Zirconia-Reinforced Lithium Silicate Crowns Research Articles

The Impact of Open versus Closed Computer-Aided Design/Computer-Aided Manufacturing Systems on the Marginal Gap of Zirconia-Reinforced Lithium Silicate Single Crowns Evaluated by Scanning Electron Microscopy: A Comparative In Vitro Study.

This study aimed to compare the impact of CAD/CAM closed systems and open systems on the marginal gap of monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns, as both systems are used in everyday dentistry, both chair-side and laboratory. For the closed system, 20 plastic teeth were scanned by a Primescan intra-oral scanner (IOS), and for the open system, the same number of plastic teeth were scanned by Trios 4 IOS. For the closed system, CEREC software was used, and for the open system, EXOCAD software was used. All 40 ZLS crowns were grinded by the same four-axis machine and cemented with Temp-bond, followed by self-adhesive resin cement. For each type of cement, an evaluation of the marginal gap was conducted by scanning electron microscopy (SEM). Before comparisons between the groups, a Kolmogorov-Smirnov test was performed on the study variables showing a normal distribution (p > 0.05). Independent T tests (α = 0.05) and paired-sample T tests (α = 0.05) were used. The independent T test found no significant mean marginal gap differences in the zirconia-reinforced lithium silicate crowns bonded with Temp-bond and scanned by Primescan (28.09 μm ± 3.06) compared to Trios 4 (28.94 μm ± 3.30) (p = 0.401), and there was no significant mean marginal gap differences in zirconia-reinforced lithium silicate crowns bonded with self-adhesive resin cement (Gcem ONE) and scanned by Primescan (46.70 μm ± 3.80) compared to Trios 4 (47.79 μm ± 2.59) (p = 0.295). Paired-sample T tests showed significantly higher mean marginal gaps with Gcem ONE compared to Temp-bond for the total mean marginal gap when scanning with Primescan (p = 0.0005) or Trios 4 (p = 0.0005). In everyday dentistry, both closed systems (Primescan with Cerec) and open systems (Trios 4 with Exocad) can be used to achieve an acceptable (<120 µm) marginal gap for ZLS CELTRA® DUO single crowns. There is a significant difference between cementation with Temp-bond and Gcem ONE self-adhesive resin cement (p < 0.05).

SEM Evaluation of the Marginal Gap of Zirconia-Reinforced Lithium Silicate Full Crowns and the Effect of Post Crystallization: An In Vitro Study.

This study compared the influence of crystallization on marginal gap adaptation by using computer-aided design and manufacturing (CAD-CAM) for producing monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns. A total of 25 plastic teeth were scanned using a Primescan intra-oral scanner (IOS), and ZLS crowns were ground. For each unit (abutment and crown), the marginal gap was evaluated pre crystallization and post crystallization at four regions of interest through the use of a scanning electron microscope (SEM). To compare the marginal gap between the two groups, a Kolmogorov-Smirnov test performed on the study variables indicated a normal distribution (p > 0.05) followed by paired samples T-tests (α = 0.0005). After crystallization, there were significantly higher circumferential marginal gaps (CMGs) for all four surfaces (distal (p = 0.0005), mesial (p = 0.0005), palatal (p = 0.0005), and buccal (p = 0.0005)). The total mean marginal gap (MMG) revealed a significantly higher result for the post-crystallization group (79.82 ± 7.86 μm) compared to the pre-crystallization group (24.25 ± 5.49 μm). The post-crystallization group showed a significantly higher marginal gap compared to the pre-crystallization group in all parameters, but both groups were in the clinically accepted threshold (<120 microns). In terms of the marginal gap, it is arguable whether to carry out post-crystallization for CELTRA® DUO crowns and achieve better mechanical properties but significantly increase the marginal gap.

Evaluation of Marginal Accuracy and Microstructure of Heat Pressed Lithium Disilicate and Zirconia Reinforced Lithium Silicate Crowns after Thermal Tempering

Evaluation of Marginal Accuracy and Microstructure of Heat Pressed Lithium Disilicate and Zirconia Reinforced Lithium Silicate Crowns after Thermal Tempering

The Effect of Thermal Tempering on Fracture Resistance and Surface characterization‏ of Lithium Disilicate and Zirconia Reinforced Lithium Silicate Crowns

The Effect of Thermal Tempering on Fracture Resistance and Surface characterization‏ of Lithium Disilicate and Zirconia Reinforced Lithium Silicate Crowns

Three-year clinical evaluation of zirconia and zirconia-reinforced lithium silicate crowns with minimally invasive vertical preparation technique

ObjectivesLarge part of the tooth is required to be removed during crown preparation. A minimally invasive method for preparing single crowns is required to increase the durability of teeth. The aim of this study was to evaluate the clinical performance of two ceramic systems fabricated with minimally invasive vertical preparation.Materials and methodsForty endodontically treated maxillary premolars were prepared with vertical preparation and received temporary crowns for a period of 21 days. Twenty zirconia-reinforced lithium silicate (Celtra Duo HT, Dentsply Sirona, Germany) and 20 monolithic high translucency zirconia (Katana HT, Kuarary Noritake, Japan) crowns were fabricated by CAD/CAM and cemented with dual-polymerizing luting resin. The crowns were evaluated clinically and radiographically for 36 months following modified FDI criteria. Statistical analysis was conducted with t Student test (Cochran Q).ResultsOver the follow-up period, there was no need to replace any of the study’s crowns. The overall survival rate of the 40 crowns was 100% according to the Kaplan–Meier survival method. The clinical quality of all crowns and the patient’s satisfaction were high. No caries was detected and no adverse soft tissue reactions around the crowns were observed. Periodontal probing depth was reported to be increased at mesial and distal sites more than the facial one in the 36-month follow-up with no statistically significant difference between both materials (P = 0.186).ConclusionsZirconia and zirconia-reinforced lithium silicate could be used as a material for restoration of teeth prepared with vertical preparation technique. Both ceramic materials achieved good esthetic results, promotes healthy and stable soft tissues with no mechanical complications after 3 years of clinical evaluation.Clinical relevanceMonolithic high translucency zirconia and zirconia-reinforced lithium silicate ceramics can be used for the restorations of minimal invasive vertical preparation in premolar area with 0.5 mm margin thickness.

Comparison of loupes versus microscope-enhanced CAD-CAM crown preparations: A microcomputed tomography analysis of marginal gaps

Statement of problemLong-term restoration success depends on a precision marginal fit to prevent marginal leakage and caries. The successful fit of a computer-aided design and computer-aided manufactured (CAD-CAM) crown may be affected by different workflow variables, including preparation, scanning, crown design, milling, sintering, and cementation. Discrepancies in any of these steps may result in poor marginal and internal fit. Evidence suggests that tooth preparation may be the most important step in the workflow for a successful outcome. Compared with the traditional means of crown preparation using the naked eye or loupes, the dental operating microscope provides higher magnification and more direct illumination. However, the impact of high magnification during preparation on the marginal quality of CAD-CAM crowns is unclear. PurposeThe purpose of this in vitro study was to compare marginal fits of CAD-CAM crowns fabricated after initial preparation with loupes and subsequent preparation refinement with either loupes or a microscope. The null hypothesis was that no significant difference would be found in the marginal gap between the preparations with loupes and those with a microscope. Material and methodsMounted extracted molars (N=18) received initial crown preparations with a coarse grit, rounded shoulder, diamond rotary instrument with loupes of ×3.0 magnification. The teeth were then randomly divided into 2 groups and refined for an additional 2 minutes with fine grit, rounded shoulder, diamond rotary instruments with either loupes (LOUP) or a microscope up to ×10.0 magnification (DOM). The prepared teeth were scanned with an intraoral scanner to fabricate zirconia-reinforced lithium silicate crowns manufactured with a 4-axis milling machine, sintered in a dental furnace in accordance with the manufacturer’s instructions, and cemented with self-adhesive resin cement. All teeth with crowns were mounted and scanned with a microcomputed tomography (μCT) system at 21-μm nominal voxel size. The resulting Digital Imaging and Communications in Medicine (DICOM) images were imported into a semiautomatic segmentation software program. Marginal and absolute gaps were measured at 24 consistent circumferential points per specimen. Absolute gaps were labeled, and the total volume was calculated. Paired and unpaired t tests were used for statistical analysis (α=.05). ResultsThe mean marginal gap was 145.0 ±259.6 μm for LOUP and 35.6 ±110.6 μm for DOM, with a statistically significant difference (P<.001). The mean gap volume for LOUP was 0.975 ±0.811 mm3, and 0.250 ±0.477 mm3 for DOM, also statistically significantly different (P=.023). A significant difference was found between the absolute and marginal gaps for LOUP (P=.007), but for DOM, the difference was not significant (P=.063). ConclusionsThis study demonstrated that the higher magnification used during tooth preparation played a significant role in the size of marginal gaps present around CAD-CAM crowns. Crown preparations finished by using fine grit diamond rotary instruments with a microscope at higher magnification than loupes resulted in a more precise marginal fit with smaller gaps.

Impact of cement type and abutment height on pull-off force of zirconia reinforced lithium silicate crowns on titanium implant stock abutments: an in vitro study

BackgroundPull-off forces of cement-retained zirconia reinforced lithium silicate (ZLS) in implant-supported single crowns on stock titanium abutments with respect to abutment height and implant cement were evaluated and compared.MethodsPull-off force of ZLS crowns on stock titanium abutments was evaluated concerning dental cement and abutment height. A total sample size of 64 stock abutments with heights of 3 mm (n = 32) and 5 mm (n = 32) was used. The ZLS crowns were cemented with four different types of cement (one temporary, two semi-permanent, and one permanent). After cementation, water storage, and thermocycling each sample was subjected to a pull-off test using a universal testing machine.ResultsThe temporary cement showed the least pull-off force regardless of abutment height (3/5 mm: means 6 N/23 N), followed by the semi-permanent methacrylate-infiltrated zinc oxide cement (28 N/55 N), the semi-permanent methacrylate-based cement (103 N/163 N), and the permanent resin composite cement (238 N/820 N). Results of all types of cement differed statistically significantly from each other (p ≤ .012). The type of implant cement has an impact on the pull-off force of ZLS crowns and titanium abutments.ConclusionsPermanent cements present higher retention than semi-permanent ones, and temporary cements present the lowest values. The abutment height had a subordinate impact.

The Influence of Three Different Digital Cement Spacers on the Marginal Gap Adaptation of Zirconia-Reinforced Lithium Silicate Crowns Fabricated by CAD-CAM System

Background: This study compared the influence of three different radial spacers (60,90,120 microns) on the marginal gap adaptation by using computer-aided manufacturing (CAD-CAM) for producing monolithic zirconia reinforced lithium silicate (ZLS) ceramic crowns. Methods: A total of 45 abutment acrylic teeth were divided into three groups of different radial spacers (60, 90, and 120 microns). In each group 15 teeth were scanned by Omnicam intra oral scanner and ZLS crowns were ground. For each unit the marginal gap was evaluated at four regions of interest by scanning electronic microscope (SEM). To compare the marginal gap between the three groups a one-way ANOVA with post-hoc Bonferroni test was preformed (α = 0.05). Results: The marginal gap for a 60 microns (162.99 ± 16.25 µm) radial spacer was found significantly higher than 90 (41.85 ± 3.57 µm) and 120 (41.85 ± 5.3 µm) microns radial spacers (p &lt; 0.05). Between 90- and 120-micron radial spacers no difference was obtained. (p &lt; 0.05). Conclusions: A radial spacer of 60 microns showed a significantly higher marginal gap compared to 90 and 120 microns and was not clinically accepted (&gt;120 microns). For both 90 and 120 microns the marginal gap was clinically accepted (&lt;120 microns) with no difference between the groups. The radial spacer which should be optimum for CELTRA® DUO crowns is 90 microns.

Evaluation of Marginal/Internal Fit and Fracture Load of Monolithic Zirconia and Zirconia Lithium Silicate (ZLS) CAD/CAM Crown Systems.

Fit accuracy and fracture strength of milled monolithic zirconia (Zi) and zirconia-reinforced lithium silicate (ZLS) crowns are important parameters determining the success of these restorations. This study aimed to evaluate and compare the marginal and internal fit of monolithic Zi and ZLS crowns, along with the fracture load, with and without mechanical aging. Thirty-two stone dies acquired from a customized master metal molar die were scanned, and ceramic crowns (16 Zi Ceramill Zolid HT+ and 16 ZLS Vita Suprinity) were designed and milled. Absolute marginal discrepancies (AMD), marginal gaps (MG), and internal gaps (IG) of the crowns, in relation to the master metal die, were evaluated using x-ray nanotomography (n = 16). Next, thirty-two metal dies were fabricated based on the master metal die, and crowns (16 Zi; 16 ZLS) cemented and divided into four groups of eight each; eight Zi with mechanical aging (MA), eight Zi without mechanical aging (WMA), eight ZLS (MA), and eight ZLS (WMA). Two groups of crowns (Zi-MA; ZLS-MA) were subjected to 500,000 mechanical cycles (200 ± 50 N, 10 Hz) followed by axial compressive strength testing of all crowns, until failure, and the values were recorded. Independent sample t tests (α = 0.05) revealed no significant differences between Zi and ZLS crowns (p > 0.05); for both internal and marginal gaps, however, there were significant differences in AMD (p < 0.005). Independent samples Mann–Whitney U and Kruskal–Wallis tests revealed significant differences between the two materials, Zi and ZLS, regardless of fatigue loading, and for the individual material groups based on aging (α = 0.05). Multiple comparisons using Bonferroni post-hoc analysis showed significant differences between Zi and ZLS material groups, with or without aging. Within the limitations of this study, the ZLS crown fit was found to be on par with Zi, except for the AMD parameter. As regards fracture resistance, both materials survived the normal range of masticatory forces, but the Zi crowns demonstrated greater resistance to fracture. The monolithic Zi and ZLS crowns seem suitable for clinical application, based on the fit and fracture strength values obtained.

Evaluation of the marginal and internal gaps of partially crystallized versus fully crystallized zirconia-reinforced lithium silicate CAD-CAM crowns: An in vitro comparison of the silicone replica technique, direct view, and 3-dimensional superimposition analysis

Statement of problemThe crystallization process of lithium disilicate crowns has been reported to cause dimensional change, but whether the fit of chairside computer-aided design and computer-aided manufactured (CAD-CAM) zirconia-reinforced lithium silicate crowns is affected is unclear. PurposeThe purpose of this in vitro study was to evaluate with a 3-dimensional superimposition analysis technique the marginal and internal adaptation of fully crystallized versus partially crystallized zirconia-reinforced lithium silicate ceramic CAD-CAM fabricated crowns. Additionally, the silicone replica technique and direct viewing of marginal gap values were compared with the 3-dimensional superimposition analysis technique. Material and methodsThe marginal and internal adaptation of a fully crystallized zirconia-reinforced lithium silicate (CELTRA DUO) were compared with those of a partially crystallized zirconia-reinforced lithium silicate (VITA SUPRINITY) after crystallization. Sixteen crowns (n=8) were fabricated with a chairside CAD-CAM system. The crowns and die and crown assembly were scanned with an optical scanner for the 3-dimensional superimposition analysis. Four hundred sixty-eight measurements were made for each crown, 78 in each 2-dimensional section. Marginal discrepancy was measured by using the direct viewing technique. The internal adaptation of the shoulder area, axial space, and occlusal space was measured by using the silicone replica technique. Both gap values were compared with the 3-dimensional superimposition analysis results by using the independent t test. The 2-way ANOVA was used to detect the effect of each variable (group and site) (α=.05). ResultsThe VITA SUPRINITY crowns showed statistically higher marginal discrepancy values than the CELTRA DUO crowns in both 3-dimensional superimposition analysis and the direct viewing method, and the lingual aspect recorded the highest marginal discrepancy mean value when compared with other aspects. The 3-dimensional superimposition analysis and the direct viewing method were statistically similar (P=.076). The VITA SUPRINTY crowns showed higher internal gap mean values than the CELTRA DUO crowns in both 3-dimensional superimposition analysis and silicone replica techniques. The occlusal space recorded the highest mean value in both groups. Assessment by 3-dimensional superimposition analysis and silicone replica techniques showed statistical difference in internal gap values (P=.04). ConclusionsCELTRA DUO showed better precision fit values than VITA SUPRINITY. Three-dimensional superimposition analysis is a reliable method of evaluating marginal and internal adaptation.

Evaluation of the Milling Accuracy of Zirconia-Reinforced Lithium Silicate Crowns Fabricated Using the Dental Medical Device System: A Three-Dimensional Analysis.

This study aimed to analyze the milling accuracy of lithium disilicate and zirconia-reinforced silicate crown fabricated using chairside computer-aided design/manufacturing (CAD/CAM) system. Mandibular left first premolar was selected for abutment. A master model was obtained for digital impression using an intraoral scanner, and crowns were designed using a CAD software design program. Amber Mill (AM), IPS e max CAD (IPS), and CELTRA DUO (CEL) were used in the CAD/CAM system, and a total 45 crowns (15 crowns each for AM, IPS, and CEL) was fabricated. Milling accuracy was analyzed with respect to trueness, measured by superimposing CAD design data and scan data through a three-dimensional program to compare the outer and inner surfaces and internal and external parts, thereby acquiring both quantitative and qualitative data. Data were analyzed using the non-parametric test and Kruskal–Wallis H test. In addition, the Mann–Whitney U test was used by applying the level of significance (0.05/3 = 0.016) adjusted by post-analysis Bonferroni correction. All the measured parts of the lithium disilicate and zirconia-reinforced silicate crowns showed statistically significant differences (p < 0.05). The lithium disilicate (AM and IPS) materials showed superior milling accuracy than the zirconia-reinforced lithium silicate (CEL) materials.

Fatigue performance of adhesively luted glass or polycrystalline CAD-CAM monolithic crowns

Statement of problemData comparing the fatigue performance of adhesively luted glass or polycrystalline ceramic systems for computer-aided design and computer-aided manufacturing (CAD-CAM) are scarce. PurposeThe purpose of this in vitro study was to evaluate and compare the fatigue performance of monolithic crowns manufactured from glass or polycrystalline CAD-CAM ceramic systems adhesively luted to a dentin analog. Materials and MethodsFifty-four pairs of standardized preparations of dentin analog (NEMA Grade G10) and simplified ceramic crowns of 1.5-mm thickness were obtained with 3 ceramic materials: lithium disilicate (LD) glass-ceramic (IPS e.max CAD); zirconia-reinforced lithium silicate (ZLS) glass-ceramic (Vita Suprinity); and translucent yttrium fully stabilized polycrystalline zirconia (Trans YZ) (Prettau Anterior). The simplified crowns (n=15) were adhesively cemented onto the preparations and subjected to step-stress fatigue test (initial load of 400 N, 20 Hz, 10 000 cycles, followed by 100-N increment steps until failure). Collected data (fatigue failure load [FFL] and cycles for failure [CFF]) were submitted to survival analysis with the Kaplan-Meier and Mantel-Cox post hoc tests (α=.05) and to Weibull analysis (Weibull modulus and its respective 95% confidence interval). Failed crowns were submitted to fractography analysis. The surface characteristics of the internal surface (roughness, fractal dimension) of additional crowns were accessed, and the occlusal cement thickness obtained in each luted system was measured. ResultsTrans YZ crowns presented the highest values of FFL, CFF, and survival rates, followed by ZLS and LD (mean FFL: 1740 N>1187 N>987 N; mean CFF: 149 000>92 613>73 667). Weibull modulus and cement thickness were similar for all tested materials. LD presented the roughest internal surface, followed by ZLS (mean Ra: 226 nm>169 nm>93 nm). The LD and ZLS internal surfaces also showed higher fractal dimension, pointing to a more complex surface topography (mean fractal dimension: 2.242=2.238>2.147). ConclusionsCAD-CAM monolithic crowns of Trans YZ show the best fatigue performance. In addition, ZLS crowns also showed better performance than LD crowns.

Zirconia-reinforced lithium silicate crowns: Effect of thickness on survival and failure mode

ObjectiveTo evaluate the reliability and failure mode of zirconia-reinforced lithium silicate (ZLS) molar crowns of different thicknesses. MethodsMonolithic ZLS molar crowns (0.5mm, 1.0mm, and 1.5 mm thickness) were modeled and milled using a CAD/CAM system (n = 21/group). Crowns were cemented on dentin-like epoxy resin replicas with a resin cement. The specimens were subjected to single load-to-failure test for step-stress profiles designing. Mouth-motion step-stress accelerated-life test was performed under water by sliding an indenter 0.7 mm lingually down on the distobuccal cusp until specimen fracture or suspension. Use level probability Weibull curves and reliability were calculated and plotted. Polarized-light optical microscope and scanning electron microscope (SEM) were used to characterize fracture patterns. ResultsIrrespective of crown thickness, beta (β) values were higher than 1 and fatigue accelerated failures. While 0.5 mm ZLS crowns exhibited a significant reduction in the probability of survival at 200N, 300N and 400 N mission loads (69%, 41% and 19%, respectively), no significant difference was observed between 1.0 mm and 1.5 mm crowns. Both thicknesses have maintained the survivability at approximately 90%. Failure primarily comprised bulk fracture where radial cracks originated from the cementation surface beneath the indenter loading trail and propagated towards the cervical margin. Significance1.5 mm- and 1.0 mm-thickness monolithic ZLS crowns presented higher probability of survival compared to 0.5 mm crowns. Bulk fracture was the chief failure mode, regardless of thickness.

Effect of Hydrochloric Acid on Resin Cement Microleakage in Zirconia-Reinforced Lithium Silicate Crowns

Effect of Hydrochloric Acid on Resin Cement Microleakage in Zirconia-Reinforced Lithium Silicate Crowns

Effect of total occlusal convergence on fit and fracture resistance of zirconia-reinforced lithium silicate crowns.

IntroductionComputer-aided design (CAD) and computer-aided manufacturing (CAM) monolithic crowns are gaining momentum. Limited evidence exists about the effect of tooth preparation total occlusal convergence (TOC) on marginal and internal gap distances in addition to load to fracture values.AimThe aim of this study was to evaluate, by microcomputed tomography (µCT), the influence of 12° and 20° TOC on marginal and internal adaptation of zirconia-reinforced lithium silicate (ZLS) crowns. Moreover, values of load to fracture with and without initial cyclic loading (CL) were compared.Material and methodsForty ZLS crowns were fabricated on dies with TOC of 12° and 20°, 20 crowns for each group. µCT was used to compare marginal and internal adaptation. Each specimen was measured at 140 points distributed on all tooth preparation surfaces for 2D gap distance assessment. 3D gap volume was also evaluated. Crowns were then cemented and divided into two subgroups; the first was stored in distilled water (no cyclic loading [NCL] subgroup), the second was subjected to CL (CL subgroup).ResultsFactorial repeated measures ANOVA followed by Bonferroni post hoc in addition to independent and dependent t-tests were used for statistical analysis. Marginal gap, absolute marginal discrepancy, and occlusal gap measurements showed significant differences between the measurement sites. Static load to fracture values showed significant differences between TOC groups for both NCL (P=0.011) and CL (P=0.025) subgroups.ConclusionAn increase of TOC from 12° to 20° did not affect marginal and internal adaptation but resulted in higher values of load to fracture of ZLS crowns. CL simulating 1 year of service did not result in fatigue failure.

Digital evaluation of the fit of zirconia-reinforced lithium silicate crowns with a new three-dimensional approach.

Several methods for the evaluation of fit of computer-aided design/computer-assisted manufacture (CAD/CAM)-fabricated restorations have been described. In the study, digital models were recorded with an intraoral scanning device and were measured using a new three-dimensional (3D) computer technique to evaluate restoration internal fit. The aim of the study was to evaluate the internal adaptation and fit of chairside CAD/CAM-fabricated zirconia-reinforced lithium silicate ceramic crowns fabricated with different post-milling protocols. The null hypothesis was that different post-milling protocols did not influence the fitting accuracy of zirconia-reinforced lithium silicate restorations. A master all-ceramic crown preparation was completed on a maxillary right first molar on a typodont. Twenty zirconia-reinforced lithium silicate ceramic crowns (Celtra Duo, Dentsply Sirona) were designed and milled using a chairside CAD/CAM system (CEREC Omnicam, Dentsply Sirona). The 20 crowns were randomly divided into two groups based on post-milling protocols: no manipulation after milling (Group MI) and oven fired-glazing after milling (Group FG). A 3D computer method was used to evaluate the internal adaptation of the crowns. This was based on a subtractive analysis of a digital scan of the crown preparation and a digital scan of the thickness of the cement space over the crown preparation as recorded by a polyvinylsiloxane (PVS) impression material. The preparation scan and PVS scan were matched in 3D and a 3D difference analysis was performed with a software program (OraCheck, Cyfex). Three areas of internal adaptation and fit were selected for analysis: margin (MA), axial wall (AX), and occlusal surface (OC). Statistical analysis was performed using 80% percentile and one-way ANOVA with post-hoc Scheffé test (P = .05). The closest internal adaptation of the crowns was measured at the axial wall with 102.0 ± 11.7 µm for group MI-AX and 106.3 ± 29.3 µm for group FG-AX. The largest internal adaptation of the crowns was measured for the occlusal surface with 258.9 ± 39.2 µm for group MI-OC and 260.6 ± 55.0 µm for group FG-OC. No statistically significant differences were found for the post-milling protocols (P > .05). The 3D difference pattern was visually analyzed for each area with a color-coded scheme. Post-milling processing did not affect the internal adaptation of zirconia-reinforced lithium silicate crowns fabricated with a chairside CAD/CAM technique. The new 3D computer technique for the evaluation of fit of restorations may be highly promising and has the opportunity to be applied to clinical studies.

Fracture strength of lithium disilicate crowns compared to polymer-infiltrated ceramic-network and zirconia reinforced lithium silicate crowns

ObjectivesThe aim of this study was to evaluate the fracture strength of crowns made from current CAD/CAM materials. In addition the influence of crown thickness and chewing simulation on the fracture strength was evaluated. MethodsCrowns were fabricated from lithium disilicate, zirconia reinforced lithium silicate (ZLS-ceramic) and a polymer-infiltrated ceramic-network (PICN) with an occlusal thickness of 1.0mm or 1.5mm, respectively (n=16). Crowns were cemented on composite dies. Subgroups of eight specimens were loaded with 5kg in a chewing simulator for 1,200,000 cycles with thermal cycling. Finally, all specimens were loaded until fracture in a universal testing machine. Three-way ANOVA was used to detect statistical interaction. Differences regarding the materials were tested with two-way ANOVA, following one-way ANOVA and a post-hoc Tukey's-Test. ResultsAll crowns survived the chewing simulation. The material had a significant influence on the fracture resistance (p≤0.05). Lithium disilicate achieved the highest values of fracture strength in almost all groups followed by ZLS-ceramic. PICN achieved the lowest values of fracture strength. Chewing simulation increased the fracture strength of thick lithium disilicate crown significantly. Greater occlusal thickness of all crown materials resulted in higher crown fracture strength before chewing simulation. After chewing simulation occlusal thickness of lithium disilicate and PICN crowns had no significant influence on the fracture strength. ConclusionsAll crowns revealed fracture strength above the clinically expected loading forces. Therefore the durability of the tested CAD/CAM materials seems promising also in an occlusal thickness of 1.0mm.

Influence of cementation on in vitro performance, marginal adaptation and fracture resistance of CAD/CAM-fabricated ZLS molar crowns

ObjectivesThis study investigated the influence of conventional cementation, self-adhesive cementation, and adhesive bonding on the in vitro performance, fracture resistance, and marginal adaptation of zirconia-reinforced lithium silicate (ZLS) crowns. MethodsHuman molar teeth (n=40) were prepared and full-contour crowns of a ZLS ceramic (Celtra Duo, DeguDent, G, n=32) and a lithium disilicate ceramic (LDS; IPS e.max CAD, Ivoclar-Vivadent, FL, n=8) were fabricated and glazed. Four groups of ZLS crowns were defined (n=8/group) and cemented with different glass-ionomer cements, resin, and resin-modified self-adhesive luting materials. The LDS crowns served as reference group with adhesive bonding.A combined thermal cycling and mechanical loading (TCML: 3000×5°C/3000×55°C; 1.2×106 cycles à 50N) with human antagonists was performed in a chewing simulator. Fracture force of surviving crowns was determined. Marginal adaptation at the cement/tooth and cement/crown interface was investigated by scanning electron microscopy before and after TCML, and the share of perfect margins was determined. Data were statistically analyzed (one-way ANOVA; post hoc Bonferroni, α=0.05). ResultsOne crown of the adhesive group failed during TCML (879,000 cycles=3.7 years). No statistically significant (p=0.078) differences in fracture resistance were found between different cementations, although highest data in tendency were found for adhesive bonding. Shares of perfect margins at the cement/tooth (93.8±5.6–99.6±0.8%) and cement/crown (84.7±6.6–100.0±0.0%) interfaces did not differ significantly (p>0.05) between the different cementation groups. SignificanceMarginal adaptation and fracture forces of all tested groups are in a range, where no restrictions should be expected for clinical application.