Juan-Luis Román-Rodríguez

Zirconia in fixed prosthesis. A literature review

Statement of problem: Evidence is limited on the efficacy of zirconia-based fixed dental prostheses. Objective: To carry out a literature review of the behavior of zirconium oxide dental restorations. Material and Methods: This literature review searched the Pubmed, Scopus, Medline and Cochrane Library databases using key search words “zirconium oxide,” “zirconia,” “non-metal restorations,” “ceramic oxides,” “veneering ceramic,” “zirconia-based fixed dental prostheses”. Both in vivo and in vitro studies into zirconia-based prosthodontic restoration behavior were included. Results: Clinical studies have revealed a high rate of fracture for porcelain-veneered zirconia-based restorations that varies between 6% and 15% over a 3- to 5-year period, while for ceramo-metallic restorations the fracture rate ranges between 4 and 10% over ten years. These results provoke uncertainty as to the long-term prognosis for this material in the oral medium. The cause of veneering porcelain fractures is unknown but hypothetically they could be associated with bond failure between the veneer material and the zirconia sub-structure. Key words:Veneering ceramic, zirconia-based ceramic restoration, crown, zirconia, tooth-supported fixed prosthesis.

Bond strength of selected composite resin-cements to zirconium-oxide ceramic

Objectives: The aim of this study was to evaluate bond strengths of zirconium-oxide (zirconia) ceramic and a selection of different composite resin cements. Study Design: 130 Lava TM cylinders were fabricated. The cylinders were sandblasted with 80 µm aluminium oxide or silica coated with CoJet Sand. Silane, and bonding agent and/or Clearfil Ceramic Primer were applied. One hundred thirty composite cement cylinders, comprising two dual-polymerizing (Variolink II and Panavia F) and two autopolymerizing (Rely X and Multilink) resins were bonded to the ceramic samples. A shear test was conducted, followed by an optical microscopy study to identify the location and type of failure, an electron microscopy study (SEM and TEM) and statistical analysis using the Kruskal-Wallis test for more than two independent samples and Mann-Whitney for two independent samples. Given the large number of combinations, Bonferroni correction was applied (α=0.001). Results: Dual-polymerizing cements provided better adhesion values (11.7 MPa) than the autopolymerizing (7.47 MPa) (p-value M-W<0.001). The worst techniques were Lava TM + sandblasting + Silane + Rely X; Lava TM + sandblasting + Silane + Multilink and Lava TM + CoJet + silane + Multilink. Adhesive failure (separation of cement and ceramic) was produced at a lesser force than cohesive failure (fracture of cement) (p-value M-W<0.001). Electron microscopy confirmed that the surface treatments modified the zirconium-oxide ceramic, creating a more rough and retentive surface, thus providing an improved micromechanical interlocking between the cement and the ceramic. Key words:Shear bond strength, silica coating, surface treatment, zirconia ceramics, phosphate monomer.

Influence of bruxism on survival of porcelain laminate veneers.

Objectives: This study aims to determine whether bruxism and the use of occlusal splints affect the survival of porcelain laminate veneers in patients treated with this technique. Material and Methods: Restorations were made in 70 patients, including 30 patients with some type of parafunctional habit. A total of 323 veneers were placed, 170 in patients with bruxism activity, and the remaining 153 in patients without it. A clinical examination determined the presence or absence of ceramic failure (cracks, fractures and debonding) of the restorations; these incidents were analyzed for association with bruxism and the use of splints. Results: Analysis of the ceramic failures showed that of the 13 fractures and 29 debonding that were present in our study, 8 fractures and 22 debonding were related to the presence of bruxism. Conclusions: Porcelain laminate veneers are a predictable treatment option that provides excellent results, recognizing a higher risk of failure in patients with bruxism activity. The use of occlusal splints reduces the risk of fractures. Key words:Veneer, fracture, debonding, bruxism, occlusal splint.

Mechanical behavior of provisional implant prosthetic abutments

Introduction: Implant-supported prostheses have to overcome a major difficulty presented by the morphology and esthetics of peri-implant tissues in the anterior sector. Diverse therapeutic techniques are used for managing the mucosa adjacent to the implant and the most noteworthy is immediate/deferred fixed provisionalization. Objectives: In vitro testing of strength and deformation of implant prosthetic abutments made from different materials (Titanium/PEEK/methacrylate). Material and Methods: Forty Sweden&Martina® implant prosthetic abutments (n=40) were divided into five groups: Group MP: methacrylate provisional abutments with machined titanium base; Group PP: Poly ether ether ketone (PEEK) provisional abutments; Group TP: titanium provisional abutments; Group TAD: titanium anti-rotational definitive abutments; Group TRD: titanium rotational definitive abutments. Their mechanical behavior under static loading was analyzed. Samples were examined under a microscope to determine the type of fracture produced. Results and Conclusions: Definitive anti-rotational titanium abutments and definitive rotational titanium abutments achieved the best mean compression strength, while PEEK resin provisional abutments obtained the lowest. The group that showed the greatest elastic deformation was the group of titanium provisional abutments. Key words:Immediate loading, immediate provisionalization, implant prosthetic abutment, definitive implant prosthetic abutment.

Methodology in specimen fabrication for in vitro dental studies: Standardization of extracted tooth preparation

Background Specimen preparation for in vitro study suffers a general lack of methodological homogeneity, as well as a lack of uniformity in the materials selected for fabricating them. This situation prevents comparisons between studies. When a specimen is not of dental origin it is not possible to study adhesion or bonding techniques realistically. The objective is to design and implement a method of specimen preparation that permits universal standardization for use in in vitro studies. Material and Methods A metal stump of specified dimensions was designed and fabricated by hand. It was scanned, the data digitalized, perfecting and standardizing the dimensions. Ten human molars were adapted to the size and shape of a standard milling block. A Cerec 3D inLab Cerec milling unit was used to prepare the molars to match the digitalized model. Results Ten specimens with identical dimensions were obtained. Conclusions CAD-CAM technology allows the preparation of natural extracted teeth to be standardized and could be used to establish a reproducible method that would facilitate comparison between different in vitro studies, and reduce bias arising from variations in sample fabrication. Key words:Test ceramic, dentin analog, dentin model, dentin samples, methodology.

Traction test of temporary dental cements

Background Classic self-curing temporary cements obstruct the translucence of provisional restorations. New dual-cure esthetic temporary cements need investigation and comparison with classic cements to ensure that they are equally retentive and provide adequate translucence. The objective is to analyze by means of traction testing in a in vitro study the retention of five temporary cements. Material and Methods Ten molars were prepared and ten provisional resin restorations were fabricated using CAD-CAM technology (n=10). Five temporary cements were selected: self-curing temporary cements, Dycal (D), Temp Bond (TB), Temp Bond Non Eugenol (TBNE); dual-curing esthetic cements Temp Bond Clear (TBC) and Telio CS link (TE). Each sample underwent traction testing, both with thermocycling (190 cycles at 5-55º) and without thermocycling. Results TE and TBC obtained the highest traction resistance values. Thermocycling reduced the resistance of all cements except TBC. Conclusions The dual-cure esthetic cements tested provided optimum outcomes for bonding provisional restorations. Key words:Temporary dental cements, cements resistance.

Influence of surface preparation on fracture load of resin composite-based repairs

The purpose of the present study is to evaluate the fracture load of composite-based repairs to fractured zirconium oxide (Z) crowns and to ceramic-fused-to-metal (CM) crowns, comparing different mechanical surface preparation methods. A total of 75 crowns were repaired; samples then underwent dynamic loading and thermocycling. Final fracture load values for failure of the repaired crowns were measured and the type of fracture registered. Group I: CM: Surface preparation with a diamond bur + 9.5% Hydrofluoric Acid (HF) etching; Group II): CM: air-particle (Al2O3) + 9.5% HF; Group III: CM: Silica coating (SiO2); Group IV): Z: air-particle (Al2O3) + HF 9.5%; Group V) Z: Silica coating (SiO2). Of the three CM groups, Group I (CM-diamond bur) showed the highest mean failure value, with significant difference in comparison with Group III (CM-silica coating). For the zirconia groups, the highest value was obtained by Group V (silica coating). Key words:Crown, ceramic-fused-to-metal, zirconia, resin-composite, ceramic covering.

Cleaning and retreatment protocol for a debonded ceramic restoration

Objectives: The aim of this article is to propose a resin cement cleaning protocol for use before recementing a debonded restoration. Study Design: Ceramic samples were fabricated from IPS d.sign® and IPS e.max Press® and were treated with hydrofluoric acid etching (HF), or HF+silane (S), or HF+S+adhesive or HF+S+A+resin cement. All samples were placed in a furnace at 650º for one minute in order to attempt to pyrolyze the composite. Each step was examined under scanning electron microscopy (SEM). Results: When the cleaning protocol had been performed, it left a clean and retentive surface. Conclusions: If the restoration is placed in a furnace at 650º for one minute, the composite cement will burn or pyrolyze and disappear, allowing conventional retreatment of the ceramic before rebonding. Key words:Ceramic, debond, surface treatment.

Shear bond strength of partial coverage restorations to dentin.

Background When partial coverage restorations (veneers, inlays, onlays…) must be cemented to dentin, bond strength may not reach the same predictable values as to enamel. The purpose of this study was: 1. To compare, with a shear bond test, the bond strength to dentin of a total-etch and a self-etching bonding agent. 2. To determine whether creating microretention improves the bond strength to dentin. Material and Methods Two bonding agents were assayed, Optibond FL® (Kerr), two-bottle adhesive requiring acid etching, and Clearfil SE Bond® (Kuraray), two-bottle self-etching adhesive. The vestibular, lingual, distal and mesial surfaces of ten molars (n=10) were ground to remove all enamel and 40 ceramic samples were cemented with Variolink II® (Ivoclar Vivadent). Half the molar surfaces were treated to create round microretention (pits) to determine whether these could influence bond strength to dentin. The 40 molar surfaces were divided into four groups (n=10): Optibond FL (O); Clearfil SE (C); Optibond FL + microretention (OM); Clearfil SE + micro retention (CM). A shear bond test was performed and the bond failures provoked examined under an optical microscope. Results O=35.27±8.02 MPa; C=36.23±11.23 MPa; OM=28.61±6.27 MPa; CM=27.01±7.57 MPa. No statistically significant differences were found between the adhesives. Optibond FL showed less statistical dispersion than Clearfil SE. The presence of microretentions reduced bond strength values regardless of the adhesive used. Conclusions 1. Clearfil SE self-etching adhesive and Optibond FL acid-etch showed adequate bond strengths and can be recommended for bonding ceramic restorations to dentin. 2. The creation of round microretention pits compromises these adhesives’ bond strength to dentin. Key words:Adhesion to dentin, bonding agent, Optibond FL, Clearfil SE, microretention, shear bond test.