Ultrathin lithium disilicate and translucent zirconia crowns for posterior teeth: Survival and failure modes.

PURPOSE: To evaluate the reliability and failure modes of ultrathin (0.5 mm) lithium disilicate, translucent and ultra-translucent zirconia crowns for posterior teeth restorations. MATERIALS AND METHODS: Fifty-four mandibular first molar crowns of three ceramic materials: (1) Lithium disilicate (e.max CAD, Ivoclar Vivadent), (2) 3Y-TZP (Zirconn Translucent, Vipi), and (3) 5Y-PSZ (Cercon XT, Dentsply Sirona), with 0.5 mm of thickness were milled and cemented onto composite resin abutments. Eighteen samples of each group were tested under mouth-motion step-stress accelerated life testing in a humid environment using mild, moderate, and aggressive profiles. Data was subjected to Weibull statistics. Use level curves were plotted and reliability was calculated for a given mission of 100,000 cycles at 100, 200, and 300 N. Fractographic analyses of representative samples were performed in scanning electron microscope. RESULTS: Beta (ß) values suggest that failures were dictated by material's strength for lithium disilicate and by fatigue damage accumulation for both zirconias. No significant differences were detected in Weibull modulus and characteristic strength among groups. At a given mission of 100,000 cycles at 100 N, lithium disilicate presented higher reliability (98% CB: 95-99) regarding 3Y-TZP and 5Y-PSZ groups (84% CB: 65%-93% and 79% CB: 37&-94%, respectively). At 200 N, lithium disilicate reliability (82% CB: 66%-91%) was higher than 5Y-PSZ (20% CB: 4%-44%) and not significantly different from 3Y-TZP (54% CB: 32%-72%). Furthermore, at 300 N no significant differences in reliability were detected among groups, with a notable reduction in the reliability of all materials. Fractographic analyses showed that crack initiated at the interface between the composite core and the ceramic crowns due to tensile stress generated at the intaglio surface. CONCLUSIONS: Ultrathin lithium disilicate crowns demonstrated higher reliability relative to zirconia crowns at functional loads. Lithium disilicate and zirconia crown's reliability decreased significantly for missions at higher loads and similar failure modes were observed regardless of crown material. The indication of 0.5 mm thickness crowns in high-load bearing regions must be carefully evaluated. CLINICAL SIGNIFICANCE: Ultraconservative lithium disilicate and zirconia crowns of 0.5 mm thickness may be indicated in anterior restorations and pre-molars. Their clinical indication in high-load requirement regions must be carefully evaluated.

Effects of relative centrifugation force on L-PRF: An in vivo submandibular boney defect regeneration study.

Properties and composition of leukocyte- and platelet-rich fibrin (L-PRF) clots may be largely affected by centrifugation protocols (function of relative centrifugal force [RCF]), which may impact biological potential repair in bone regeneration. The present in vivo study sought to assess the effect of the RCF on the composition of L-PRF clots, as well as to compare the repair potential of L-PRF clots obtained with different RCF protocols in submandibular boney defects using PLGA scaffolds for bone regeneration. Complete blood count and volumetric evaluations were performed on L-PRF clots obtained through centrifugation for 12 min at 200, 400, and 600 RCF-clot centrifugation speeds. These evaluations were completed from blood collected immediately prior to any surgical procedures. The in vivo portion comprised of three submandibular unilateral, full thickness, osteotomies (~0.40cm3 ) which were created in the submandibular region of six sheep, using rotary instrumentation under continuous irrigation. Subsequently, poly(lactic-co-glycolic acid) (PLGA) scaffolds were enveloped in a L-PRF membrane from one of the three spinning speeds (n = 6/RCF) and inserted into the defect (sites were interpolated to avoid site bias). Six-weeks after surgery, the mandibles were harvested en bloc and prepared for volumetric and histomorphometric evaluations. Membranes harvested from 600 RCF produced significantly larger L-PRF clots (6.97g ± 0.95) in comparison to the lower 200 RCF (5.7g ± 0.95), with no significant differences between 600 and 400, and from 400 and 200 RCF. The three tested RCFs did not alter the platelet count of the L-PRF clot. For the in vivo component, quantitative bone regeneration analyses demonstrated significantly higher values obtained with L-PRF membranes extracted post 600 RCF (27.01 ± 8%) versus 200 RCF (17.54 ± 8%), with no significant differences regarding 400 RCF (~23 ± 8%). At the qualitative histological analyses, L-PRF membranes obtained at 600 and 400 RCFs yielded improved healing throughout the defect, where the L-PRF sourced from the lowest speed, 200 RCF, presented healing primarily at the margins along with the presence of connective tissue at the central aspect of the surgical defect. Higher 600 RCF yielded larger L-PRF clots/membranes, resulting in enhanced bone repair potential in association with PLGA scaffolds for the treatment of critical size bone defects.

Implant-abutment fit influences the mechanical performance of single-crown prostheses.

OBJECTIVES: To evaluate the three-dimensional fit of abutments fabricated by the industry to those either milled or cast by a commercial laboratory and to correlate the implant-abutment connection fit with stress at fatigue failure of prostheses. Probability of survival (reliability) and fractography to characterize failure modes were also performed for cemented and screw-retained prostheses. METHODS: One-hundred and twenty-six maxillary central incisor crowns were milled to restore implants and divided in 3 cemented and 3 screwed-retained groups (n = 21/each), as follows: [Digital-Sc]: milled one-piece monolithic abutment/crown; [TiB-Sc]: milled crowns cemented onto Ti-base abutments; [UCLA]: screw-retained crown using UCLA abutments; [Digital-Ce]: milled two-piece assembly comprised by screwed monolithic abutment and a cemented crown; [TiB-Ce]: milled coping cemented onto Ti-base abutments to receive a cemented crown; [UCLA-Ce]: UCLA abutments that received an overcast coping and a cemented crown. Implant-abutment volume misfit was assessed by micro-computed tomography using the silicone replica technique. Implant/crown systems were subjected to step-stress accelerated life testing (SSALT) in water. The use-level probability Weibull curves and reliability for a mission of 50,000 cycles at calculated stress at failure of 2,300, 3300 and 4300 MPa were plotted. Fractographic analysis was performed with scanning electron microscopy. Internal misfit was analyzed through one-way ANOVA following post-hoc comparisons by Tukey test (p < 0.05). Correlation between misfit volume and the stress at fatigue failure was assessed by Pearson test. RESULTS: Similar misfit volumes were observed for TiB-Sc (0.458 mm3), TiB-Ce (0.461 mm3), UCLA (0.471 mm3) and UCLA-Ce (0.480 mm3), which were significantly lower than Digital-Sc (0.676 mm3) and Digital-Ce (0.633 mm3). The mean ß values were: 1.68, 1.39, 1.48, 2.41, 2.27 and 0.71 for Digital-Sc, TiB-Sc, UCLA, Digital-Ce, TiB-Ce and UCLA-Ce, respectively, indicating that fatigue was an accelerating factor for failure of all groups. Higher stress at failure decreased the reliability of all groups, more significantly for screw compared to cement-retained groups, especially for Digital-Sc that demonstrated the lowest reliability. The failure mode was restricted to abutment screw fracture. A negative correlation was observed between misfit values and stress at failure (r = -0.302, p = 0.01). CONCLUSIONS: Abutments milled by a commercial lab presented higher misfit compared to those provided by the industry and a moderate correlation was observed between higher misfit and lower stress at failure during fatigue. Probability of survival decreased at higher stress, especially for screw compared to cement-retained groups, and failures were confined to abutment screws.

Zirconia-reinforced lithium silicate crowns: Effect of thickness on survival and failure mode.

OBJECTIVE: To evaluate the reliability and failure mode of zirconia-reinforced lithium silicate (ZLS) molar crowns of different thicknesses. METHODS: Monolithic ZLS molar crowns (0.5mm, 1.0mm, and 1.5 mm thickness) were modeled and milled using a CAD/CAM system (n = 21/group). Crowns were cemented on dentin-like epoxy resin replicas with a resin cement. The specimens were subjected to single load-to-failure test for step-stress profiles designing. Mouth-motion step-stress accelerated-life test was performed under water by sliding an indenter 0.7 mm lingually down on the distobuccal cusp until specimen fracture or suspension. Use level probability Weibull curves and reliability were calculated and plotted. Polarized-light optical microscope and scanning electron microscope (SEM) were used to characterize fracture patterns. RESULTS: Irrespective of crown thickness, beta (ß) values were higher than 1 and fatigue accelerated failures. While 0.5 mm ZLS crowns exhibited a significant reduction in the probability of survival at 200N, 300N and 400 N mission loads (69%, 41% and 19%, respectively), no significant difference was observed between 1.0 mm and 1.5 mm crowns. Both thicknesses have maintained the survivability at approximately 90%. Failure primarily comprised bulk fracture where radial cracks originated from the cementation surface beneath the indenter loading trail and propagated towards the cervical margin. SIGNIFICANCE: 1.5 mm- and 1.0 mm-thickness monolithic ZLS crowns presented higher probability of survival compared to 0.5 mm crowns. Bulk fracture was the chief failure mode, regardless of thickness.

Effect of CAD/CAM Abutment Height and Cement Type on the Retention of Zirconia Crowns.

PURPOSE: To evaluate Ti-Base abutment height and cement type on the retentiveness of zirconia-based restorations. MATERIAL AND METHODS: Four millimeter (tall) and 2.5-mm-height (short) abutments along with temporary (provisional), glass ionomer (Meron), self-adhesive (U200), and conventional resin cement (Ultimate) were evaluated using pull-out testing (n = 10 crowns/group). RESULTS: Tall and short abutments demonstrated similar retention for all within cement comparisons, except U200 (P = 0.032). Resin cements exhibited superior retentiveness than others (P < 0.01). Although no significant difference was evidenced between resin cements for short abutments, Ultimate evidenced higher retention than U200 for tall abutments (P = 0.043). CONCLUSIONS: Although Ti-Base abutment height has not influenced zirconia superstructures' retentiveness, resin-based cements significantly evidenced higher retention than glass ionomer and temporary cements.