Carlo Monaco

Pilot evaluation of four experimental conditioning treatments to improve the bond strength between resin cement and Y-TZP ceramic.

PURPOSE This study evaluated the bond strength between resin cement and Y-TZP ceramic (Yttrium-stabilized Tetragonal Zirconia Polycrystalline) submitted to different surface conditionings. MATERIALS AND METHODS Fifty Y-TZP ceramic discs (Ø= 10 mm) were allocated into five groups: Gr1 (control)-no conditioning; Gr2-tribochemical silica coating (30-μm SiO(2)) before sintering; Gr3-air abrasion with 50-μm Al(2)O(3) before sintering; Gr4-air abrasion with 110-μ Al(2)O(3) before sintering; Gr5 - air abrasion with 50-μm Al(2)O(3) after sintering. After specimen preparation, cylinders of composite resin were prepared and immediately cemented onto the ceramic. A shear test was performed. RESULTS One-way ANOVA indicated a statistically significant difference among the groups (p= 0.0019). The mean shear bond strengths (MPa) were: Gr1 = 4.7 ± 0.8,(b) Gr2 = 4.6 ± 0.9,(b) Gr3 = 6.4 ± 1.0,(a) Gr4 = 6.5 ± 1.8,(a) Gr5 = 6 ± 1.3(ab) (same superscript letter indicates statistical similarity). Adhesive fracture between the ceramic and resin cement was the most common failure. No complete cohesive fracture at the ceramic or composite cylinders was noted. CONCLUSION Within the limitations of this study, additional surface treatment with air abrasion before and after sintering provided a significant increase in bond strength. Tribochemical silica coating before sintering was not effective as a surface treatment.

Immediate facial rehabilitation in cancer patients using CAD–CAM and rapid prototyping technology: a pilot study

PurposeThis study describes the workflow in a procedure to create a provisional facial prosthesis for cancer patients using digital and rapid prototyping technologies without the need for supporting craniofacial implants.Materials and methodsAn integrated workflow procedure aimed at the construction of provisional silicone prosthesis was used to rehabilitate a facial disfigurement in a patient who had undergone ablative surgery of the midface. A laser scan of the defect was obtained, and a digital model of the patient′s face was constructed using virtual mirroring of the healthy side and referencing the “Nose Digital Library.”ResultsThe missing volume of the face was reconstructed, and a rapid-prototyped mold was devised to process the silicone prosthesis. A provisional eyeglasses-supported prosthesis designed with a CAD/CAM-projected titanium substructure was connected using the micro-components of implant prosthetic devices.ConclusionsThe workflow described herein offers a viable procedure for quickly restoring facial defects by means of provisional prosthetic rehabilitation.

Clinical evaluation of tooth-supported zirconia-based fixed dental prostheses: a retrospective cohort study from the AIOP clinical research group

PURPOSE The aim of this retrospective cohort study was to evaluate the clinical performance of tooth-supported zirconia-based fixed dental prostheses (FDPs) made by 15 members of the Italian Academy of Prosthetic Dentistry over a time period of up to 5 years. MATERIALS AND METHODS Ninety-eight patients were treated with a total of 137 zirconia-based FDPs in anterior and posterior regions using primarily chamfer or knife-edge tooth preparations. The cohort group with parafunctional habits was compared with patients without parafunctional habits according to the esthetic, functional, and biologic United States Public Health Service criteria modified by the FDI World Dental Federation. RESULTS The estimated cumulative survival of all restorations was 94.70% ± 1.25% standard error (SE), whereas the estimated cumulative success decreased to 89.78% ± 2.58 SE. Mechanical failures, including three zirconia framework fractures, two hairline cracks, nine chippings, and one delamination of the ceramic veneering, were recorded during the 1- to 5-year observation period. An odds ratio of 2.02 (95% confidence interval: 0.67 to 6.12) showed a moderate association between parafunction and failure. CONCLUSIONS Zirconia-based tooth-supported FDPs showed promising clinical results over a period of up to 5 years. Technical complications were more commonly detected in patients with parafunctional habits.

Adhesion mechanisms at the interface between Y-TZP and veneering ceramic with and without modifier ☆

OBJECTIVE This study investigated the mechanism of action at the interface between a commercially available Y-TZP and its veneering ceramic after final firing. Particular attention was paid, from a microstructural point of view, to evaluating the effects of different surface treatments carried out on the zirconia. METHODS In total, 32 specimens of presintered zirconia Y-TZP (LavaFrame, 3M ESPE, Germany) were cut with a low-speed diamond blade. The specimens were divided in two major groups, for testing after fracture or after mirror finishing, and were sintered following the manufacturers instructions. Each major group was then randomly divided into four subgroups, according to using or not using the dedicated framework modifier, with or without a preliminary silica coating (CoJet, 3M ESPE). A suitable veneering ceramic was used for each group (Lava Ceram Overlay Porcelain, 3M ESPE). A detailed microstructural study of the interfaces of the zirconia-veneering ceramic was performed using a scanning electron microscope equipped with an energy-dispersive X-ray spectrometer to evaluate chemical variation at the interfaces. RESULTS When the framework modifier was not applied on the Y-TZP surface, microdetachments, porosities, and openings in the ceramic layer were observed at the interlayers. A degree of diffusion of different elements through the interfaces from both the zirconia and veneering layers was detected. CONCLUSIONS Application of the framework modifier can increase the wettability of the zirconia surfaces, allowing a continuous contact with the veneering layer. The micro-analysis performed showed the presence of a reaction area at the interface between the different materials. CLINICAL SIGNIFICANCE the increase of the wettability of the zirconia surface could improve the adhesion at interface with the veneering ceramic and reduce the clinical failure as chipping or delamination.

Effect of lithium disilicate veneers of different thickness on the degree of conversion and microhardness of a light-curing and a dual-curing cement

PURPOSE Various materials and systems for bonding lithium disilicate to the tooth substrate are available to clinicians, who can adapt the materials to each clinical situation to maximize the performance of indirect esthetic restorations. This study aimed to evaluate the degree of conversion (DC) and the microhardness (MH) of a dual-curing and a light-curing cement under lithium disilicate discs of different thicknesses. MATERIALS AND METHODS A total of 48 lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) samples were prepared and divided into three groups (n = 16) according to the thickness (group A was 0.6 mm; group B was 1.0 mm; group C was 1.5 mm). Each group was further divided into two subgroups (n = 8) according to the resin cement employed, NX3 (Kerr) or Choice 2 (Bisco). A standardized quantity of cement was placed on the sample, and DC was evaluated with an attenuated total reflectance Fourier transformed infrared spectrophotometer (Nicolet IS10, Thermo Scientific). Twenty-four hours after DC was established, Vickers test was performed on the cement with a microindentometer (Leica Microsystems). Results were statistically analyzed with analysis of variance test and significance set at P < .05. RESULTS Statistical analysis showed cement type had a significant influence (P = .005) on DC. MH results were influenced by thicknesses only between 0.6 and 1.5 mm when light-cured cement was employed. CONCLUSION The light-curing and the dual-curing cements reached comparable DCs between 0.6 and 1.5 mm. However, the light-curing resin showed a higher DC and MH.

A systematic method for predetermined scanning electron microscope analysis in dental science.

Scanning electron microscope evaluation could be criticized if the method adopted to correct for bias is not specified in the study design. Observers can draw conclusions from images unconsciously chosen to best support their research hypotheses, impairing the basic research principle of operators impartiality. In this study, a systematic observation method has been described and verified for repeatability. The number and the observation points on a certain specimen have been predetermined using a scheme along with observation rules previously established in the research protocol. When our instrument is used at an operating magnification between 500x and 1,000x (corresponding to a frame of 250x190 micro and 120x90 micro, respectively), the method allowed 100% repeatable observation frames, with linear frame errors in finding an observation point of 12.5% in length and 16.8% in height. With modifications to accommodate research objective and statistical requirements, the method could be applied to many SEM observation study.

A Standardized Approach for the Early Restorative Phase After Esthetic Crown-Lengthening Surgery.

The aim of the present case series article was to provide a standardized approach for the early restorative phase after a crown-lengthening surgical procedure. Different advantages can be ascribed to this approach: the clinician can prepare a definitive prosthetic finishing line in the supragingival location; the early postsurgical temporization allows the conditioning of soft tissues, especially the interdental papillae, during their maximum growing phase; and the clinician can choose the time for the definitive prosthetic rehabilitation in a patient-specific manner according to the individual potential and duration of the soft tissue rebound. In this study, this standardized approach was applied to the treatment of two esthetic cases requiring crown-lengthening procedures.

Fracture Strength of Endodontically Treated Teeth Restored with Composite Overlays with and without Glass-fiber Reinforcement.

PURPOSE To evaluate the fracture strength and the failure mode of endodontically treated teeth restored with composite resin overlays with and without glass-fiber reinforcement. MATERIALS AND METHODS A total of 32 extracted molars were divided into four equal groups. In the NFR-NFRC (no foundation restoration, no fiber-reinforced composite) and NFR-FRC (no foundation restoration, fiber-reinforced composite) groups, only a 5-mm-thick composite resin layer sealed the pulp chamber floors, whereas in the FR-NFRC (foundation restoration, no fiber-reinforced composite) and FR-FRC (foundation restoration, fiber-reinforced composite) groups, a 3.0-mm foundation restoration was used. NFR-NFRC and FR-NFRC groups were restored with composite resin overlays, whereas NFR-FRC and FR-FRC groups were restored with fiber-reinforced composite resin overlays. All specimens were subjected to mechanical loading in a computer-controlled masticator and then the fracture resistance was evaluated. Differences in means were compared using two-way ANOVA and Tukeys test. The level of significance was set at ɑ = 0.05. RESULTS All specimens successfully completed the fatigue test. The least fracture-resistant group was NFR-FRC, exceeded by FR-NFRC, NFR-NFRC, and FR-FRC, in that order, with FR-FRC being the most fracture-resistant group. Statistically significant differences were detected between the pairs NFR-NFRC/FR-FRC (p = 0.001), NFR-FRC/FR-FRC (p = 0.001), and FR-NFRC/FR-FRC (p = 0.001). Eight vertical root fractures occurred in group FR-NFRC, six in group NFR-NFRC, four in group NFR-FRC, and none occurred in group FR-FRC. CONCLUSIONS Within the limitations of this in vitro study, the incorporation of glass fibers and the presence of a foundation restoration were found to increase the fracture resistance and can favorably influence the fracture mode.

Restoring Nonvital Premolars with Composite Resin Onlays: Effect of Different Fiber-reinforced Composite Layers on Marginal Adaptation and Fracture Load

PURPOSE To evaluate the marginal adaptation and fracture load of composite resin onlays reinforced with different substructures. MATERIALS AND METHODS Thirty-two extracted, caries-free premolars were selected for this study and endodontically treated. Group 1 was used as the control group, and the teeth were restored only with as-manufactured composite resin overlays. Group 2 teeth were restored with composite resin overlays with 3 fiber-reinforced composite (FRC) layers placed horizontally on the bottom of the restoration. Group 3 teeth were restored with composite resin overlays with 6 fiber-reinforced composite (FRC) layers placed as in group 2. Group 4 teeth were restored with composite resin overlays and FRC placed with an anatomical design. All specimens underwent SEM evaluation of their marginal adaptation before and after thermocycling and cyclic mechanical loading. All specimens were then subjected to a fracture test, recording the value for the initial (IF) and final (FF) failure. Differences in the means were compared using matched-pairs t-tests and one-way ANOVA. The level of significance was set at α = 0.05. RESULTS No statistically significant difference between the four groups in terms of marginal adaptation was observed at the tooth/luting composite and luting composite/overlay interfaces before and after loading. The fracture loads of IF and FF, from most to least resistant were: group 4 (1431.8 ± 294.3 N/1710.1 ± 326.6 N), group 3 (1428.1 ± 251.4 N/1467.9 ± 242.4 N), group 2 (852.6 ± 413.5 N/1058.1 ± 251.5 N) and group 1 (899.8 ± 352.7 N/923.5 ± 318.8 N). Significant differences (p = 0.026) were observed comparing group 1 to groups 2 and 3, and group 1 to 4. Three irreparable fractures were found in group 3, four in group 2, and five in groups 1 and 4. CONCLUSIONS The presence or absence of reinforcement and the different configuration of the reinforcement fibers affect fracture strength but only partially the failure modality. The presence or absence of reinforcement does not alter marginal adaptation.

In Vitro Assessment of Single-Retainer Tooth-Colored Adhesively Fixed Partial Dentures for Posterior Teeth

The purpose of this paper was to investigate, by means of marginal adaptation and fracture strength, three different types of single retainer posterior fixed partial dentures (FPDs) for the replacement of a missing premolar. Two-unit cantilever FPDs were fabricated from composite resin, feldspathic porcelain, and fiber-reinforced composite resin. After luting procedures and margin polishing, all specimens were subjected to a Scanning Electron Microscopic marginal evaluation both prior to and after thermomechanical loading with a custom made chewing simulator comprising both thermal and mechanical loads. The results indicated that the highest score of marginal adaptation, that is, the closest score to 100% of continuous margins, at the tooth-composite resin interface was attained by the feldspathic porcelain group (88.1% median), followed by the fiber-reinforced composite resin group (78.9% median). The worse results were observed in the composite resin group (58.05% median). Fracture strength was higher in feldspathic porcelain (196N median) when compared to resin composite (114.9 N median). All the fixed prostheses made of fiber-reinforced composite resin detached from the abutment teeth before fracturing, suggesting that the adhesive surfaces retainer should be increased.