In vitro evaluation of CAD/CAM composite materials.

OBJECTIVES: The purpose of this in vitro study was to evaluate the microstructural, elemental and mechanical properties of contemporary computer-aided-design/computer-aided manufacturing (CAD/CAM) resin based composite (RBC) materials. METHODS: Six CAD/CAM RBC materials [Brilliant CRIOS (Coltene Whaledent AG), Cerasmart (GC), Lava Ultimate (3M ESPE), Tetric CAD (Ivoclar Vivadent), Shofu Block HC (Shofu), Grandio Blocs (VOCO GmbH)] were tested. Ten rectangular blocks (14 Χ 12 Χ 18 mm) for each material, after metallographic grinding and polishing, were subjected to Instrumented Indentation Testing (ΙIT). Martens Hardness (HM), Indentation Elastic Modulus (EIT), Elastic (ηIT) and Creep indices (CIT) were determined according to formulas provided by ISO 14577. The diagonal length of each indentation was measured and HV was determined. The results of HM, EIT, ηΙΤ, HV, and CIT were statistically analyzed by one-way ANOVA and Tukey post hoc test employing the material as a discriminating variable (a = 0.05), while the possible correlations were determined by Spearman's correlation test. One specimen from each group was examined by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). RESULTS: Backscattered Electron images and EDX analysis demonstrated differences in size, shape and type of fillers along with elemental composition among materials tested. Statistical significant differences were identified for all mechanical properties tested. Grandio Blocs had the significantly higher HM (953±7 N/mm2), HV (136±1) and EIT (23±1 GPa) followed by Lava Ultimate (ΗM=674±25 N/mm2, HV=105±2, EIT=15±1 GPa). Elastic index ranged from 41% to 52%, with Shofu Block demonstrating the significantly highest ηIT (52 ± 1%) values. Cerasmart had significantly higher CIT value (8.4 ± 0.1%) than all other materials tested, while Grandio Blocs and Lava Ultimate had the lowest ones. Spearman's correlation revealed that all mechanical properties tested exhibited correlations with each other, apart from ηΙΤ. CONCLUSIONS: The results showed that the CAD/CAM materials tested have differences in their microstructure, elemental composition and mechanical properties. CLINICAL SIGNIFICANCE: The RBCs tested showed significant differences in mechanical properties and thus differences in clinical performance are anticipated. RBCs with increased filler loading had the most favorable combination of hardness, elastic modulus and creep index indicating that these materials may have better clinical performance under intraoral loading conditions.

Effect of aging on color, gloss and surface roughness of CAD/CAM composite materials.

OBJECTIVES: To assess the effect of aging procedures on color, gloss and surface roughness of CAD/CAM composite materials. METHODS: 6 CAD/CAM composite materials (Brilliant CRIOS, Cerasmart, Lava Ultimate, Tetric CAD, Shofu Block HC, Grandio Blocs) were tested. 10 CAD/CAM fabricated specimens of each material polished according to manufacturers' recommendations, were subjected to one of the following aging procedures; immersion in coffee (30 days, 37οC), water thermocycling (5000 cycles, 5-55 °C) and photoaging (150,000 kJ/m2). Color, gloss and surface roughness measurements were performed before and after aging and the respective changes were calculated. Kruskal-Wallis tests, paired t-tests, one-way ANOVA and Bonferroni post-hoc tests were used for statistical analysis (a = 0.05). RESULTS: Color changes ranged from 3.03 to 4.13 after coffee immersion, from 1.33 to 2.55 after thermocycling and from 1.02 to 2.75 after photoaging. No statistically significant differences for ΔE*ab were found among materials after coffee immersion and thermocycling (p>0.05). Gloss changes ranged from -5.7 to -1.6 GU after coffee immersion, from -2.3 to 0.1 GU after thermocycling and from -4.4 to 0.5 GU after photoaging. No significant differences in gloss changes were found among materials after aging (p>0.05). Tetric CAD demonstrated the significantly lower gloss and the higher surface roughness after polishing. Except for gloss after thermocycling, aging procedures caused significant alteration of gloss and surface roughness parameters from baseline levels. CONCLUSIONS: Aging procedures caused perceptible but acceptable color changes and small but visible gloss changes, while surface roughness parameters of the tested CAD/CAM composite materials were significantly affected by aging. CLINICAL SIGNIFICANCE: Aging procedures affected CAD/CAM composite materials indicating that these materials may be prone to color and surface alterations in the oral environment that could compromise the esthetics and the performance of the restorations. Clinical studies are needed to investigate the long-term behavior of the newly introduced CAD/CAM materials.

Effect of Staining Solutions on Color Stability, Gloss and Surface Roughness of Removable Partial Dental Prosthetic Polymers.

PURPOSE: To assess the effect of commonly used solutions on color stability, gloss, and surface roughness of removable partial dental prostheses polymers. MATERIALS AND METHODS: Discs (n = 112) were made of a poly(etheretherketone) (PEEK) polymer, a polyamide, an acetal resin and a heat-cured poly(methylmethacrylate) PMMA acrylic resin polished according to manufacturers' instructions. Seven specimens of each material were immersed in coffee, red wine, coca cola and distilled water for 30 days at 37ο C. Changes of color (ΔΕ*) and color coordinates L*α*b* after immersion were calculated with a colorimeter. Changes in the values of gloss and surface roughness parameters (Sa, Sz, Str, Sdr, Sci, Svi) were also measured. Two-way ANOVA and pairwise comparisons were used to evaluate the effect of material and staining solution on parameter value alterations (α = 0.05). RESULTS: The two-way ANOVA revealed that the interaction between material and staining solution significantly affected color changes after immersion [F(9,96) = 44.67, p < 0.001]. PEEK presented the lowest color change (ΔΕ* = 3.83 ± 2) while polyamide had the highest color change overall (ΔΕ* = 14.59 ± 8.65) (p < 0.001). Coffee caused the highest color (ΔΕ* = 13.08 ± 6.98) and gloss changes (ΔG = -6.36 ± 19.2 GU) among different solutions (p < 0.001). PEEK showed the highest alteration of gloss (ΔG = -11.31 ± 15.49 GU), with significant difference with the other three materials (p < 0.001). Insignificant interaction of material and immersing solution was found for surface roughness parameters (p > 0.05). CONCLUSIONS: Among the materials tested, PEEK seemed to be the most stable material when subjected to common, everyday staining solutions. Therefore, PEEK could be a viable solution for an RPDP framework fabrication, expanding the material list of prosthetic options. Further research and clinical trials are required to confirm the above statement.

The use of PEEK in digital prosthodontics: A narrative review.

BACKGROUND: Advanced computer-aided design and computer-aided manufacturing (CAD-CAM) technology led to the introduction of an increasing number of machinable materials suitable for dental prostheses. One of these materials is polyetheretherketone (PEEK), a high performance polymer recently used in dentistry with favorable physical, mechanical and chemical properties. The purpose of this study was to review the current published literature on the use of PEEK for the fabrication of dental prostheses with CAD-CAM techniques. METHODS: Electronic database searches were performed using the terms "PEEK", "CAD-CAM", "dental", "dentistry" to identify studies related to the use of PEEK for the fabrication of CAD-CAM prostheses. The search period spanned from January 1990 through February 2020. Both in vivo and in vitro studies in English were eligible. Review articles and the references of the included publications were searched to identify relevant articles. RESULTS: A great number of in vitro studies are available in the current literature pointing out the noticeable properties of PEEK. The use of PEEK has been recommended for a wide range of CAD-CAM fabricated fixed and removable dental prostheses. PEEK was additionally recommended for occlusal splints, intra-radicular posts, implant abutments, customized healing abutments and provisional restorations. However, only a few clinical studies were identified. CONCLUSIONS: PEEK could be considered as a viable alternative for CAD-CAM fixed and removable dental prostheses to well-established dental materials. Due to the scarcity of clinical data, clinical trials are needed to assess the long-term performance of PEEK prostheses.

Modified PEEK as an alternative crown framework material for weak abutment teeth: a case report.

This case report describes the fabrication of 3 single crowns for a patient with weakened abutment teeth. The patient exhibited nocturnal bruxism and clenching but refused to use an occlusal appliance. The abutment teeth were endodontically treated and presented with loss of tooth structure and thin axial walls. The patient was seeking a metal-free restoration, and all-ceramic restorations were contraindicated because of the potential for abrasion of the opposing teeth and direct force transmission to the weak abutment teeth. The restoration of choice was a modified polyetheretherketone (PEEK) framework material veneered with an indirect light-cured composite resin. This approach offered characteristics such as biocompatibility, protection of opposing teeth, a cushioning effect, abrasion resistance almost equal to that of dentin, ease of intraoral repair in case of chipping, and a high level of comfort. The use of PEEK frameworks veneered with indirect light-cured composite resin could be a viable alternative for the treatment of weakened abutment teeth in patients with parafunctional habits.

Effects of sociodemographic, treatment variables, and medical characteristics on quality of life of patients with maxillectomy restored with obturator prostheses.

STATEMENT OF PROBLEM: Restoration of maxillary defects resulting from tumor ablative surgery presents a difficult challenge, with both functional and esthetic issues. Whether rehabilitation with an obturator prosthesis could significantly contribute to improved quality of life in patients with maxillary resection has been scarcely studied, with relatively small study samples. PURPOSE: The purpose of this survey study was to assess the overall functioning of the obturator prosthesis and the effect of specific sociodemographic, medical, and treatment variables on obturator functioning and quality of life in patients with maxillectomy. MATERIAL AND METHODS: Global quality of life (QOL) and satisfaction with the obturator prosthesis of 57 patients who underwent maxillectomy and prosthetic rehabilitation at the National and Kapodistrian University of Athens were assessed using 3 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30), the EORTC QLQ-HN35, and the obturator functioning scale. The data were analyzed using the Kruskal-Wallis 1-way ANOVA on ranks, hierarchical multiple regression analysis, and the Spearman rank order correlation (α=.05). RESULTS: Satisfactory functioning of the obturator prosthesis was the most significant predictor of improved QOL (P<.05). QOL was significantly related to additional treatments (P<.05), the size of the primary tumor (P<.05), and the size of the maxillectomy defect (P<.05). The most significant predictors of good obturator functioning were additional treatments (P<.01), age at the time of surgery (P<.05), presence of mandibular teeth (P<.05), and previous maxillary removable prosthetic experience (P<.05). Obturator functioning scale appearance and insertion subscales (r=0.47, P<.01), followed by speech (r=0.42, P<.01), were significantly related to better QOL. CONCLUSIONS: A well-functioning obturator prosthesis was the most significant determinant for improved QOL in patients with maxillary resection. Age at the time of surgery, adjuvant treatments, presence of mandibular teeth, and previous maxillary removable prosthetic experience were the most significant predictors for better obturator functioning, whereas the size of the maxillectomy defect had a significant effect on QOL but did not influence the functional outcome.

Modified PEEK resin-bonded fixed dental prosthesis as an interim restoration after implant placement.

A polyetheretherketone (PEEK) (BioHPP) framework veneered with composite resin was used as an alternative material for the fabrication of an interim 3-pontic resin-bonded fixed dental prosthesis (RBFDP) after implant placement. The low modulus of elasticity (4 GPa) of PEEK combined with the use of indirect light-polymerized resin as a veneering material used for a RBFDP provided an advantage over metal ceramics or ceramics in dampening the occlusal forces and reducing debonding rates. Further long-term clinical evidence is required before recommending the application as a substitute material.

The Use of a Modified Poly-Ether-Ether-Ketone (PEEK) as an Alternative Framework Material for Removable Dental Prostheses. A Clinical Report.

This clinical report presents a modified poly-ether-ether-ketone (PEEK) as an alternative material for the fabrication of distal extension removable dental prosthesis (RDP) frameworks. This material can be used for patients allergic to metals, or who dislike the metallic taste, the weight, and the unpleasant metal display of the denture framework and retentive clasps. This modified PEEK material, known as BioHPP, is a biocompatible, nonallergic, rigid material, with flexibility comparable to bone, high polishing and low absorption properties, low plaque affinity, and good wear resistance. It has been used for years in orthopedics and medical technology. BioHPP frameworks can be constructed either via CAD/CAM manufacturing or via the conventional lost wax technique. The clinical use of a BioHPP RDP framework is presented as an alternative for the treatment of a distal extension case.

Marginal discoloration of all-ceramic restorations cemented adhesively versus nonadhesively.

BACKGROUND: The authors conducted a systematic review to correlate the clinical incidence of marginal discoloration of all-ceramic restorations with the mode of cementation (adhesive versus nonadhesive). TYPES OF STUDIES REVIEWED: The authors conducted a literature search by using electronic databases, relevant references, database citations and journal hand searches for clinical studies of marginal discoloration of all-ceramic restorations with a mean follow-up time of at least five years. The search period spanned January 1990 through February 2011. The authors reported and compared summary estimates and five-year event rates. RESULTS: The authors selected 16 studies for final analysis from an initial yield of 346 articles. The mean observation time ranged between five and 10 years. The majority of studies used adhesive luting procedures for definitive cementation. In only one study did investigators report regarding the incidence of marginal discoloration of both adhesively and nonadhesively cemented all-ceramic restorations, and the difference between the luting types in terms of discoloration was not statistically significant (P = .5). CLINICAL IMPLICATIONS: The results of this systematic review showed that there is a lack of studies with findings regarding marginal discoloration rates of nonadhesively luted all-ceramic restorations. Unacceptable marginal discoloration rates of adhesively luted all-ceramic prostheses were relatively low even at 10 years of service.