A. Della Bona

A double blind randomized clinical trial of at-home tooth bleaching using two carbamide peroxide concentrations: 6-month follow-up

OBJECTIVES This double blind randomized clinical trial evaluated the longevity of the whitening effect (6-month follow-up) of two carbamide peroxide concentrations used in at-home vital bleaching. METHODS Ninety-two volunteers with shade mean C1 or darker for the six maxillary anterior teeth were randomized into two balanced groups (n=46) according to bleaching agent concentration: 10% (CP10) or 16% (CP16) carbamide peroxide. Patients were instructed to use the whitening agent in a tray for 2h/day during 3 weeks. Shade evaluations were done with a value-oriented shade guide, and a spectrophotometer at baseline, and at 1-week and 6-month post-bleaching. Volunteers for both treatment groups had to answer questions related to dietary and oral hygiene behavior. RESULTS At 6-month recall, tooth shade remained significantly lighter than at baseline, in both treatment groups, considering the color parameters: DeltaL, Deltaa, Deltab, DeltaE (p<0.0001) or the tooth shade median values (p<0.001). Additionally, shade median relapse at 6-month follow-up was not statistically different between CP10 and CP16 groups using the spectrophotometer (p=0.1) or the visual matching (p=0.7) analyses. Overall, subjects from CP10 and CP16 reported high consumption of beverage and food stains, which was not different between groups (p=0.5). CONCLUSIONS The whitening effect remained similar 6-month after the bleaching treatment for both carbamide peroxide concentrations tested. Additionally, the high consumption of staining beverages and foods reported by patients had no influence in the whitening effect longevity at 6-month.

Apparent Interfacial Fracture Toughness of Resin/Ceramic Systems

We suggest that the apparent interfacial fracture toughness (KA) may be estimated by fracture mechanics and fractography. This study tested the hypothesis that the KA of the adhesion zone of resin/ceramic systems is affected by the ceramic microstructure. Lithia disilicate-based (Empress2-E2) and leucite-based (Empress-E1) ceramics were surface-treated with hydrofluoric acid (HF) and/or silane (S), followed by an adhesive resin. Microtensile test specimens (n = 30; area of 1 ± 0.01 mm2) were indented (9.8 N) at the interface and loaded to failure in tension. We used tensile strength (σ) and the critical crack size (c) to calculate KA (KA = Yσc1/2) (Y = 1.65). ANOVA and Weibull analyses were used for statistical analyses. Mean KA (MPa·m1/2) values were: (E1HF) 0.26 ± 0.06; (E1S) 0.23 ± 0.06; (E1HFS) 0.30 ± 0.06; (E2HF) 0.31 ± 0.06; (E2S) 0.13 ± 0.05; and (E2HFS) 0.41 ± 0.07. All fractures originated from indentation sites. Estimation of interfacial toughness was feasible by fracture mechanics and fractography. The KA for the systems tested was affected by the ceramic microstructure and surface treatment.

Flexural strength and reliability of monolithic and trilayer ceramic structures obtained by the CAD-on technique

OBJECTIVE To evaluate the flexural strength, Weibull modulus, fracture toughness, and failure behavior of ceramic structures obtained by the CAD-on technique, testing the null hypothesis that trilayer structures show similar properties to monolithic structures. METHODS Bar-shaped (1.8mm×4mm×16mm) monolithic specimens of zirconia (IPS e.max ZirCAD - Ivoclar Vivadent) and trilayer specimens of zirconia/fusion ceramic/lithium dissilicate (IPS e.max ZirCAD/IPS e.max CAD Crystall./Connect/IPS e.max CAD, Ivoclar Vivadent) were fabricated (n=30). Specimens were tested in flexure in 37°C deionized water using a universal testing machine at a crosshead speed of 0.5mm/min. Failure loads were recorded, and the flexural strength values were calculated. Fractography principles were used to examine the fracture surfaces under optical and scanning electron microscopy. Data were statistically analyzed using Students t-test and Weibull statistics (α=0.05). RESULTS Monolithic and trilayer specimens showed similar mean flexural strengths, characteristic strengths, and Weibull moduli. Trilayer structures showed greater mean critical flaw and fracture toughness values than monolithic specimens (p<0.001). Most critical flaws in the trilayer groups were located on the Y-TZP surface subjected to tension and propagated catastrophically. Trilayer structures showed no flaw deflection at the interface. SIGNIFICANCE Considering the CAD-on technique, the trilayer structures showed greater fracture toughness than the monolithic zirconia specimens.

Lifetime comparison of Y-TZP/porcelain crowns under different loading conditions.

OBJECTIVES To compare the lifetime of Y-TZP/porcelain crowns under three different load conditions using step-stress accelerated lifetime testing. METHODS The Y-TZP frameworks were milled using CAD/CAM, veneered with a porcelain and cemented onto dentine analogue dies. Specimens were divided according to the occlusal load condition (n=20): central fossa load (CFL), cusp tip load (CTL) and sliding contact (SC). For CFL and CTL, the cyclic load was applied parallel to the long axis of the preparation using a ceramic piston. For SC, the axial load was associated to 1mm lateral displacement at the disto-lingual cusp. Different stress profiles were used. Failures were detected with an acoustic system. A Weibull distribution (95% confidence boundary) was used to analyse the data, and fractographic principles were used to evaluate fractured specimens. RESULTS The acoustic monitor was able to detect the initial crack. The probability of failure (at 300 N load and 200,000 cycles) was statistically greater for CTL (0.63; 0.44-0.81) compared to CFL (0.23; 0.12-0.43). The Weibull modulus of CFL (2.1; 1.5-3.6) was greater than for SC (0.7; 0.5-1.2), with no difference in the lifetime. All specimens failed by chipping, which originated predominantly at the contact (66.7%) on CTL, and in the bulk of the porcelain on CFL (100%) and SC (80%). CONCLUSIONS Contact at the cusp tip is more harmful than at the central fossa. Data from sliding contact are less consistent than from axial contacts, but more clinically relevant. CLINICAL SIGNIFICANCE The loading condition of Y-TZP/porcelain crowns can influence on the probability of failure and failure mode. The contact at the cusp tip is more harmful than at the central fossa, where the stress is better distributed. Sliding contact is a better simulator of the chewing cycle compared to axial contacts.

ADM guidance-ceramics: Fatigue principles and testing

BACKGROUND Clinical failure of dental ceramics is usually reported as partial fracture of the restoration (chipping) or as catastrophic fracture of the whole structure. In contrast to metals, ceramics are linear-elastic, brittle materials exhibiting extremely low damage tolerance to failure. Well documented clinical and lab reports have shown this fracture event often occurs at loads far below their fracture strength due to intrinsic fatigue degradation via slow crack growth or cyclic fatigue mechanisms. The presence and development of surface flaws have a dominant role in damage accumulation and lifetime reduction of ceramic structures. AIMS This ADM guidance document aims to summarize the aspects related to fatigue degradation of dental ceramics, reviewing the concepts of fatigue testing and furthermore aims to provide practical guidance to young scientists entering into fatigue related research. The description of fatigue strength is always accompanied by a clear understanding of the underlying fracture mechanisms.