Comparison of internal fit of metal-ceramic crowns in CAD/CAM and lost-wax techniques in all fabrication stages through replica weighting, triple scanning, and scanning electron microscope.

OBJECTIVES: Restoration fit is one of the prerequisites of clinical durability. It is controversial as to whether computer-assisted design/computer-aided milling (CAD/CAM) or lost-wax fabrication methods result in more fit metal-ceramic crowns. This in-vitro study was conducted to examine the internal fit of porcelain fused to metal crowns fabricated using CAD/CAM and lost-wax techniques during fabrication stages (framework, porcelain, cementation) through digital triple scanning, replica weighting, and observation with electron microscopy. MATERIAL AND METHODS: Twenty uniform resin dies of prepared first maxillary molars were randomly divided into two groups according to the fabrication technique: lost wax and CAD/CAM. The internal fit was measured in all steps of completing the crowns (framework, porcelain, and cementation) using different methods, including triple scanning, replica weighting, and scanning electron microscopy. The data were statistically analyzed using t test, Pearson, and repeated measures analysis of variance (α = .05). RESULTS: Triple scanning revealed no difference in the internal fit of CAD/CAM and lost-wax groups in all the fabrication steps (p > .05). The replica weighting method showed no difference between groups in the framework step (p > .05), while the internal fit was significantly better in the CAD/CAM group after porcelain application (p < .05). After cementation, electron microscopy measurements showed no difference between CAD/CAM and lost wax groups (p > .05). The Pearson correlation test showed no significant correlation between electron microscopy, replica weighing, and triple scanning methods (p > .05). CONCLUSION: According to scanning electron microscopy as the superior evaluation method, the internal fit of cobalt-chrome PFM crown of both CAD/CAM and lost wax groups was within the acceptable clinical range and there was no significant difference between them. Triple scanning revealed no difference in the internal fit of framework and porcelain steps but a better fit after cementation. According to replica weighting, the internal fit in the porcelain step was higher than the framework.

Interfacial Fracture Toughness Comparison of Three Indirect Resin Composites to Dentin and Polyether Ether Ketone Polymer.

OBJECTIVES: Advances in laboratory composites and their high wear resistance and fracture toughness have resulted in their growing popularity and increasing use for dental restorations. This study sought to assess the fracture toughness of three indirect composites bonded to dental substrate and polyether ether ketone (PEEK) polymer. MATERIALS AND METHODS: This in vitro study was conducted on two groups of dental and polymer substrates. Each substrate was bonded to three indirect composite resins. Sixty blocks (3 × 3 × 12 mm) were made of sound bovine anterior teeth and PEEK polymer. Sixty blocks (3 × 3 × 12 mm) were fabricated of CRIOS (Coltene, Germany), high impact polymer composite (HIPC; Bredent, Germany), and GRADIA (Indirect; GC, Japan) composite resins. Composites were bonded to dentin using Panavia F 2.0 (Kuraray, Japan). For bonding to PEEK, Combo.lign (Bredent) and Visio.Link (Bredent) luting cements were used. In all samples, a single-edge notch was created by a no. 11 surgical blade at the interface. The samples were subjected to 3,500 thermal cycles, and their fracture toughness was measured in a universal testing machine (Zwick/Roell, Germany) by application of four-point flexural load. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance, Kruskal-Wallis. RESULTS: The fracture toughness of CRIOS-PEEK interface was significantly higher than HIPC-PEEK. The fracture toughness of GRADIA-PEEK was not significantly different from that of HIPC and CRIOS. The fracture toughness of GRADIA-dentin was significantly higher than HIPC-dentin. CONCLUSION: Considering the limitations of this study, GRADIA has the highest bond strength to dentin, while CRIOS shows the highest bond strength to PEEK.

Fracture Toughness Comparison of Three Indirect Composite Resins Using 4-Point Flexural Strength Method.

OBJECTIVES: The advantages of indirect composite restorations such as less crack formation during their computer-aided design/computer-aided manufacturing process, compared with ceramic restorations, have resulted in their growing popularity. However, restoration failure is a major concern with regard to the long-term clinical success of restorations and may occur as the result of propagation of a crack originated from an internal flaw in the restoration. This study aimed to compare the fracture toughness of three indirect composite resins. MATERIALS AND METHODS: In this in vitro experimental study, 10 specimens measuring 3 × 3 × 18 mm were fabricated of Gradia, Crios, and high impact polymer composite indirect composites. A single edge notch with a diameter < 0.3 mm and 0.3 mm length was created in the 9 mm longitudinal dimension of specimens using a no. 11 surgical scalpel. The specimens were then subjected to 4-point flexural strength test in a universal testing machine with a crosshead speed of 0.1 mm/s until failure. STATISTICAL ANALYSIS: Data were analyzed using IBM SPSS Statistics via one-way analysis of variance (ANOVA) and Tukey's HSD (honestly significant difference) test. The statistical power was set at p ˂ 0.05. RESULTS: One-way ANOVA showed a significant difference in fracture toughness of the three composite groups (p = 0.000). According to the Tukey HSD analysis, the fracture toughness of HIPC was significantly higher than that of the other two composites. The fracture toughness of Gradia was significantly lower among all. CONCLUSIONS: Within the limitations of this study, the results showed that high temperature-pressure polymerization can increase resistance to crack propagation and subsequently improve the clinical service of indirect composite restorations. Although we do not know the filler volume percentage of HIPC, it seems that filler volume percentage of the composite is inversely correlated with fracture toughness.

Comparison of the marginal discrepancy of PFM crowns in the CAD/CAM and lost-wax fabrication techniques by triple scanning.

BACKGROUND: Computer-aided design/computer-aided manufacturing (CAD/CAM) systems are widely used for the fabrication of porcelain-fused-to-metal (PFM) crowns. OBJECTIVES: This study was conducted to compare PFM crowns through triple scanning in terms of marginal discrepancy between the CAD/CAM and lost-wax fabrication techniques. MATERIAL AND METHODS: Twenty uniform resin dies of a prepared maxillary first molar were randomly divided into 2 groups: conventional lost-wax; and milling. Marginal discrepancy was evaluated at the framework and porcelain steps through triple scanning and direct visualization under a stereomicroscope. Then, the crowns were cemented to the related die and the marginal gap was measured with triple scanning, direct visualization under a stereomicroscope and scanning electron microscopy (SEM). The data was analyzed using the independent t test and the one-way analysis of variance (ANOVA). The significance level was set at 0.05. RESULTS: Differences in the mean marginal gap were measured by the various evaluation methods. Triple scanning and stereomicroscopy identified increasing discrepancy during the fabrication process. According to the results of the independent t test, stereomicroscopy showed no difference after cementation between the CAD/CAM and lost-wax groups (p > 0.05), triple scanning showed higher fitness in the CAD/CAM group (p < 0.05), and SEM showed better adaptation in the lost-wax group (p < 0.05); however, there was a positive correlation between the findings of stereomicroscopy and SEM (p < 0.05). CONCLUSIONS: The cobalt-chromium crowns had clinically acceptable marginal fitness from both the CAD/CAM and lost-wax techniques; however, the lost-wax group showed lower marginal discrepancy after cementation according to SEM.

Cytotoxicity of the Ingredients of Commonly Used Toothpastes and Mouthwashes on Human Gingival Fibroblasts.

OBJECTIVES: Toothpastes and mouthwashes contain ingredients that may be toxic for oral mucosal tissues. This study aimed to assess the cytotoxicity of the ingredients of commonly used toothpastes and mouthwashes. MATERIALS AND METHODS: This experimental study was performed on 16 toothpastes and four mouthwashes widely available in the Iranian market. First, the concentration of six main ingredients of these products, namely sodium fluoride (NaF), sodium lauryl sulfate, cocamidopropyl betaine, zinc lactate, paraben, and sodium benzoate, was determined. The methyl thiazolyl tetrazolium (MTT) assay was used to assess the cytotoxicity of these materials for human gingival fibroblasts (HGFs). The MTT assay was performed at 1, 15, and 30 minutes following exposure to five concentrations of each material in triplicate (according to the concentrations obtained in the isolation step). Data were analyzed using three-way analysis of variance (ANOVA). RESULTS: The difference in the cytotoxicity of the materials was statistically significant (P<0.001). Cytotoxicity was time- and concentration-dependent; by an increase in the concentration of the materials, their cytotoxicity increased over time. The cytotoxicity of sodium lauryl sulfate and cocamidopropyl betaine was >90%. The cytotoxicity of NaF varied from 25% to 70%, and the cytotoxicity of all concentrations of zinc lactate and sodium benzoate was <50% for HGFs. CONCLUSION: To decrease the cytotoxic effects of toothpastes, sodium lauryl sulfate and cocamidopropyl betaine should be replaced with safer detergents, and the concentration of fluoride should be decreased to 400 parts per million (ppm). Alternatively, fluoride may be replaced with other antibacterial and cariostatic agents.

Color Stability of Ceramic Veneers Cemented with Self-Adhesive Cements after Accelerated Aging.

OBJECTIVES: Color change of cements over time can be detected through translucent ceramic veneers, compromising the aesthetic appearance of restorations in the long-term. This study aimed to assess the color stability of ceramic laminate veneers cemented with self-adhesive resin cements after accelerated aging. MATERIALS AND METHODS: In this study, 21 IPS e.max ceramic discs, measuring 8mm in diameter and 0.7 mm in thickness, were fabricated and divided into three groups (n=7) for the application of Choice 2 total-etch light-cure resin cement, RelyX U200 dual-cure self-adhesive resin cement, and SpeedCEM self-cure self-adhesive resin cement. The ceramic discs in each group were cemented on the prepared facial surface of bovine teeth. The color parameters were assessed using a spectrophotometer. Subsequently, the samples were subjected to accelerated aging for 100 hours, and the color parameters were measured again. The data were analyzed using two-way repeated-measures analysis of variance (ANOVA) and Tamhane's post-hoc test (P<0.05). RESULTS: Aging significantly affected the ceramic laminate color parameters in all three groups (P<0.05). SpeedCEM cement showed the lowest color stability (ΔE=4.2) after aging, and its color change was clinically unacceptable (ΔE>3.5). The color change of the other two groups was clinically acceptable (1<ΔE<3.5). CONCLUSION: The self-adhesive dual-cure cement showed color stability comparable to that of the total-etch light-cure cement for cementation of IPS e.max ceramic laminates. The color stability of both cements was superior to that of the self-adhesive self-cure cement.

Effects of different ceramic primers and surface treatments on the shear bond strength of restorative composite resin to zirconium.

BACKGROUND AND AIMS: Data are limited about the effect of ceramic primers on the bond of zirconia to restorative resin composite. The aim of this study was to assess the effect of different surface treatments and two ceramic primers on shear bond strength (SBS) of zirconia to restorative resin composite. MATERIALS AND METHODS: 100 samples of zirconium ceramic blocks were randomly divided into 5 groups (n = 20) and received the following surface treatments: a)Control groupb)AL2O3 abrasionc)Nd:YAG laserd)Er:YAG lasere)Bur preparation.Next, each group was divided into two subgroups of 20. In ten out of 20 specimens in each group, monobond plus and Tetric ceram composite resin were applied on the surface. ZPrime Plus and Elite composite were applied on the surfaces of the remaining 10 specimens in each group. Samples were then subjected to shear bond strength test in a universal testing machine until fracture. The mean SBS were calculated and statistically analyzed by two-way ANOVA and T-Test. P < 0.05 was considered statistically significant. RESULTS: In ZPrime plus subgroups, diamond bur yielded the highest bond strength. Laser groups showed no significant difference with the control group. In monobond plus subgroups, SBS of air abrasion and diamond bur subgroups was highest and Nd:YAG laser showed the lowest SBS. The lowest bond strength belonged to the Nd:YAG laser subgroup of monobond plus group. CONCLUSIONS: Type of surface preparation significantly affected the bond strength.

Effect of Accelerated Aging on Color Change of Direct and Indirect Fiber-Reinforced Composite Restorations.

OBJECTIVES: The aim of this study was to assess the effect of artificial accelerated aging (AAA) on color change of direct and indirect fiber-reinforced composite (FRC) restorations. MATERIALS AND METHODS: Direct (Z250) and indirect (Gradia) composite resins were reinforced with glass (GF) and polyethylene fibers (PF) based on the manufacturers' instructions. Forty samples were fabricated and divided into eight groups (n=5). Four groups served as experimental groups and the remaining four served as controls. Color change (ΔE) and color parameters (ΔL*, Δa*, Δb*) were read at baseline and after AAA based on the CIELAB system. Three-way ANOVA and Tukey's test were used for statistical analysis. RESULTS: Significant differences were found in ΔE, ΔL*, Δa* and Δb* among the groups after AAA (P<0.05). Most of the studied samples demonstrated an increase in lightness and a red-yellow shift after AAA. CONCLUSIONS: The obtained ΔE values were unacceptable after AAA (ΔE≥ 3.3). All indirect samples showed a green-blue shift with a reduction in lightness except for Gradia/PF+ NuliteF.