Maria Jacinta Moraes Coelho Santos

Clinical evaluation of ceramic inlays and onlays fabricated with two systems: five-year follow-up.

This study evaluated the five-year clinical performance of ceramic inlays and onlays made with two systems: sintered Duceram (Dentsply-Degussa) and pressable IPS Empress (Ivoclar Vivadent). Eighty-six restorations were placed by a single operator in 35 patients with a median age of 33 years. The restorations were cemented with dual-cured resin cement (Variolink II, Ivoclar Vivadent) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at baseline, and at one, two, three, and five years using the modified United States Public Health Service (USPHS) criteria. At the five-year recall, 26 patients were evaluated (74.28%), totalling 62 (72.09%) restorations. Four IPS restorations were fractured, two restorations presented secondary caries (one from IPS and one from Duceram), and two restorations showed unacceptable defects at the restoration margin and needed replacement (one restoration from each ceramic system). A general success rate of 87% was recorded. The Fisher exact test revealed no significant difference between Duceram and IPS Empress ceramic systems for all aspects evaluated at different recall appointments (p>0.05). The McNemar chi-square test showed significant differences in relation to marginal discoloration, marginal integrity, and surface texture between the baseline and five-year recall for both systems (p<0.001), with an increased percentage of Bravo scores. However, few Charlie or Delta scores were attributed to these restorations. In conclusion, these two types of ceramic materials demonstrated acceptable clinical performance after five years.

Hardening of a dual-cure resin cement using QTH and LED curing units

Objective This study evaluated the surface hardness of a resin cement (RelyX ARC) photoactivated through indirect composite resin (Cristobal) disks of different thicknesses using either a light-emitting diode (LED) or quartz tungsten halogen (QTH) light source. Material and Methods Eighteen resin cement specimens were prepared and divided into 6 groups according to the type of curing unit and the thickness of resin disks interposed between the cement surface and light source. Three indentations (50 g for 15 s) were performed on the top and bottom surface of each specimen and a mean Vickers hardness number (VHN) was calculated for each specimen. The data were analyzed using two-way ANOVA and Tukey-Kramer test was used for post-hoc pairwise comparisons. Results Increased indirect resin disk thickness resulted in decreased mean VHN values. Mean VHN values for the top surfaces of the resin cement specimens ranged from 23.2 to 46.1 (QTH) and 32.3 to 41.7 (LED). The LED curing light source produced higher hardness values compared to the QTH light source for 2- and 3-mm-thick indirect resin disks. The differences were clinically, but not statistically significant. Increased indirect resin disk thickness also resulted in decreased mean VHN values for the bottom surfaces of the resin cement: 5.8 to 19.1 (QTH) and 7.5 to 32.0 (LED). For the bottom surfaces, a statistically significant interaction was also found between the type of curing light source and the indirect resin disk thickness. Conclusions Mean surface hardness values of resin cement specimens decreased with the increase of indirect resin disk thickness. The LED curing light source generally produced higher surface hardness values.

Shear bond strength of resin cement bonded to alumina ceramic after treatment by aluminum oxide sandblasting or silica coating

PURPOSE To evaluate the shear bond strength and bond durability between a dual-cured resin cement (RC) and a high alumina ceramic (In-Ceram Alumina), subjected to two surface treatments. MATERIALS AND METHODS Forty disc-shaped specimens (sp) (4-mm diameter, 5-mm thick) were fabricated from In-Ceram Alumina and divided into two groups (n = 20) in accordance with surface treatment: (1) sandblasting by aluminum oxide particles (50 μm Al(2) O(3) ) (SB) and (2) silica coating (30 μm SiO(x) ) using the CoJet system (SC). After the 40 sp were bonded to the dual-cured RC, they were stored in distilled water at 37°C for 24 hours. After this period, the sp from each group were divided into two conditions of storage (n = 10): (a) 24 h-shear bond test 24 hours after cementation; (b) Aging-thermocycling (TC) (12,000 times, 5 to 55°C) and water storage (150 days). The shear test was performed in a universal test machine (1 mm/min). RESULTS ANOVA and Tukey (5%) tests noted no statistically significant difference in the bond strength values between the two surface treatments (p = 0.7897). The bond strengths (MPa) for both surface treatments reduced significantly after aging (SB-24: 8.2 ± 4.6; SB-Aging: 3.7 ± 2.5; SC-24: 8.6 ± 2.2; SC-Aging: 3.5 ± 3.1). CONCLUSION Surface conditioning using airborne particle abrasion with either 50 μm alumina or 30 μm silica particles exhibited similar bond strength values and decreased after long-term TC and water storage for both methods.

Enamel wear opposing different surface conditions of different CAD/CAM ceramics.

OBJECTIVE The aim of this study was to evaluate bovine enamel wear opposed to four different ceramic substrates (CEREC) in the glazed and polished conditions. METHOD AND MATERIALS Sixty-three ceramic (IPS Empress CAD, Paradigm C, Vitablocs Mark II) and fourteen composite resin (MZ100) styli were prepared. Ceramics were subdivided into three surface conditions (n = 7), unpolished, polished, and glazed, and the composite resin (n = 7) into unpolished and polished. All styli were used as wear antagonists opposing bovine enamel blocks (8 mm × 9 mm) in an oral wear simulator. Wear tests were conducted at 30 N abrasion and 70 N attrition forces applied at 1.7 Hz for 5,000 simulated mastication cycles. Abrasion and attrition wear were evaluated using an automatic profilometer. Statistical analyses were conducted using Tukeys B rank order test, P = .05. RESULTS For bovine enamel opposing glazed Vitablocs, abrasion and attrition wear showed a volume loss significantly higher than bovine enamel opposing polished Vitablocs (P < .05). For attrition wear, bovine enamel opposing glazed Vitablocs and untreated Paradigm C showed a volume loss higher than bovine enamel opposing the other ceramic conditions. CONCLUSION Abrasion and attrition wear of bovine enamel opposing antagonist ceramic was affected according to the ceramic surface condition and the ceramic material. Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel. In addition, the glaze layer presented as a protection, exhibiting fewer cracks and less loss of material on the ceramic surface.

Retrospective clinical evaluation of ceramic onlays placed by dental students

Statement of problem. Indirect restorations with partial or complete occlusal surface coverage have been recommended to restore teeth with weakened walls in order to prevent cusp fracture. The success of these restorations when performed by dental students is unknown. Purpose. The purpose of this retrospective study was to evaluate the clinical performance of adhesively bonded ceramic onlay restorations placed by third‐ and fourth‐year dental students. Material and methods. Sixty‐five ceramic onlays were placed in patients between 2009 and 2015. The onlays were laboratory or chairside fabricated with a computer‐aided design and computer‐aided manufacturing (CAD‐CAM) system, using either IPS e.max Press or IPS e.max CAD. An adhesive technique and luting composite resin agent were used to cement the restorations. Thirty‐seven onlays were evaluated clinically using the modified United States Public Health Service (USPHS) criteria. Data were statistically analyzed using the Cox proportional hazards model to compare tooth type and failures and the Fisher exact and McNemar tests to compare the USPHS criteria for significant differences (&agr;=.05). Survival probability was calculated using the Kaplan‐Meier algorithm. Results. Five onlays were considered to be failures and needed replacement. According to the Kaplan‐Meier analysis, the estimated survival rate was 96.3% after 2 years and 91.5% at 4 years. All 5 of the failures occurred on molars (13.5%) and none on premolars (P=.025). A statistically significant difference was found for marginal discoloration between onlays placed within 0 to 3 years and 3 to 6 years (P<.05) but no differences between any other criteria. Conclusions. Ceramic onlays placed by dental students demonstrated acceptable long‐term clinical performance.

Marginal adaptation of CAD-CAM onlays: Influence of preparation design and impression technique

Statement of problem. Factors that may affect the marginal adaptation of computer‐aided design and computer‐aided manufacturing (CAD‐CAM) restorations include preparation design, impression technique, and CAD‐CAM system. The influence of impression technique and preparation design on CAD‐CAM partial coverage restorations has not been fully addressed. Purpose. The purpose of this in vitro study was to investigate the influence of direct and indirect digital scanning techniques and 2 preparation designs on the marginal adaptation of CAD‐CAM onlays. Material and methods. Two mesio‐occlusal buccal onlay preparations with reduction of the mesiobuccal cusp were made: conventional preparation (CP) with a 1.2‐mm modified shoulder margin and modified preparation (MP) flat cuspal reduction without shoulder. Virtual models were generated from each preparation by using a digital scanner (BlueCam; Dentsply Sirona) from the plastic teeth (direct digital scan) or from the stone dies (indirect digital scan). Onlays were designed using a CAD‐CAM system (CEREC 4.0; Dentsply Sirona), and nanoceramic resin blocks (Lava Ultimate Restorative; 3M ESPE) were milled using the CEREC MCX milling machine. Marginal discrepancy was evaluated using an optical stereomicroscope at ×25 magnification in 18 locations distributed along the margins of the preparation. The data were analyzed by using 3‐way ANOVA followed by the Tukey HSD test (&agr;=.05). Results. CP presented a statistically significant reduced average marginal adaptation (59 ±50 &mgr;m) than did MP (69 ±58 &mgr;m) (P<.001). The Tukey HSD test showed the presence of a significantly larger marginal discrepancy in the mesial and buccal locations of MP when compared with CP. Regarding impression techniques, the buccal location presented the smallest average marginal discrepancy in restorations fabricated with indirect impression when compared with direct impression (42 ±33 &mgr;m and 60 ±39 &mgr;m) (P<.001). Conclusions. The results showed that conventional preparation with a modified shoulder margin presented improved marginal adaptation compared with modified preparation with flat cuspal reduction. Direct and indirect digital scanning techniques produced restorations within a clinically acceptable range; however, the indirect scanning technique resulted in the fabrication of restorations with superior marginal adaptation on the buccal location.