Durability of cantilever inlay-retained fixed dental prosthesis fabricated from multilayered zirconia ceramics with different designs.

PURPOSE The purpose of this in-vitro study was to investigate the effect of framework design on fracture resistance and failure modes of cantilever inlay-retained fixed partial dentures (IRFDPs) fabricated from two multilayered monolithic zirconia materials. MATERIALS AND METHODS Seventy-two natural premolar teeth were prepared as abutments for cantilever IRFDPs using three designs: mesial-occlusal (MO) inlay with short buccal and palatal wings (D1), MO inlay with long palatal wing (D2), MO inlay with long palatal wing and occlusal extension (D3). Full-contoured IRFDPs were fabricated from two monolithic zirconia materials; IPS e.max ZirCAD Prime and Zolid Gen-X. Adhesive surfaces were air-abraded and bonded with MDP-containing resin cement. Specimens were subjected to thermocycling (5-55 °C, 5000 cycles); then, mechanical loading (1.2 × 10⁶ cycles, 49 N). Surviving specimens were loaded until failure in the universal testing machine. All specimens were examined under stereomicroscope, and two samples from each group were evaluated using Scanning Electron Microscope. RESULTS Mean failure loads were not significantly different between different framework designs or between two materials. However, IPS e.max ZirCAD Prime showed significantly higher failure rate than Zolid Gen-X during dynamic fatigue (p = 0.009). Samples with D1 design showed higher debonding rate, D2 failed mainly by fracture of the palatal wing and debonding, and D3 failed mainly by fracture of the abutment tooth. Debonded restorations showed mainly mixed failures. CONCLUSION Cantilever IRFDPs with framework designs that maximize adhesion to enamel exhibited promising results. IPS e.max ZirCAD Prime was more susceptible to fractures with the long palatal wing design

Fracture strength of endocrown maxillary restorations using different preparation designs and materials.

PURPOSE This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging. MATERIALS AND METHODS Eighty two-rooted maxillary premolar crowns underwent endodontic treatment (N = 80, n = 10). The teeth were categorized into ten groups (4-mm deep with no intracanal extension lithium disilicate glass ceramic & multilayer zirconia endocrowns (LE0 & ZE0); 4-mm deep with 4-mm intracanal extension in one canal (LE1 & ZE1); 4-mm deep with 2-mm intracanal extensions in both canals (LE2 & ZE2); flat overlays with no endocore (LO & ZO); glass fiber reinforced post & core and crown (LC & ZC)). After cementation, all specimens were subjected to 1500 thermocycles and 1,200,000 chewing cycles with an axial occlusal load of 49 N. A static loading test was performed at a non-axial 45° loading using a universal testing machine and failure modes (Type I: restoration debonding; Type II: restoration fracture; Type III: restoration/tooth complex fracture above bone level; Type IV: restoration/tooth complex fracture below bone level) were evaluated using a stereoscope. Data were ananalzed using 2-way ANOVA and Tukey's tests (alpha = 0.05). RESULTS The endocrowns manufactured from multilayered zirconia and pressed lithium disilicate glass ceramic exhibited a fracture load ranging between 1334 ± 332 N and 756 ± 150 N, with ZC presenting the highest and LE2 the lowest values. The differences were not statistically significant (p > 0.05). CONCLUSION All endocrowns tested in this study performed similar considering the different designs and materials tested. The distribution of fracture modes did not differ significantly depending on the design of the restoration and the type of material used

Evaluation of Marginal and Internal Fit of Ceramic Laminate Veneers Fabricated with Five Intraoral Scanners and Indirect Digitization.

The long-term success of ceramic laminate veneers (CLVs) is influenced by the marginal and internal fit of the restorations. However, studies comparing the fit of CLVs using different intraoral scanners or the indirect digitization technique are lacking. The purpose of this study was therefore to assess the marginal and internal fit of CAD/CAM-milled CLVs using different intraoral scanners and the indirect digitalization technique. An ivorine typodont maxillary left-central incisor was prepared; the tooth and the neighboring teeth were scanned and used as a template to print ninety 3D partial models. Thereafter, ceramic laminate veneers (CLVs) (N = 90) were milled from IPS-Emax CAD blocks and divided into six equal groups (15 specimens each) according to the type of intraoral scanner (IOS), as follows: Omnicam IOS, SC3600 IOS, Trios 3 IOS, Emerald IOS, I500 IOS. Fifteen further CLVs were fabricated using the conventional indirect digitalization technique. After cementation on the resin dies and embedding in clear epoxy resin, specimens were sectioned inciso-gingivally and mesio-distally. At the incisal and cervical positions, the marginal discrepancy was measured and evaluated in addition to the internal gap at six locations using SEM (200×). Differences between gap measurements among the six groups were determined using ANOVA. Games-Howell multiple comparisons for homogenous variances and LSD multiple comparisons for non-homogenous variances were used with 95% confidence intervals. The significance level was set at 0.05. The lowest mean absolute marginal gap at the incisal margins (AMGI) was recorded for Omnicam group (203.28 ± 80.14) µm, while the highest mean absolute marginal gap at the cervical margins (AMGC) was recorded for Omnicam group (147.16 ± 59.78) µm. The mean AMGC was reported to be significantly different between the conventional technique (146.75 ± 38.43) µm and Trios 3 (91.86 ± (35.51) µm; p = 0.001) and between Emerald (112.37 ± (50.31) µm; p = 0.042) and I500 (86.95 ± (41.55) µm; p 0.05). Marginal gaps were higher in the incisal region compared to the cervical region with both the indirect digitization technique and the IOSs. Ceramic laminate veneers (CLVs) fabricated using IOSs produced overall internal and marginal fit adaptation results comparable to CLVs fabricated from the indirect digitalization method, and both techniques produced clinically acceptable results

Fracture strength of endocrown maxillary restorations using different preparation designs and materials

PURPOSE: This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging. MATERIALS AND METHODS: Eighty two-rooted maxillary premolar crowns underwent endodontic treatment (N = 80, n = 10). The teeth were categorized into ten groups (4-mm deep with no intracanal extension lithium disilicate glass ceramic & multilayer zirconia endocrowns (LE0 & ZE0); 4-mm deep with 4-mm intracanal extension in one canal (LE1 & ZE1); 4-mm deep with 2-mm intracanal extensions in both canals (LE2 & ZE2); flat overlays with no endocore (LO & ZO); glass fiber reinforced post & core and crown (LC & ZC)). After cementation, all specimens were subjected to 1500 thermocycles and 1,200,000 chewing cycles with an axial occlusal load of 49 N. A static loading test was performed at a non-axial 45° loading using a universal testing machine and failure modes (Type I: restoration debonding; Type II: restoration fracture; Type III: restoration/tooth complex fracture above bone level; Type IV: restoration/tooth complex fracture below bone level) were evaluated using a stereoscope. Data were ananalzed using 2-way ANOVA and Tukey's tests (alpha = 0.05). RESULTS: The endocrowns manufactured from multilayered zirconia and pressed lithium disilicate glass ceramic exhibited a fracture load ranging between 1334 ± 332 N and 756 ± 150 N, with ZC presenting the highest and LE2 the lowest values. The differences were not statistically significant (p > 0.05). CONCLUSION: All endocrowns tested in this study performed similar considering the different designs and materials tested. The distribution of fracture modes did not differ significantly depending on the design of the restoration and the type of material used

A Comparison of the Surface Properties of CAD/CAM and Conventional Polymethylmethacrylate (PMMA)

Purpose To compare surface properties of 2 brands of pre‐polymerized resin blocks for complete dentures (CAD/CAM PMMA) to conventional heat‐polymerized PMMA. Materials and Methods A total of 45 rectangular specimens (25 × 25 × 3 mm) were fabricated from 3 brands of PMMA (n = 15/group): AvaDent CAD/CAM PMMA, Tizian‐Schütz CAD/CAM PMMA, Meliodent conventional PMMA. Specimens were examined for wettability using the sessile drop method, surface roughness using a digital contact profilometer, and microhardness using Vickers hardness number. Statistical analysis was performed using one‐way ANOVA and Tukey pairwise multiple comparisons. p‐Values of ≤0.05 were considered significant. Results AvaDent specimens demonstrated the highest mean contact angle (72.87 ± 48°) and the highest mean Vickers hardness number (20.62 ± 0.33). The conventional heat‐polymerized specimens showed the highest mean surface roughness (0.22 ± 0.071 μm). Tizian‐Schütz specimens showed the lowest mean surface roughness (0.12 ± 0.02 μm). Conclusions As CAD/CAM PMMA groups exhibited significantly more favorable surface properties in comparison to the conventional heat‐polymerized groups, CAD/CAM dentures are expected to be more durable. Different brands of CAD/CAM PMMA may have inherent variations in surface properties

Success of 3-Unit Posterior All-Ceramic Inlay-Retained Fixed Dental Prostheses: A Narrative Literature Review

PURPOSE OF REVIEW: This narrative review aimed to offer evidence on 3-unit all-ceramic posterior inlay-retained prostheses (IRFDPs) with an emphasis on material choice and design principles. Clinical trials and in vitro studies were identified using an electronic search in PubMed database. Overall, 16 in vitro publications and 8 clinical trials were included that reported on retainer designs, connector dimensions, and tooth preparation designs and detailed bonding techniques, evaluated replacement of posterior teeth, were clinical studies (follow-up ≥ 1 year), or addressed survival or failure rate, based on in vitro chewing simulator, fracture load, and in vivo technical or biological complications. RECENT FINDINGS: Material properties, restoration design, and adhesive technique showed a high impact on performance of IRFDPs. High-strength zirconia ceramics with intracoronal design bonded to enamel seem to perform well in the posterior region of the mouth. Furthermore, air abrasion at moderate pressure in combination with phosphate-containing resins provides durable bonding to zirconia ceramics. SUMMARY: Despite the advances in ceramic materials, there have been few scientific evidence to support the ideal preparation design that might improve clinical performance and restoration lifetime of 3-unit IRFDPs

Evaluation of Clinical Periodontal Parameters of Abutment Teeth Supporting Distal-Extension Base Removable Partial Dentures: A Cross-sectional Study

To assess the clinical periodontal status of abutment teeth in regards of different design components of distal-extension removable partial dentures. Subjects (N=100) with acrylic or cobalt-chromium distal-extension removable partial dentures were enrolled and their periodontal parameters plaque and gingival indices [PI, GI], probing depths [PD], clinical attachment loss [CAL] and a mobility index [MI] evaluated. Denture base type, major connector, occlusal rests position, design of direct retainers, retention, stability and denture wearing habits were further evaluated. Acrylic RPDs were associated with higher mean±SE PI [1.70±0.74], GI [1.76±0.55], PD scores [2.47±1.02 mm] and CAL values [4.46±2.11 mm] compared to CO-CR RPDs [p⟨0.05]. For abutments, the PI [1.6±0.83], GI [1.72±0.57], PD [2.32±1.03] and CAL [4.26±2.08] were higher than their non-abutments counterparts [p⟨0.05]. CAL scores were found to be significantly higher for mandibular abutments compared to maxillary ones [P=0.002]. The highest PI [1.83±1.10] and GI [2.00±0.00] scores were associated with lingual bars and horse-shoe connectors, respectively. Full palatal coverage and lingual plates were associated with the highest PD [2.80±0.48] and CAL [4.70±0.37] scores. Acrylic RPDs, type of major connector, wrought wire clasps and distal occlusal rests may be considered as risk factors for periodontal disease progression in distal-extension removable partial denture wearers