Influence of Different Post-endodontic Restorations on the Survival Rate Against Fracture of Endodontically Treated Anterior Teeth Affected by Cervical Lesions with Pulpal Involvement: A Retrospective Clinical Study.

OBJECTIVE: To compare the survival rate against fracture of endodontically treated anterior teeth (ETT) affected by cervical (class V) lesions with pulpal involvement restored with resin composite or a post/core and crown, and to identify the prognostic factors for fracture. METHODS: Dental records and radiographs of ETT affected by cervical lesions with pulpal involvement restored with resin composite or a post/core and crown during a recall period from 2009-2022 were selected according to the inclusion and exclusion criteria. The number of tooth fracture, the restorability after fracture and any possible risk factors were identified. The survival rate against ETT fracture were analyzed and com- pared between the two restoration groups by Kaplan-Meier survival analysis and the Tarone-Ware test. Non- proportional hazard models were used to identify the prognostic factors. The sub-analysis in each restoration group was also performed. RESULTS: The study comprised 175 ETT restored with resin composite (n=125) or a crown (n=50). With a mean recall period of 32.9+-15.8 months, the survival rate against ETT fracture with resin composite (85.6%) was not significantly different from those with a crown (88%) (p≥0.05). The most frequent mode of fracture was crown-root fracture, which accounted for 78% and 83.30% of the fractures in the resin composite and crown groups, respectively. A significant prognostic factor for ETT fracture affected by cervical lesions with pulpal involve- ment was additional tooth structure loss from a class III, class IV or another class V lesion on the opposite side (p<0.05). The ETT affected by cervical lesions with pulpal involvement combined with additional tooth structure loss had a 7.25-fold higher risk of fracture than those with single-surface affected by cervical lesions with pulpal involvement (hazard ratio [HR] = 7.25; 95% confidence interval [CI], 1.68-31.30). The sub-analysis in the crown and resin composite groups revealed that the survival rates of ETT with single-surface affected by cervical lesions with pulpal involvement was 100% and 96.15%, respectively, which were significantly higher than those of ETT with additional tooth loss at 80.65% and 78.08%, respectively (p<0.05). CONCLUSION: With a mean 33-month recall period, the survival rate against ETT fracture affected by cervical lesions with pulpal involvement restored with resin composite or crown were not significantly different. Additional tooth structure loss was a significant prognostic factor for fracture.

Flexural strength, fatigue life, and stress-induced phase transformation study of Y-TZP dental ceramic.

OBJECTIVES: Yttria partially-stabilized zirconia polycrystalline (Y-TZP) has been the subject of extensive research because of its high strength and toughness. The aim of this study was to evaluate the biaxial flexural strength, fatigue life, and to investigate in more detail on single cycle specimens, the pressure-induced phase transformation of a Y-TZP dental ceramic using Raman microspectroscopy. MATERIALS AND METHODS: Thirty standardized discs (15 x 1.2 mm(2)) were used to examine the biaxial flexural strength (ISO 6872 standard) using a Dartec HC10 Servohydraulic testing machine (Zwick Ltd., UK). The specimens were also submitted to Vickers hardness (on polished and as-received surfaces within the same specimen) and dynamic fatigue test. The initial bulk phases were examined via X-ray diffraction and the local phase transformations that occurred in the zirconia induced by the various Vickers indentation loads (20-50 kg) were examined via Raman microspectroscopy on single cycle specimens. The fracture surface after biaxial flexural testing was also examined via Raman spectroscopy. RESULTS: The Cercon specimens tested had flexural strength and Weibull modulus (m) of approximately 823.3 (+/-114.7) MPa and 8.3, respectively. As-received surfaces (1378.7 +/- 51.8 Hv) had slightly higher hardness value compared with polished surfaces (1354.33 +/- 50.9 Hv); however, two-way analysis of variance showed no significant difference in hardness values between polished and as-received surfaces (P > 0.05). Additionally, the specimens survived to 5 x 10(5) cycles when using a load of 70% of the mean biaxial flexural strength or lower. Raman microspectroscopy showed transformation of tetragonal to cubic and monoclinic phases within the indentation area. The fraction of monoclinic phase showed only limited variation with load or distance from the center to indentation edge. The level of cubic phase, however, was greatest at the indentation center. Transformation to cubic phase was observed on the lower surfaces (tension side) of fractured specimens. It was also observed near the specimen center exposed upon fracture. In the latter region an increase in monoclinic phase was additionally observed. Further work will be carried out using Raman microspectroscopy to assess the effect of fatigue on phase transformations. CONCLUSION: The zirconia based ceramic has mechanical properties that may allow it to withstand the loading found in posterior areas. Transformation toughening was found when high loads impacted on the surface of zirconia. However it should be born in mind that this work was not carried out on veneered specimens, which exhibit different failure modes.

Fatigue and fracture properties of yttria partially stabilized zirconia crown systems.

OBJECTIVES: The purpose of this study was to test in vitro the fatigue and fracture properties of the Zirconia Everest core material after being veneered with a sintered or a heat-pressed veneer material. METHODS: Fifty zirconium copings were made using Kavo Everest ZS-blanks and the CAD/CAM technology. These were divided equally into two groups. Group one was veneered by a heat-pressed material (IPS e.max ZirPress) and group two was veneered by a sintered material (IPS e.max Ceram). All the crown shapes were subjected to 50,000 cycles of cyclic loading in water between 20 and 200 N, at a rate of 1 Hz and then loaded dynamically at a crosshead speed of 1 mm/min, until failure. Specimens of the core and the veneering materials were characterized using X-ray diffraction (XRD) and secondary electron imaging (SEI). RESULTS: There was no statistically significant difference in the mean failure load (N+/-S.D.) between group 1: 2135.6+/-330.1 and group 2: 2189.9.1+/-317.6 (p>0.05). No difference was found in the Weibull modulus and characteristic failure load values between the two groups (p>0.05). The specimens displayed mainly cohesive failure within the veneering material. XRD of the zirconium powder before sintering revealed tetragonal and monoclinic phases while after sintering only tetragonal zirconia could be identified. SIGNIFICANCE: There was no difference in the fatigue properties of the Zirconia Everest core material following sintering or heat pressing of the veneering material (p>0.05).

The biaxial flexural strength and fatigue property of Lava Y-TZP dental ceramic.

OBJECTIVES: The development of yttrium oxide partially stabilized zirconia (Y-TZP) has allowed the use of ceramic in load-bearing sites. The aim of this study was to evaluate and compare the biaxial flexural strength, hardness and fatigue life of colored and uncolored zirconia in the LAVAtrade mark system. MATERIALS AND METHODS: Eight groups (n=30) of standardized disc specimens (15mmx1.3mm) were used to examine the biaxial flexural strength (ISO 6872 standard) using a Dartec HC10 Fatigue Tester (Zwick Ltd., UK) and Vickers hardness was also measured. The uncolored, FS4, FS7 groups were also submitted to dynamic fatigue testing to produce stress-number curves. The strength reliability was analyzed using Weibull distribution. RESULTS: All groups had a mean biaxial flexural strength, hardness and Weibull modulus (m) of approximately 1100MPa, 1300HV and 9.8-12.9, respectively. One-way analysis of variance (ANOVA) showed no significant difference in biaxial flexural strength among the eight groups (p>0.05). Two-way ANOVA showed no significant differences in hardness values among groups except FS1 and FS5 which had significantly higher hardness values than FS4 and FS7 (p<0.001) and FS5 also had a higher hardness value than FS3 (p<0.05). Additionally, uncolored, FS4 and FS7 survived at 5x10(5) cycles at a stress level in the range of 60-65% of the mean biaxial flexural strength. CONCLUSION: There was no difference in flexural strength of uncolored and colored Y-TZP ceramic. The fatigue limit of uncolored, FS4 and FS7 zirconia may be defined as lying between 60 and 65% of the stress to failure.