Morphogenic designer--an efficient tool to digitally design tooth forms.

BACKGROUND AND PURPOSE: Different digital software tools are available today for the purpose of designing anatomically correct anterior and posterior restorations. The current concepts present weaknesses, which can be potentially addressed by more advanced modeling tools, such as the ones already available in professional CAD (Computer Aided Design) graphical software. AIM: This study describes the morphogenic designer (MGD) as an efficient and easy method for digitally designing tooth forms for the anterior and posterior dentition. MATERIALS AND METHOD: Anterior and posterior tooth forms were selected from a collection of digitalized natural teeth and subjectively assessed as "average". The models in the form of STL files were filtered, cleaned, idealized, and re-meshed to match the specifications of the software used. The shapes were then imported as wavefront ".obj" model into Modo 701, software built for modeling, texturing, visualization, and animation. RESULTS: In order to create a parametric design system, intentional interactive deformations were performed on the average tooth shapes and then further defined as morph targets. By combining various such parameters, several tooth shapes were formed virtually and their images presented. CONCLUSION: MGD proved to be a versatile and powerful tool for the purpose of esthetic and functional digital crown designs.

Reliability of reduced-thickness and thinly veneered lithium disilicate crowns.

The present investigation hypothesized that the reliability of reduced-thickness monolithic lithium disilicate crowns is high relative to that of veneered zirconia (Y-TZP) and comparable with that of metal ceramic (MCR) systems. CAD/CAM first mandibular molar full-crown preparations were produced with uniform thicknesses of either 1.0-mm or 2.0-mm occlusal and axial reduction, then replicated in composite for standard crown dies. Monolithic 1.0-mm (MON) and 2.0-mm CAD/CAM lithium disilicate crowns, the latter with a buccal thin veneer (BTV) of 0.5 mm, were fabricated and then sliding-contact-fatigued (step-stress method) until failure or suspension (n = 18/group). Crack evolution was followed, and fractography of post mortem specimens was performed and compared with that of clinical specimens. Use level probability Weibull calculation (use load = 1,200 N) showed interval overlaps between MON and BTV. There was no significant difference between the Weibull characteristic failure loads of MON and BTV (1,535 N [90% CI 1,354-1,740] and 1,609 N [90% CI 1,512-1,712], respectively), which were significantly higher than that of Y-TZP (370 N [90% CI 322-427]) and comparable with that of MCR (1,304 N [90% CI 1,203-1,414]), validating the study hypothesis.

Performance of dental ceramics: challenges for improvements.

The clinical success of modern dental ceramics depends on an array of factors, ranging from initial physical properties of the material itself, to the fabrication and clinical procedures that inevitably damage these brittle materials, and the oral environment. Understanding the influence of these factors on clinical performance has engaged the dental, ceramics, and engineering communities alike. The objective of this review is to first summarize clinical, experimental, and analytic results reported in the recent literature. Additionally, it seeks to address how this new information adds insight into predictive test procedures and reveals challenges for future improvements.

Modified Y-TZP core design improves all-ceramic crown reliability.

This study tested the hypothesis that all-ceramic core-veneer system crown reliability is improved by modification of the core design. We modeled a tooth preparation by reducing the height of proximal walls by 1.5 mm and the occlusal surface by 2.0 mm. The CAD-based tooth preparation was replicated and positioned in a dental articulator for core and veneer fabrication. Standard (0.5 mm uniform thickness) and modified (2.5 mm height lingual and proximal cervical areas) core designs were produced, followed by the application of veneer porcelain for a total thickness of 1.5 mm. The crowns were cemented to 30-day-aged composite dies and were either single-load-to-failure or step-stress-accelerated fatigue-tested. Use of level probability plots showed significantly higher reliability for the modified core design group. The fatigue fracture modes were veneer chipping not exposing the core for the standard group, and exposing the veneer core interface for the modified group.

Reliability of metalloceramic and zirconia-based ceramic crowns.

Despite the increasing utilization of all-ceramic crown systems, their mechanical performance relative to that of metal ceramic restorations (MCR) has yet to be determined. This investigation tested the hypothesis that MCR present higher reliability over two Y-TZP all-ceramic crown systems under mouth-motion fatigue conditions. A CAD-based tooth preparation with the average dimensions of a mandibular first molar was used as a master die to fabricate all restorations. One 0.5-mm Pd-Ag and two Y-TZP system cores were veneered with 1.5 mm porcelain. Crowns were cemented onto aged (60 days in water) composite (Z100, 3M/ESPE) reproductions of the die. Mouth-motion fatigue was performed, and use level probability Weibull curves were determined. Failure modes of all systems included chipping or fracture of the porcelain veneer initiating at the indentation site. Fatigue was an acceleration factor for all-ceramic systems, but not for the MCR system. The latter presented significantly higher reliability under mouth-motion cyclic mechanical testing.

In vitro evaluation of the implant abutment connection sealing capability of different implant systems.

This study sought to evaluate the sealing capability of the implant abutment connection of different dental implant systems. Five Nobel Replace select, Straumann and Intra-lock implants of approximately 4.5 mm diameter with their respective abutments were provided by the manufacturers. A calibration curve was determined by placing toluidine blue (TB) increments of 0.1 microL into 1.5 mL of distilled water and recording its absorbance in a spectrophotometer until reaching 0.7 microL. Then, 0.7 microL of TB was placed in the deepest portion of each implant's internal screw, the abutments were adapted to the implant according to the manufacturer's instructions and the specimens were placed in vials with 1.5 mL of distilled water. Spectrophotometric analysis was performed at 1, 3, 6, 24, 48, 72, 96 and 144 h. Statistical analysis was performed by One-way anova at 95% level of significance. The calibration curve was linear with respect to the TB amount in 1.5 microL distilled water (R(2) = 0.9961). All implant abutment systems presented an increase in absorbance as a function of time. As time elapsed in vitro, significantly higher amounts of TB was released from the Straumann and Nobel Replace Select connection systems (P < 0.0001). Leakage was significant between the groups. Despite controlled torquing, the seal between the implant body and the abutment could not be maintained in all three of the systems tested.

Laboratory and FEA evaluation of dentin-to-composite bonding as a function adhesive layer thickness.

OBJECTIVE: The aim of this study was to test the hypothesis that microtensile bond strength values are inversely proportional to dentin-to-composite adhesive layer thickness through laboratory mechanical testing and finite element analysis. METHOD: Eighteen noncarious third molars were obtained, and occlusal enamel removed perpendicular to the tooth long axis. Two different adhesive systems were utilized as follows (n=3): (1) application of a single layer of Single Bond (3M ESPE Co.) and Clearfil SE Bond (Kuraray Co.) following the manufacturer's directions; (2) application of one layer of both adhesive systems followed by one additional layer; (3) application of one layer of both adhesive systems followed by two additional layers. A 4mm build up was fabricated in increments on each tooth sample (Z 100 composite, 3M ESPE). Section measurements were performed and specimens were separated into three adhesive thickness groups per material (40, 40-80 and 80-120 microm) for microtensile testing. The bond strength data (MPa) were analyzed by one-way ANOVA and Tukey test. Maximum principal stresses (MPS) were determined through FEA for three different adhesive layer thicknesses (20, 50 and 100 microm). RESULTS: The bond strength data obtained for Single Bond at 0-40 microm presented significantly higher values compared to higher adhesive layer thickness groups. There were no statistical differences among bond strength values for all Clearfil SE Bond adhesive layer thicknesses. FEA modeling indicated that MPS increased as adhesive layer increased. The hypothesis was accepted for the Single Bond only. SIGNIFICANCE: Correspondence (not tested statistically) between microtensile laboratory testing and FEA model was only observed for Single Bond as increased adhesive layer thickness did not reduce Clearfil SE Bond strength.

Evaluation of a self-limiting concept in dentinal caries removal.

The mechanical removal of dentinal caries traditionally involves the use of tactile sensation and/or caries-indicating dyes. This study tested the hypothesis that self-limiting polymer burs are as effective as conventional carbide burs in creating substrates for dentin bonding. Carious dentin from extracted human molars was removed with carbide or polymer burs, with dental explorer hardness as the end-point for caries removal. Dentin substrates were bonded with etch-and-rinse or self-etch adhesives and prepared for microtensile bond testing and transmission electron microscopy. For each bur type, there was no difference in bond strength between adhesives. However, the polymer bur surface exhibited significantly lower bond strengths than the carbide bur, and both were lower than flat, non-carious dentin controls. TEM revealed areas of incompletely removed, denatured caries-infected dentin in the polymer bur specimens. These first-generation polymer burs might best be utilized for deep caries removal where pulpal exposure is a concern.

Comparison of bond strength of a pressed ceramic fused to metal versus feldspathic porcelain fused to metal.

PURPOSE: To compare the debonding/crack initiation strength (D/CIS) of a low-fusing pressable leucite-based glass ceramic (PC) fused to metal to a feldspathic porcelain (FP) fused to metal. MATERIALS & METHODS: As per ISO 9693:1999, 40 rectangular metal specimens (25.0 mm x 0.5 mm x 3.0 mm) were prepared. Twenty of the specimens were cast in a base metal nickel-chromium alloy (BA), and 20 were cast in a noble metal palladium-silver alloy (NA). Ten randomly selected NA and BA alloy specimens had FP applied. The remaining 10 NA and BA alloy specimens had ash-free wax patterns applied, the metal-wax complexes invested, and were pressed with a PC. The dimensions of the ceramic specimens were 8.0 mm x 1.0 mm x 3.0 mm, creating a combined metal-ceramic complex thickness of 1.5 mm. All specimens were subject to a three-point bending test at a crosshead speed of 1.5 mm/min. Fracture loads were recorded in Newtons and D/CISs calculated by the formula tau(b)=k x F(fail). RESULTS: Mean D/CISs, measured in MPa (standard deviations): NA-FP 32.56 (4.62), NA-PC 30.23 (5.06), BA-FP 30.98 (4.41), and BA-PC 31.81 (3.48). A two-way ANOVA (p > 0.05) did not demonstrate significant difference between groups. CONCLUSION: The debonding/crack initiation strength of a low-fusing pressable leucite-based glass ceramic fused to metal was equivalent to that of a feldspathic porcelain fused to metal.

Adhesive permeability affects coupling of resin cements that utilise self-etching primers to dentine.

OBJECTIVES: To examine the effects of an experimental bonding technique that reduces the permeability of the adhesive layer on the coupling of resin cements to dentine. METHODS: Extracted human third molars had their mid to deep dentin surface exposed flat by transversally sectioning the crowns. Resin composite overlays were constructed and cemented to the surfaces using either Panavia F (Kuraray) or Bistite II DC (Tokuyama) resin cements mediated by their respective one-step or two-step self-etch adhesives. Experimental groups were prepared in the same way, except that the additional layer of a low-viscosity bonding resin (LVBR, Scotchbond Multi-Purpose Plus, 3M ESPE) was placed on the bonded dentine surface before luting the overlays with the respective resin cements. The bonded assemblies were stored for 24 h in water at 37 degrees C and subsequently prepared for microtensile bond strength testing. Beams of approximately 0.8 mm(2) were tested in tension at 0.5 mm/min in a universal tester. Fractured surfaces were examined under scanning electron microscopy (SEM). Additional specimens were prepared and examined with TEM using a silver nitrate-staining technique. RESULTS: Two-way ANOVA showed significant interactions between materials and bonding protocols (p<0.05). When bonded according to manufacturer's directions, Panavia F produced bond strengths that were significantly lower than Bistite II DC (p<0.05). The placement of an additional layer of a LVBR improved significantly the bond strengths of Panavia F (p<0.05), but not of Bistite II DC (p>0.05). SEM observation of the fractured surfaces in Panavia F showed rosette-like features that were exclusive for specimens bonded according to manufacturer's directions. Such features corresponded well with the ultrastructure of the interfaces that showed more nanoleakage associated with the more permeable adhesive interface. The application of the additional layer of the LVBR reduced the amount of silver impregnation for both adhesives suggesting that reduced permeability of the adhesives resulted in improved coupling of the resin cements to dentin. CONCLUSIONS: Placement of an intermediate layer of a LVBR between the bonded dentine surface and the resin cements resulted in improved coupling of Panavia F to dentine.