Monolithic Lithium Disilicate Crowns Research Articles

Clinical Survival of Reduced-Thickness Monolithic Lithium-Disilicate Crowns: A 3-Year Randomized Controlled Trial.

The aim of this randomized controlled trial was to see if the minimally invasive approach (reduced restoration thickness) would result in good clinical success of monolithic ceramic crowns compared to conventional layered all-ceramic crowns, and thus be an alternative to conventional tooth preparation. The ceramic that was investigated was IPS e.max lithium-disilicate ceramic produced using two different processing methods. A comparison was made between monolithic crowns with reduced thickness and standard layered crowns. Fifty-two patients, who had undergone endodontic treatment on either a premolar or molar, were randomly assigned into two groups. The teeth intended for layered crowns underwent to a 2 mm occlusal reduction with a 1 mm rounded shoulder, whereas the teeth intended for monolithic crowns underwent to a 1 mm reduction in the occlusal area with a 0.6 mm rounded shoulder. The clinical success was evaluated in eight categories using modified United States Public Health Service (USPHS) criteria. The observation period was 36 months, with control appointments every 6 months. There was no significant difference in clinical success between monolithic and conventional layered crowns after 3 years. One monolithic crown fractured while all other crowns were intact and the survival rate was 96%. All layered crowns were intact and the survival rate was 100%. The results of this study indicate that the minimally invasive approach can be a good alternative to conventional tooth preparation. IPS e.max lithium-disilicate ceramic demonstrated an exceptional three-year survival rate independently of the thickness of the material.

Er:YAG laser lithium disilicate crown removal: removal time and pulpal temperature change.

Since the removal of resin-luted all-ceramic restorations is a challenge, the use of Er:YAG lasers has become popular. The aim of this study was to determine the removal time of monolithic lithium disilicate crowns in different thicknesses and heat transmission to pulp using Er:YAG laser.Forty-five full-coverage monolithic lithium disilicate crowns in 1 mm (n = 15), 1.5 mm (n = 15), and mixed thickness (n = 15) were resin luted on relevant extracted human maxillary first premolars and subjected to Er:YAG laser irradiation for crown removal after 24 h. Laser parameters for each thickness, respectively, were 5 W, 5.6 W, and 5.9 W (10 Hz). The removal time and temperature change values were recorded for each sample. The statistical evaluations were performed using one-way ANOVA variance and post hoc Duncan and Tamhane's T2 tests (p < 0.05), and Pearson correlation coefficient was used to examine the significance within each group and without group discrimination.All crowns were laser-debonded successfully. The removal time (min:s) at the succeeding laser parameter for each group is as follows: between 2:30 and 4:45 at 5 W power for 1-mm samples, between 5:00 and 11:15 at 5.9 W power for 1.5-mm samples, and between 8:45 and 15:00 at 5.9 W power for samples in mixed thickness. Moreover, it was observed that the temperature changes in the pulp chamber did not exceed the critical value of 5.5 °C for any sample.Er:YAG laser irradiation is an effective and safe method for removal of all-ceramic crowns when appropriate laser parameters are used according to thickness.

Which dentine analogue material can replace human dentine for crown fatigue test?

To seek dentine analogue materials in combined experimental, analytical, and numerical approaches on the mechanical properties and fatigue behaviours that could replace human dentine in a crown fatigue laboratory test. A woven glass fibre-filled epoxy (NEMA grade G10; G10) and a glass fibre-reinforced polyamide-nylon (30% glass fibre reinforced polyamide-nylon 6,6; RPN) were investigated and compared with human dentine (HD). Flexural strength and elastic modulus (n=10) were tested on beam-shaped specimens via three-point bending, while indentation hardness (n=3) was tested after fracture. Abutment substrates of G10, RPN and HD were prepared and resin-bonded with monolithic lithium disilicate crowns (n=10), then subjected to wet cyclic loading in a step-stress manner (500N initial load, 100N step size, 100,000 cycles per step, 20Hz frequency). Data were statistically analysed using Kruskal-Wallis one-way ANOVA followed by post-hoc comparisons (α=0.05). Survival probability estimation was performed by Mantel-Cox Log-Rank test with 95% confidence intervals. The fatigue failure load (FFL) and the number of cycles until failure (NCF) were evaluated with Weibull statistics. Finite Element Models of the fatigue test were established for stress distribution analysis and lifetime prediction. Fractographic observations were qualitatively analysed. The flexural strength of HD (164.27±14.24MPa), G10 (116.48±5.93MPa), and RPN (86.73±3.56MPa) were significantly different (p<0.001), while no significant difference was observed in their flexural moduli (p=0.377) and the indentation hardness between HD and RPN (p=0.749). The wet cyclic fatigue test revealed comparable mean FFL and NCF of G10 and RPN to HD (p=0.237 and 0.294, respectively) and similar survival probabilities for the three groups (p=0.055). However, RPN promotes higher stability and lower deviation of fatigue test results than G10 in Weibull analysis and FEA. Even though dentine analogue materials might exhibit similar elastic properties and fatigue performance to human dentine, different reliabilities of fatigue on crown-dentine analogues were shown. RPN seems to be a better substrate that could provide higher reliability and predictability of laboratory study results.

The effects of cement thickness and cement shade on the final color of lithium disilicate crowns.

The aim of this study is to evaluate the effect of resin cement color, cement thickness, and thermocycling on the final color of monolithic lithium disilicate crowns. A total of ninety prepared central incisors of typodont teeth were restored with lithium disilicate crowns which have different cement thicknesses (40 µm, 80 µm, and 120 µm) and cement shades (clear, yellow, and white). Color parameters of restorations were measured with a spectrophotometer in three different steps 1) before cementing 2) after cementing and 3) after thermocycling with 10000 cycles. Color differences (ΔE00) were calculated with the CIEDE2000 formula and evaluated according to perceptibility (0.8) and acceptability (1.8) thresholds. The ΔE00 data were analyzed by using two-way ANOVA before and after thermocycling (α = .05). There was no interaction between the cement shade and the cement thickness factors. After cementation, the mean ΔE00 was under the perceptibility threshold in the group of 40 µm cement thickness and clear cement while it was between the perceptibility and acceptability thresholds (0.8 < ΔE00 < 1.8) for all other groups. After thermocycling, the ΔE00 values were between the perceptibility and acceptability thresholds for all experimental groups. Although there were no significant differences among the groups, thermocycling increased the color difference values. The cementation of restorations with clear, yellow, and white resin cements resulted in color differences with uncemented restorations except for the group cemented with clear cement in 40 µm cement thickness. All study groups revealed perceptible color change after thermocycling.

An in vitro investigation of the fracture strength of root-filled - posterior teeth restored with polymer full-coverage crowns

Objectives: To investigate, by an in vitro study, the fracture strength of root-filled teeth restored with polyetheretherketone (PEEK) full-coverage crowns.Materials and Methods: Two single-rooted maxillary second premolar Typodont teeth were prepared according to the standardized preparation guidelines for two different full-coverage crown restorations: computer-aided design/computer-aided manufacturing monolithic lithium disilicate crowns (E.max) for the control samples and machine pressed monolithic PEEK crowns for the test samples. Teeth were duplicated in a polyurethane-based resin, with properties analogous to human dentin; n = 5 for each category. Replicas were embedded in polyurethane-based resin material using a retaining copper ring, with a simulated 200-μ periodontal ligament. Subsequently, all samples received orthograde root canal treatment using standardized preparation and obturation techniques. Crowns were cemented with resin-modified glass ionomer cement using a standardized cementation force. All teeth were subjected to a monotonic, axial static load of 2500 N to the point of fracture.Results: All control group samples displayed failure as a combined crown/tooth fracture. The crowns in the test group samples (PEEK) did not fracture under the experimental loads. Under the maximum loads, the crowns exhibited plastic deformation visible as an indentation created on the occlusal surface. Subsurface cohesive damage of the interface cement was noted. T-test showed that the resistance to fracture of the test group compared to the control group was highly significant (P < 0.001).Conclusions: Within the limitations of this study, PEEK crowns help preserve the remaining tooth structure and provide more predictable protection when compared to E.max crowns. They demonstrate failure by surface deformation and subsurface cohesive damage to the interface cement layer. It is unknown if this failure mode would occur under normal masticatory loads.

Clinical Evaluation of Reduced-Thickness Monolithic Lithium-Disilicate Crowns: One-Year Follow-Up Results

Purpose: The purpose of this in vivo study was to investigate whether the less invasive approach (reduced thickness of the restoration) will result in a comparable risk of failure and similar aesthetic results, compared to conventional layered full porcelain crowns, and can, therefore, be used as a good alternative. Material and Methods: The tested ceramic was lithium-disilicate ceramic (IPS e.max). Forty-four patients with endodontically treated premolars or molars were randomized into two groups and provided with single crowns. One group received conventional all-ceramic crowns made from a lithium-disilicate core and hand-veneered aesthetic ceramic, while another group received full-contoured lithium-disilicate ceramic crowns with reduced wall thickness than manufactures recommendations. The teeth for conventional crowns were prepared with 1 mm rounded shoulder and 2 mm occlusal reduction, while teeth for monolithic crowns were prepared with 0.6 mm wide rounded shoulder and 1 mm occlusal reduction. All crowns were prepared by the same clinician and manufactured in the same laboratory by the same technician. The survival and aesthetics of the crowns were assessed by the independent clinician. Apart from this, patients’ aesthetic satisfaction was evaluated. The assessment was double blind as both the examiner and the patients did not know which type of crown was provided. The observation period was 36 months. Survival of the crowns was assessed using the modified United States Public Health Service (USPHS) criteria and aesthetics and participants’ aesthetic satisfaction with the crowns was evaluated using a visual analogue scale. Results: The one-year survival rate for layered crowns was 100% and for monolithic crowns 95.5%. The median patients’ aesthetic satisfaction with both crowns was 100%. Conclusions: The results indicate similar one-year survival rate of reduced-thickness monolithic lithium-disilicate crowns and conventional veneered crowns. Differences with patients’ satisfaction with the aesthetics of both crowns were not statistically significant and it can be said that the patients’ aesthetic satisfaction was the same for both crowns.

Cemented versus screw-retained posterior implant-supported single crowns: A 24-month randomized controlled clinical trial.

To compare the incidence of biological and technical complications of cemented and screw-retained monolithic lithium-disilicate implant-supported posterior single crowns. Forty-one subjects with a total of 56 implants received randomly allocated 28 cemented and 28 screw-retained crowns. In the screw-retained group, monolithic lithium-disilicate restorations were luted to titanium bases extraorally. In the cemented group, monolithic lithium-disilicate crowns were cemented on individualized titanium abutments intraorally. All restorations were examined according to modified FDI criteria within 2weeks of inserting the crowns (baseline) and after 12 (n=46) and 24 (n=43) months. Bone loss was evaluated by standardized radiographs at baseline and 12months. After 12months, the incidence of mucositis (positive bleeding on probing) was 14.2% (screw-retained) and 17.9% (cement-retained). The gingival and plaque index and a mean marginal bone loss between 0.03-0.15mm showed no significant difference between the groups. In the cemented group, cement residues were detected at baseline at two restorations (6.9%) by radiographic examination. A complete digital workflow was realized in most cases (85.7%). At 24months, no restoration had failed, and no chipping of the ceramic had occurred. In the screw-retained group, screw loosening occurred in one implant. In both groups, there was obvious deterioration in the quality of 32% of the occlusal and of 18% of the proximal contact points. The type of retention mode of monolithic implant-retained lithium-disilicate posterior crowns had no influence on the biological and technical complication rate.

Comparison of the residual cement on custom computer-aided design and computer-aided manufacturing titanium and zirconia abutments: A preliminary cohort study

Statement of problemClinical studies comparing the occurrence and quality of residual cement between custom zirconia and custom titanium abutments with subgingival margins are scarce. PurposeThe purpose of this clinical study was to assess the difference in the amount of residual cement between custom zirconia and titanium abutments with a 1-mm subgingival margin. Material and methodsEighty participants were randomized to receive either a custom zirconia abutment with a bonded titanium insert or a custom titanium abutment with a 1-mm subgingival margin on a posterior bone-level implant. Monolithic lithium disilicate crowns with a screw-access hole were cemented to abutments randomly with either a resin-modified glass ionomer cement or a resin cement. After cementation, the crown-abutment assemblies were removed and photographed from the mesial, buccal, distal, and lingual of the specimen to record the residual cement. The length along the abutment margin of each aspect of the assembly was measured. The surface area of the residual cement (SA) and the surface area of the residual cement per unit length of margin (SA_P) were calculated. Results for the groups were compared with the Fisher exact test, the Friedman test, and the Mann-Whitney U test (α=.05). ResultsThe median (lower quartile, upper quartile) of SA and SA_P for the custom zirconia abutment with a bonded titanium insert was 1.9 (0.5, 3.9) mm2 and 0.086 (0.032, 0.02) mm2, respectively, and for the custom titanium abutment, the values were 2.9 (1.3, 5.1) mm2 and 0.138 (0.062, 0.239) mm2, respectively. No significant difference was found between the custom zirconia abutments with bonded titanium inserts and titanium abutments for SA (P=.075) and SA_P (P=.083) with the Mann-Whitney U test. No significant difference was found in residual cement between the 4 aspects of the abutment (SA: P=.852; SA_P: P=.954) with the Friedman test and between the 2 types of cement (SA: P=.447; SA_P: P=.878) with the Mann-Whitney U test. ConclusionsA similar amount of subgingival residual cement was recorded around the abutment-crown assembly, regardless of the abutment material or cement type used.

THE IMPACT OF A HIGH MAGNIFICATION APPROACH FOR TEETH PREPARATIONS ON THE MARGINAL FIT OF CAD/CAM MONOLITHIC LITHIUM DISILICATE CROWNS (IN VITRO STUDY)

Introduction: Marginal integrity is a challenging goal revealing an accurate restoration with definite marginal adaptation thus inflammation of gingival tissues and bone destruction correlate directly with a poor marginal property of the restoration. These days improved vision is essential in dentistry upgrading exactness and flawlessness. Objectives: To assess the impact of amplification on the marginal adaptation of CAD/CAM monolithic lithium disilicate crowns. Materials and Methods: In-vitro study using 16 upper right cuspid typodont teeth; divided into two entities according to tooth preparation approach (n=8). Group I teeth preparation without magnification (control group), Group II teeth preparation utilizing the dental operating microscope (DOM) under magnification of 16x. Optical impressions were taken through scanning by Sirona inEOS X5 extra-oral scanner where full anatomical crowns were structured, processed, Sintered and glazed. CBCT was utilized to quantify the minimal gapes before and after cementation/aging. Results: Marginal gaps were significantly increased after cementation and aging in both groups yet still inside the worthy minimal gap values. Group II demonstrated recognizable less marginal gaps. Conclusions: Operating microscopy OM is a significant supplement to the armamentarium of present-day dentistry. It helps set the bar of greatness and flawlessness at the most elevated level including every dental field.

Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems

Statement of problemThe fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions. PurposeThis clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery. Material and methodsForty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05). ResultsThe marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05). ConclusionsThe lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

Comparison of marginal adaptation and internal fit of monolithic lithium disilicate crowns produced by 4 different CAD/CAM systems.

To evaluate the marginal adaptation and internal space of crowns produced by 4 CAD/CAM systems using microcomputed tomography (μCT) and replica technique (RT). Monolithic lithium disilicate crowns were milled (Ceramill, Cerec, EDG, and Zirkonzahn) (n = 10). The cement film obtained with low viscosity silicone was scanned by the μCT system and captured by a stereomicroscope, according to RT. Two-way ANOVA followed by Tukey's test were used for statistical analysis (α = 0.05). A uniformity index (UI) was idealized to describe the distribution of crowns' internal space and submitted to the Kruskal-Wallis and Tukey's test (α = 0.05).The correlation betweenμCT and RT was performed by Pearson's Correlation Coeficient (α = 0.05). Marginal adaptation and internal space were statistically significant different between the experimental groups for the μCT and RT (p < 0.05). The medians of the 4 systems tested were within clinically acceptable range and the mean (± SD) highest marginal discrepancy was recorded in the Ceramill group at 133.0 ± 71.5 μm (μCT) and 90.6 ± 38.5 μm (RT). For internal fit, the UI disclosed a better distribution of the internal space for the Zirkonzahn group (p < 0.001). There was a strong correlation between the methods (p = 0.01 and r = 0.69). Because of the variability of the CAD/CAM systems available, evaluating their accuracy is of clinical interest. The 4 systems are capable to produce restorations adaptated within clinically appropriate levels. The μCT and RT are efficient adaptation methodologies.

Effect of neutralization and hydrofluoric acid precipitate remotion on the compressive strength of monolithic lithium disilicate crowns.

The cleaning protocol for the ceramic surface after acid etching resulted in a decrease in bond strength and flexural strength of a glass ceramic. This study aims to evaluate the effect of different ceramic surface treatments after hydrofluoric acid etching (HF) on the compressive strength of monolithic lithium disilicate crowns. Forty (40) human third molars received conventional full coverage preparation. After performing digital impressions of teeth preparations, ceramic blocks were machined using a CAD/CAM system in order to obtain the crowns. The crowns were distributed in 4 groups as ceramic surface treatment (N.=10): (HF) - 4.9% HF for 20s + air-water spray for 30s; (HFN) - HF + neutralizing agent for 5 min (N); (HFU) - HF + ultrasonic bath for 5 min (U); e (HFNU) - HF + N + U. SEM and EDS analysis was performed in each group in order to characterize the ceramic surface and to verify the chemical element distribution after HF cleaning protocols. A silane layer was applied (for 60s), and crowns were then cemented with dual resin cement. A compressive load was applied on the middle of the occlusal crown surface with a crosshead speed of 1 mm/min until fracture. Data were analyzed using ANOVA and Tukey test (α=0.05). Fluoride ions were found in samples of all postetching cleaning protocols. The mean value (Kgf) was: HF =169.92±21.37; HFN =187.34±34.79; HFU =166.63±40.22 and HFNU=175.26±40.22. The ceramic surface treatment after HF etching did not significantly influence (P>0.05) the compressive strength of the tested ceramic crowns. Surface treatments with neutralizing agent associated with the ultrasonic bath as the pre-cementation protocol was the most efficient protocol in eliminating the precipitate deposited on the porosities created by acid etching.

Influence of Different Cements on the Color Outcomes of Titanium-Based Lithium Disilicate All-Ceramic Crowns and Peri-implant Soft Tissue.

To evaluate the influence of different cements on the color outcomes of CAD/CAM lithium-disilicate implant crowns cemented to titanium-base abutments utilizing spectrophotometric analysis. A clinical situation with a missing lateral incisor was mimicked using a maxillary plastic model. Titanium-base-supported monolithic lithium disilicate crowns with identical designs were fabricated using a laboratory CAD/CAM system. The crowns were cemented with three provisional cements and with six definitive cements on both nonsandblasted and sandblasted titanium-base abutments for a total of 15 test groups. As a control group, identical crowns were attached with try-in paste on composite die abutments that duplicated the shape of the titanium-base abutments. The colors of the labial surfaces of the crowns and the peri-implant artificial soft tissue were measured with a spectrophotometer and recorded in CIE L*a*b* parameters. Color differences between the test and control groups were calculated as: ΔE = ([ΔL*]2 + [Δa*]2 + [Δb*]2)1/2. Kruskal-Wallis test was used to compare ΔE values across different groups. The median ΔE values reported for crowns cemented with different definitive cements on titanium-base abutments ranged from 1.4 to 2.9 for the crown surface and from 1.7 to 1.9 on the peri-implant artificial soft tissue; when the titanium-base abutments were sandblasted, the respective median ΔE values ranged from 0.8 to 4.0 and from 1.4 to 2.2. Ceramic crowns cemented with Multilink HO 0 cement presented significantly (P < .01) lower ΔE values than the other cement types for the crown surface independent of sandblasting and for the artificial soft tissue surface when the titanium abutments were sandblasted (P = .011). Within the limitations of this study, Multilink HO 0 (Ivoclar Vivadent) cement showed the most favorable masking ability and the most favorable color outcome among the evaluated definitive cements. Cements of more opaque shades appeared in general to be more favorable in terms of masking the gray color of the titanium-base abutments.

Monolithic CAD-CAM lithium disilicate versus monolithic CAD-CAM zirconia for single implant-supported posterior crowns using a digital workflow: A 3-year cross-sectional retrospective study

Statement of problemDentistry has evolved significantly with the introduction of digital technologies and materials; however, clinical evidence for the performance of the complete digital workflow for single implant–supported posterior crowns is lacking. PurposeThe purpose of this cross-sectional retrospective clinical study was to compare the clinical outcomes of 2 types of implant-supported crown used to replace a single missing posterior tooth in a completely digital workflow: transocclusal screw-retained monolithic lithium disilicate crowns versus transocclusal screw-retained monolithic zirconia crowns. Material and methodsA total of 38 participants who had been provided with dental implants and transocclusal screw-retained monolithic lithium disilicate or zirconia single crowns were evaluated in the study. Clinical and esthetic outcomes were recorded after a 3-year follow-up. ResultsBoth groups had comparable clinical outcomes with a survival rate of 100%. In the lithium disilicate group, 89% of the participants were free of technical complications, and 95%, in the zirconia group. Only 1 patient experienced minor chipping affecting a lithium disilicate crown. All complications were considered minor and were easily resolved, and none of the participants required replacement of a crown. No biological complications were recorded in either group. ConclusionsWithin the limitations of this cross-sectional retrospective clinical study, monolithic lithium disilicate and zirconia screw-retained single crowns fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM) and a fully digital workflow were found to be reliable and suitable clinical options for restoring a posterior missing tooth on a dental implant.

Mechanical stability of zirconia meso-abutments bonded to titanium bases restored with different monolithic all-ceramic crowns.

To evaluate the bending moments and failure modes of zirconia meso-abutments bonded to titanium bases restored with different monolithic all-ceramic crowns after aging, and to compare them to titanium abutments restored with all-ceramic crowns. Forty-eight internal conical connection implants (Conelog, Camlog 4.3 mm diameter) were restored with four different computer-aided design/computed-aided manufacturing (CAD/CAM) abutment-crown combinations (n = 12). Thirty-six customized zirconia meso-abutments were bonded to titanium bases (Conelog Titanium Base CAD/CAM crown, Camlog) and divided into three groups according to the different crown materials: (T1) monolithic lithium-disilicate (e-max CAD, Ivoclar), (T2) monolithic PICN (polymer-infiltrated ceramic network [Enamic, Vita]), and (T3) monolithic zirconia (Lava Plus, 3M ESPE). Twelve titanium customized abutments restored with monolithic lithium-disilicate (e-max CAD, Ivoclar) crowns served as the control group (C). The crowns were equal maxillary central incisors and were adhesively bonded with a resin-based cement (Panavia 21, Kuraray). All samples were embedded in acrylic holders. After aging (1,200,000 cycles, 49 N, 1.67 Hz, 5°C to 50°C, 120 seconds), static load was applied until failure. Bending moments were calculated for comparison of the groups. Data were statistically treated with one-way analysis of variance (ANOVA) followed by Tukey post hoc test (P < .05). Failure modes were analyzed descriptively. The means of the bending moments were 356.4 ± 20.8 Ncm (T1), 357.7 ± 26.3 Ncm (T2), 385.5 ± 21.2 Ncm (T3), and 358.8 ± 25.3 Ncm (C). Group T3 revealed significantly higher mean bending moments than the other groups (P < .05). No differences were found between zirconia meso-abutments supported by titanium bases and customized titanium abutments when lithium-disilicate crowns were used (P > .05). No failures were identified during and after aging. After static load, failures occurred due to fracture of the abutment in the internal connection in all the groups. Zirconia meso-abutments bonded to titanium bases showed similar mechanical stability compared with customized titanium abutments. Regarding the crown material, all three tested ceramics (lithium-disilicate, PICN, and zirconia) revealed very good stability when used in the monolithic state.

Fracture Resistance of Titanium, Zirconia, and Ceramic-Reinforced Polyetheretherketone Implant Abutments Supporting CAD/CAM Monolithic Lithium Disilicate Ceramic Crowns After Aging.

The purpose of this study was to compare the fracture resistances and the fracture types of titanium, zirconia, and ceramic-reinforced polyetheretherketone (PEEK) implant abutments supporting CAD/CAM monolithic lithium disilicate ceramic crowns after in vitro dynamic loading and thermocycling aging. Three implant abutment (SKY Implant) groups-titanium (group Ti, control); zirconia with titanium base (group Zr); and ceramic-reinforced PEEK (BioHPP) with titanium base (group RPEEK); n = 12 each-were used. Thirty-six CAD/CAM monolithic lithium disilicate crowns (IPS e.max CAD) in the form of a maxillary central incisor were cemented with Panavia V5 on the abutments. The specimens were subjected to dynamic loading and thermocycling. Fracture resistances of the restorations were tested with a universal testing machine (0.5 mm/min), and their fracture patterns were analyzed. One-way ANOVA and Tukey post-hoc test were used for statistical analyses (α = .05). All samples survived after aging. The fracture strength values (mean ± standard deviation) of the groups were as follows: group Ti, 787.8 ± 120.9 N; group Zr, 623.9 ± 97.4 N; and group RPEEK, 602.9 ± 121 N. The fracture strengths were significantly higher in group Ti compared to groups Zr and RPEEK (P = .001). No significant difference was observed between groups Zr and RPEEK. Failures generally occurred due to fracture of the screw in group Ti, abutment and crown in group Zr, and crown in group RPEEK. Ceramic-reinforced PEEK abutments may be an alternative to zirconia abutments with a titanium base for single-implant restorations in the anterior region. However, there is need for further in vitro and clinical studies to evaluate the long-term performance of ceramic-reinforced PEEK abutments.

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.

Influence of titanium base, lithium disilicate restoration and vertical soft tissue thickness on bone stability around triangular-shaped implants: A prospective clinical trial.

To evaluate how vertical mucosal tissue thickness affects crestal bone stability around triangular-shaped bone-level implants, restored with low profile titanium bases and monolithic lithium disilicate restorations. Fifty-five bone-level implants of 4.3mm diameter were evaluated in 55 patients (22 males and 34 females, mean age 48.3±3.4years) in prospective cohort study. According to vertical mucosal thickness, patients were assigned into three groups: 1 (thin, 2mm or less), 2 (medium, 2.5mm) and 3 (thick, 3mm and more). Implants were placed in posterior mandible and maxilla in one-stage approach and, after integration, were restored with single screw-retained monolithic lithium disilicate crowns, using low gingival profile titanium bases. Radiographic examination was performed after implant placement and after 1-year follow-up. Crestal bone loss was registered mesially and distally, and mean value was calculated. One-way ANOVA and Tukey's HSD tests were applied; significance was set to 0.05. Mean vertical tissue thickness in 1 group was 1.76±0.26mm, 2 group-2.5mm and 3.91±0.59mm in group 3, with statistically significant difference between all groups (p<0.001). After 1-year follow-up, implants in group 1 (thin) had 1.25±0.8mm bone loss. Implants in group 2 (medium) had 0.98±0.06, while implants in group 3 (thick) lost 0.43±0.37mm of crestal bone. Tukey's HSD test showed that differences between 1/3 and 2/3 were statistically significant (p<0.001 and p=0.0014, respectively), while between 1 and 2 was not significant (p=0.310). Significantly less bone loss occurs around triangular-shaped bone-level implants in thick mucosal tissues (≥3mm), compared to medium or thin tissue biotype. Crestal bone loss did not differ between medium and thin tissues.

In vitro analysis of the fracture resistance of CAD-CAM monolithic lithium disilicate molar crowns with different occlusal thickness

Aim: To compare the fracture resistance and mode of failure of CAD-CAM monolithic lithium disilicate crowns with different occlusal thickness. Materials and methods: Thirty CAD-CAM monolithic lithium disilicate crowns with different occlusal thickness were randomly distributed into 3 experimental groups: 0.5 mm (group 1), 1.0 mm (group 2) and 1.5 mm (group 3). The restorations were cemented onto human molars with a self-adhesive resin cement. The specimens were loaded until fracture; the fracture resistance and mode of failure were recorded. The data were statistically analyzed with the one-way ANOVA followed by the Fisher’s Exact test with Bonferroni’s correction (p=0.05). Results: The fracture resistance values of all the specimens exceeded the maximum physiological occlusal loads in molar regions. The highest fracture resistance was noticed in 1.0 mm-thick crowns. Ultrathin restorations (group 1) proved to be statistically less resistant to fracture than those of the other experimental groups (p<0.05). The crowns were mainly interested by unrestorable fractures. Conclusions: The occlusal thickness of CAD-CAM monolithic lithium disilicate crowns influences either the fracture resistance and the mode of failure of the restorations; the occlusal thickness of such restorations can be reduced up to a lower bound of 1.0 mm in order to keep sufficient strength to withstand occlusal loads; CAD-CAM monolithic lithium disilicate crowns showed sufficient fracture resistance to be used in molar regions but not in an ultrathin configuration (0.5 mm).

Fracture resistance of implant- supported monolithic crowns cemented to zirconia hybrid-abutments: zirconia-based crowns vs. lithium disilicate crowns.

PURPOSEThe aim of this in vitro study was to investigate the fracture resistance under chewing simulation of implant-supported posterior restorations (crowns cemented to hybrid-abutments) made of different all-ceramic materials.MATERIALS AND METHODSMonolithic zirconia (MZr) and monolithic lithium disilicate (MLD) crowns for mandibular first molar were fabricated using computer-aided design/computer-aided manufacturing technology and then cemented to zirconia hybrid-abutments (Ti-based). Each group was divided into two subgroups (n=10): (A) control group, crowns were subjected to single load to fracture; (B) test group, crowns underwent chewing simulation using multiple loads for 1.2 million cycles at 1.2 Hz with simultaneous thermocycling between 5℃ and 55℃. Data was statistically analyzed with one-way ANOVA and a Post-Hoc test.RESULTSAll tested crowns survived chewing simulation resulting in 100% survival rate. However, wear facets were observed on all the crowns at the occlusal contact point. Fracture load of monolithic lithium disilicate crowns was statistically significantly lower than that of monolithic zirconia crowns. Also, fracture load was significantly reduced in both of the all-ceramic materials after exposure to chewing simulation and thermocycling. Crowns of all test groups exhibited cohesive fracture within the monolithic crown structure only, and no abutment fractures or screw loosening were observed.CONCLUSIONWhen supported by implants, monolithic zirconia restorations cemented to hybrid abutments withstand masticatory forces. Also, fatigue loading accompanied by simultaneous thermocycling significantly reduces the strength of both of the all-ceramic materials. Moreover, further research is needed to define potentials, limits, and long-term serviceability of the materials and hybrid abutments.