Chairside Computer-aided Design And Computer-aided Manufacturing Research Articles

Influence of occlusal thickness on the fracture resistance of chairside milled lithium disilicate posterior full-coverage single-unit prostheses containing virgilite: A comparative in vitro study.

To evaluate the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate mandibular posterior crowns with virgilite of different occlusal thicknesses and compare them to traditional lithium disilicate crowns. Seventy-five chairside CAD-CAM crowns were fabricated for mandibular right first molars, 60 from novel lithium disilicate with virgilite (CEREC Tessera, Dentsply Sirona), and 15 from traditional lithium disilicate (e.max CAD, Ivoclar Vivadent). These crowns were distributed across five groups based on occlusal thickness and material: Group 1 featured CEREC Tessera crowns with 0.8mm thickness, Group 2 had 1.0mm thickness, Group 3 had 1.2mm thickness, Group 4 with 1.5mm thickness, and Group 5 included e.max CAD crowns with 1.0mm thickness. These crowns were luted onto 3D-printed resin dies using Multilink Automix resin cement (Ivoclar Vivadent). Subsequently, they underwent cyclic loading (2,000,000 cycles at 1Hz with a 275 N force) and loading until fracture. Scanning electron microscopy (SEM) assessed the fractured specimens. Statistical analysis involved one-way ANOVA and the Kruskal-Wallis Test (α = 0.05). Fracture resistance varied significantly (<0.001) across mandibular molar crowns fabricated from chairside CAD-CAM lithium disilicate containing virgilite, particularly between crowns with 0.8mm and those with 1.2 and 1.5mm occlusal thickness. However, no significant differences were found when comparing crowns with 1, 1.2, and 1.5mm thicknesses. CEREC Tessera crowns with 1.5mm thickness exhibited the highest resistance (2119N/mm2), followed by those with 1.2mm (1982N/mm2), 1.0mm (1763N/mm2), and 0.8mm (1144N/mm2) thickness, whereas e.max CAD crowns with 1.0mm occlusal thickness displayed the lowest resistance (814N/mm2). The relationship between thickness and fracture resistance in the virgilite lithium disilicate full-coverage crowns was directly proportional, indicating that increased thickness corresponded to higher fracture resistance. No significant differences were noted among crowns with thicknesses ranging from 1 to 1.5mm. This novel ceramic exhibited superior fracture resistance compared to traditional lithium disilicate.

Fracture load of chairside CAD-CAM veneers fabricated with pre-and fully crystalized lithium disilicate ceramics.

To evaluate the fracture load of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) veneers fabricated with two conventional pre-crystallized and two fully crystallized lithium disilicate ceramic materials. Seventy-five chairside CAD-CAM veneers (15 specimens/group) for maxillary right central incisors were fabricated with different lithium disilicate brands: (1) IPS e.max CAD; (2) Amber Mill; (3) Cerec Tessera; (4) n!ce Straumann; and (5) GC Initial LiSi Block. Restorations were cemented with resin luting cement (Variolink Esthetic, Ivoclar) to 3D-printed resin dies. Bonded restorations received 5000 thermal cycles and then were loaded until fracture. Statistical analysis included One-Way ANOVA. Conventional pre-crystallized e.max CAD displayed the highest fracture load value (640 N), followed by fully-crystallized n!ce Straumann (547 N), pre-crystallized Cerec Tessera (503 N), pre-crystallized Amber Mill (476 N), respectively; fully-crystallized GC Initial LiSi Block (431 N) displayed the lowest values. When comparing the fracture load of recent lithium disilicate ceramic material to the e.max group, which acted as the control, significant differences were noted. The LiSi Block GC group, in particular, had considerably higher mean difference values (208.867, p < 0.001, 95% CI [89.63, 328.10]), as did the Amber Mill group (164.200, p = 0.002, 95% CI [44.96, 283.44]) and CEREC Tessera group (137.533, p = 0.016, 95% CI [18.30, 256.77]). The e.max and n!ce Straumann groups had no statistically significant differences in mean scores (92.933, p = 0.198, 95% CI [-26.30, 212.17]). These findings imply that the clinical performance of recent lithium disilicate veneers varies when compared to the e.max CAD group. The fracture load of chairside CAD-CAM lithium disilicate veneers for maxillary central incisors varies according to the type of ceramic brands. Conventional pre-crystallized e.max CAD displayed higher fracture load than the recent pre- and fully-crystallized lithium disilicate materials, emphasizing the significance of choosing the right product based on the desired clinical outcome.

Fracture resistance of chairside CAD-CAM lithium disilicate occlusal veneer with various designs after mechanical aging.

This study evaluated the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate crown, onlay, and non-anatomical occlusal veneer (A-OV) with and without margin fabricated. Sixty-four CAD-CAM lithium disilicate restorations were designed as (1) complete coverage crown (CCC); (2) A-OV with margin; (3) non-A-OV with margin (NA-OV-M); and (4) non-A-OV without margin (NA-OV-NM), 16 of each. Restorations were crystallized and adhesively luted to resin dies using resin cement. Specimens were then subjected to 400,000 cycles of chewing in a mastication simulator. A universal testing machine was used to apply a compressive load at a crosshead speed of 1mm/min to the long axis of the tooth with a stainless-steel sphere until fracture occurred. One-way ANOVA followed by post hoc tests were used to assess the impact of preparation design on the fracture load of CAD-CAM lithium disilicate restorations. The highest fracture load was recorded for CAD-CAM lithium disilicate indirect restorations for non-A-OVs preparation with margin (2549±428 N) and onlay (2549±293 N) and the lowest fracture load was recorded for CCCs (2389±428 N); however, there was no significant (p = 0.640) between groups. CAD-CAM lithium disilicate restorations fabricated for anatomical and non-A-OV preparation display a fracture resistance similar to CCCs. Conservative partial coverage restorations may be considered an acceptable approach for posterior teeth.

Fracture Resistance of Chairside CAD/CAM Lithium Disilicate-reinforced Ceramic Occlusal Veneers With and Without Margin and Full Coverage Crowns.

The aim of this investigation was to compare the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate-reinforced ceramic occlusal veneers with and without margin and traditional full coverage premolar crowns. A total of 60 chairside CAD/CAM lithium disilicate-reinforced ceramic (Amber Mill, Hass Bio) restorations were designed and fabricated with a chairside CAD/CAM system (CEREC Dentsply Sirona). The restorations were divided into three groups (n=20): 1) occlusal veneer with 1.0-mm uniform occlusal thickness and with chamfer margin; 2) occlusal veneer with 1.0-mm uniform occlusal thickness and without margin; and 3) full coverage crown with uniform occlusal thickness and gingival margin. Occlusal veneers and crowns were cemented with dual cured resin luting cement (Multilink, Ivoclar Vivadent) to printed resin dies, load cycled (5 million load cycles at 1 Hz with 275 N force), and then loaded until fracture. Load at break (LB) and peak load (PL) until fracture were recorded. Scanning electron microscope images of the tested restorations on the abutments were obtained. Fracture strengths were different depending on the design of the restoration. There was no significant difference in fracture strength between the two types of occlusal veneer (LB: 1132.45 N; PL: 1143.30 N for veneers with margin; LB: 1149.25 N; PL: 1219.05 N for veneers without margin). Full coverage crowns showed the lowest fracture resistance (LB: 936.26 N, PL: 976.42 N), which was significantly lower than both designs of occlusal veneer. The fracture resistance of the CAD/CAM lithium disilicate-reinforced ceramic restorations was influenced by the design. Occlusal veneers with and without margin displayed higher fracture resistance than traditional crowns.

Effect of resin cement selection on fracture resistance of chairside CAD-CAM lithium disilicate crowns containing virgilite: A comparative in vitro study

Studies on the fracture performance of a recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate ceramic containing virgilite with different cements are lacking. The purpose of this in vitro study was to evaluate the fracture resistance of crowns made of a recently introduced chairside CAD-CAM lithium disilicate containing virgilite cemented with different types of adhesive luting cement. Sixty complete coverage crowns for a maxillary right central incisor were milled out of a lithium disilicate with virgilite (CEREC Tessera) (n=48) and a traditional lithium disilicate (e.max CAD) (n=12) using a chairside CAD-CAM system (Primescan). The central incisor tooth preparation included a 1.5-mm incisal reduction, a 1.0-mm axial reduction, and a 1.0-mm chamfer finish line. The restorations were bonded with different types of resin cement to 3D printed dies of the tooth preparation and were divided into 5 groups (n=12 per group): e.max CAD with Multilink Automix (E.Mu); Tessera with Multilink Automix (T.Mu); Tessera with Calibra (T.Ca); Tessera with Unicem (T.Un); and Tessera with Speedcem (T.Sp). The cemented restorations were stored in water for 30 days and then loaded until they were fractured in compression. The load at fracture was analyzed with a 1-way analysis of variance (ANOVA) and the honestly significant difference (HSD) Tukey test (α=.05). The mean fracture resistance of traditional lithium disilicate and virgilite lithium disilicate anterior crowns significantly differed depending on the type of resin cement used (P<.05). Group E.Mu displayed the highest values (946.35 ±155N), followed by group T.Un (819.59 ±232N), group T.Sp (675.52 ±153N), and group T.Mu (656.95 ±193N). The lowest values were displayed by group T.Ca (567.94 ±184N). The fracture resistance of lithium disilicate containing virgilite and traditional lithium disilicate crowns cemented with the same cement displayed statistically similar values. However, significant differences were observed when the virgilite lithium disilicate crowns were cemented with different types of adhesive luting cement. The crowns in the T.Ca group displayed the lowest fracture resistance.

Fracture resistance of zirconia surveyed crowns with four different occlusal rest seat designs.

To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.

Effect of sintering on the translucency of CAD-CAM lithium disilicate restorations: A comparative in vitro study.

The available independent data on the translucency of novel pre and fully sintered chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate are limited. This comparative in vitro study evaluated the translucency degree of pre and fully sintered chairside CAD-CAM lithium disilicate crowns after optional, required, and additional firing processes. One hundred and five maxillary left central incisor crowns manufactured by three different CAD-CAM lithium disilicate brands shade A1 were assigned into seven groups as follows (n=15): (1) Straumann n!ce without sintering; (2) Straumann n!ce with one additional sintering process; (3) Straumann n!ce with two additional sintering processes; (4) Amber Mill with one sintering process; (5) Amber Mill with two sintering processes; (6) IPS e.max CAD with one sintering process; and (7) IPS e.max CAD with two sintering processes. The translucency of all crowns was evaluated with a color imaging spectrophotometer. All statistical analyses were performed using statistical software. A standard level of significance was set at α<0.05. All the milled crowns presented different degrees of translucency, and additional sintering processes altered it. IPS e.max CAD with two (4.33±0.26) and one (4.01±0.15) sintering processes displayed the highest translucency, whereas Straumann n!ce with no sintering process provided the lowest value (2.82±0.16). The translucency of chairside lithium disilicate single-unit full-coverage restorations manufactured with subtractive technology was significantly influenced by the brand and the number of sintering processes. The traditional presintered IPS e.max CAD and the fully crystallized glass-ceramic Straumann n!ce considerably increased the translucency after one additional firing process, whereas Amber Mill decreased its translucency.

Traditional versus conservative endodontic access impact on fracture resistance of chairside CAD-CAM lithium disilicate anterior crowns: An in vitro study.

To evaluate the effect of traditional and conservative endodontic access hole preparation on fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate maxillary right central incisor crowns. Fifty-seven milled lithium disilicate maxillary right central incisor crowns were designed and fabricated with a chairside CAD-CAM system (Planmeca Romexis, Planmeca). The abutment preparation had a 1.0mm incisal reduction and 1.0mm chamfer finish. The restorations were bonded with resin cement to printed resin dies (n = 19 per group) and were treated and divided into three groups, (1) no endodontic access, (2) traditional triangular endodontic access, and (3) conservative ovoidal endodontic access. The endodontic access of the crowns was sealed with flowable resin composite. Restorations were subjected to 10,000 cycles of thermal cycling between 5° and 55°C. Then, restorations were loaded and exposed to compressive loading force, and the crack initiation (CI) and complete fracture (CF) were recorded. SEM micrographs of broken specimens on the printed dies were captured. ANOVA test and Bonferroni's correction were used for statistical comparison. The fracture resistance among the three groups varied. Crowns with no endodontic access displayed significantly (p < 0.001) higher resistance [CI: 1025 (121) N; CF 1134 (127) N], followed by crowns with conservative ovoidal endodontic access [CI: 924 (60) N; CF: 1000 (72) N. Crowns with traditional triangular endodontic access showed the significantly (p < 0.001) lowest fracture resistance [CI: 635 (82) N; CF: 709 (75) N]. The fracture resistance of chairside CAD-CAM lithium disilicate maxillary anterior crowns is influenced by the type of endodontic access provided. Conservative ovoidal endodontic access provides crowns with higher fracture resistance than traditional triangular endodontic access. Crowns with no endodontic access provided the highest resistance than other types of endodontic access.

Effectiveness of Different Polishing Kits for Chairside CAD/CAM Provisional Restorative Materials.

To investigate the efficacy of three specially designed polishing kits for provisional restorations made from three chairside computer-aided design and computer-aided manufacturing (CAD/CAM) provisional resin blocks. Ninety-six chairside CAD/CAM provisional restorations were milled out of three chairside CAD/CAM provisional resin blocks: (1) ArtBloc Temp (Merz Dental); (2) Telio CAD (Ivoclar Vivadent); and (3) Vita CAD-Temp (VITA Zahnfabrik). The provisional restorations for each material were allocated into the following groups: (1) milled restorations (no polish); (2) polished with CADMaster CAD/CAM Adjustment & Polishing Kit (CM, Shofu); (3) polished with KUT Ultimate Bisacryl (Temporaries) Polishing Kit (KU, Dental Savings Club); and (4) polished with K0330 PMMA Adjusting, Finishing & Polishing (KP, Brasseler USA). Optical profilometry and atomic force microscopy (AFM) were used to assess the surface roughness (Ra) of each provisional restoration at the microscale and nanoscale, respectively, and obtain topographical images. In addition, the milled and polished restorations were visually evaluated by 16 dentists. There was a strong positive correlation with Ra values between optical profilometry and AFM. Only KP significantly improved the surface roughness of CAD/CAM provisional restorations compared to the milled equivalent, regardless of material type or measurement modality (ie, lateral length scale). Although surface topography imaging with AFM revealed some shallow scratches, even for KP polished specimens, all KP polished restorations were categorized as clinically acceptable for provisional restorations in visual inspections from dentists. Specially designed polishing kits for provisional restorations did not all improve the surface roughness of chairside CAD/CAM provisional restorations, regardless of the measurement method. KP was more consistently effective in polishing milled chairside CAD/CAM provisional restorations than CM and KU.

Guideline for chairside computer aided design and computer aided manufacturing all ceramic rehabilitation

With the rapid development of digital techniques and the lack of reference standards for chairside computer aided design and computer aided manufacturing (CAD/CAM) operation and application, it is imperative to draft guidelines for chairside CAD/CAM restoration techniques for all ceramics. Therefore, the Society of Prosthodontics, Chinese Stomatological Association recruited experts to compose a recommended application guideline based on the relevant literatures and clinical experiences, including the selection of indications, tooth preparation, optical impression making and other key steps. This guideline is aimed at providing a standardized operation procedure to improve the quality and long-term success rate of chairside CAD/CAM rehabilitation for all ceramics.

Guidelines for chairside computer aided design and computer aided manufacturing rehabilitation with resin-ceramic composites

Based on evidence-based clinical and material researches, the Society of Prosthodontics, Chinese Stomatological Association organized a panel of experts to write a recommended application guideline via in-depth discussion and literature reviewing. This guideline formulates the standardized operation procedures for the clinical usage of chairside computer aided design and computer aided manufacturing (CAD/CAM) rehabilitation with resin-ceramic composites, aiming at guiding and specifying this clinical technique. This guideline will help to improve the quality, the clinical efficacy, and the long-term success rate of chairside CAD/CAM rehabilitation with resin-ceramic composites via standardizing this restoration technique. At the same time, this guideline will contribute to the clinical promotion of this technique.

Effects of loupes and microscopes on a dental technician's working posture from ergonomic aspects.

This work aimed to study the effects of loupes and microscopes on a dental technician's working posture during practical operation from ergonomic aspects. The technician's working postures under the conditions of the naked eye, loupes, and microscopes were compared. The practical value of loupes and microscopes was assessed based on the evaluation index of working posture from ergonomic aspects. Three dental technicians who were skilled in using loupes and microscopes from West China Stomatology Technology Department of Sichuan University were involved in this prospective rando-mized controlled trial. Before the operation, cameras were installed in the sagittal position, top-view position, and dorsal position of the operation. Each technician made five porcelain veneers of the right maxillary central incisor following the standard process. A chairside computer-aided design and computer-aided manufacturing (CAD/CAM) system was used to mill and layer the ceramic block under the naked eye (A: control group), 3.5× headwear loupes (B: loupe group), and 9× desktop microscopes (C: microscope group). The working posture was recorded by videos throughout the entire process. After each operation, the investigator used OpenPose to recognize the working posture. The joint angles of the arm, elbow, wrist, neck, and trunk, as well as their corresponding rapid upper limb assessment (RULA) scores, were calcula-ted by MATLAB. The working posture was assessed from ergonomic aspects based on the joint angles, RULA scores, and operation time. Statistical analysis was performed using SPSS 26.0. The RULA score of upper limb joint angles showed that the angles of the arm, elbow, wrist, neck, and trunk under the naked eye were 14.93°±9.44°, 120.19°±2.99°, 23.97°±2.84°, 47.27°±5.72°, and 7.76°±2.30°, respectively. All of the joint angles were significantly different among the three groups (P<0.05). Compared with the control group, the angles of the neck and trunk in the loupe group were reduced by 29.09% and 42.53%, respectively, whereas those in the microscope group were significantly reduced by 43.99% and 87.11%, respectively. Multiple comparisons by LSD for the angles of neck and trunk revealed that the loupe group and the microscope group were significantly different from the control group (P<0.05), and they were also significantly different from each other (P<0.05). The mean RULA scores were 6.24±0.34 in the control group, 5.53±0.35 in the loupe group, and 3.31±0.19 in the microscope group. Compared with the control group, the mean RULA score in the loupe group was lower, and that in the microscope group was significantly lower. The differences between every two groups were statistically significant (P<0.05). The mean RULA score in the microscope group was significantly lower than that in the loupe group (P<0.05). The average operation times of the control group, loupe group, and microscope group were (50.69±36.78), (52.01±34.65), and (59.44±35.81) min, respectively. No significant difference was found among the three groups (P>0.05). Use of loupes and microscopes showed an improvement in ergonomics and working posture of dental technicians. Microscopes had a better effect in the ergonomic convenience of the technician than loupes.

How a 16% Carbamide Peroxide Home Bleaching Agent Affects the Surface Properties of Chairside CAD/CAM Materials?

Surface changes of restorative materials after bleaching have clinical importance in terms of the durability and survival of restorations. This study aimed to evaluate the effect of home bleaching on the surface roughness, microhardness, and surface analysis of four different types of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) materials. Specimens were prepared from composite resin (Brilliant Crios: BC), resin nanoceramic (Lava Ultimate: LU), polymer-infiltrated ceramic-network (Vita Enamic: VE), and zirconia-reinforced lithium silicate glass-ceramic (Vita Suprinity: VS) CAD/CAM materials. Specimens were polished using 800, 1000, 1200, and 2000 grit SiC papers. Each restorative material was randomly divided into two groups; control and bleaching (n=10). The 16% carbamide peroxide bleaching agent (Whiteness Perfect 16%, FGM) was applied to the specimens for 4 h/day for 14 days. Surface roughness values (Ra) were obtained using a profilometer, and microhardness values (VHN) were obtained using a Vickers microhardness test. Surface analysis of specimens was evaluated by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Data were analyzed Two-way ANOVA and Fisher’s Least Significant Difference (LSD) test (p&lt;0.05). After bleaching, the surface roughness of BC (p&lt;0.001) and VE (p&lt;0.032) significantly increased. Bleaching did not significantly affect the microhardness of CAD/CAM materials. SEM evaluation showed material-dependent surface damages after bleaching procedures. The effect of 16% carbamide peroxide home bleaching agent on surface roughness and microhardness of chairside CAD/CAM materials is material-dependent. Before bleaching, restorative materials should be protected by applying a protective barrier and contact with the bleaching agent should be minimized. Also, after bleaching, the restoration surface should be carefully inspected, and re-polishing might be beneficial.

Behavior of CAD/CAM ceramic veneers under stress: A 3D holographic study

ObjectivesCeramic veneers restorations may undergo damages, such as cracks, fractures, or debonding. Full-field measurements must be carried out in order to visualize and analyze the strain fields. This paper demonstrates that digital holography permits to investigate the mechanical behavior under stress of a natural incisor and a natural incisor reconstructed with CAD/CAM ceramic veneer. MethodsThe facial surface of a maxillary central incisor is prepared to receive a monolithic ceramic reconstruction manufactured using a chairside computer-aided design and computer aided manufacturing (CAD/CAM) system (Cerec AC® system, Sirona Dental System®, Bensheim, Germany). One incisor is kept intact for comparison. The samples are sectioned longitudinally to obtain a planar observation of the region of interest. A mechanical indentation head and digital holographic set-ups permit a full-field, contact-less and single-shot measurement of the three-dimensional displacement fields at the surface of the tooth sample when subjected to load. Stain fields are then estimated and comparison of the results between two samples can be carried out. Results3D displacement, fields and strain fields are measured and highlight the behavior of the region of interest in three directions of space for the ceramic veneer and the natural incisor. The strain maps reveal the local behavior, especially the concentration or the sudden change in strain. The transition zones are clearly observed, particularly for the veneered sample. ConclusionDigital holography highlights the localization of stress concentration zones in regions of interest and yields comparative analysis between samples with different tooth preparations. Significanceholography permits to visualize and compare the mechanical response of the ceramic veneer and natural tooth. This helps choosing the mechanical properties of the bonding interface.

Impact of simulated toothbrushing on surface properties of chairside CAD-CAM materials: An in vitro study

Statement of problemChairside computer-aided design and computer-aided manufacturing (CAD-CAM) materials that do not require any firing steps are a promising option to expedite restoration production; however, little information is available to determine the most suitable material for each clinical situation. PurposeThe purpose of this in vitro study was to evaluate the effect of simulated toothbrushing on surface gloss, roughness, and wear of chairside CAD-CAM materials. Material and methodsDisk-shaped specimens (n=15) were prepared of the following materials: ENA—VITA Enamic; LAV—Lava Ultimate; EMP—IPS Empress CAD; CER—Cerasmart; GRA—Grandio blocs. Gloss (Gloss Unit—GU) and surface roughness (Ra—μm) were evaluated before and after simulated toothbrushing (100 000 strokes). Wear (μm) was assessed by contact profilometry. Additional analyses of microhardness by scanning electron microscopy were also performed. Data were analyzed with 2-way repeated measures ANOVA test for roughness and gloss, and 1-way ANOVA for wear (α=.05). To estimate the correlation between Ra and GU, the Pearson correlation was calculated. ResultsBefore brushing, CER showed the lowest Ra (P<.001), and GRA the lowest GU values. After brushing, the feldspathic ceramic-based materials (ENA and EMP) presented the highest gloss, whereas the ceramic group (EMP) showed the lowest Ra. Before and after brushing, GRA showed the lowest GU values. Higher wear values were found for the composite resin groups (CER>GRA), with the exception of LAVA, which was similar to ENA, and EMP showing improved wear resistance. A strong negative correlation (-0.925) between GU and Ra values was detected (P<.001). ConclusionsThe materials containing a glass phase (ENA and EMP) presented higher wear resistance, higher gloss, and lower roughness after brushing than the other materials tested. The correlation test showed that the higher the surface roughness, the lower the gloss.

Effect of different cement systems and aging on the bond strength of chairside CAD-CAM ceramics

Statement of problemThe bond strength of different chairside computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials to dentin with different resin cements needs to be evaluated. PurposeThe purpose of this in vitro study was to investigate the effect of 3 different cementation systems after thermal aging on the shear bond strength of different CAD-CAM materials. Material and methodsThe occlusal surfaces of 63 molar teeth of similar size were removed, and 21 zirconia-reinforced lithium disilicate (Vita Suprinity-VS), 21 polymer infiltrated ceramic (Vita Enamic-VE), and 21 resin nanoceramic (GC Cerasmart-GC) rectangular specimens of 2.5 mm in thickness were obtained. The ceramics were cemented using total etch (TE), self-etch (SE), and self-adhesive (SA) cement systems. Half of the specimens were subjected to thermal aging with 5000 cycles. The shear bond strength test of all the specimens was measured. Fractured ceramic surfaces were examined by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDX) analysis. The Shapiro-Wilk test, 3-way analysis of variance (ANOVA), and Fisher Least Significant Difference (LSD) tests were used to analyze the shear bond strength test data (α=.05). ResultsThe highest bond strength value was found in the nonthermal aged VS-TE and the lowest in the thermal aged VE-TE. Significant interaction was found between TE and SE cemented ceramics (P<.001). For specimens cemented with the SA system, significant interaction was found among ceramics with thermal aged specimens (P<.001). Thermal aging significantly decreased the mean bond strength (P<.05). ConclusionsDifferences in bond strength were observed in chairside CAD-CAM ceramics when cemented with TE, SE, and SA systems. Additionally, thermal aging significantly reduced the bond strength values of all the ceramic materials, regardless of the cementation procedure. Clinicians should consider these variables and choose the most suitable cementation systems for the material used.

Short-term and long-term release of monomers from newly developed resin-modified ceramics and composite resin CAD-CAM blocks

Statement of problemMonomer leaching from restorations may affect the oral mucosa and general health; however, information on monomer leaching from chairside computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials is lacking. PurposeThe purpose of this in vitro study was to investigate the leaching of monomers from newly introduced resin-modified ceramics and composite resin CAD-CAM blocks that were immersed in water and ethanol for short-term and long-term incubation periods. Material and methodsTen square-shaped specimens of 5 newly introduced CAD-CAM blocks were suspended by means of a silk thread in distilled water and in 75% ethanol. After 1 day, 7 days, 30 days, and 60 days, the eluates bisphenol A (BPA), urethane dimethacrylate (UDMA), triethylene glycol dimethacrylate (TEGDMA), N, N-dimethylacrylamide (DMA), bisphenol A-glycidyl dimethacrylate (Bis-GMA), and bisphenol A ethoxylate dimethacrylate (Bis-EMA) were analyzed by means of high-performance liquid chromatography (HPLC). Additional specimens of each material, before and after immersion in the solutions, were investigated by scanning electron microscopy, and elemental analysis was performed by energy-dispersive X-ray spectrometry. ResultsTEGDMA and UDMA were the main monomers eluted from all the materials tested. A pattern of declining release was detected for all the monomers. Bisphenol-A was not released by any of the investigated ceramic-composite or composite resin blocks either in water or ethanol. ConclusionsCAD-CAM blocks release less monomer when they are immersed in aqueous solutions in the short-term and long-term periods than conventional resin composite materials. The amount of monomer release declined until no monomer could be detected.

Comparison of marginal fit between CAD-CAM and hot-press lithium disilicate crowns

Statement of problemHot-pressing and computer-aided design and computer-aided manufacturing (CAD-CAM) are major techniques for the fabrication of lithium disilicate crowns. They exhibit different accuracies regarding marginal fit, an important factor in restoration survival. However, studies comparing the marginal fit of different fabrication methods are lacking. PurposeThe purpose of this in vitro study was to compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of lithium disilicate crowns produced by the hot-press and CAD-CAM techniques. Material and MethodsThirty typodont teeth were divided into 2 groups. Fifteen teeth were scanned with the CEREC Omnicam intraoral scanner, and crowns were fabricated with the CEREC MC XL chairside CAD-CAM milling unit from IPS e.max CAD blocks. Fifteen typodont teeth were sent to a dental laboratory, and lithium disilicate crowns were fabricated from IPS e.max press ingots using the hot-press technique. The 30 crowns were cemented and then sectioned with a precision saw. The MD and AMD were measured for each crown with a light microscope. One-way ANOVA was conducted to analyze significant differences in crown marginal fit between the fabrication systems (α=.05). ResultsFor the CAD-CAM technique, the mean values of the AMD measurements were 115 μm, and for the hot-press technique, 130 μm. The MD measurements were 87 μm for the CAD-CAM technique and 90 μm for the hot-press technique. One-way ANOVA revealed no significant differences between the fabrication methods regarding marginal fit (P>.05). ConclusionsNo significant differences were found between the fabrication methods tested. Both the CAD-CAM and hot-press techniques for producing monolithic lithium disilicate crowns produced MD values of less than 120 μm, within the clinically acceptable range.

Scanning of root canal impression for the fabrication of a resin CAD-CAM-customized post-and-core

Customization of post-and-cores using computer-aided design and computer-aided manufacturing (CAD-CAM) requires the scanning of a pattern and the subsequent digital design. This technique describes a method of fabricating a CAD-CAM-customized post-and-core designed from a scanned polyvinyl siloxane impression and milled from a nanoparticle/nanocluster-filled resin block. The polyvinyl siloxane impression allowed a faster and more efficient customization of the CAD-CAM post-and-core than a conventional acrylic resin pattern. The properties of the nanoparticle/nanocluster filled resin block make the material suitable for chairside CAD-CAM post-and-core fabrication.

Fracture resistance of CAD-CAM monolithic ceramic and veneered zirconia molar crowns after aging in a mastication simulator

Statement of problemThe demand for ceramic restorations has increased over the past years, and now various machinable materials can be used for chairside computer-aided design and computer aided manufacturing (CAD-CAM) systems. Limited studies of these new materials make it difficult to evaluate their mechanical performance, advantages, and limitations. PurposeThe purpose of this in vitro study was to investigate the fracture resistance of CAD-CAM monolithic ceramic and veneered zirconia molar crowns after thermomechanical aging. Material and methodsA mandibular first molar tooth was prepared, and 12 different experimental groups were generated (n=10). An aging procedure was performed by subjecting the specimens to 12×105 mechanical cycles and 5000 thermocycles. Survival analysis was performed according to the thermomechanical aging. The fracture resistance (load at fracture) of all specimens was evaluated with 1-way analysis of variance after the means had been compared using the Tukey honest significant difference test and Weibull distributions of the experimental groups (α=.05). ResultsAccording to the results, the differences between the fracture resistance of the groups were found to be significant. Restorations in the dual network ceramic crown group fractured catastrophically during thermomechanical aging. In all groups, the highest value was found for monolithic zirconia, followed by monolithic lithium disilicate crowns (P<.05). Both of the monolithic crowns made of lithium disilicate derivates and zirconia crowns veneered with lithium disilicate ceramic showed no differences from each other (P>.05). The Weibull modulus (m) ranged from 4.22 to 8.58, and conventionally veneered and overpressed zirconia showed the lowest Weibull modulus values among the tested groups, indicating greater variation of the data. ConclusionsThe highest fracture resistance was observed for yttria-stabilized zirconia crowns, followed by lithium disilicate derivates. Veneered zirconia restorations generally showed lower resistance than these ceramics. The dual network ceramic crowns fractured during thermomechanical aging.