Polymer-infiltrated Ceramics Research Articles

Effect of Common Staining Beverages on Color Stability of Polymer-infiltrated Ceramics and Extra Translucent Zirconia: An In Vitro Study.

The current study aims to assess the color change of polymer-infiltrated ceramic Vita Enamic (VE) and extra translucent multilayer zirconia (XTML) after being immersed in different types of beverages, which are coffee, tea, and cola in comparison to distilled water as control. A total of 80 rectangular-shaped specimens were prepared with fixed dimensions (14 × 12 × 0.5 mm) and then were divided into two groups (n = 40) according to ceramic material (VE, XTML). Specimens were sliced as each slice measures about 0.5 mm thick. Each group specimens were divided into four subgroups (n = 10) based on the immersion solutions in which specimens were stored (water, coffee, tea, and cola) for 28 days. The color parameters (L-a-b) of the specimens were recorded before immersion and at the end of the 7th (T1), 14th (T2), 21st (T3) and 28th (T4) days after immersion. Color measurements were statistically analyzed with a significance threshold of p < 0.05. There was a significant difference in color change between VE and XTML in all periods of tea and coffee immersion subgroups and in T3 and T4 in cola immersion subgroups (p < 0.001). Vita Enamic showed the highest differences in ΔE through all storage periods after 28 days of tea immersion (ΔE of VE= 8.06 ± 1.04). Extra translucent multilayer zirconia showed the highest differences in ΔE through all storage periods after 28 days of tea immersion (ΔE of XTML = 3.0 ± 0.33). Commonly consumed staining beverages influenced the color stability of the polymer-infiltrated ceramics more than extra translucent zirconia ceramics. This study may provide guidance for clinicians to select the appropriate ceramic restorative material with high color stability and low tendency for color change by common staining beverages to achieve long-lasting esthetic results for the patients. How to cite this article: Abdelhafez MHA, Abu-Eittah MRH. Effect of Common Staining Beverages on Color Stability of Polymer-infiltrated Ceramics and Extra Translucent Zirconia: An In Vitro Study. J Contemp Dent Pract 2024;25(5):411-416.

3D-printed intracoronal restorations, occlusal and laminate veneers: Clinical relevance, properties, and behavior compared to milled restorations; a systematic review and meta-analysis.

To assess the feasibility of producing 3D-printed intracoronal restorations, thin and ultrathin veneers, and to compare their mechanical behavior, accuracy, biological, and stain susceptibility to the currently applied milled restorations. The databases were comprehensively searched for relevant records up to January 2024 without language restrictions. All studies that assessed 3D-printed partial coverage restorations including inlays, onlays, laminate, and occlusal veneers were retrieved. The web search yielded a total of 1142 records, with 8 additional records added from websites at a later stage. Only 17 records were ultimately included in the review. The included records compared 3D-printed; alumina-based- and zirconia ceramics, lithium disilicate ceramics, polymer infiltrated ceramics, polyetheretherketone (PEEK), resin composites, and acrylic resins to their CNC milled analogs. The pooled data indicated that it is possible to produce ultrathin restorations with a thickness of less than 0.2 mm. 3D-printed laminate veneers and intracoronal restorations exhibited superior trueness, as well as better marginal and internal fit compared to milled restorations (p < 0.05). However, it should be noted that the choice of materials and preparation design may influence these outcomes. In terms of cost, the initial investment and production expenses associated with 3D printing were significantly lower than those of CNC milling technology. Additionally, 3D printing was also shown to be more time-efficient. Using additive manufacturing technology to produce restorations with a thickness ranging from 0.1 to 0.2 mm is indeed feasible. The high accuracy of these restorations, contributes to their ability to resist caries progression, surpassing the minimum clinical threshold load of failure by a significant margin and reliable adhesion. However, before 3D-printed resin restorations can be widely adopted for clinical applications, further improvements are needed, particularly in terms of reducing their susceptibility to stains. 3D-printed intracoronal restorations and veneers are more time and cost-efficient, more accurate, and could provide a considerable alternative to the currently applied CNC milling. Some limitations still accompany the resin materials, but this could be overcome by further development of the materials and printing technology.

Fracture resistance of CAD/CAM endocrowns made from different materials in maxillary premolar interproximal defects.

This in vitro study aims to compare the fracture resistance of three CAD/CAM materials used in endocrown restoration of interproximal defects in maxillary premolars. 45 maxillary premolars extracted as part of orthodontic treatment were included. Following standardized root canal treatment, all teeth were prepared into Mesial-Occlusal (MO) cavity types. The samples were then randomly divided into three groups: LD [repaired with lithium disilicate glass ceramics (IPS e.max CAD)], VE [treated with polymer-infiltrated ceramics (Vita Enamic)], and LU [repaired with resin-based nanoceramics (Lava Ultimate)]. Axial static loading was applied using a universal testing machine at 1mm/min until fracture, and fracture resistance and failure modes were recorded. Regarding Fracture Resistance Values (FRVs), the LD group exhibited significantly higher values than the other two groups, VE (P = 0.028) and LU (P = 0.005), which showed no significant difference (P = 0.778). On the other hand, regarding failure modes, the LD group had a higher prevalence of irreparable fractures compared to the other two groups, VE (P < 0.001) and LU (P < 0.001), which showed no significant difference. Although lithium disilicate glass ceramics exhibited higher FRVs, they had a lower repair probability. In contrast, polymer-infiltrated ceramics and resin-based nanoceramics contributed to tooth structure preservation. For maxillary premolars with interproximal defects following root canal treatment, resin ceramic composites are recommended for restoration to enhance abutment teeth protection.

In-Vitro SEM-EDX Analysis of Surface Roughness, Shear Bond Strength, and Color Change in Polymer-Infiltrated Ceramic Treated with Rose Bengal Activated by Low-Level Laser Therapy, Non-Thermal Plasma, and Er: YAG Laser

<i>In-Vitro</i> SEM-EDX Analysis of Surface Roughness, Shear Bond Strength, and Color Change in Polymer-Infiltrated Ceramic Treated with Rose Bengal Activated by Low-Level Laser Therapy, Non-Thermal Plasma, and Er: YAG Laser

Adhesive Cementation of CAD/CAM Silica-based Ceramics: Effect of Adhesive Type and Long-term Aging on the Bond Strength to Composite Cement.

To investigate the effect of adhesive type and long-term aging on the shear bond strength (SBS) between silica-based ceramics and composite cement (CC). Lithium-silicate (LS), feldspathic (FD) and polymer-infiltrated ceramic (PIC) blocks were sectioned (10 x 12 x 2 mm) and divided into 24 groups considering the factors: "ceramics" (LS, FD, and PIC), "adhesive" (Ctrl: without adhesive; 2SC: 2-step conventional; 3SC: 3-step conventional; 1SU: 1-step universal), and "aging" (non-aged or aged [A]). After the surface treatments, CC cylinders (n = 15, Ø = 2 mm; height = 2 mm) were made and half of the samples were subjected to thermocycling (10,000) and stored in water at 37°C for 18 months. The samples were submitted to SBS testing (100 kgf, 1 mm/min) and failure analysis. Extra samples were prepared for microscopic analysis of the adhesive interface. SBS (MPa) data was analyzed by 3-way ANOVA and Tukey's test (5%). Weibull analysis was performed on the SBS data. All factors and interactions were significant for SBS (p<0.05). Before aging, there was no significant difference between the tested groups and the respective control groups. After aging, the LS_1SU (22.18 ± 7.74) and LS_2SC (17.32 ± 5.86) groups exhibited significantly lower SBS than did the LS_Ctrl (30.30 ± 6.11). Only the LS_1SU group showed a significant decrease in SBS after aging vs without aging. The LS_1SU (12.20) group showed the highest Weibull modulus, which was significantly higher than LS_2SC_A (2.82) and LS_1SU_A (3.15) groups. No type of adhesive applied after silane benefitted the long-term adhesion of silica-based ceramics to CC in comparison to the groups without adhesive.

Effect of Thermomechanical Fatigue Loading on the Internal and Marginal Adaptation of Endocrowns Utilizing Different CAD/CAM Restorative Materials

To assess the impact of fatigue loading on the internal and marginal fit of CAD/CAM-fabricated endocrowns for restoring endodontically treated molars using different machinable blocks. A total of 72 mandibular first molars were prepared using a standardized method and were divided into four groups (n = 18), each restored with a different CAD/CAM material: group V = polymer-infiltrated ceramic (Vita Enamic); group K = partially stabilized tetragonal zirconia (Katana); group E = lithium disilicate ceramic (IPS e.max CAD; and group B = polyetheretherketone (BioHPP). Endocrowns were subjected to thermomechanical fatigue loading. Internal and marginal adaptation of the endocrowns were examined at 66 points using the sectioning technique and a stereomicroscope. Data were analyzed using one-way ANOVA and Tukey post hoc test (α = .05). Statistical tests showed that adhesive cementation resulted in significantly increased marginal and internal gap values in all regions in all four tested groups (P < .001). After thermomechanical fatigue loading, all regions in groups B and K showed a statistically significant difference, while no significant differences were found in the regions in group V (P > .05). In group E, the marginal (F = 71.00) and pulpal (F = 28.065) regions showed statistically significant differences (P < .001). Polymer-infiltrated ceramics showed the lowest gap even after thermomechanical fatigue loading and may therefore provide enhanced clinical survival of the restored tooth, favoring the use of this material for fabricating endocrown restorations.

Comparative evaluation of wear resistance between lithium disilicates and polymer infiltrated ceramics manufactured by computer aided design (CAD) computer aided manufacturing (CAM) against natural tooth enamel

Advances in CAD/CAM technology led to development of monolithic all ceramic restorations with superior esthetics like Lithium disilicate. But the major concern of ceramic materials was its wear towards the opposing enamel. Polymer infiltrated ceramics were developed by incorporating resin polymer in ceramics to produce esthetic stability of ceramics and low abrasive nature of composites and very few studies were done on this material. A total of 30 disc specimens were fabricated by CAD/CAM .15 discs of CAD/CAM lithium disilicate (IPS E.max CAD) and 15 discs of Polymer infiltrated ceramics of dimensions 10mmx3mm. They were named as group 1 (CAD/CAM Lithium disilicate) and group 2(Polymer infiltrated ceramics). 30 tooth specimens were mounted on auto polymerising acrylic resin blocks. Tooth specimens were placed on the upper member of the two body wear testing machine (Pin on disc wear and friction test rig, Magnum) and Lithium disilicate and polymer infiltrated ceramic disc specimens were positioned on disc of wear testing apparatus under constant load of 5kg (49N). The specimens were made to rub against one another in a rotating cycle to simulate oral wear cycle. The test was run for total of 10,000 wear cycles at 30rpm on wear machine for each sample. Wear of group 1 and group 2 and enamel wear of group 1 and group 2 was measured before and after wear test by profile projector.Wilcoxon test was done to compare the groups. Results showed that wear was greater in group 1 (Polymer infiltrated ceramics) compared to group 2 (CAD/CAM Lithium disilicate) and enamel wear of group 1 was greater than enamel wear of group 2. Advances in CAD/CAM technology led to development of aesthetic all ceramic restorations with superior mechanical properties such as CAD/CAM Lithium disilicate. But the major concern of ceramic materials is wear towards the opposing enamel. To meet the above requirements polymer infiltrated ceramics are developed by incorporating resin polymer in ceramics to produce esthetic stability of ceramics and low abrasive nature of composites. The restorative materials should not cause wear to opposing enamel and also should possess wear resistance similar to enamel for its success and longevity. This study was performed to evaluate the wear resistance of CAD/CAM lithium disilicate and Polymer infiltrated ceramics against natural teeth enamel.

Clinical performance of monolithic polymer-infiltrated ceramic and lithium disilicate posterior crowns: A controlled, randomized, and double-blind clinical trial

The success rate of monolithic polymer-infiltrated ceramic posterior crowns after 1 year is unclear. The purpose of this controlled, randomized, and double-blind clinical trial was to evaluate the performance of posterior complete crowns in polymer-infiltrated and lithium disilicate ceramics and to assess the impact of oral rehabilitation on esthetic satisfaction, quality of life, and periodontal health. A total of 33 crowns were provided in 18 participants allocated to 2 groups: Control (Lithium disilicate-IPS e.max CAD; Ivoclar AG) and Experimental (Polymer-infiltrated ceramic-Vita Enamic; Vita Zahnfabrik). The crowns were evaluated before treatment (T0) and after 1 (T1), 6 (T2), and 12 (T3) months by using modified United States Public Health Service (USPHS) criteria, visual analog scales (VASs), oral impacts on daily performances (OIDP), and periodontal parameters. Survival analysis was performed by using Kaplan-Meier followed by the log-rank test (α=.05). The OIDP and USPHS data were analyzed descriptively while VASs for esthetic satisfaction and periodontal parameters were statistically evaluated by using the Mann-Whitney Friedman, and Wilcoxon post hoc tests. For 18 participants with a mean age of 47.2 years, 19 crowns were manufactured in lithium disilicate and 14 in polymer-infiltrated ceramic. The Kaplan-Meier test revealed similar survival rates of 92.5% for polymer-infiltrated ceramic and 94.7% for lithium disilicate (P>.05). The analysis of periodontal parameters revealed a significant increase in the bleeding on probing (BOP) for polymer-infiltrated ceramics (P=.032) but for lithium disilicate, it was not significant (P=.387). Survival rates between the evaluated materials were not significantly different, with acceptable clinical performance after 1 year of follow-up.

Influence of different surface treatment on bonding of metal and ceramic Orthodontic Brackets to CAD-CAM all ceramic materials

BackgroundDeveloping efficient bonding techniques for orthodontic brackets and all-ceramic materials continues to pose a clinical difficulty. This study aimed to evaluate the shear bond strengths (SBS) of metal and ceramic brackets to various all-ceramic CAD-CAM materials, such as lithium disilicate CAD (LDS-CAD), polymer-infiltrated ceramic (PIC), zirconia-reinforced lithium silicate glass ceramic (ZLS), and 5YTZP zirconia after different surface treatments and thermal cycling.Materials and methodsThe samples were divided into two groups to be bonded with ceramic and metal lower incisor brackets. Each group was subdivided into a control group devoid of any surface treatment, 10% HF acid (HFA) etching, ceramic etch & prime (MEP), Al2O3 air abrasion, and medium grit diamond bur roughening. After surface treatment, brackets were bonded with composite resin cement, thermal cycled, and tested for shear bond strength. The failed surfaces were evaluated with a digital microscope to analyse the type of failure. The data were statistically analysed using a one-way ANOVA and Tukey HSD tests at p < 0.05.ResultsThe highest mean bond strengths were found with HFA etching in LDS-CAD (13.17 ± 0.26 MPa) and ZLS (12.85 0.52 MPa). Diamond bur recorded the lowest mean bond strength roughening across all the ceramic groups. There were significant differences in mean shear bond values per surface treatment (p < 0.001) and ceramic materials.ConclusionAmong the surface treatment protocols evaluated, HFA etching and MEP surface treatment resulted in enhanced bond strength of both ceramic and metal brackets to CAD-CAM all ceramic materials.

Wear behavior of bonded occlusal veneers constructed from machine milled glass and polymer infiltrated ceramics in contact with enamel: An in vitro study

Statement of problem: Occlusal veneer is considered an extra-coronal restoration with less invasive preparation. Yet there is a shortage of information as regards the wear behavior of materials from which occlusal veneers are manufactured and their opposing enamel. Purpose: Evaluate the wear of bonded occlusal veneers constructed from two dissimilar materials along with their opposing enamel following chewing simulation. Material and Methods: 16 table tops of two dissimilar materials

Effect of CAD/CAM aesthetic material thickness and translucency on the polymerisation of light- and dual-cured resin cements.

This study investigated potential variations in polymerisation of light- and dual-cured (LC and DC) resin cements photoactivated through four CAD/CAM restorative materials as a function of substrate thickness. Four CAD/CAM materials [two resin composites CeraSmart (CS) and Grandio Blocs (GB); a polymer infiltrated ceramic Vita Enamic (VE) and a feldspathic ceramic Vita Mark II (VM)], with five thicknesses (0.5, 1, 1.5, 2, and 2.5mm) were prepared and their optical characteristics measured. 1mm discs of LC and DC resin cement (Variolink® Esthetic, Ivoclar AG) were photoactivated through each specimen thickness. After 1h post-cure, polymerisation efficiency was determined by degree of conversion (DC%) and Martens hardness (HM). Interactions between materials, thicknesses and properties were analysed by linear regressions, two-way ANOVA and one-way ANOVA followed by post hoc multiple comparisons (α=0.05). All substrates of 0.5- and 1.0-mm thickness transmitted sufficiently high peak irradiances at around 455nm: (It = 588-819mW/cm2) with translucency parameter TP =21.14 - 10.7; ranked: CS>GB =VM>VE. However, increasing the substrate thickness (1.5-2.5mm) reduced energy delivery to the luting cements (4 - 2.8J/cm2). Consequently, as their thicknesses increased beyond 1.5mm, HM of the cement discs differed significantly between the substrates. But there were only slight reduction of DC% in LC cements and DC cement discs were not affected. Photoactivating light-cured Ivocerin™ containing cement through feldspathic ceramics and polymer-infiltrated ceramics achieved greater early hardness results than dual-cured type, irrespective of substrate thickness (0.5 - 2.5mm). However, only 0.5 and 1mm-thick resin composites showed similar outcome (LC>DC). Therefore, for cases requiring early hardness development, appropriate cement selection for each substrate material is recommended.

Evaluating the Bond Strength of a Polymer Infiltrated Ceramic Network to Zirconia Using the Crossbeam Push-Off Method.

Porcelains and glass-ceramics have been used to produce CAD-milled veneers and crowns for zirconia copings and implant-abutments. This study evaluated the bondstrength of a polymer-infiltrated-ceramic-network to zirconia using two adhesive cement systems: Panavia 21 and Multilink Automix. Lithium disilicate and feldspathic porcelain were also tested as reference CAD-On materials. Long beams (3x6x40 mm³) of zirconia and short beams (3x6x15 mm³) of the CAD-On materials were prepared. Zirconia and each CAD-On material were bonded in a crossbeam arrangement and subjected to a modified tensile bond-strength test. Half of the samples in each group (n=10) were tested 5 days after bonding (baseline) and the remaining (n=10) underwent aging (50,000 thermocycles at 5°C and 55°C) prior to bond-strength testing. The effects of material, cement, and aging on the tensile bond-strength were tested using a three-way ANOVA. The reference lithium disilicate/Multilink system showed no significant differences in bond strength compared to polymer-infiltrated-ceramic-network and porcelain. The long-term retention of polymer-infiltrated-ceramic-network was not statistically different compared to the baseline values and the two reference materials. With comparable bond strength between all materials, polymer-infiltrated-ceramic-network is the favorable choice for CAD-On to zirconia copings and implant-abutments due to its superior resistance to fatigue fracture relative to porcelain.

Effect of Adhesive Resin Application on the Durability of Adhesion to CAD/CAM Glass-Ceramics after either Hydrofluoric Acid Etching or Self-etch Primer Application.

To evaluate the effect of two surface conditioning methods, namely conventional hydrofluoric acid vs self-etching primer, and the application of adhesive on the bond strength of resin cement to CAD/CAM glass-ceramics. Blocks (N = 96) (12 x 10 x 2.5 mm) were manufactured, 24 for each tested ceramic type: lithium silicate ceramic (LS), polymer-infiltrated ceramic (PIC), leucite-reinforced feldspathic ceramic (FD), and lithium-disilicate glass-ceramic (LD). For bond strength testing, 64 blocks were randomly divided into 16 groups (4 blocks per group) according to the following factors: ceramic: 4 levels; etching: 2 levels (HFS: hydrofluoric acid + silane or Monobond Etch & Prime [MEP]); and adhesive application: 2 levels, with (signified as A) and without. Then for each group, 15 resin cement cylinders (AllCem Dual, FGM) were built up. All specimens were subjected to thermocycling (10,000 cycles) and to shear bonding strength testing (SBS) (100 kgf, 0.5 mm/min). Mean shear stresses (MPa) were statistically analyzed by three-way ANOVA, Tukey's test, and Weibull analysis. The mean bond strength of group PIC-HFS-A (28.45 ± 7.6 MPa) was significantly higher than that of groups LS-HFS-A (12.11 ± 2.7MPa) and FDHFSA (20.86 ± 2.0MPa). Group PIC-HFS bond strength (25.02 ± 6.5 MPa) was significantly higher only when compared to group LS-HFS (15.82 ± 4.4 MPa). The LS group presented lower SBS compared to all other groups. No significant differences were found between HFS and MEP surface treatments. Surface treatment with MEP promotes adhesion similar to that of HFS. Additional application of adhesive after the surface treatments did not improve the bond strength.

Is the radiopacity of CAD/CAM aesthetic materials sufficient?

ObjectivesThis study was designed to investigate CAD/CAM restorative blocks and other resin-based materials by (i) determining their chemical composition, (ii) comparing their radiopacity and (iii) correlating their radiopacity with specimen thickness. MethodsDisk specimens, of 1and 2 mm thickness (n = 3), were prepared from five CAD/CAM and six resin-based composites (RBCs). The CAD/CAM resin-composites included aesthetic types: CeraSmart (CS), Grandio Blocs (GB), Lava Ultimate (LU), plus a polymer infiltrated ceramic Vita Enamic (VE), and a feldspathic ceramic Vita Mark II (VM II). The six RBCs were for different clinical applications: direct filling, flowable, bulk fill, base and two luting cements. The specimens were radiographed alongside an aluminium step wedge and a tooth section. Digital images were analysed, and the radiopacity of each specimen was determined according to ISO 1311/2014. Statistical analyses of radiopacity, expressed as mm Al (n = 15), were carried out using the Kruskal-Wallis test followed by pairwise comparisons (α = 0.05). ResultsRadiopacities of CAD/CAM materials were, in ascending order, VE, VM II, CS, LU, and GB. At 1 mm thickness, the radiopacities of all CAD/CAM specimens were matching or slightly lower than enamel. At 2-mm thickness, the resin composite blocks were significantly more radiopaque than the ceramics VE and VM II (p < 0.0001). No statistically significant differences in radiopacity were detected between the 1-mm thick infiltrated ceramic, enamel, dentin and various resin composites except for filling and bulk fill types. The radiopacity of polymer-infiltrated ceramics was low despite the presence of radiopacifying elements and high filler content. SignificanceIdentifying thin restorations in standard radiographs is necessary with the development and expanded application of ‘digital’ dental materials in restorative treatment. This study confirmed the joint influence of composition and thickness on radiopacity. CAD/CAM restorative materials showed thickness-dependant radiopacity. But polymer-infiltrated ceramics were fairly radiolucent. There is a need to revisit radiopacity requirements for CAD/CAM restorative materials.

Quantitative nano-mechanical mapping AFM-based method for elastic modulus and surface roughness measurements of model polymer infiltrated ceramics

ObjectivesThe aim of this in vitro investigation was to assess and compare surface characteristics and nanomechanics of model polymer infiltrated ceramic network (PICN) materials compared to CAD/CAM resin composite blocks. Material and methodsFour model PICN materials sintered at different temperatures (Exp.125, Exp.130, Exp.135 and Exp.155) were investigated along with three CAD/CAM resin composites; Lava Ultimate (LU), Cerasmart (CS) and Grandio Bloc (GB), and one commercial PICN block - Vita Enamic (VE). Forty samples were prepared with dimensions of 14 × 12 × 2 mm for resin ceramic and VE blocks and 15 × 2 mm discs for model PICN materials. All samples were scanned using atomic force microscopy (AFM) (n = 3) at multiple locations and two different scan sizes (20 ×20 µm and 3 ×3 µm). Surface optical gloss (n = 5) at 60° was also determined for all the groups. Data were analysed using one-way ANOVA, and Tukey’s post hoc test (α = 0.05). ResultsResin composite blocks showed smoother surfaces compared to the PICN materials. The average surface roughness values (Ra) ranged from 7.75 nm to 31.21 nm and the gloss value ranged from 56.43 GU to 91.81 GU. The highest surface roughness value was found for Exp.125 (31.21 nm) while LU showed the lowest roughness value (7.75 nm) (the difference being statistically significant: p = 0.001). Variation was noticed in terms of nanomechanical mapping within and between the groups. Images generated from the elastic modulus map values clearly indicated that all PICN materials had more than one phase and very different components. ConclusionsCAD/CAM resin composite blocks exhibited higher gloss and lower roughness values compared to PICN materials. However, both the commercial and model PICN materials showed more stiffness than resin composite with the presence of at least two different phases. Sintering temperature appears to have a significant effect on material topography and nanomechanical properties. The model PICN sintered at 1550 °C showed a comparable range of elastic modulus values to those of enamel.

Finite element analysis and nanomechanical properties of composite and ceramic dental onlays

The aim is to evaluate the mechanical properties of the composite and ceramic based indirect restorative materials used in dental treatments with scanning nanoindentation test (NT). Finite element analysis (FEA) was applied to investigate the stress distribution. Four hybrid composite materials; Indirect resin composite (IRC), Resin nanoceramic (RNC), Polymer infiltrated ceramic (PIC) and Zirconia-reinforced lithium-di-silicate (ZRC) were divided into two subgroups for NT (n = 20) and fracture test (n = 40). Statistical analyses were performed with independent t-test, ANOVA and post-hoc Tukey tests (p ≤ 0.05). The highest hardness, elasticity and fracture toughness were observed in ZRC (p = 0.001). Frequency of vertical root fractures in RNC and IRC were statistically lower than ZRC (p = 0.032). Reinforced CAD-CAM ceramics revealed higher mechanical properties compared with IRC materials. The FEA model for fracture mechanism of RNC demonstrated lowest stress values and uniform stress distribution amongst all groups, while ZRC and PIC presented the highest fracture toughness.

Influence of Toothbrush Abrasion and Surface Treatments on Roughness and Gloss of Polymer-Infiltrated Ceramics.

The aim of this study was to compare the surface roughness and gloss of polymer-infiltrated ceramics after simulated in vitro toothbrushing in different storage mediums. Four polymer- infiltrated ceramics were evaluated, Lava ultimate (LU), Vita enamic (EN), Shofu (SH), and Crystal ultra (CU). The control group was a feldspathic ceramic, Vita Mark II (VM). One hundred and twenty specimens (12 × 14 × 2.5 mm) were prepared using a precision saw. For each material (n = 24), the specimens were allocated into two groups, polished and stained. The specimens of each group were stored (for 7 days) in either citric acid (0.2N) or distilled water. Data for surface gloss (ΔE*SCE-SCI) and roughness (Ra) were evaluated before (baseline) and after simulated toothbrushing. For toothbrushing simulation, a toothpaste slurry containing a toothpaste of 100 relative dentin abrasion (RDA) and 0.3 ml distilled water was used for 3650 cycles (7300 strokes) for each specimen. Data were analyzed using t-test and ANOVA. A p-value of ≤ to 0.05 was considered significant. The highest mean value of surface gloss was identified in CU (stained—water) (4.3 (0.47)) (ΔE*) and EN (stained—acid) (4.3 (1.00)) (ΔE*) specimens, whereas the lowest mean value was shown by SH (stained—acid) (2.04 (0.42)) (ΔE*) samples. The highest mean value of surface roughness was observed in SH (0.40 (0.99)) Ra (stained—acid) whereas the lowest in VM (0.13 (0.039)) Ra (polished— water). A significant difference (p < 0.05) was observed in surface roughness and gloss between the materials with simulated toothbrushing, except in VM and LU, respectively. Therefore, it can be concluded that simulated toothbrushing impacts on surface roughness and gloss, irrespective of the storage medium.

Material Thickness Influence on Fracture Load of Polymer Infiltrated Ceramic Network CAD/CAM Restorations

Polymer infiltrated ceramics are hybrid materials that combine the strength of ceramics and the flexibility of polymers. The aim of this study was to compare the fracture load capacity of monolithic CAD/CAM crowns with different occlusal thicknesses, made from polymer infiltrated ceramic network. Fifteen full contour CAD/CAM crowns made of Vita Enamic with occlusal thicknesses of 0.5 mm, 1.0 mm and 1.5 mm were fabricated with a wet milling machine. Restorations were cemented on human molars with adhesive cement. Samples were loaded along the long axis until fracture, with a single static compressive force. A scanning electron microscope (SEM) was used to examine the fracture surface of specimens after the fracture. The results of this study reveals that the fracture load of the samples increased progressively with the occlusal thickness. The highest fracture value was recorded for1.5 mm occlusal thickness of the crown. No statistically significant difference was reported between the three experimental groups. It can be concluded that hybrid monolithic CAD-CAM crowns showed sufficient fracture strength to be used for single restorations in the posterior area, even with a reduced occlusal thickness.

In vitro evaluation of material dependent force damping behavior of implant-supported restorations using different CAD-CAM materials and luting conditions

Statement of problemAlthough force-damping behavior that matches natural teeth may be unobtainable, an optimal combination of crown material and luting agent might have a beneficial effect on the force absorption capacity of implant-supported restorations. However, the force-absorbing behavior of various restorative materials has not yet been satisfactorily investigated. PurposeThe purpose of this in vitro study was to evaluate the material dependent force-damping behavior of implant-supported crowns fabricated from different computer-aided design and computer-aided manufacturing (CAD-CAM) materials luted to implant abutments under different conditions. Material and methodsTitanium inserts (N=84) were screwed to implant analogs, scanned to design zirconia abutments, and divided into 4 groups to receive CAD-CAM fabricated crowns in 4 materials: zirconia, polyetheretherketone (PEEK), polymer-infiltrated ceramics (VITA ENAMIC), and lithium disilicate (e.max). The crowns were subdivided as per the luting agent: none, interim cement, and adhesive resin cement. Measurements were performed by loading specimens in a universal testing machine with an increasing force and measuring the resulting force with a digital forcemeter, followed by image processing and data acquisition. Two-way multivariate analysis of variance (MANOVA) was used to assess all interactions with multiple pairwise comparisons (α=.05). ResultsThe curve progression of the applied and resulting forces varied significantly among the investigated materials, resulting in differently inclined slopes for each material (P<.001). With no cementation, the mean slope values of the resulting force curves ranged from 77.5 ±0.03 degrees for zirconia, followed by 71.8 ±0.03 degrees for lithium disilicate, 56.2 ±0.1 degrees for polymer-infiltrated ceramics, and 51.1 ±0.01 degrees for polyetheretherketone. With interim cementation, the mean slope values ranged from 75.4 ±0.01 degrees for zirconia, followed by 70.05 ±0.02 degrees for lithium disilicate, 56.1 ±0.02 degrees for polymer-infiltrated ceramics, and 52.2 ±0.1 degrees for polyetheretherketone. As with adhesive cementation, curve slopes ranged from 73.2 ±0.02 degrees for zirconia, followed by 70.5 ±0.2 degrees for lithium disilicate, 55.9 ±0.04 degrees for polymer-infiltrated ceramics, and 52.3 ±0.1 degrees for polyetheretherketone. Slope loss was significant after the cementation of zirconia and lithium disilicate crowns but less significant for polymer-infiltrated ceramics and polyetheretherketone. ConclusionsForce damping is generally material dependent, yet implant-supported crowns fabricated from resilient materials such as polymer-infiltrated ceramics and PEEK show better force absorption than rigid materials such as zirconia and lithium disilicate ceramics. Furthermore, cementation of rigid materials significantly increased slope loss, indicating enhancement in their force-damping behavior, whereas less-rigid materials benefit less from cementation. Further studies are essential to investigate the effect of prosthetic materials on the stress distribution to the peri-implant bone in the crown-abutment-implant complex.

Influence of material type, thickness and storage on fracture resistance of CAD/CAM occlusal veneers

ObjectivesThe present study aimed to evaluate the effect of restoration thickness, CAD/CAM material, and 6 months of artificial saliva storage on the fracture resistance of occlusal veneers. Materials and methodsA total of 84 intact maxillary molars were sectioned 4.0 mm occlusal to the cementoenamel junction to expose the dentine. The teeth were assigned into 3 main groups according to the type of restorative material (e.max CAD, Vita Enamic, and Lava Ultimate). In each group, the teeth were allocated into 2 subgroups (n = 14) according to restoration thickness (1.0 and 1.5 mm). The veneers were adhesively bonded using dual-cure self-adhesive luting agent. A total of 42 specimens comprising half the tested subgroups were stored in distilled water for 24-h before the test. The remaining half was stored in artificial saliva at 37 ± 1 °C in an incubator for 6 months. All specimens (n = 84) were subjected to 5000 thermal cycles between 5 and 55 °C ± 2 before the fracture resistance test. The maximum force at fracture was recorded in Newton. Failure mode was analyzed using a stereomicroscope. The results were analyzed using a parametric Three-way ANOVA test. ResultsThe results of the Three-way ANOVA test revealed that material type and restoration thickness significantly affected fracture resistance values (p < 0.5), while 6 months of storage in artificial saliva had no significant effect on mean fracture resistance values (p˃0.5). The most common failure patterns in CAD/CAM resin composite and polymer-infiltrated ceramics were scores I and score II. For glass ceramic groups, score IV and III were more dominant. ConclusionsAll the tested CAD/CAM restorations in both thicknesses exhibited fracture resistance values exceeding normal and parafunctional bite forces. Polymer-infiltrated ceramics and CAD/CAM resin composite veneers showed more favorable fracture patterns.