementation space than all CAD-CAM composite resin post-and-cores (P<.041). The conventional indirect modeling group had a lower volume of the cementation space mean than PDC (P<.024) but was not significantly different from PIC (P=.577) or PSC (P=.221). Regardless of the fabrication workflow, no differences were observed among the CAD-CAM composite resin post-and-cores (P>.05). At the apical root third, conventional direct modeling and conventional indirect modeling had lower film thickness means than PSC or PDC (P<.05). In the middle third, conventional direct modeling and conventional indirect modeling had lower film thickness means than PDC (P≤.001). At the cervical third, no differences in film thickness means were observed among the groups (P>.05). PDC had a lower apical gap mean than PSC (P=.013), while no significant differences were found for other pair comparisons (P>.05). CONCLUSIONS: Metal post-and-cores had slightly better adaptation than the CAD-CAM composite resin post-and-cores; however, the part-digital fabrication workflow of CAD-CAM composite resin post-and-cores provided adaptation parameters within a clinically acceptable range and is less time consuming.

CAD/CAM post-and-core using different esthetic materials: Fracture resistance and bond strengths.

PURPOSE: To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. METHODS: 90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). RESULTS: The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±100.3 (RC), and 407.6±109.0 (FG), with RC showing significantly higher FR values (P< 0.05). For BS, there was no statistically significant difference among the materials, with and without fatigue (P> 0.05). The type of material used to obtain the CAD/CAM-customized post-and-cores had a significant effect on the FR, but not on the BS of the specimens. Fatigue did not influence the BS for the tested materials. CLINICAL SIGNIFICANCE: CAD/CAM custom-made esthetic post-and-cores showed good performance relative to fracture resistance and bond strength to root canal dentin walls. The CAD/CAM materials tested could be used as an alternative to restore wide flared root canals in esthetically compromised teeth.

Técnica Indirecta Para Reparación De Prótesis Parcial Fija Metal-Porcelana Relato Del Caso

Debido a la excelente estética y biocompatibilidad, las restauraciones con cerámicas son frecuentemente utilizadas en la práctica clínica diaria. A pesar de la evolución de las propiedades mecánicas de las cerámicas, existen casos extensos en que la indicación principal es el uso de coronas metalo-cerâmicas. Frente a la posibilidad de la fractura de esas prótesis, que ocurren del 5 y al 10% en 10 años de uso, existe la opción de reparar dichas prótesis, disminuyendo el costo y el tiempo operacional. Cuando la falla expone la porción metálica de la pieza, se indica una reparación indirecta, que consiste en la confección de una sobre estructura, cementada en la región previamente preparada, a partir de un modelo de trabajo. El objetivo de este trabajo fue demostrar una técnica de reparación indirecta de prótesis parciales fijas utilizando una sobre estructura metalo-cerámica.

Due the excellent esthetic and biocompatibility, metal ceramic restrations are frequently used at clinical daily practice. In sipte of the ceramic mechanical properties evolution, there are extensive cases that the primary indication are metalceramic crowns. Ahead of the possible fractures of these prosthesis, that happen from the 5 to 10% in 10 years of use, there are option to repair it, diminishing cost and chair time. When the failure expose the metal portion it indicates a indirect repair wich consist in manufacturing of a overlay, cemented on region that was previosly prepared, from a work cast. The aim of this study was demonstrate a indirect repair technique of fixed partial dentures using a metalceramic overlay.