Digitally produced fiber-reinforced composite substructures for three-unit implant-supported fixed dental prostheses.

PURPOSE: This study aimed to evaluate the probability of survival, Weibull modulus, characteristic strength, and failure modes of computer-aided design/computer-assisted manufacture (CAD/CAM) fiber-reinforced composite (FRC) substructures used for implant-supported fixed dental prostheses (ISFDPs). MATERIALS AND METHODS: Three-unit ISFDPs (first molar pontic) fabricated as a monolithic composite piece or as composite veneered on a CAD/CAM FRC substructure with either a 12-mm² or 3-mm² connector area (n = 18 each) were subjected to step-stress accelerated life testing in water. Use-level probability Weibull curves and the probability of survival were calculated. Fractographic analysis was performed under polarized light and scanning electron microscopy. RESULTS: Fatigue did not accelerate the failure of any group, whereas prosthesis strength was the main factor in increased failure (ß < 1). The probability Weibull contour plot showed no differences between the ISFDPs with 12 mm² and the monolithic composite ISFDP in characteristic strength (η = 643.5 N and 742.7 N, respectively) or Weibull modulus (6.7 and 5.8, respectively), whereas both were significantly higher than 3 mm² (444.91 N and 9.57). The probability of survival was not statistically different between groups at 100,000 mission cycles at 300 N. Differences were observed in fatigue failures above 800 N; monolithic composite ISFDPs failed catastrophically, whereas those with CAD/CAM FRC substructures presented veneer/composite cohesive or adhesive failures. Cracks evolved from the occlusal contact toward the margins of the cohesively failed composite, and in CAD/CAM FRC prostheses, competing failure modes of cracks developing at the connector area with those at the indentation contact were observed. CONCLUSION: The probability of survival did not differ between CAD/CAM FRC with either 3-mm² or 12-mm² connector areas, monolithic composite, or metal-ceramic ISFDPs previously tested under the same methodology. However, differences in failure modes were detected between groups.

Resolution of complex esthetic problems in abnormal anterior teeth: a clinical report.

A conservative treatment is presented for a patient with complex severe esthetic problems related to the presence of anomalous teeth. The patient showed a rare occurrence of macrodontia of the maxillary right lateral incisor and microdontia of the maxillary left lateral incisor. The treatment plan was conservative to avoid tooth extraction, periodontal tissue trauma, and the risk of an unpredictable esthetic outcome. A multidisciplinary treatment involving orthodontic extrusion, endodontic therapy, periodontal therapy, and minimally invasive restorations was performed. A successful outcome was observed after a 2-year follow-up.

Cements and adhesives for all-ceramic restorations.

Dental cements are designed to retain restorations, prefabricated or cast posts and cores, and appliances in a stable, and long-lasting position in the oral environment. Resin-based cements were developed to overcome drawbacks of nonresinous materials, including low strength, high solubility, and opacity. Successful cementation of esthetic restorations depends on appropriate treatment to the tooth substrate and intaglio surface of the restoration, which in turn, depends on the ceramic characteristics. A reliable resin cementation procedure can only be achieved if the operator is aware of the mechanisms involved to perform the cementation and material properties. This article addresses current knowledge of resin cementation concepts, exploring the bonding mechanisms that influence long-term clinical success of all-ceramic systems.

Cements for use in esthetic dentistry.

Dental cements are designed to retain restorations, appliances, and post and cores in a stable and, presumably, long-lasting position in the oral environment. Conventional glass ionomer and zinc phosphate cements are among the most popular materials for luting metallic restorations and posts, whereas resin-based cements are preferred for esthetic applications. Successful cementation of esthetic restorations is largely dependent on the appropriate treatment and silane application to the internal surface of the restoration. Clinicians are frequently advised to use three-step total-etch or two-step self-etch adhesive for luting purposes to avoid problems of incompatibility between adhesives and chemical- or dual-cure cements. A reliable cementation procedure can only be achieved if the operator is aware of the mechanisms involved and the material limitations.