Resistance to Fracture of Two All-Ceramic Crown Materials Following Endodontic Access

Statement of problem There is currently no protocol for managing endodontic access openings for all-ceramic crowns. A direct restorative material is generally used to repair the access opening, rendering a repaired crown as the definitive restoration. This endodontic procedure, however, may weaken the restoration or initiate microcracks that may propagate, resulting in premature failure of the restoration. Purpose The purpose of this in vitro study was to evaluate how an endodontic access opening prepared through an all-ceramic crown altered the structural integrity of the ceramic, and the effect of a repair of this access on the load to failure of an all-ceramic crown. Material and methods Twenty-four alumina (Procera) and 24 zirconia (Procera) crowns were fabricated and cemented (Rely X Luting Plus Cement) onto duplicate epoxy resin dies. Twelve crowns of each were accessed to simulate root canal treatment therapy. Surface defects of all accessed specimens were evaluated with an environmental scanning electron microscope. The specimens were repaired with a porcelain repair system (standard adhesive resin/composite resin protocol) and were loaded to failure in a universal testing machine. Observations made visually and microscopically noted veneer delamination from the core, core fracture, shear within the veneer porcelain, or a combination thereof. A Kruskal-Wallis test was used to determine if a significant difference (α=.05) in load to failure existed between the 4 groups, and a Mann-Whitney test with a Bonferroni correction (P Results All specimens exhibited edge chipping around the access openings. Some displayed larger chips within the veneering porcelain, and 4 zirconia crowns showed radial crack formation. There was a significant difference in load to failure among all groups with the exception of the alumina intact and repaired specimens (P=.695). The alumina crowns generally showed fracture of the coping with the veneering porcelain still bonded to the core, whereas the zirconia copings tended not to fracture but experienced veneering porcelain delamination. Conclusion Endodontic access through all-ceramic crowns resulted in a significant loss of strength in the zirconia specimens but not in the alumina specimens

Thermal stress analysis of a new turbine shroud seal concept

The thermal stress field of a two piece turbine shroud seal concept was analyzed and results compared to one piece designs by finite element analysis. The two piece seal has independently formed structure (substrate) and ceramic components that are assembled at ambient conditions. The boundary conditions used for analysis were hot gas surface temperatures of 1370 and 1650 C (2500 and 3000 F) and cooled surface temperature of 700 C (1285 F). The resulting thermal stress field, of the two piece seal when compared to the one piece seals in the region of all ceramic material, was reduced substantially

Tape casting as an approach to an all-ceramic turbine shroud seal

Gas path seals have a one-dimensional variation in material requirement. Tape casting is a method which allows the fabrication of thin ceramic sheets, which may be laminated to accommodate these requirements. Using tape casting, thin sheets of zirconia (0.25 mm) were fabricated. These castings were successfully laminated and fired without bloating or delamination, demonstrating the feasibility of this approach

Optimizing Anterior Implant Outcome Immediately After Implant Placement and Grafting by Using Patient’s Extracted Teeth: A Case Report

Optimizing anterior implant outcome using patient’s extracted teeth. Successful implant treatment in the anterior maxilla is predicated on providing a functional and esthetically acceptable outcome. As well, achieving a predictable ideal emergence profile and soft tissue contour is expected. Placing immediate provisional restorations utilizing the patient’s modified extracted teeth can facilitate initiate facial soft tissue contouring while precluding undue pressure on the surgical site during the early healing phase. This allows for a one stage surgical procedure, fixed provisionalization and ideal tissue contouring. This clinical report presents the use of a patient’s modified extracted permanent teeth as bonded fixed provisional restorations placed immediately after implant placement and bone grafting. The gingival-lingual and cingulum tooth structure was recontoured to allow no contact with the implant or bone graft material. A combination of cement and screw-retained definitive restorations were fabricated with contours reflecting the tissue contours established by the interim restoration

Full maxillary rehabilitation with an all-ceramic system

With the appearance of all-ceramic systems, providing a choice of framework porcelains and allowing the same material to be used for the veneer, it is now possible to select the ideal structure in terms of both function and esthetics. Silicate ceramics allow porcelain laminate veneers and crowns to be used in the anterior region, providing excellent esthetics; while for the posterior area, where function takes precedence, oxide ceramics, specifically zirconium oxide, are preferred. The IPS e.max ceramic system, heir apparent to the IPS Empress 2 system, combines the advantages of zirconium oxide ceramics (IPS e.max Zircad) with the excellent esthetic qualities of silicate ceramics (IPS e.max Press). This paper presents a clinical case requiring complete maxillary rehabilitation for esthetic purposes. An overview of some of the porcelains used in this system, analyzed from both the clinical and laboratory perspective is provided. The esthetic advantages of a single ceramic veneer, the need to select appropriate ceramics for anterior and posterior regions, and cementation and surface treatments are discussed

Fracture Resistance of Zirconia Oral Implants In Vitro: A Systematic Review and Meta-Analysis

Various protocols are available to preclinically assess the fracture resistance of zirconia oral implants. The objective of the present review was to determine the impact of different treatments (dynamic loading, hydrothermal aging) and implant features (e.g., material, design or manufacturing) on the fracture resistance of zirconia implants. An electronic screening of two databases (MEDLINE/Pubmed, Embase) was performed. Investigations including > 5 screw-shaped implants providing information to calculate the bending moment at the time point of static loading to fracture were considered. Data was extracted and meta-analyses were conducted using multilevel mixed-effects generalized linear models (GLMs). The Šidák method was used to correct for multiple testing. The initial search resulted in 1864 articles, and finally 19 investigations loading 731 zirconia implants to fracture were analyzed. In general, fracture resistance was affected by the implant design (1-piece > 2-piece, p = 0.004), material (alumina-toughened zirconia/ATZ > yttria-stabilized tetragonal zirconia polycrystal/Y-TZP, p = 0.002) and abutment preparation (untouched > modified/grinded, p < 0.001). In case of 2-piece implants, the amount of dynamic loading cycles prior to static loading (p < 0.001) or anatomical crown supply (p < 0.001) negatively affected the outcome. No impact was found for hydrothermal aging. Heterogeneous findings of the present review highlight the importance of thoroughly and individually evaluating the fracture resistance of every zirconia implant system prior to market release

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement. (Am J Orthod Dentofacial Orthop 2011;139:533-43

Fem and Von Mises analysis of OSSTEM ® dental implant structural components: evaluation of different direction dynamic loads

Abstract PURPOSE: The objective of this investigation is to study prosthodontics and internal components resistance to the masticatory stress and considering different force directions by using Finite Element Method analysis (FEM). The structural materials of the components are usually Titanium alloy grade 4 or 5 and thus, guarantee the integration of the fixture in the bone due to the osteointegration phenomena. Even if the long-term dental implant survival rate is easy to be obtained and confirmed by numerous researches, the related clinical success, due to the alteration of the mechanical and prosthodontics components is still controversial. METHODS: By applying engineering systems of investigations like FEM and Von Mises analyses, it has been investigated how dental implant material was held against the masticatory strength during the dynamic masticatory cycles. A three-dimensional system involved fixture, abutment and the connection screws, which were created and analyzed. The elastic features of the materials used in the study were taken from recent literature data. RESULTS: Data revealed a different response for both types of devices, although implant neck and dental abutment showed better results for all conditions of loading while the abutment screw represented aweak point of the system. CONCLUSION: The data of this virtual model showed all the features of different prosthetic retention systems under the masticatory load. Clinicians should find better prosthetic balance in order to better distribute the stress over the component and to guarantee patients' clinical long-term results

Porcelain Surface Roughness, Color and Gloss Changes after Orthodontic Bonding

The purpose of this study was to evaluate the alteration in surface characteristics after orthodontic debonding of two types of porcelain systems commonly used in prosthetic dentistry. For this purpose, porcelain specimens were fabricated from low-fusing (n = 20) and high-fusing (n = 20) porcelain. The baseline surface roughness, color, and gloss were evaluated using profilometry, color shade index, and gloss study. All specimens were bonded with brackets and debonded using a testing machine at a rate of 0.1 mm/minute crosshead speed. The porcelain surfaces were polished using a 12-fluted carbide composite removal bur (low-fusing, n = 20; high-fusing, n = 20). In addition, half of each porcelain group was further polished using a series of Sof-Lex discs (low-fusing, n = 10; high-fusing, n = 10). The postdebond porcelain surface characteristics roughness, color, and gloss were reevaluated and compared with baseline measurements. The results were analyzed with two-way analysis of variance and Tukey multiple comparisons test, with porcelain type (low-fusing or high-fusing) and polishing protocol (carbide bur or carbide bur and discs) serving as discriminate variables at α = 0.05 level of significance. Bonding and debonding increased all roughness parameters tested; however, no change was revealed between the two polishing protocols. Similarly, gloss and color index changes were significantly altered after resin grinding, regardless of the polishing method used. No difference was identified between the two porcelain types with respect to roughness, color index, or gloss. Orthodontic bonding alters the porcelain surfaces, and postdebond polishing does not restore the surface to the prebond state