Marília Pivetta Rippe

Inlays Made From a Hybrid Material: Adaptation and Bond Strengths

The aim of this study was to evaluate the internal fit, marginal adaptation, and bond strengths of inlays made of computer-aided design/computer-aided manufacturing feldspathic ceramic and polymer-infiltrated ceramic. Twenty molars were randomly selected and prepared to receive inlays that were milled from both materials. Before cementation, internal fit was achieved using the replica technique by molding the internal surface with addition silicone and measuring the cement thicknesses of the pulpal and axial walls. Marginal adaptation was measured on the occlusal and proximal margins of the replica. The inlays were then cemented using resin cement (Panavia F2.0) and subjected to two million thermomechanical cycles in water (200 N load and 3.8-Hz frequency). The restored teeth were then cut into beams, using a lathe, for microtensile testing. The contact angles, marginal integrity, and surface patterns after etching were also observed. Statistical analysis was performed using two-way repeated measures analysis of variance (p<0.05), the Tukey test for internal fit and marginal adaptation, and the Student t-test for bond strength. The failure types (adhesive or cohesive) were classified on each fractured beam. The results showed that the misfit of the pulpal walls (p=0.0002) and the marginal adaptation (p=0.0001) of the feldspathic ceramic were significantly higher when compared to those of the polymer-infiltrated ceramic, while the bond strength values of the former were higher when compared to those of the latter. The contact angle of the polymer-infiltrated ceramic was also higher. In the present study, the hybrid ceramic presented improved internal and marginal adaptation, but the bond strengths were higher for the feldspathic ceramic.

Evaluation of Tensile Retention of Y-TZP Crowns After Long-term Aging: Effect of the Core Substrate and Crown Surface Conditioning

This study evaluated the effect of the core substrate type (dentin and composite resin) on the retention of crowns made of yttrium oxide stabilized tetragonal zirconia polycrystal (Y-TZP), submitted to three inner surface conditionings. For this purpose, 72 freshly extracted molars were embedded in acrylic resin, perpendicular to the long axis, and prepared for full crowns: 36 specimens had crown preparations in dentin; the remaining 36 teeth had the crowns removed, and crown preparations were reconstructed with composite resin plus fiber posts with dimensions identical to the prepared dentin. The preparations were impressed using addition silicone, and 72 Y-TZP copings for the tensile test were produced. Cementation was performed with a dual-cured cement containing phosphate monomers. For cementation, the crown preparation (dentin or resin) was conditioned with the adhesive system, and the ceramic was subjected to one of three surface treatments: isopropyl alcohol, tribochemical silica coating, or thin low-fusing glassy porcelain layer application plus silanization. After 24 hours, all specimens were submitted to thermocycling (6000 cycles) and placed in a special tensile testing device in a universal testing machine to determine failure loads. The failure modes of all samples were analyzed under a stereomicroscope. Two-way analysis of variance showed that the surface treatment and substrate type (α=0.05) affected the tensile retention results. The dentin substrate presented the highest tensile retention values, regardless of the surface treatment. When the substrate was resin, the tribochemical silica coating and low-fusing glaze application plus silanization groups showed the higher retention values.

Evaluation of Tensile Retention of Y-TZP Crowns Cemented on Resin Composite Cores: Effect of the Cement and Y-TZP Surface Conditioning

This study evaluated the effect of the cement type (adhesive resin, self-adhesive, glass ionomer, and zinc phosphate) on the retention of crowns made of yttria-stabilized polycrystalline tetragonal zirconia (Y-TZP). Therefore, 108 freshly extracted molars were embedded in acrylic resin, perpendicular to their long axis, and prepared for full crowns: the crown preparations were removed and reconstructed using composite resin plus fiber posts with dimensions identical to the prepared dentin. The preparations were impressed using addition silicone, and Y-TZP copings were produced, which presented a special setup for the tensile testing. Cementation was performed with two adhesive resin cements (Multilink Automix, Ivoclar-Vivadent; RelyX ARC, 3M ESPE, St Paul, MN, USA), one self-adhesive resin cement (RelyX U100, 3M ESPE), one glass ionomer based cement (RelyX Luting, 3M ESPE), and one zinc phosphate cement (Cimento de Zinco, SS White, Rio de Janeiro, Brazil). For the resin cement groups, the inner surfaces of the crowns were subjected to three surface treatments: cleaning with isopropyl alcohol, tribochemical silica coating, or application of a thin low-fusing glass porcelain layer plus silanization. After 24 hours, all groups were subjected to thermocycling (6000 cycles) and included in a special device for tensile testing in a universal testing machine to test the retention of the infrastructure. After testing, the failure modes of all samples were analyzed under a stereomicroscope. The Kruskal-Wallis test showed that the surface treatment and cement type (α=0.05) affected the tensile retention results. The Multilink cement presented the highest tensile retention values, but that result was not statistically different from RelyX ARC. The surface treatment was statistically relevant only for the Multilink cement. The cement choice was shown to be more important than the crown surface treatment for cementation of a Y-TZP crown to a composite resin substrate.

Are posts necessary for the restoration of root filled teeth with limited tissue loss? A structured review of laboratory and clinical studies

Guidelines for post placement are lacking in respect of the amount of tooth structure, particularly in cases in which ≥50% of coronal structure is preserved. The aim of this review was to provide evidence-based principles for the use of posts in the restoration of root filled teeth with limited tissue loss. A literature search of laboratory and clinical studies published between 2000 and 2014 was conducted in PubMed. Included studies contained at least one study group with root filled teeth restored without a post, presented at least one group with root filled teeth with limited tissue loss, and, in the case of laboratory studies, performed mechanical cycling prior to a fracture resistance test. Based on the evidence from laboratory studies, root filled premolars and molars with limited tissue loss can be restored without posts, particularly when total coverage is planned. However, when no cusp protection is provided, post placement appears to be beneficial in premolars. Evidence regarding the best restoration option for root filled incisors with limited tissue loss remains controversial. When total coverage is intended, reconstruction seems to be successfully performed by restoration with composite. However, some reports consider that post insertion increases fracture loads. The review of clinical studies demonstrated that survival of teeth with substantial tooth tissue is not influenced by the use of posts. Exceptions were found when only premolars were investigated; in these cases, post placement was associated with greater survival rates in crowned teeth and fewer root fractures in teeth without cusp protection.

Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength

Objective To evaluate the impact of the type of root canal preparation, intraradicular post and mechanical cycling on the fracture strength of roots. Material and Methods eighty human single rooted teeth were divided into 8 groups according to the instruments used for root canal preparation (manual or rotary instruments), the type of intraradicular post (fiber posts- FRC and cast post and core- CPC) and the use of mechanical cycling (MC) as follows: Manual and FRC; Manual, FRC and MC; Manual and CPC; Manual, CPC and MC; Rotary and FRC; Rotary, FRC and MC; Rotary and CPC; Rotary, CPC and MC. The filling was performed by lateral compactation. All root canals were prepared for a post with a 10 mm length, using the custom #2 bur of the glass fiber post system. For mechanical cycling, the protocol was applied as follows: an angle of incidence of 45°, 37°C, 88 N, 4 Hz, 2 million pulses. All groups were submitted to fracture strength test in a 45° device with 1 mm/ min cross-head speed until failure occurred. Results The 3-way ANOVA showed that the root canal preparation strategy (p<0.03) and post type (p<0.0001) affected the fracture strength results, while mechanical cycling (p=0.29) did not. Conclusion The root canal preparation strategy only influenced the root fracture strength when restoring with a fiber post and mechanical cycling, so it does not seem to be an important factor in this scenario.

Surface agents' influence on the flexural strength of bilaminated ceramics

The objective of this study was to evaluate the influence of different surface agents on the flexural strength of a ceramic system. Eighty bar-shaped specimens of zirconia were divided into four groups according to the agent to be used: group Control--to be cleaned with alcohol; group VM9--application of a fluid layer of porcelain; group Effect Bonder--application of a bonding agent; and group Coloring Liquid--application of coloring liquid. All specimens received the porcelain application by the layering technique and were then subjected to thermocycling. The four-point bending test was performed to calculate the strength values (σ, MPa) and the failure modes were classified. ANOVA did not detect significant differences among the groups. The Weibull modulus were 5 (Control, VM9 and Effect Bonder) and 6 (Coloring Liquid). The cracking of the porcelain ceramic toward the interface was the predominant failure mode. It was concluded that the surface agents tested had no effect on the flexural strength of the bilaminated ceramic specimens.

Retentive Strength of Y-TZP Crowns: Comparison of Different Silica Coating Methods on the Intaglio Surfaces

OBJECTIVE To evaluate the effect of different methods of silica deposition on the intaglio surface of yttrium oxide stabilized zirconia polycrystal (Y-TZP) crowns on the retentive strength of the crowns. METHODS One hundred simplified full-crown preparations produced from fiber-reinforced polymer material were scanned, and 100 Y-TZP crowns with occlusal retentions were milled. Crown/preparation assemblies were randomly allocated into five groups (n=20) according to the treatment of the intaglio surfaces: TBS = tribochemical silica coating via air-abrasion with 30-μm silica-coated alumina particles; GHF1 = application of thin glaze layer + hydrofluoric acid (HF) etching for 1 minute; GHF5 = glaze application + HF for 5 minutes; GHF15 = glaze application + HF for 15 minutes; NANO = silica nanofilm deposition (5 nm) via magnetron sputtering. All groups received a silane application. The surfaces of the preparations (polymer) were conditioned with 10% HF for 30 seconds and silanized. The crowns were cemented with resin cement, thermocycled (12,000 cycles; 5°C/55°C), stored for 60 days, and subjected to a retentive strength test (0.5 mm/min until failure). The retention data (MPa) were analyzed using one-way analysis of variance, Tukey tests, and Weibull analysis. Failures were classified as 50C (above 50% of cement in the crown) and 50S (above 50% of cement on the substrate). RESULTS The TBS (5.6±1.7 MPa) and NANO groups (5.5±1 MPa) had higher retentive strength than the other groups (p<0.0001) and had the highest values of characteristic strength. There was no difference in Weibull modulus, except for the GHF1 group (lower values). The TBS and GHF15 groups, respectively, had 60% and 70% of their failures classified as 50C, while most of the other groups had 50S failures. CONCLUSION Tribochemical silica coating and silica nanofilm deposition on the inner surface of zirconia crowns promoted a higher retentive strength.

Fatigue strength of yttria-stabilized zirconia polycrystals: Effects of grinding, polishing, glazing, and heat treatment

This study aimed to evaluate and compare the effect of different surface post-processing treatments (polishing, heat treatment, glazing, polishing + heat treatment and polishing + glazing) on the superficial characteristics (micromorphology and roughness), phase transformation and fatigue strength of a Y-TZP ceramic ground with diamond bur. Discs of Y-TZP ceramic were manufactured (ISO:6872-2015; final dimensions of 15mm in diameter and 1.2 ± 0.2mm in thickness) and randomly allocated according to the surface condition: Ctrl - as-sintered; Gr - ground with coarse diamond bur; Gr+HT - ground and subjected to the heat treatment; Gr+Pol - ground and polished; Gr+Pol+HT - ground, polished and heat treated; Gr+Gl - ground and glazed; Gr+Pol+Gl - ground, polished and glazed. The following analyses were performed: roughness (n = 25), surface topography (n = 2), phase transformation (n = 2) and fatigue strength by staircase method (n = 20). All treatments influenced to some extent the surface characteristics of Y-TZP, being that polishing reduced the surface roughness, the m-phase content and improved the fatigue strength; glazing led to the lowest roughness values (Ra and Rz), although it showed the worst fatigue strength; heat treatment showed limited effect on surface roughness, led to complete reversion of the existing m-phase content to t-phase, without enhancing fatigue performance. Thus, a polishing protocol after clinic adjustment (grinding) of monolithic restorations based on polycrystalline zirconia material is mandatory for surface characteristics and fatigue performance improvements.

Mechanical reliability, fatigue strength and survival analysis of new polycrystalline translucent zirconia ceramics for monolithic restorations

This study characterized the mechanical properties (static and under fatigue), the crystalline microstructure (monoclinic - m, tetragonal - t and cubic - c phase contents) and the surface topography of three yttrium-stabilized zirconia (YSZ) materials with different translucent properties, before and after aging in an autoclave (low temperature degradation). Disc-shaped specimens were produced from second generation (Katana ML/HT - high-translucent) and third generations (Katana STML - super-translucent and UTML - ultra-translucent) YSZ ceramics (Kuraray Noritake Dental Inc.), following ISO 6872-2015 guidelines for biaxial flexural strength testing (final dimensions: 15 mm in diameter and 1.2 ± 0.2 mm in thickness), and then subjected to the respective tests and analyses. ML was mainly composed of tetragonal crystals, while STML and UTML presented cubic content. Aging increased the monoclinic content for ML and did not affect STML and UTML. Topographical analysis highlights different grain sizes on the ceramic surface (UTML > STML > ML) and aging had no effect on this outcome. Weibull analysis showed the highest characteristic strength for ML both before and after aging, and statistically similar Weibull moduli for all groups. ML material also obtained the highest survival rates (ML > STML > UTML) for both fatigue strength and number of cycles to failure. All fractures originated from surface defects on the tensile side. Third generation zirconia (Katana STML and UTML) are fully stabilized materials (with tetragonal and cubic crystals), being totally inert to the autoclave aging, and presented lower mechanical properties than the second-generation zirconia (Katana ML - metastable zirconia).

Different Methods for Inlay Production: Effect on Internal and Marginal Adaptation, Adjustment Time, and Contact Point

The aim of this study was to evaluate the effect of different production methods of resin and ceramic inlays on marginal and internal adaptation, adjustment time, and proximal contacts. Forty premolars were selected, embedded (their roots), and prepared to receive inlays that were made as follows (n=10): LaRe-digital impression with a Lava C.O.S. scanner, followed by milling of Lava Ultimate block (composite resin) in a milling center; CeRe-digital impression with a Cerec 3D Bluecam scanner, followed by milling of Lava Ultimate block in Cerec; CeDis-digital impression with a Cerec 3D Bluecam scanner, followed by milling of IPS e.max CAD block (lithium disilicate) in Cerec; and PresDis-impression with polyvinyl siloxane, inlay made using the lost wax technique and IPS e.max Press pressed ceramic (lithium disilicate). Marginal and internal adaptations were measured using the replica technique. The inlay adjustments were performed using diamond burs in a contra-angle hand piece, and the time for adjustment was recorded using a timer, in seconds. The tightness of the proximal contact was measured using standardized metal blades. The statistical analyses for marginal fit data showed that at the cervical edge, CeDis (177.8 μm) had greater misfit than CeRe (116.7 μm), while all the groups had similar adaptation at the occlusal edge. The groups had similar internal fit at the pulpal wall, while LaRe (104.7 μm) > CeDis (66.7 μm) = CeRe (76.7 μm) at the axial wall. The groups restored with lithium disilicate ceramic took more time for adjustment when compared to the resin restorative material. The lowest proximal contact, in micrometers, was seen in the CeRe group (8.8 μm).