Mouthguard use and TMJ injury prevention with different occlusions: A three-dimensional finite element analysis

Background/Aims: There is a lack of data regarding the mechanical responses of the temporo-mandibular joints during an impact to the orofacial region. The aim of this study was to analyze the biomechanical effects of wearing a mouthguard (MG) on the impact response of the mandibular condyle and articular disk according to the type of occlusion. The hypothesis was that the MG would minimize the effect in those structures, regardless of the occlusion type. Methods: Using modeling software, a human skull with jaw, teeth and articular disk was created. The models were divided according to the occlusion type (Class I, II, or III) and the presence of a mouthguard (with or without). The geometries were exported to analysis software, and the materials were considered ideal. Fixation occurred at the base of the foramen magnum. The load (0-500N, 1s) was applied to the upper central incisors with a steel ball. Maximum principal stress and Von Mises results (MPa) were obtained in the mandibular condyle and articular disk. Minimum principal stress and maximum shear stresses were also recorded in the articular disk. Results: For both structures, the MG caused a decrease in stress concentration regardless of the occlusion and stress criteria. The condyle neck was the most tensile-stressed area while for the articular disk, both the superior and inferior surfaces were the most stressed areas. The highest stress peaks in the disk were found for compression followed by tensile and then shear stress. Conclusion: This biomechanical analysis of the effects of using a mouthguard exhibited considerably decreased stresses on the mandibular condyle and articular disk, regardless of the occlusion type

Polymerization shrinkage and push-out bond strength of different composite resins for sealing the screw-access hole on implant-supported crowns

Purpose: To evaluate the effect of composite resin polymerization shrinkage stress on the stress distribution in the implant-supported crown-access hole, and on the bond strength between the ceramic and composite resin. Materials and Methods: A 3D model of a ceramic crown, in which the access hole was filled with composite resin (conventional or bulk-fill), was used to evaluate the stress distribution in the access hole using finite element analysis. The contacts were considered bonded and the polymerization shrinkage was simulated based on the coefficient of linear thermal expansion of each resin. The push-out test (1 mm/min, 100 kgf) was performed on perforated lithium disilicate samples filled with conventional or bulk-fill resins to validate the stress data of the bond strength. One-way ANOVA and Tukey's test were used to analyze the bond strength data, with α set at 5%. Results: Conventional resin showed the worst stress distribution and highest displacement values, von Mises stress, maximum principal strain, maximum principal stress, and maximum shear stress vs the bulk-fill resin. Statistically significantly greater bond strength was observed for bulk-fill (13.40 ± 5.59 MPa) than the conventional resin (8.70 ± 3.02 MPa). Conclusion: Comparing both materials tested in the present study, the use of bulk-fill composite resin to seal the screw-access hole is suggested to reduce the stress concentration and increase bond strength to the ceramic crown

Three-body wear effect on different CAD/CAM ceramics staining durability: Staining durability after wear

Regardless the materials properties, the vast majority of ceramic restorations could require an individualization through the extrinsic staining to improve aesthetics. This study aimed to compare the staining wear durability of different monolithic ceramics. Specimens of high translucent zirconia (YZHT), zirconia reinforced lithium silicate (ZLS), hybrid ceramic (HC) and feldspathic ceramic (FLD) were divided in five groups according to each material staining technique. The ZLS ceramic was tested with stained prior (ZLS1) and after crystallization (ZLS2). All specimens were extrinsically characterized, i.e. stained, and crystallized or sintered in specific ovens, according to the manufacturer's recommendation. The specimens were submitted to three-body wear tests in ACTA wear machine, simulating the presence of food bolus and antagonist (pH 7, 15 N, 1 Hz). The wear rate of the stain surface was determined after 5 intervals of 200,000 cycles, using a profilometer. The ceramic surface before and after staining, and after wear were inspected by Scanning Electron Microscopy (SEM). The wear rates were analyzed using two-way ANOVA and post-hoc Tukey test. The wear rates of the staining were affected by ceramic and the number of cycles (P < 0.001). 100% of staining was removed after 200,000 cycles for HC, and after 600,000 cycles for YZHT and ZLS1. Staining of ZLS2 and FLD remained on ceramic surface even after 1,000,000 cycles. Furthermore, FLD showed a significant higher staining durability than ZLS2. SEM revealed different surface morphologies for each group with and without staining and after the wear test. Ceramics with fired staining showed higher durability compared to the polymerized one. The feldspar ceramic presented superior staining durability, followed by zirconia reinforced lithium silicate and high translucent zirconia. The conventional two steps staining technique showed improved durability for zirconia reinforced lithium silicate

Survival probability, weibull characteristics, stress distribution, and fractographic analysis of polymer-infiltrated ceramic network restorations cemented on a chairside titanium base: An in vitro and in silico study

Different techniques are available to manufacture polymer-infiltrated ceramic restorations cemented on a chairside titanium base. To compare the influence of these techniques in the mechanical response, 75 implant-supported crowns were divided in three groups: CME (crown cemented on a mesostructure), a two-piece prosthetic solution consisting of a crown and hybrid abutment; MC (monolithic crown), a one-piece prosthetic solution consisting of a crown; and MP (monolithic crown with perforation), a one-piece prosthetic solution consisting of a crown with a screw access hole. All specimens were stepwise fatigued (50 N in each 20,000 cycles until 1200 N and 350,000 cycles). The failed crowns were inspected under scanning electron microscopy. The finite element method was applied to analyze mechanical behavior under 300 N axial load. Log-Rank (p = 0.17) and Wilcoxon (p = 0.11) tests revealed similar survival probability at 300 and 900 N. Higher stress concentration was observed in the crowns' emergence profiles. The MP and CME techniques showed similar survival and can be applied to manufacture an implant-supported crown. In all groups, the stress concentration associated with fractographic analysis suggests that the region of the emergence profile should always be evaluated due to the high prevalence of failures in this area

Durability of staining and glazing on a hybrid ceramics after the three-body wear: Hybrid ceramic stain durability

Hybrid ceramic is a promising material for monolithic restorations that could require an individualization through the extrinsic staining to improve aesthetics. Due to the possibilities to treat this ceramic prior to staining, this study evaluated the wear resistance of surface treatments prior to staining and glazing a hybrid ceramic. Thirty-two specimens (Vita Enamic) were divided into 8 groups according to the surface treatment prior to the staining (Polishing: Pol, Acid etching: Ac, Sandblasting with Al2O3: Sd or Self-etching silane: Ses) and glaze application (with: gl or without: gl). The specimens were submitted to the ACTA wear machine simulating the presence of food bolus and antagonist. The wear rate of the stain was determined after 7 intervals of 20,000 cycles, using a profilometer. The surface before and after staining, and after wear were inspected using Scanning Electron Microscopy (SEM). The rates were analyzed using three-way ANOVA and Tukey test. The wear was affected by surface treatment, glaze application and number of cycles (p < 0.001). 100% of the staining was removed after 20,000 cycles for Pol, 40,000 for Pol + gl, 60,000 for Ses + gl, 80,000 for Ac, 100,000 for Sd and Ses, 120,000 for Ac + gl and 140,000 for Sd + gl. SEM showed similar worn surfaces. Sandblasting followed by glaze application was the most durable treatment to maintain the external staining on the hybrid ceramic surface when subjected to three-body wear

Effect of microwave crystallization on the wear resistance of reinforced glass-ceramics

This study compared the wear resistance of different reinforced glass-ceramics crystalized by conventional or microwave firing. The wear rate of three ceramics [one lithium disilicate ceramic (LD): IPS e.max CAD – Ivoclar Vivadent; and two zirconia reinforced lithium silicates: Suprinity – VITA Zahnfabrik (ZLS1) and Celtra Duo – Dentsply (ZLS2)] crystallized by conventional (c) or microwave (mw) firing protocols were collected according to the contact- [two-body (n = 20/gr)] and contact-free wear tests [three-body (n = 20/gr)]. After wear tests performed on ACTA wear machine, mean surface roughness (Ra) and Scanning Electron Microscopy (SEM) analyzes were performed to evaluate the surface alterations. The wear and roughness data (in μm) were evaluated using two-way ANOVA and Tukey post-hoc test (α = 0.05). Two-body wear test revealed that ZLS1 (1.30 ± 1.79)A showed higher wear rate than LD (0.79 ± 2.15)B and ZLS2 (0.85 ± 0.94)B, regardless the crystallization approach. For three-body test, conventional crystallization (0.62 ± 0.4)A showed higher wear rates than microwave (0.22 ± 0.71)B; while the type of ceramic was not significant. The crystallization protocol (p < 0.001) and ceramic material (p = 0.001) affected the surface roughness in the three-body; whereas the two-body test, only the crystallization protocol (p = 0.046). SEM analysis showed a similar and smother surface morphology for LD and ZLS2 compared to ZLS1. Conventional crystallization showed materials more prone to wear than the microwave, in the presence of food bolus. Therefore, the microwave crystallization can be suggested as an alternative to improve the evaluated glass-ceramics wear resistance

Survival probability of zirconia-reinforced lithium silicate ceramic: Effect of surface condition and fatigue test load profile

Objectives: The present investigation evaluated the step stress accelerated test (SSALT) load profiles on the survival probability of a glass ceramic under two surface conditions (polished or roughened). Methods: Suprinity–ZLS blocks (Vita Zhanfabrik) were shaped into cylinders, cut in a sawing machine, and crystalized according to the manufacturer's instructions. 60 discs were obtained (Ø = 12 mm, thickness = 1.2 mm) and randomly assigned into two surface conditions: “p” polished surface (400–1200-grit SiC papers), and “r” roughened surface (200-grit SiC papers). Profilometry was performed in all discs to evaluate average surface roughness prior to flexural fatigue strength testing. 3 discs of each group were submitted to biaxial flexural strength in an universal testing machine (0.5 mm/min) and the mean load to failure (N) was calculated to determine SSALT profiles. 27 specimens per surface condition were assigned into three profiles – Mild (n = 9), Moderate (n = 9), and Aggressive (n = 9), and submitted to the fatigue test (60–320 N, 140,000 cycles at 1.4 Hz). The results were analyzed using the Kaplan-Meier and Wilcoxon tests (5%), 2-way ANOVA and Tukey test (α = 5%). Results: Kaplan-Meier and generalized Wilcoxon showed (P = 0.002) that polished groups showed higher survival probability than roughened condition (P < 0.05). A rough internal surface impacted deleteriously on the fatigue strength and reliability of ZLS ceramic. Both surface conditions were more sensitive to the aggressive profile than the other profiles, even worst for the roughened group. Regardless the load profile, 0% survival probability was observed at 384 MPa for polished condition. While for roughened, aggressive tested specimens did not survived 147 MPa followed by moderate at 312 MPa and mild at 384 MPa. The failure modes showed fracture marks originating from superficial grooves for both surface conditions. Significance: Polished specimens are sensitive to the load profile variation, confirming the effect of surface morphology on the fatigue results