The influence of Zircos-E® etchant, silica coating, and alumina air-particle abrasion on the debonding resistance of endocrowns with three different preparation designs.

OBJECTIVES: The study aimed to evaluate the debonding resistance of three different endocrown designs on molar teeth, using three different zirconia surface pretreatments. MATERIAL AND METHOD: Ninety human mandibular first molars were divided into three main groups: endocrowns without ferrule, with 1 mm ferrule, and with 2 mm ferrule. The subgroups were defined by their surface pretreatment method used (n = 15): 50 µm alumina air-particle abrasion, silica coating using 30 µm Cojet™ particles, and Zircos-E® etching. The endocrowns were fabricated using multilayer zirconia ceramic, cemented with self-adhesive resin cement, and subjected to 5000 thermocycles (5-55°C) before debonding. The data obtained were analyzed using a two-way ANOVA. RESULTS: All test specimens survived the thermocyclic aging. The results indicated that both the preparation design and the surface treatment had a significant impact on the resistance to debonding of the endocrowns (p < .001). The 2 mm ferrule followed by the 1 mm ferrule designs exhibited the highest debonding resistance, both were superior to the endocrown without ferrule. Zircos-E® etching and silica coating yielded comparable debonding resistance, which were significantly higher than alumina air-particle abrasion. All endocrowns demonstrated a favorable failure mode. CONCLUSIONS: All designs and surface treatments showed high debonding resistance for a single restoration. However, ferrule designs with Zircos-E® etching or silica coating may represent better clinical options compared to the nonferrule design or alumina airborne-particle abrasion. Nonetheless, further research, including fatigue testing and evaluations with different luting agents is recommended.

Clinical survival and complication rate of ceramic veneers bonded to different substrates: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Evidence on the long-term clinical assessment and longevity of ceramic veneers bonded to different substrates is limited. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of various substrates, including enamel, dentin, or an existing composite resin restoration, on the clinical survival and complication rates of ceramic veneers. MATERIAL AND METHODS: The PubMed, Scopus, and the Cochrane Library electronic databases were searched, and related journals were hand searched without time or language restrictions to identify clinical trials that compared the survival rate and clinical complication rates when bonding ceramic veneers to different tooth substrates. The success rate of the included participants was estimated by the number of veneers that did not require a clinical intervention, and the survival rate by all veneers that did not fail absolutely. The risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes was used to quantify the intervention effect. RESULTS: Of 973 screened articles, 6 clinical studies were included. The survival and success rates varied depending on the bonding substrate. Enamel-bonded veneers had almost perfect rates of survival (99% with a range of 98% to 100%) and success (99% with a range of 98% to 100%). Veneers bonded to composite resin or surfaces with minimal dentin exposure had slightly lower survival rates (94% with a range of 91% to 97% and 95% with a range of 91% to 100%, respectively) and success rates (70% with a range of 60% to 80% and 95% with a range of 90% to 99%). Severe dentin exposure significantly decreased both survival rates (91% with a range of 84% to 98%) and success rates (74% with a range of 64% to 85%). The combined findings suggested that ceramic veneers bonded to enamel had fewer clinical complications (RD: -0.04; 95% CI: -0.09 to 0.02) and lower failure rates (RD: -0.13; 95% CI: -0.32 to 0.07) compared with those bonded to exposed dentin. Additionally, veneers attached to teeth with minimal dentin exposure were significantly less likely to require clinical interventions (RD: -0.16; 95% CI: -0.31 to -0.01) and had a reduced incidence of failure (RD: -0.08; 95% CI: -0.17 to 0.01) compared with those with severe dentin exposure. CONCLUSIONS: Ceramic veneers bonded to enamel showed higher survival and success rates with lower clinical incidences of complications and failure than those bonded to dentin or teeth with existing composite resin restorations.

The Influence of Ferrule Design and Pulpal Extensions on the Accuracy of Fit and the Fracture Resistance of Zirconia-Reinforced Lithium Silicate Endocrowns.

The study aimed to assess the marginal, axial, and internal adaptation, as well as the fracture resistance of zirconia-reinforced lithium silicate (ZLS) endocrowns with varying pulpal inlay extensions and marginal geometry. Sixty extracted maxillary first molar teeth were divided into six groups (n = 10) according to pulpal inlay extension and marginal configuration. The first three groups (J2, J3, and J4) utilized prepared teeth for endocrowns without ferrule design and 2 mm, 3 mm, and 4 mm pulpal extensions, respectively. The second three groups (F2, F3, and F4) utilized prepared teeth with 1 mm shoulder margins and 2 mm, 3 mm, and 4 mm pulpal extensions. The endocrowns were fabricated from ZLS blocks using CAD/CAM milling technology. After cementation, the specimens underwent thermal aging for 5000 cycles and were evaluated for marginal adaptation. Using a universal testing machine, the fracture resistance was tested under quasistatic loading (1 mm/min). Two-way ANOVA and the Tukey's post hoc test were employed for data analysis (p ≤ 0.05). The results of this study revealed that endocrowns without ferrule exhibited superior fracture strength than a 1 mm ferrule design p < 0.05, irrespective of the inlay depth. All designs with and without ferrule and all inlay depths showed clinically acceptable marginal and internal fit. The conventional endocrown design without ferrule and 2 mm inlay depth showed the lowest surface gap. The pulpal surface showed the highest discrepancy among all groups compared to the other surfaces. Endocrowns without ferrule are more conservative and have higher fracture strength than 1 mm ferrule designs; extending the inlay depth showed a significant increase in fracture resistance of the 1 mm ferrule design, but not for the conventional design without ferrule and 2 mm inlay depth. All groups exhibited a high auspicious fracture strength value for molar endocrown restorations.

Effect of ceramic materials and tooth preparation design on computer-aided design and computer-aided manufacturing endocrown adaptation and retentive strength: An in vitro study.

OBJECTIVES: To evaluate how various tooth preparation designs impact the adaptation-both at the margins and internally-and the retentive strength of computer-aided design and computer-aided manufacturing (CAD/CAM) produced endocrowns. MATERIALS AND METHODS: 60 extracted human mandibular first molars were endodontically treated and assigned into three groups (n = 20) according to the tooth preparation design: Group N: butt joint design, Group F and F1 received 1- and 2-mm circumferential ferrule preparation, respectively. Endocrowns were milled using either lithium disilicate glass-ceramic (IPS emax ceramic) or monolithic zirconia. The internal and marginal adaptation of the endocrowns were evaluated using the replica technique. After cementation, the endocrowns of all test groups were dislodged axially at 0.5 mm/min using a universal testing machine. A 2-way ANOVA and the independent samples t-test (α = .05) were performed to statistically analyze the data. RESULTS: The effect of changing the design of the tooth preparation (butt joint, ferrule) on the marginal and internal gap was shown to be statistically significant (p < .05); the lower gap values were recorded at the axial followed by cervical, marginal, and pulpal floor walls in both ceramic groups regardless of the teeth preparation design. The ANOVA test revealed similar average removal forces and stresses for the two types of tested ceramic materials. CONCLUSION: IPS emax ceramic adapted better than monolithic zirconia ceramic, regardless of the preparation design. Ferrule preparation design is more retentive than butt joint preparation, regardless of the type of ceramic material used.

Marginal discrepancy and load to fracture of monolithic zirconia laminate veneers: The effect of preparation design and sintering protocol.

To investigate and analyze the impact of teeth preparation designs and sintering protocol on marginal fit and fracture resistance of monolithic translucent zirconia laminate veneers. A total of 40 extracted intact human maxillary central incisors were assigned into 4 groups (n=10/each group) to investigate 2 variables: (1) the design of tooth preparation (a 1.5 mm incisal reduction with or without palatal chamfer) and (2) the two different sintering programs used for translucent zirconia restoration (standard or speed sintering procedure). Marginal discrepancy was evaluated using a digital microscope. The specimens were loaded to failure in the compression mode, using a universal testing machine with a crosshead speed of 0.5 mm/min. Marginal adaptation of monolithic translucent zirconia laminates are affected by both tooth preparation design and sintering protocol. However, resistance to fracture of translucent zirconia laminates has affected mainly by sintering procedure regardless the teeth preparation design used.

Effect of surface finishing and polishing procedures on color properties and translucency of monolithic zirconia restorations at varying thickness.

OBJECTIVE: This study aimed to assess the impact of monolithic zirconia thickness on its color properties after different surface finishing and polishing procedures, and following aging in coffee solution. MATERIALS AND METHODS: Two types of monolithic zirconia brands [Prettau Anterior (PA) and DD Cubex2 (DDC)] with three different thicknesses: 0.5, 1, and 1.5, and 10 mm diameter were tested. The color properties were evaluated after various surface finishing procedures (glazing, adjusting with burs + glaze, polishing, adjusting with burs + polishing) and after 5,000 cycles in a coffee solution were evaluated. The differences in color (ΔE) and translucency, were calculated and statistically analyzed by three-way ANOVA and pairwise comparison (α = 0.05). RESULTS: The brand, material thickness, and surface finishing protocol before and after coffee thermocycling had significant effect on color variations (p < 0.001). For translucency, 3-way ANOVA revealed a significant interaction between the material thickness and surface finishing protocol following aging in coffee solution (p < 0.001), however no significant interaction was observed following the surface finishing protocols (p = 0.247). CONCLUSIONS: The optical properties of monolithic zirconia ceramics can be influenced by the material brand, material thickness and the procedure of surface finishing and polishing. CLINICAL SIGNIFICANCE: Clinicians should take into consideration the potential change of the color properties of monolithic zirconia restorations following both contouring and occlusal adjustment procedures and coffee intake.

Impact of sintering procedure and clinical adjustment on color stability and translucency of translucent zirconia.

STATEMENT OF PROBLEM: Chairside and laboratory adjustments of translucent monolithic zirconia restorations sintered by short cycles are inevitable. Therefore, the optical properties of these materials should be evaluated under conditions similar to those in the oral environment. PURPOSE: The purpose of this in vitro study was to evaluate the color stability and the translucency changes of translucent monolithic zirconia after the sintering procedure, simulated clinical adjustment, and coffee thermocycling. MATERIAL AND METHODS: Eighty monolithic zirconia disks (diameter: 10 mm; thickness: 1 mm) were milled from 4 zirconia brands (Zolid FX Preshaded, Zolid FX White, DD Cubex2, and DD Bio ZX2). Two sintering procedures (standard or speed) were performed for each zirconia brand. The color coordinates and the translucency after sintering, clinical adjustment, and after 5000 cycles in a coffee solution were analyzed with a reflectance spectrophotometer, and the translucency parameters and contrast ratio were measured. The color differences and the translucency variations were calculated for each tested variable and statistically analyzed with 2-way ANOVA and pairwise comparison (α=.05). RESULTS: Both clinical adjustment procedure and coffee thermocycling had significant influence on color differences (P<.001). For translucency, 2-way ANOVA showed a significant interaction between sintering procedure and zirconia brand after coffee thermocycling (P<.001) while no significant interaction was recorded after the clinical adjustment procedure (P=.247). For all evaluated groups, the translucency parameter values decreased after either clinical adjustment procedure or coffee thermocycling (P<.001). For tested zirconia, group DD Cubex2 showed higher translucency parameter regardless of the variables tested. CONCLUSIONS: The color and the translucency of the translucent zirconia can be affected by the type of the zirconia brand and the sintering protocol. Furthermore, the color and the translucency were affected by both the clinical adjustment procedure and the coffee thermocycling, but not beyond the clinically acceptable limit of the color difference.

Resistance to Fracture of Zirconia Abutments with Different Angulations: Impact of Implant Platform Diameter.

OBJECTIVE: The aim of this study was to assess the impact of implant platform diameters on ultimate force to failure of zirconia abutments with different angulation. MATERIALS AND METHODS: Forty-two zirconia abutments with either 0 degree (ST) or 15-degree (AN) angulation were assembled on tapered internal connection titanium implants (Direct's Legacy; 13 mm Implant Direct, LLC, Las Vegas, United States) with a platform diameter of Ø3.0, Ø3.5, and Ø4.5 mm (14 per group). Zirconia crowns (Ceramill Zolid; Amann Girrbach GmbH) were fabricated and cemented using self-adhesive resin cement (MaxCem Elite, Kerr). The specimens were thermomechanically loaded (TCML= 6,000 cycles of 5 to 50°C for 2 minutes/cycle followed by cyclic loading 600,000 cycles) followed by static loading until fracture. The data of load (N) at which fracture occurred were statistically analyzed by using Kruskal-Wallis analysis of variance and Mann-Whitney U tests at 5% significance level. RESULTS: Higher load to fracture was reported for zirconia crowns in straight abutments groups and a platform of 4.5, 3.5, and 3 mm diameter was 438.2± 85.4, 345.5± 71.3, and 331.1± 59.1 N, respectively. However, the groups restored with zirconia crowns in angulated abutments groups and a platform of 4.5, 3.5, or 3 mm diameter showed a fracture load of 411.4 ± 49.8, 354.2 ± 52.5, and 302.8 ± 52.5 N, respectively. CONCLUSION: Straight and angulated zirconia abutments presented similar load to fracture on 3 and 3.5 mm platform diameters yet being significantly less for 4.5 mm diameter.

Ten-Year Clinical Survival of Anterior Cantilever Resin-Bonded Fixed Dental Prostheses: A Retrospective Study.

PURPOSE: To assess the 10-year clinical retention and survival rates of metal-ceramic (MC) and all-ceramic (AC) cantilever resin-bonded fixed dental prostheses (CRBFDPs). MATERIALS AND METHODS: Forty CRBFDPs constructed from either cobalt-chromium ceramic (MC group; n = 20) or glass-infiltrated alumina ceramic (AC group; n = 20) were placed in 40 patients between August 2007 and December 2009. After baseline recordings, the patients were followed up using modified United States Public Health Services (USPHS) criteria after 6 months and thereafter annually for 10 years. Data were statistically analyzed using Kaplan-Meier estimation with log-rank (Mantel-Cox) test. RESULTS: The 10-year clinical retention rate was 95.0% in the MC group and 70% in the AC group. The difference was statistically significant (P = .02, log-rank test). Three all-ceramic CRBFDPs fractured at 6, 12, and 84 months after insertion. No statistically significant difference in survival rate was observed between the MC and AC groups over the 10 years of clinical observation (MC: 100%; AC: 85%; P = .075) (Kaplan-Meier method, confidence interval = 92.5% to 97.5%). CONCLUSION: Although glass-infiltrated alumina ceramic anterior CRBFDPs exhibited a lower clinical retention rate compared to metal-ceramic CRBFDPs, the debonded prostheses were recemented and continued in function over the observation period. Additionally, an acceptable 10-year clinical longevity was recorded.

Influence of Surface Modification Protocol and Type of Luting Cement on Bonding of Monolithic Zirconia to Dentin Substrate.

AIM AND OBJECTIVE: To assess microtensile bond strength (µTBS) of two types of luting cement to monolithic zirconia and dentin following various surface modifications and aging. MATERIALS AND METHODS: Monolithic zirconia blocks were divided into four main groups. Group N: no surface modification; Group SB: sandblasted using 50 µm Al2O3 particles. Group GH: glazed with a thin film of low-fusing porcelain glaze and etched with 10% hydrofluoric acid for 60 seconds. Group CJ: sandblasted with CoJet sand. Surface-treated ceramic blocks were bonded to dentin using either self-adhesive cement or resin-modified glass ionomer cement and submitted to 3 or 150 days of water storage protocol with aging. The specimens were subjected to tensile force until de-bonding. Surface roughness (Ra, µm) was assessed after surface treatment. Analysis of variance (ANOVA) tests followed by Tukey's tests were used to analyze the data (α = 0.05). RESULTS: Surface modification using selective infiltration etching (SIE) showed significantly higher µTBS (p < 0.05) compared to tribochemical silica coating, sandblasting, and no treatment groups. The surface roughness of the SB and CJ groups were statistically higher compared to GH and N groups. CONCLUSION: Selective glass infiltration etching was an effective method in altering the surface properties, creating a strong and durable bond to monolithic zirconia. CLINICAL SIGNIFICANCE: Surface treatment procedures using SIE techniques combined with the use of universal 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)-containing adhesives could establish a long-lasting and strong bonding to monolithic zirconia restorations. Resin-modified glass-ionomer cement (RMGIC) is an alternative luting cement for monolithic zirconia based on the assessment of its bond strength and bond durability.

The impact of etching time and material on bond strength of self-adhesive resin cement to eroded enamel.

The purpose of this study was to assess the effect of pre-etching time and material on shear bond strength (SBS) of self-adhesive resin cements to eroded and sound enamel. Eroded enamel specimens were assigned into 5 groups (n=20 each) based on enamel surface treatment as follow: Group N, eroded enamel (without surface pre-treatment); Group PH15, 35% H3PO4 etching for 15 s; Group PH30, 35% H3PO4 etching for 30 s; Group L30, 20% lactic acid etching for 30 s and Group L60, 20% lactic acid etching for 60 s.Composite blocks were fabricated and cemented to enamel surfaces with one of two self-adhesive cements. Notched-edge SBS was assessed. Bond strength of self-adhesive cement to eroded enamel surface significantly enhanced following application of 20% lactic acid for 30 s.

Clinical and Radiographic Assessment of Reasons for Replacement of Metal- Ceramic Fixed Dental Prostheses in Patients Referring to Dental School.

BACKGROUND: The expected length of service and reasons for fixed dental prostheses (FDPs) replacement are a frequent inquiry by patients while the answers were mainly based on studies reports that was conducted outside the middle east region. This clinical and radiographic survey was constructed to assess and survey clinically and radiographically the reasons of replacement of metal-ceramic fixed dental prostheses, amongst patients reporting at dental school in Taibah University. MATERIAL AND METHODS: Between January and May 2016, 151 patients were recruited for this study. Interview (include questions pertained to the length of service of the prosthesis, the nature of complaint as told by patient in her own words), clinical examination, intra-oral photographs, and periapical radiographs, were done by the researchers. The parameters assessed were secondary caries, open margins, loss of retention, failure of endodontic treatment of the abutment and periodontal diseases. RESULTS: A total number of 249 failed fixed dental prostheses were evaluated. Of which 180 (39.7%) were single crowns, 159 (35.0%) were retainers and 117 (25.8%) were pontics in 69 fixed partial denture. The most common reason for replacement of fixed restorations was periodontal diseases affecting 92.8% of all types' restorations, followed by defective margin in 90.4% of examined restoration, poor aesthetic in 88% of restorations, while periapical involvement was found in 85.5% of fixed dental prosthesis. The survival rates of fixed prostheses were not predictable, and no association was found between number of years in service and the number of restorations. CONCLUSIONS: The most common reasons for replacing single unit fixed dental prostheses are periodontal diseases and periapical involvement, while defective margins and poor aesthetic mainly associated with multi-unit fixed dental prostheses. Key words:Failure, Fixed dental prosthesis, Survival, Replacement.

Fracture Resistance of Straight and Angulated Zirconia Implant Abutments Supporting Anterior Three-Unit Lithium Disilicate Fixed Dental Prostheses.

PURPOSE: The purpose of this study was to evaluate fracture resistance of straight and angulated zirconia implant abutments supporting anterior three-unit lithium disilicate fixed dental prostheses (FDPs). MATERIALS AND METHODS: Four different test groups (n = 8) representing anterior three-unit implant-supported all-ceramic FDPs were fabricated to fit an in vitro model with two implants. Groups 1 and 2 simulated a clinical situation with an ideal implant position for maxillary left central and right lateral incisors from a prosthetic point of view, which allowed for the use of a straight, prefabricated zirconia and titanium abutment. Groups 3 and 4 simulated a situation with a compromised implant position that required an angulated (15-degree) abutment. Tapered internal-connection implants (Direct's Legacy, 13-mm length, 3.7-mm diameter, Implant Direct) mounted in epoxy resin models were used in this study. Lithium disilicate (IPS e.max press, Ivoclar Vivadent) three-unit FDPs were fabricated and cemented using self-adhesive resin cement. The samples were subjected to thermocycling (2 × 3,000 × 5°C/55°C) and mechanical loading (TCML; 50 N × 600,000 cycles). Fracture resistances were determined for all the samples that survived aging. Kruskal-Wallis analysis of variance and Mann-Whitney U tests were performed to test for differences in fracture strength values at a 5% significance level. RESULTS: All samples subjected to TCML survived without mechanical failure. The highest fracture loads were associated with FDPs supported by implants with 0-degree abutment angulations compared with those FDPs supported by 15-degree abutment angulations (group 1: 538.7 ± 24.77 N; group 2: 542.17 ± 21.64 N; group 3: 523.57 ± 19.71 N; group 4: 528.37 ± 24.57 N). This difference in load-bearing capacity was not statistically significant (P > .05). CONCLUSION: The use of angulated zirconia abutments for compensation of nonideal implant locations is possible without reducing the load-bearing capacity of implant-supported anterior three-unit lithium disilicate FDPs.

Influence of Surface Conditioning Protocols on Reparability of CAD/CAM Zirconia-reinforced Lithium Silicate Ceramic.

PURPOSE: To test the effect of surface conditioning protocols on the reparability of CAD/CAM zirconia-reinforced lithium silicate ceramic compared to lithium-disilicate glass ceramic. MATERIALS AND METHODS: Zirconia-reinforced lithium silicate ceramic (Vita Suprinity) and lithium disilicate glass-ceramic blocks (IPS e.max CAD) were categorized into four groups based on the surface conditioning protocol used. Group C: no treatment (control); group HF: 5% hydrofluoric acid etching for 60 s, silane (Monobond-S) application for 60 s, air drying; group HF-H: 5% HF acid etching for 60 s, application of silane for 60 s, air drying, application of Heliobond, light curing for 20 s; group CO: sandblasting with CoJet sand followed by silanization. Composite resin (Tetric EvoCeram) was built up into 4 x 6 x 3 mm blocks using teflon molds. All specimens were subjected to thermocycling (5000x, 5°C to 55°C). The microtensile bond strength test was employed at a crosshead speed of 1 mm/min. SEM was employed for evaluation of all the debonded microbars, the failure type was categorized as either adhesive (failure at adhesive layer), cohesive (failure at ceramic or composite resin), or mixed (failure between adhesive layer and substrate). Two-way ANOVA and the Tukey's HSD post-hoc test were applied to test for significant differences in bond strength values in relation to different materials and surface pretreatment (p < 0.05). RESULTS: The highest microtensile repair bond strength for Vita Suprinity was reported in group CO (33.1 ± 2.4 MPa) and the lowest in group HF (27.4 ± 4.4 MPa). Regarding IPS e.max CAD, group CO showed the highest (30.5 ± 4.9 MPa) and HF the lowest microtensile bond strength (22.4 ± 5.7 MPa). Groups HF, HF-H, and CO showed statistically significant differences in terms of all ceramic types used (p < 0.05). The control group showed exclusively adhesive failures, while in HF, HF-H, and CO groups, mixed failures were predominant. CONCLUSIONS: Repair bond strength to zirconia-reinforced lithium silicate ceramics and lithium-disilicate glass ceramic could be improved when ceramic surfaces are sandblasted with CoJet sand followed by silanization.

Adhesive strength of self-adhesive resins to lithium disilicate ceramic and dentin: effect of dentin chelating agents.

The aim of this study was to test the effect of different chelating agents on microtensile bond strength (MTBS) of self-adhesive resin cements to dentin. The occlusal surfaces of extracted human mandibular molars (N = 80) were cut horizontally to expose sound dentin. The teeth were randomly divided into four groups (n = 20 per group) and dentin surfaces were conditioned according to one of the following methods: group C: no treatment (control group); group CH: 0.2 % chitosan; group E: 17 % ethylene diamine tetra acetic acid (EDTA) and group P: 25 % polyacrylic acid (PAA). Lithium disilicate glass ceramic (e.max CAD) blocks were cemented to conditioned dentin surfaces with self-adhesive cements (RelyX Unicem or Clearfil SA) and photo-polymerized. Specimens were stored in distilled water at 37 °C for 24 h and thermocycled for 6,000 times. The beams were obtained from bonded ceramic-cement-tooth assemblies and were subjected to the MTBS test (1 mm/min). Failure types were analyzed and selected beams were examined under scanning electron microscope. Data (MPa) were analyzed using two-way ANOVA and Tukey's test (P < 0.05). While cement type significantly affected the MTBS results (P < 0.05), no significant difference was observed between the dentin chelating agents (P = 0.785). Interaction terms were not significant (P = 0.114). Control group with no dentin conditioning presented significantly lower results with both cements (RelyX Unicem: 8.1 ± 1.9(a), Clearfil SA: 8 ± 1.6(a)) than those of conditioned groups (19.3 ± 4.2(b)-24.5 ± 5.2(b)) (P < 0.05). Failure types were predominantly adhesive in all groups. Chitosan (2 %), EDTA (17 %) or PAA (25 %) could all be used as dentin chelating agents in conjunction with self-adhesive resin cements tested.

Retentive strength of fiber-reinforced composite posts with composite resin cores: Effect of remaining coronal structure and root canal dentin conditioning protocols.

STATEMENT OF PROBLEM: The prognosis of a fixed dental prosthesis cemented to endodontically treated teeth is primarily determined by the presence of a ferrule on the tooth. Adhesion of the post in the root canal, conditioning methods for the canal and the amount of coronal structure could also be decisive on survival of reconstructions cemented on endodontically treated teeth. PURPOSE: The purpose of this in vitro study was to test the effect of remaining coronal structure on the retention of airborne-particle abraded fiber-reinforced composite resin posts built up with composite resin cores after the treatment of root canal dentin with different conditioning protocols. MATERIAL AND METHODS: One hundred and fifty extracted human teeth with single root canal space were endodontically treated and divided into 3 groups as follows: group CEJ: the teeth were sectioned at the level of cementoenamel junction (CEJ); group CEJ1: the teeth were sectioned 1 mm above the CEJ; group CEJ2: the teeth were sectioned 2 mm above the CEJ. Each group was further divided into 5 subgroups (n=10 per group) according to the root canal treatments as follows: group C: no conditioning (control); group PH: conditioning with 37% phosphoric acid gel for 15 seconds; group E: conditioning with 17% ethylenediaminetetraacetic acid (EDTA) for 60 seconds; group CHX: conditioning with 2% chlorhexidine (CHX) for 60 seconds; group Q: conditioning with combination of 2% CHX with 17% EDTA and a surfactant solution for 60 seconds. Glass fiber-reinforced composite resin posts were airborne-particle abraded and luted to the root canal dentin with a self-adhesive resin cement (RelyX Unicem). The retentive force was tested by applying a tensile load parallel to the long axis of these posts at a crosshead speed of 2 mm/min. Two-way ANOVA and the Tukey HSD post hoc test were used to analyze the data. RESULTS: The highest retention (N) was obtained with the CHX-EDTA conditioned group (374.7 ±29.8) followed by 17% EDTA (367.9 ±33.3) conditioning when 2 mm remaining coronal structure was available. Conditioning with the CHX-EDTA showed comparable retention values to 17% EDTA conditioned groups when 0 or 1 mm coronal structure was present that differed significantly compared to 37% PH and 2% CHX conditioning (P<.05). CONCLUSIONS: Conditioning root canal either with CHX-EDTA or 17% EDTA delivered superior retention values for fiber-reinforced composite resin posts with composite resin cores that were luted with self-adhesive resin cement to endodontically treated teeth with 2 mm remaining coronal structure.

Effect of non-ionizing radio frequency signals of magnetic resonance imaging on physical properties of dental alloys and metal-ceramic adhesion.

PURPOSE: To assess the influence of non-ionizing radio frequency signals of magnetic resonance imaging (MRI) on physical properties of dental alloys and metal-ceramic adhesion. MATERIALS AND METHODS: A total of 120 disk-shaped wax patterns (10 mm x 10 mm x 1 mm) were cast in a base metal alloy (Ni-Cr alloy) and commercially pure titanium (Ti) following the manufacturing recommendation. After casting, air abrasion and ultrasonic cleaning, feldspathic ceramic was applied and fired according to manufacturer's instructions using a standard mold. The specimens were subjected to 3000 thermocycles in distilled water between 5°C and 55°C, then veneered alloy specimens were randomly assigned to three groups according to MRI exposure time: a) 15 min of MRI exposure, b) 30 min of MRI exposure and c) no MRI exposure (control group). The specimens were subjected to shear loading until failure. A separate set of Ni-Cr and Ti specimens were prepared, and after exposure to MRI for 15 and 30 min, x-ray diffraction (XRD) analysis, surface roughness, and Vicker's hardness were measured. RESULTS: Both the alloy type (p < 0.005) and exposure duration (p < 0.005) had a significant effect on the bond results. While the control group presented the highest bond strength for Ni-Cr and Ti (36.9 ± 1.4 and 21.5 ± 1.6 MPa, respectively), 30 min MRI exposure significantly decreased the bond strength for both alloys (29.4 ± 1.5 and 12.8 ± 1.5 MPa, respectively) (p < 0.05). XRD analysis indicated formation of the crystalline phase as well as change in crystal size and position for Ni-Cr and Ti after MRI. Compared to the control group where alloys were not exposed to MRI (Ni-Cr: 0.40 µm; Ti: 0.17 µm), surface roughness increased (Ni-Cr: 0.54 µm; Ti: 1.1 µm). Vicker's hardness of both alloys decreased after 30 min MRI (Ni-Cr: 329.5; Ti: 216.1) compared to the control group c (Ni-Cr: 356.1; Ti: 662.1), being more significant for Ti (p < 0.005). CONCLUSION: Ni-Cr alloy is recommended over Ti for the fabrication of metal-ceramic restorations for patients with a history of frequent exposure to MRI.

Clinical survival of anterior metal-ceramic and all-ceramic cantilever resin-bonded fixed dental prostheses over a period of 60 months.

PURPOSE: To evaluate the survival of maxillary anterior cantilever resin-bonded metalceramic (MC) and all-ceramic (AC) fixed dental prostheses (RBFDPs). MATERIALS AND METHODS: Between August 2007 and December 2009, 40 patients received 40 RBFDPs made of either cobalt-chromium-ceramic (n = 20) or glass-infiltrated alumina (In-Ceram, Vident; n = 20) and were followed up until December 2012. Restorations were adhesively cemented (Panavia 21, Kuraray). RESULTS: Two fractures were observed with AC. No debondings were observed with MC (n = 0) but were observed with AC (n = 3). The difference in survival rates of MC and AC was not significant (MC: 100%; AC: 90%; P = .15) (Kaplan-Meier method, confidence interval = 95%). CONCLUSIONS: Cantilever AC RBFDPs could be a promising alternative to MC RBFDPs for replacement of missing anterior incisors, provided that no mechanical complications were experienced with the latter.

WITHDRAWN: Effect of different dentin cleaning techniques on bond strength and the micromorphology of dentin/self-adhesive resin cement interface.

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