Resin Nanoceramic Research Articles

Does the Translucency of Novel Monolithic CAD/CAM Materials Affect Resin Cement Polymerization with Different Curing Modes?

The translucency of CAD/CAM blocks influences the polymerization efficiency of resin cement used underneath. The aim of this study is to evaluate the influence of the translucency parameters (TPs) of current monolithic CAD/CAM blocks on the microhardness of light-cured or dual-cured resin cement. 100 specimens were prepared from five types of CAD/CAM blocks (Mark II, Suprinity, Enamic, e.max, Ultimate), and their TP values were measured by spectrophotometry; 100 resin cement specimens (Duolink) were cured underneath five ceramic specimen groups by indirect LED light for 40 seconds with dual-cure (with catalyst) and light-cure (without catalyst) polymerization modes. Control group resin cement specimens (n = 20) were cured with both polymerization modes by direct LED light without any ceramic disc, making 120 resin cement specimens in total. The specimens were then stored in a dry environment for 24 hours before measurement of the polymerization depth with a digital micrometer. Vickers hardness measurements were performed at different resin cement sections. The results were statistically analyzed with 1-, 2-, and 3-way ANOVA, Student's t-test and Tukey's HSD test (α = 0.05). The highest TP values occurred for Suprinity and Ultimate, whereas the lowest TP value occurred for Enamic (p < 0.01). The depth of cure and Vickers hardness values changed proportionally with TP value. In all specimens, dual polymerization provided higher depth of cure and Vickers hardness values than those obtained using light polymerization (p < 0.01). In all specimens except Enamic, the hardness value differences between the sections were statistically insignificant (p > 0.05). In Enamic, the hardness values for both polymerization types decreased significantly in the deeper sections (p < 0.01). Lower depth of cure was observed as the amount of transmitted light decreased in the investigated materials. In clinical practice, light-cured resin cements may result in inadequate polymerization for ceramic materials with lower TP values. Zirconia-reinforced lithium silicate and nanoceramic resins may be reliable restorative materials for a restoration with both optimal esthetics and sufficient mechanical strength resulting from proper polymerization.

Assessment of marginal adaptation and fracture resistance of endocrown restorations utilizing different machinable blocks subjected to thermomechanical aging

This in vitro study was conducted to assess the marginal adaptation and fracture resistance of computer aided design/computer aided manufacturer (CAD-CAM) fabricated endocrowns restoring endodontically treated molars using different machinable blocks with thermomechanical loading protocols. Devitalized mandibular molars were prepared in a standardized way and divided into 4 groups (n = 10) to receive CAD/CAM fabricated endocrowns using four materials (Lithium disilicate ceramics, polymer infiltrated ceramics, zirconia-reinforced lithium silicate ceramics and resin nanoceramics. Marginal gaps (µm) were measured using stereomicroscope before cementation and after cementation. After thermomechanical aging, marginal gap measurements were repeated, and then fracture resistance test was performed. Two-way analysis of variance (ANOVA) and Tukey HSD multiple comparisons were used to assess the effect of material on the marginal gap before, after cementation, and after thermomechanical aging. One Way ANOVA was used to assess the effect of material on the fracture resistance. The difference between marginal gaps values of the tested materials was statistically insignificant but with significant increase after cementation and after thermomechanical aging. Cerasmart endocrowns showed the highest mean fracture load value (1508.5 ± 421.7N) with statistically significant difference than Vita Enamic endocrowns and Celtra Duo. The tested materials showed marginal vertical gap readings within the limits of clinically acceptable standards. Resin nanoceramics and lithium disilicate showed the highest values of fracture resistance followed by polymer infiltrated ceramics favoring their use for endocrown restorations. The mechanical behavior of ceramic materials varies with the variation of their structure and mechanical properties. Accordingly, further investigation is always needed to explore the biomechanical behavior of recent materials when used as endocrowns before clinical trials.

Surface topography and bacterial adhesion of CAD/CAM resin based materials after application of different surface finishing techniques

Aim: This study evaluated the surface topography and bacterial adhesion of a hybrid ceramic and a nano ceramic resin composite after different surface finishes. Methods: Hybrid ceramic (Vita Enamic, VITA - EN) and nano ceramic resin composite (Lava Ultimate, 3M/ESPE - LV) blocks of 12 x 14 x 18 mm were cut into 1 mm slices. Each slice was divided into four specimens (6 x 7 mm) that were randomly allocated into 4 groups (n=8) according to the surface finishing: CTL - without surface finish (control); DB - wear with a diamond bur; VT - polishing system for hybrid ceramic (VITA); and DD - polishing system for ceramics (Dedeco). The specimens were analyzed regarding surface roughness parameters (Ra, Rz, Rq), sterilized and subjected to bacterial adhesion. Representative specimens from each group were observed by SEM and Confocal Laser Scanning Microscopy. Data were submitted to two-way ANOVA and Tukey's test (α=0.05). Results: EN had lower surface roughness and bacterial adhesion than LV (p&lt;0.05), regardless of the surface finish. The highest values for all roughness parameters was observed in LVDB group, differing from the other groups, which were not significantly different. Smaller bacterial adhesion values (CFU/mL) were observed for ENDD and ENVT, which differed significantly from the other groups, except ENCTL. For LV groups there was no significant difference between the different surface finishes (p&gt;0.05). The type of material and surface finish system significantly interfered with surface roughness parameters and bacterial adhesion. The hybrid ceramic performed better after polishing than the nano-ceramic resin. Conclusion: An adequate finishing/polishing technique should always be performed after any kind of adjustment to indirect restorations made with these materials tested.

Repair Success of Two Innovative Hybrid Materials as a Function of Different Surface Treatments.

To evaluate surface treatments for chipping in order to avoid bonding problems between hybrid materials and composite resin and to determine the optimal surface treatment method during intraoral repair of restorations to achieve clinical success. A total of 96 samples were prepared from computer-aided design/computer-assisted manufactured (CAD/CAM) blocks: 48 polymer-infiltrated ceramic (PIC) and 48 resin nano-ceramic (RNC). Prior to application of the surface treatments, the two test groups were each divided into four subgroups: control group; hydrofluoric acid group; hydrofluoric acid with silane group; and air-abraded with silica-coated aluminum oxide (Al2O3) sand with silane group. Each subgroup contained 12 samples. A shear bond strength (SBS) test was performed after artificial aging (5,000 cycles, 5°C to 55°C). For both types of ceramic used, all subgroups showed significantly higher SBS values than the control groups (P < .05). The highest SBS values for both types of ceramic were observed in the air-abraded with silica-coated Al2O3 particles group. Each of the surface treatment methods increased the SBS, with the most effective method being air abrasion with silica-coated Al2O3.

Marginal adaptation of CAD-CAM onlays: Influence of preparation design and impression technique

Statement of problemFactors that may affect the marginal adaptation of computer-aided design and computer-aided manufacturing (CAD-CAM) restorations include preparation design, impression technique, and CAD-CAM system. The influence of impression technique and preparation design on CAD-CAM partial coverage restorations has not been fully addressed. PurposeThe purpose of this in vitro study was to investigate the influence of direct and indirect digital scanning techniques and 2 preparation designs on the marginal adaptation of CAD-CAM onlays. Material and methodsTwo mesio-occlusal buccal onlay preparations with reduction of the mesiobuccal cusp were made: conventional preparation (CP) with a 1.2-mm modified shoulder margin and modified preparation (MP) flat cuspal reduction without shoulder. Virtual models were generated from each preparation by using a digital scanner (BlueCam; Dentsply Sirona) from the plastic teeth (direct digital scan) or from the stone dies (indirect digital scan). Onlays were designed using a CAD-CAM system (CEREC 4.0; Dentsply Sirona), and nanoceramic resin blocks (Lava Ultimate Restorative; 3M ESPE) were milled using the CEREC MCX milling machine. Marginal discrepancy was evaluated using an optical stereomicroscope at ×25 magnification in 18 locations distributed along the margins of the preparation. The data were analyzed by using 3-way ANOVA followed by the Tukey HSD test (α=.05). ResultsCP presented a statistically significant reduced average marginal adaptation (59 ±50 μm) than did MP (69 ±58 μm) (P<.001). The Tukey HSD test showed the presence of a significantly larger marginal discrepancy in the mesial and buccal locations of MP when compared with CP. Regarding impression techniques, the buccal location presented the smallest average marginal discrepancy in restorations fabricated with indirect impression when compared with direct impression (42 ±33 μm and 60 ±39 μm) (P<.001). ConclusionsThe results showed that conventional preparation with a modified shoulder margin presented improved marginal adaptation compared with modified preparation with flat cuspal reduction. Direct and indirect digital scanning techniques produced restorations within a clinically acceptable range; however, the indirect scanning technique resulted in the fabrication of restorations with superior marginal adaptation on the buccal location.

Effect of surface finishing on the colour stability and translucency of dental ceramics

BackgroundThe purpose of this study was to investigate the effects of staining solutions and surface finishing on the colour stability and translucency of hybrid ceramic (HC) and resin nanoceramic (RNC) materials.MethodsTwenty four groups consisting of 10 specimens (240 specimens in total) were created out of HC and RNC, including six groups to be stored in distilled water served as the controls groups. The Vita Enamic technical set, Shofu polishers, medium and fine rubber wheels and Sof-Lex polishing discs were used as polishing instruments. Cola, tea, and coffee were used as staining solutions. The colour differences (∆E*) and translucency parameter (TP) were evaluated by a spectrophotometer. Data were analysed by a One-way Analysis of Variance (ANOVA) and Mann-Whitney U test.ResultsThere was a statistically significant difference between the ∆E* values of the HC specimens in the coffee groups and the ∆E* values of the other HC groups (p < 0.05). The ∆E* values of the RNC specimens in the coffee and tea groups were not different from the specimens in the cola groups (p > 0.05). The TP values of the polished groups were higher than the Sof-Lex groups and the Shofu groups on both HC and RNC materials (p < 0.05).ConclusionsIncreased ∆E* values were observed in HC specimens stored in a coffee solution compared to the specimens stored in a tea or cola solution. Both of the RNC specimens stored in coffee and tea had higher ∆E* values than the RNC specimens stored in the cola. The TP values of both HC and RNC specimens stored in the coffee solution decreased.

A literature review on the new polymer-infiltrated ceramic-network material (PICN).

Ceramics and composites are the most used materials for dental application. Recently, the characteristics of both were combined on the called "polymer-infiltrated ceramic-network" (PICN). The aim of this review is to report the behavior of PICN, comparing the findings that may support the correct clinical application. The PICN material is a structure with a sintered ceramic matrix infiltrated with a polymer matrix. Studies evaluated this material microstructure and composition, mechanical properties and adhesive behavior. The most cited mechanical properties are flexural strength, compressive strength, elastic modulus, Weibull modulus, hardness, fracture toughness and fatigue resistance. Most studies compared PICN with feldspathic porcelain, lithium disilicate glass-ceramic, lithium silicate, zirconia-reinforced glass-ceramic, leucite reinforced glass-ceramic, polycrystalline alumina and zirconia. Other studies evaluated a similar material (a nanoceramic resin). The mechanical properties of the PICN are equivalent to the properties of nanoceramic resins, lower to lithium disilicate glass ceramic and superior to feldspathic porcelain. Yet, the findings suggest a highly resistant material to degradation at low loads (close to physiological situation) when cemented on a substrate.

The Effect of Surface Treatments on the Mechanical and Optical Behaviors of CAD/CAM Restorative Materials.

To evaluate the effect of different surface treatments on mechanical and optical properties of lithium disilicate ceramic (IPS e.max CAD), 2 resin nanoceramics (Lava Ultimate, GC Cerasmart), and polymer-infiltrated ceramic network material (Vita Enamic). CAD/CAM blocks were sectioned into 4 × 1 × 14 mm3 bars for three-point bending test and 1 × 8 × 8 mm3 square specimens were obtained for color and translucency measurements. Bar-shaped and square specimens were divided into five groups according to the surface treatment method as: control (no treatment), hydrofluoric acid etching, airborne-particle abrasion, 2 W and 3 W Er,Cr:YSGG laser irradiation (n = 10). Three-point bending test was carried out on a universal test machine with a 1 mm/min crosshead speed. Color and translucency measurements were performed with a spectrophotometer and repeated after surface treatments. Flexural strength, translucency parameter, and ΔE values were calculated and data were statistically analyzed using one-way ANOVA and Bonferroni post hoc tests. ΔE values >1.2 and >2.7 were considered as perceptible and unacceptable, respectively. All surface treatment methods decreased the flexural strength of all tested materials (P < 0.05) except for 2 W laser-irradiated and airborne-particle abraded Vita Enamic and 2 W laser irradiated Lava Ultimate (P > 0.05). Color changes of lithium disilicate specimens were not perceptible except for airborne-particle abraded specimens. All ΔE values of resin-based materials were above the perceptibility threshold. Acid-etched and 3 W laser-irradiated GC Vita Enamic specimens revealed unacceptable color changes. The translucencies of resin-based materials significantly decreased after all surface treatment applications. Surface treatments affected the flexural strength and optical properties of CAD/CAM restorative materials. Er,Cr:YSGG laser irradiation with 2 W energy level may be an alternative surface treatment method for CAD/CAM materials.

Evaluation of five CAD/CAM materials by microstructural characterization and mechanical tests: a comparative in vitro study

BackgroundPolymer infiltrated ceramics and nano-ceramic resins are the new restorative materials which have been developed in order to enhance the adverse properties of glass-matrix ceramics and resin composites. The aim of the present in vitro study was to evaluate the characteristics of various CAD/CAM materials through mechanical, microstructural, and SEM analysis.MethodsFive test groups (n = 22) were formed by using the indicated CAD/CAM blocks: VITA Enamic (VITA Zahnfabrik), Lava Ultimate (3 M ESPE), IPS e.max CAD (Ivoclar Vivadent), IPS Empress CAD (Ivoclar Vivadent), and VITA Mark II (VITA Zahnfabrik). Two specimens from each test group were used for XRD and EDS analysis. Remaining samples were divided into two subgroups (n = 10). One subgroup specimens were thermocycled (5 °C to 55 °C, 30s, 10,000 cycles) whereas the other were not. All of the specimens were evaluated in terms of flexural strength, Vickers hardness, and fracture toughness. Results were statistically analyzed using two-way ANOVA, one-way ANOVA, Tukey’s HSD, and Student’s t tests (α = .05). Fractured specimens were evaluated using SEM.ResultsThe highest Vickers microhardness value was found for VITA Mark II (p < .001), however flexural strength and fracture toughness results were lowest conversely (p < .05). IPS e.max CAD was found to have the highest flexural strength (p < .001). Fracture toughness of IPS e.max CAD was also higher than other tested block materials (p < .001). Lava Ultimate and VITA Enamic’s mechanical properties were affected negatively from thermocycling (p < .05). Microhardness, flexural strength, and fracture toughness values of Lava Ultimate and VITA Enamic were found to be similar to VITA Mark II and IPS Empress CAD groups.ConclusionsIt should be realised that simulated aging process seem to affect ceramic-polymer composite materials more significantly than glass ceramics.

Mechanical Wear and Surface Roughness of Glass and Hybrid Ceramics

Aim: The purpose of this invitro study was to evaluate wear resistance and surface roughness of two hybrid ceramics in comparison to lithium disilicate glass ceramic before and after mechanical abrasion.Materials and methods: Thirty samples were divided according to material of construction into three groups, group (1): Lithium disilicate glass ceramic (IPS e.max, n=10), group (2): Resin nanoceramic (Lava Ultimate, n=10), group (3): Polymer infiltrated ceramic (Vita Enamic, n=10). All samples were fabricated out of CAD CAM ceramic blocks, weighed and evaluated for surface roughness before and after mechanical wear.Results: Resin nanoceramic (Lava ultimate), showed significantly low weight loss and surface roughness change after mechanical wear than IPS e.max. The polymer infiltrated ceramic (Vita Enamic) showed significantly high surface roughness than Resin nanoceramic (Lava ultimate), while IPS e.max showed the highest weight loss and surface roughness change. Conclusions: Resin nanoceramics revealed highest mechanical wear resistance contributed by terms of weight loss and surface roughness change, while Lithium disilicate glass ceramic showed the least wear resistance.

Comparative Study between Resin Nano Ceramic and CAD/CAM Ceramic Regarding Their Fracture Resistance, Microtensile Bond Strength and Fatigue Resistance

Purpose: In an attempt to improve the mechanical properties, industriallyCAD/CAM ceramics blocks have been introduced to dentistry. This study was directed to investigate the influence of the material thickness on the fracture resistance ofCAD/CAM Resin Ceramic and CAD/CAM Ceramic and asses the fatigue resistance of class II mesio-occlusal-distal (MOD) inlays of both materials and compare their micro-tensile bond strength (μTBS) after cementation by two different adhesive resin cements. Materials and Methods: A total of 70 specimens were fabricated. The specimens were divided according to the material used into two main groups (n= 35). Group 1 specimens were fabricated from CAD/CAM Resin Ceramic (Vita Enamic), whereas Group 2 specimens were fabricated from Lithium disilicate glass ceramic (IPS e-max CAD). Specimens of each group were further subdivided into 3 subgroups according to type of testing (microtensile bond strength test, fracture resistance and fatigue resistance tests). Specimens of subgroup of microtensile bond strength test (n=40) were further subdivided into 2 divisions (n=20) according to type of surface treatment (control and sandblasting). Then each division was further subdivided into 2 subdivisions (n=10) according to type of cement used (Rely X Ultimate and multilink N). Furthermore, subgroup of fracture resistance test (n=20) was further divided into 2 division (n=10) according to thickness (0.5 mm and 3 mm). Two-way analysis of variance ANOVA test and three-way analysis of variance ANOVA test of significance were done for comparing variables. Results: For microtensile bond strength, it was found that the highest μ-tensile bond strength value was recorded for Multilink N control subgroup (54.07±7.9 MPa), while the lowest μ-tensile bond strength mean values was for Rely X Ultimate sandblasted subgroup (37.12±2.5 MPa) and IPS e-max CAD. Results revealed that the highest μ-tensile bond strength mean value was recorded for Rely X Ultimate

On the mechanical properties of monolithic and laminated nano-ceramic resin structures obtained by laser printing

Abstract The purpose of this study was to evaluate the mechanical properties of laser printed monolithic and laminated nano ceramic resins (NCR) for dental prosthetic applications. Three different types of discs were produced by laser printing: monolithic NCR discs and laminated NCR discs with 100 μm (laminate_100) and 500 μm (laminate_500) resin interlayers (n = 10). To assess the adhesion strength of the photosensitive resin used as interlayer to the NCR, cylindrical specimens were produced. The biaxial flexural strength and shear bond strength of the specimens were measured using a universal testing machine. Data was statistically analyzed by one-way ANOVA followed by Tukey HSD test (α = 0.05). The microstructure and fracture surfaces were analyzed by SEM/EDS. Results were rationalized with finite element analysis (FEA). Laminate_100 specimens showed significantly higher flexural strength (∼50%) than monolithic and Laminate_500 specimens (p

Comparative approach to analyse the effects of different surface treatments on CAD/CAM resin nanoceramics–resin composite repair bond strength

ABSTRACTLimited data are available on the repair bond strength between computer-aided design and manufacturing (CAD/CAM) resin nanoceramics and composite repair materials. Therefore, the purpose of this study was to test the influence of several different surface treatment modalities, intermediate agents and phosphoric acid on the shear bond strength (SBS) of repair composites with water-aged CAD/CAM resin nanoceramics. Three pretreatment and four conditioning methods comprised 12 different groups. A universal testing machine was used to test the SBS. Specimens were examined with a stereomicroscope and scanning electron microscope to determine the fracture mode. The results showed that a combination of the pretreatment and conditioning methods significantly enhanced the SBS of the resin nanoceramic (p:0.001; p < 0.01), while etching with phosphoric acid did not affect the SBS (p:0.841; p > 0.05). This study showed that surface pretreatment in combination with a conditioning method should be used in the repair of CAD/CAM nanoceramics. The highest SBS values were achieved by grinding the surface with a diamond bur followed by silane and adhesive application, whereas the lowest values were obtained in the non-conditioned non-pretreated group.

Mechanical properties and internal fit of 4 CAD-CAM block materials

Statement of problemRecent polymer-based computer-assisted design and computer-assisted manufacturing (CAD-CAM) materials have been commercialized for inlay restorations, a polymer-infiltrated ceramic-network (PICN) and composite resin nanoceramics. Little independent evidence regarding their mechanical properties exists. Internal adaptation is an important factor for the clinical success and longevity of a restoration, and data concerning this parameter for inlays made with these blocks are scarce. PurposeThe purpose of this in vitro study was to evaluate and compare the mechanical properties (flexural strength, flexural modulus, Vickers hardness, fracture toughness) and the internal adaptation of these recent polymer-based blocks with a lithium disilicate glass-ceramic block. Material and methodsThe materials tested in this study were a PICN material (Vita Enamic), 2 composite resin nanoceramics (Lava Ultimate; 3M ESPE and Cerasmart; GCDental Products), and a lithium disilicate glass-ceramic (IPS e.max CAD). Mechanical properties were evaluated according to ISO norm DIS 6872:2013. Bar-shaped specimens (18×3×3 mm) were prepared and submitted to a 3-point bend test using a universal testing machine at a cross-head speed of 0.5 mm/min. In addition, identical cavities were prepared in 60 human mandibular extracted molars (n=15) and optically scanned to receive mesioocclusodistal inlays milled with the 4 materials tested in a CEREC Inlab milling machine. The replica technique and a stereomicroscope (×20) were used to measure the internal fit of the inlays at 9 preselected locations. All data were statistically analyzed using 1-way ANOVA and the post hoc Tukey multiple comparison or Games-Howell test (α=.05). ResultsThe mean flexural strength of the tested blocks ranged from 148.7 ±9.5 MPa (Vita Enamic) to 216.5 ±28.3 MPa (Cerasmart). The mean flexural modulus ranged from 23.3 ±6.4 GPa (Vita Enamic) to 52.8 ±10.5 GPa (IPS e.max CAD). The mean Vickers hardness ranged from 0.66 ±0.02 GPa (Cerasmart) to 5.98 ±0.69 GPa (IPS e.max CAD). The mean fracture toughness ranged from 1.2 ±0.17 MPa.m1/2 (Cerasmart) to 1.8 ±0.29 MPa.m1/2 (IPS e.max CAD). The values for internal discrepancy ranged from 119 ±55 μm to 234 ±51 μm. The mean internal discrepancy was significantly higher for Lava Ultimate (P<.05) than IPS e.max CAD and Cerasmart but not for Vita Enamic. The factor ‘‘material’’ was statistically significant in relation to the mechanical properties evaluated in this study (P<.05). The Pearson correlation was negative between the flexural strength results and the internal discrepancy of the materials tested (R2=0.941; P<.05). ConclusionsThe mechanical properties of the CAD-CAM block materials tested were within the acceptable range for fabrication of single restorations according to the ISO standard for ceramics (ISO 6872:2008). IPS e.max CAD and Cerasmart were observed to have superior flexural strength and better internal fit.

Wear Behavior of Ceramic CAD/CAM Crowns and Natural Antagonists.

Objective: Evaluation of wear behavior of computer-aided design/computer-aided manufacturing (CAD/CAM) crowns from various restorative materials and natural antagonists. Method: Full CAD/CAM crowns fabricated with nanoceramic resin (Lava Ultimate (LU)), a glass ceramic in a resin interpenetrating matrix (Vita Enamic (VE)) and a lithium silicate reinforced ceramic enriched with zirconia (Vita Suprinity (VS)) were cemented on human molars. The crown and antagonists were subjected to simulated chewing. 3D data sets, before and after the chewing simulation, were generated and matched. Occlusal surface roughness, vertical and volume loss of the crowns and antagonists were analyzed. Results: Crown roughness was significantly different between the LU and VE groups after chewing simulation. Crown vertical loss differed in all groups. The highest crown volume loss was found in the LU group, and the lowest in the VE group. Comparisons between the LU and VE groups and the LU and VS groups were significantly different. The highest antagonist volume loss was reached in the VE group, the lowest was in the LU group. Conclusion: Roughness increased after chewing simulation. LU crowns are the most natural antagonist-friendly; these were the most susceptible to vertical and volume loss. Of the tested materials, the VE crowns are the most stable regarding occlusion.

Repair bond strengths of non-aged and aged resin nanoceramics.

PURPOSETo explore the influence of different surface conditionings on surface changes and the influence of surface treatments and aging on the bond strengths of composites to non-aged and aged resin nanoceramics.MATERIALS AND METHODSRectangular-shaped non-aged and aged (5000 thermocycles) resin nanoceramic specimens (Lava Ultimate) (n=63, each) were divided into 3 groups according to surface treatments (untreated, air abrasion, or silica coating) (n=21). The surface roughness was measured and scanning electron microscopy was used to examine one specimen from each group. Afterwards, the specimens were repaired with a composite resin (Filtek Z550) and half were sent for aging (5000 thermocycles, n=10, each). Shear bond strengths and failure types were evaluated. Roughness and bond strength were investigated by two- and three-way analysis of variance, respectively. The correlation between the roughness and bond strength was investigated by Pearson's correlation test.RESULTSSurface-treated samples had higher roughness compared with the untreated specimens (P=.000). For the non-aged resin nanoceramic groups, aging was a significant factor for bond strength; for the aged resin nanoceramic groups, surface treatment and aging were significant factors. The failures were mostly adhesive after thermal cycling, except in the non-aged untreated group and the aged air-abraded group, which had mostly mixed failures. Roughness and bond strength were positively correlated (P=.003).CONCLUSIONSurface treatment is not required for the repair of non-aged resin nanoceramic; for the repair of aged resin nanoceramic restorations, air abrasion is recommended.

Fatigue behavior of resin-modified monolithic CAD–CAM RNC crowns and endocrowns

ObjectiveTo evaluate the influence of different types of modifications with resin on fatigue resistance and failure behavior of CAD–CAM resin nano ceramic (RNC) restorations for maxillary first premolars. MethodsSixty standardized resin composite root dies received CAD–CAM RNC endocrowns (n=30) and crowns (n=30) (Lava Ultimate, 3M Espe). Restorations were divided into six groups: full anatomic endocrowns (group A) and crowns (group D), buccal resin veneered endocrowns (group B) and crowns (group E) and buccal resin veneered endocrowns (group C) and crowns (group F) with a central groove resin filling. A nano-hybrid resin composite was used to veneer the restorations (Filtek Supreme, 3M Espe). All specimens were first submitted to thermo-mechanical cyclic loading (1.7Hz, 49N, 600000 cycles, 1500 thermo-cycles) and then submitted to cyclic isometric stepwise loading (5Hz) until completion of 105000 cycles or failure after 5000 cycles at 200N, followed by 20000 cycles at 400N, 600N, 800N, 1000N and 1200N. In case of fracture, fragments were analyzed using SEM and modes of failure were determined. Results were statistically analyzed by Kaplan–Meier life survival analysis and log rank test (p=0.05). ResultsThe differences in survival between groups were not statistically significant, except between groups D and F (p=0.039). Endocrowns fractured predominantly with a mesio-distal wedge-opening fracture (82%). Partial cusp fractures were observed above all in crowns (70%). Analysis of the fractured specimens revealed that the origin of the fracture was mainly at the occlusal contact points of the stepwise loading. SignificanceVeneering of CAD–CAM RNC restorations has no influence on their fatigue resistance except when monolithic crowns are modified on their occlusal central groove.

Effect of material and fabrication technique on marginal fit and fracture resistance of adhesively luted inlays made of CAD/CAM ceramics and hybrid materials

This study evaluated the fracture resistance and marginal fit of CAD/CAM ceramic and composite inlays. Molars (N = 80) were prepared to receive Mesio-occlusal-distal (MOD) inlays and randomly divided into four groups to be restored depending on the materials: (a) HLD: heat-pressed lithium disilicate ceramic (IPS e.max Press), (b) CLD: CAD/CAM-fabricated lithium disilicate ceramic (IPS e.max CAD), (c) NC: CAD/CAM nano-ceramic resin (Lava Ultimate), (d) RC: Indirect resin composite (Filtek P60). Each group was randomly divided into two subgroups regarding the resin cement: (a) High-viscosity resin cement (Syntac, Variolink II), (b) Self-adhesive low-viscosity cement (RelyX Ultimate). After marginal gap and cement thickness measurements, specimens were loaded to fracture in a Universal Testing Machine (1 mm/min). Intact molars acted as the control group (n = 10). Data were analyzed using one-way and two-way ANOVA, Tukey’s tests (α = 0.05). Before cementation, CLD group showed significantly lower mean marginal gap (65 ± 22.4 μm) and after cementation, cement thickness was again the lowest with CLD (82.6 ± 24.6 μm) and the highest with HLD (108.4 ± 21.3 μm) (p < 0.001). The mean marginal gaps of inlays at the gingival margin were significantly higher than at the occlusal and the axial margins (p < 0.05). While material type significantly affected the mean fracture resistance (p < 0.001), the cement type had no effect on the results (p = 0.083). NC group (2486 ± 40 N) showed significantly higher mean fracture load compared to those of other three groups (1997.5 ± 60–2007 ± 30) (p < 0.05). The mean fracture resistance of control group with the intact teeth was significantly higher than those of all groups (p < 0.05) except for NC (p > 0.05).

Ceramic-Reinforced Polymers: CAD/CAM Hybrid Restorative Materials

Newly developed ceramic-reinforced polymers CAD/CAM restorative materials (CRP) represent a viable esthetic material for dental restorations. They can be classified into polymer-infiltrated ceramic (PIC) and resin nano-ceramic (RNC). This review article analyzes the latest scientific findings on wear, fatigue resistance, bonding mechanisms, fracture resistance, and esthetic properties. The literature shows that fatigue resistance of ceramic-reinforced polymers appears to be adequate to survive the masticatory forces. PIC and RNC CAD/CAM blocks have similar fracture toughness, but lower than that of ceramic-based CAD/CAM blocks. The roughness of polished different ceramic-reinforced polymers is comparable; however, aging increases the surface roughness significantly. Different CRPs require a dedicated surface treatment; nonetheless, PIC and RNC are able to attain high bond strengths. The esthetic properties of CRPs are clinically acceptable. Ceramic-reinforced polymers appear to be an ideal material for minimally invasive restorations.

Edge chipping resistance and flexural strength of polymer infiltrated ceramic network and resin nanoceramic restorative materials

Statement of problemTwo novel restorative materials, a polymer infiltrated ceramic network (PICN) and a resin nanoceramic (RNC), for computer-assisted design and computer-assisted manufacturing (CAD-CAM) applications have recently become commercially available. Little independent evidence regarding their mechanical properties exists to facilitate material selection. PurposeThe purpose of this in vitro study was to measure the edge chipping resistance and flexural strength of the PICN and RNC materials and compare them with 2 commonly used feldspathic ceramic (FC) and leucite reinforced glass-ceramic (LRGC) CAD-CAM materials that share the same clinical indications. Material and methodsPICN, RNC, FC, and LRGC material specimens were obtained by sectioning commercially available CAD-CAM blocks. Edge chipping test specimens (n=20/material) were adhesively attached to a resin substrate before testing. Edge chips were produced using a 120-degree, sharp, conical diamond indenter mounted on a universal testing machine and positioned 0.1 to 0.7 mm horizontally from the specimen’s edge. The chipping force was plotted against distance to the edge, and the data were fitted to linear and quadratic equations. One-way ANOVA determined intergroup differences (α=.05) in edge chipping toughness. Beam specimens (n=22/material) were tested for determining flexural strength using a 3-point bend test. Weibull statistics determined intergroup differences (α=.05). Flexural modulus and work of fracture were also calculated, and 1-way ANOVA determined intergroup differences (α=.05) ResultsSignificant (P<.05) differences were found among the 4 CAD-CAM materials for the 4 mechanical properties. Specifically, the material rankings were edge chipping toughness: RNC>LRGC=FC>PICN; flexural strength: RNC=LRGC>PICN>FC; flexural modulus: RNC<PICN<LRGC<FC; and work of fracture: RNC>LRGC=PICN>FC. ConclusionsThe RNC material demonstrated superior performance for the mechanical properties tested compared with the other 3 materials.