Michael Behr

Influence of substructure design and spacer settings on the in vitro performance of molar zirconia crowns

OBJECTIVES The aim of this study was to evaluate the in vitro behaviour of all-ceramic zirconia molar crowns in regard to different core designs and marginal fit. METHODS Identically shaped methacrylate molars were prepared according to the ceramic restoration directives resulting in a 1-mm deep circular shoulder preparation. They were embedded in polymethylmethacrylate resin after covering their roots with a polyether layer to simulate periodontal mobility. The crown cores were made of yttria-stabilized zirconia veneered with a corresponding veneering ceramic. The crowns were divided into 5 groups (n=8) which differed in core design and cement gap thickness: #1: simple core, 40 microm cement; #2: core with minimal occlusal support, 40 microm cement; #3: core with optimized cusp support, 40 microm cement; #4: core with optimized cusp support, 30 microm cement; #5: core with optimized cusp support, 10 microm cement. All crowns were cemented with zinc oxide phosphate cement and thermo mechanically loaded (1.2 x 10(6) x 50N; 6000x5 degrees C/55 degrees C) with identical metal ceramic restorations as antagonists. Crown failures were monitored and described. Area and direction of the chipping failures of the veneering ceramic were documented by means of scanning electron micrographs. RESULTS All core designs showed chipping during chewing simulation with different numbers (defect areas). #1: 6 chippings (8.1mm(2)); #2: 2 chippings (3.5mm(2)); #3: 2 chippings (2.1mm(2)); #4: 3 chippings (5.7 mm(2)); #5: 3 chippings (7.3mm(2)). CONCLUSIONS An optimized core design reduced number and surface area of occurring chippings. A variation of the gap thickness showed no significant influence on the in vitro performance.

Flexural properties of fiber reinforced composite using a vacuum/pressure or a manual adaptation manufacturing process

PURPOSE This study investigated the influence of fiber content and water storage on the flexural strength of beams made of two fiber-reinforced composites (FRC), the Vectris and the FibreKor system. MATERIAL AND METHODS A manual adaptation method (FibreKor, n=30) and a vacuum/pressure process (Vectris, n=30) were compared using 25x4x2mm(3) beams. One group of the Vectris (n=10) and the FibreKor beams (n=10) was stored in water for 24h, a further group was thermal-cycled (TC) 6000x5 degrees C/55 degrees C, and a third group was stored in water for 30days at 37 degrees C. All beams were then loaded to failure using a three-point bending test and the flexural strength was calculated. Finally, the fiber volume percent (vol%) was determined. RESULTS Generally, the flexural strength decreased significantly with increasing storage time independent of the investigated fiber- and/or manufacturing system. With the parameters 24h/TC/30days, the mean of flexural strength for the Vectris beams was 618/579/545N/mm(2), and for FibreKor 585/534/499N/mm(2). A fiber content of 28.1+/-0.4vol% was assessed for the Vectris beams and 12.8+/-0.6vol% for the FibreKor beams. After 24h storage in water, the Vectris and the FibreKor beams demonstrated a statistically significant higher flexural strength than after 30days storage in water. CONCLUSIONS A vacuum/pressure manufacturing process in contrast to manual adaptation, resulted in a markedly higher fiber content, but did not necessarily lead to significantly higher flexural strength. Not only the fiber content, but also matrix composition as well as the bond between fibers and matrix determined the properties of FRC.

Saliva substitutes for the treatment of radiation-induced xerostomia—a review

GoalThe aim of this review is to summarize the in vitro and in vivo evidence on the performance of contemporary saliva substitutes in the treatment of xerostomia and hyposalivation caused by radiation therapy for head and neck malignancies.MethodsA literature search was conducted during July to September 2008 in PubMed, using the query terms “saliva substitute”, “saliva substitute and xerostomia”, “artificial saliva”, and “artificial saliva and xerostomia”; for clinical studies, only studies in patients suffering from radiation-induced xerostomia have been included in the review.Results and conclusionFifty-two studies met the inclusion criteria and were allotted either to the in vitro topics “viscosity”, “lubrication”, “wetting properties”, “antimicrobial effects”, and “enamel and dentin de- and remineralization”, or to the in vivo topics “clinical acceptance” or “influence on plaque formation and oral mucosa and microflora”. The findings suggest that there are significant differences in the performance of various saliva substitutes concerning the review parameters, yet indicate that further in vitro and in vivo studies on the properties of saliva substitutes are necessary.

Wear performance of substructure ceramics and veneering porcelains

AIM The aim of this in vitro study was to compare the two-body wear resistance of substructure zirconia and veneering porcelain versus steatite and human enamel antagonists, respectively. MATERIALS AND METHODS Two-body wear tests were performed in a chewing simulator with steatite and enamel antagonists (enamel cusps). A pin-on-block design with a vertical load of 50 N for 1.2 × 10(5) cycles; (f=1.6 Hz; lateral movement: 1mm, mouth opening: 2mm) was used for the wear test. For quantification of the wear resistance, wear tests were performed with standardized steatite spheres. Human enamel was used as a reference. Five zirconia ceramics and four veneering porcelains were investigated. One zirconia ceramic was tested with superficial glaze, which was applied after polishing or sandblasting, respectively. Surface roughness R(a) (SP6, Perthen-Feinprüf, G) and wear depth were determined using a 3D-Profilometer (Laserscan 3D, Willytec, G). SEM (Quanta FEG 400, FEI, USA) pictures were used for evaluating wear performance of both, ceramics and antagonists. RESULTS No wear was found for zirconia substructures. Veneering porcelain provided wear traces between 186.1±33.2 μm and 232.9±66.9 μm (steatite antagonist) and 90.6±3.5 μm and 123.9±50.7 μm (enamel). Wear of the steatite antagonists varied between 0.812±0.256 mm(2) and 1.360±0.321 mm(2) for zirconia and 1.708±0.275 mm(2) and 2.568±0.827 mm(2) for porcelain. Enamel generally showed wear, cracks or even fractures at the ridge, regardless whether opposed by zirconia or porcelain/glaze. Enamel was polished, when opposed to zirconia, or plowed, provoked and grinded, when opposed to porcelain/glaze. CONCLUSION The results of the wear test with steatite or enamel antagonists indicated no measurable wear on zirconia surfaces. Porcelain showed higher wear than zirconia, but comparable or lower wear than an enamel reference. Antagonistic wear against zirconia was found to be lower than wear against porcelain.

Wear performance of dental ceramics after grinding and polishing treatments.

AIM The aim of this in vitro study was to determine the two-body wear resistance of different dental ceramics after grinding and polishing treatments. MATERIAL AND METHODS Standardized specimens were prepared from three zirconia and two veneering ceramics and were subjected to different surface treatments. Zirconia ceramics were polished, ground and repolished, veneering ceramics were ground and repolished. One zirconia ceramic was investigated with a superficial glaze. Human enamel was used for reference. Surface roughness R(a) was determined using a profilometric contact surface measurement device. Two-body wear tests were performed in a chewing simulator with steatite and enamel antagonists, respectively. Specimens were loaded pneumatically in a pin-on-block design for 1.2x10(5) mastication cycles (50 N, 1.2 Hz, lateral movement: 1 mm, mouth opening: 2 mm) under simultaneous thermal cycling (600 cycles, 5/55 °C). Wear depths of specimens were determined using a 3D laser scanning device, wear areas of steatite antagonists were measured by means of light-optical micrographs. Means and standard deviations were calculated, and statistical analysis was performed using one-way analysis of variance (ANOVA) and the Bonferroni multiple comparison test for post hoc analysis (α=0.05). Scanning electron microscopy was applied for evaluating the wear performance of ceramics and antagonists. RESULTS No wear was found for polished, ground and repolished zirconia. Compared to the wear depths of the enamel reference with 274.1±187.4 μm versus steatite and 123.3±131.0 μm versus enamel, relative wear depths of porcelains ranged between 0.54±0.07 and 0.62±0.09 with steatite antagonists and between 0.66±0.26 and 1.04±0.27 with enamel antagonists. Relative wear areas of steatite antagonists (enamel reference: 1.25 mm(2)) varied between 0.84±0.13 and 1.90±0.29 for zirconia and between 1.97±0.38 and 2.47±0.40 for porcelains. Enamel antagonists generally showed wear, cracks or even fractures, but revealed smooth surfaces when opposed to polished/ground/repolished zirconia and ploughed surfaces when opposed to ground/repolished porcelains or glaze. CONCLUSIONS Zirconia ceramics yielded superior wear behavior and lower antagonistic wear compared to porcelains. A trend to higher ceramic and antagonistic wear was shown after grinding treatments.

Adhesion of Candida albicans to various dental implant surfaces and the influence of salivary pellicle proteins

Dental implants may be considered a potential reservoir for (re)infection with oral Candida albicans. Our aim was to evaluate initial fungal adhesion to three differentially textured titanium and one zirconia implant surface, and to correlate these findings to differences in specific surface characteristics (surface roughness (R(a)) and surface free energy (SFE)). Additionally, we investigated the influence of salivary protein films and two pellicle proteins (mucin and albumin). Implant surfaces were characterized by perthometer (R(a)) and goniometer (SFE) measurements. Implant specimens were rinsed with human whole saliva, mucin, albumin, or phosphate buffered saline and incubated in C. albicans suspension for 2.5h. Adherent fungi were quantified by means of a bioluminometric assay. The lowest amount of fungal cells was found on sand-blasted titanium, whereas zirconia implants did not show any reduced potential to adhere C. albicans. The influence of the implant SFE on fungal biofilm formation appears to be more important than the influence of R(a). The protein mucin enhanced C. albicans accumulation. In contrast, albumin is unlikely to be involved in the adhesion process of C. albicans.

Efficacy of denture disinfection methods in controlling Candida albicans colonization in vitro

Objective. The aim of this study was to rank 10 denture disinfection methods according to their efficacy in reducing Candida albicans (C. albicans) colonization on soft denture relining material. Material and Methods. Circular specimens (diameter 8 mm) were made of soft denture relining material (Mucopren E, Kettenbach) and thermally aged. Specimens were incubated with C. albicans (strain 1386, DSMZ) followed by 1 of 10 disinfection procedures (6 soaks, 2 microwave irradiation regimes, 1 effervescent commercial cleansing product, and denture left dry overnight). Incubation with phosphate buffered saline (PBS) served as a control. Adhering fungi were quantified using a bioluminometric assay in combination with an automated plate reader for cell quantification. Scanning electron micrographs (SEMs) were made for validation. Results. Low median luminescence intensities indicated the presence of a few viable fungi after the soaking of specimens in sodium hypochlorite (10 relative luminescence units (rlu)), microwave irradiation immersed in water (8 rlu), and application of effervescent cleansing tabs (22 rlu). No statistically significant difference (p>0.05) to control PBS (200 rlu) was found after immersion in hydrogen peroxide (172 rlu), glutaraldehyde (103 rlu), household vinegar (196 rlu), Listerine coolmint (194 rlu), Plax (222 rlu), dry microwave irradiation (221 rlu) and specimens left dry overnight (165 rlu). SEM displayed C. albicans monolayers with different morphologic forms on each surface investigated. Conclusions. Only soaking in sodium hypochlorite (1%; 10 min), microwave irradiation immersed in water (800 W; 6 min), and application of effervescent cleansing tabs (Blend-a-dent tabs; 10 min) proved to be effective against C. albicans colonization on soft denture relining material.

In vitro failure and fracture resistance of veneered and full-contour zirconia restorations.

OBJECTIVES This study evaluated the failure and fracture resistance of zirconia-based fixed partial dentures (FPDs) under the influence of different surface treatments and adjustment procedures. METHODS Seven groups (n=8/group) of three-unit zirconia-based FPDs were fabricated in anatomic design (AD) or anatomically reduced design (ARD) and surfaces were prepared according to clinical relevance: #1: AD - sintered; #2: AD - sintered - glazed; #3: AD - sintered - sandblasted - glazed; #4: AD - sintered - polished - grinded (contact points adjusted); #5: AD - sintered - polished - grinded - repolished; #6: ARD - sintered - veneered; #7: control: analogous to #3 but without thermal cycling (TC) and mechanical loading (ML). FPDs were adhesively bonded to polymethylmethacrylate abutment teeth. TCML (TC: 6000 × 5°/55°; ML: 1.2 × 10(6)× 50 N, 1.6 Hz) was conducted in a chewing simulator with steatite spheres as antagonists. Failures were monitored and fracture resistance was determined after ageing. Data were analysed statistically with Mann-Whitney U-test (Kolmogorov-Smirnov-test; α=0.05). FPDs were subjected to scanning electron microscopy for fractographic failure analysis. RESULTS None of the FPDs failed during TCML, but showed wear at contact points. Median fracture force ranged between 1173.5 N (#4) and 1316.0 N (#3) without significant (p=0.910) differences between the groups or in comparison to the control (p>0.462). CONCLUSIONS Zirconia restorations showed high resistance to failures and fracture under different surface treatment variations. Full-contour polished or glazed zirconia FPDs might be an alternative to common veneered restorations.

Adhesive-fixed partial dentures in anterior and posterior areas

Abstract Within the framework of an on-going prospective clinical study begun in 1985, 120 adhesive-fixed partial dentures (AFPD) continued to be examined. The manufacture and the fitting of the AFPDs were carried out following a standard procedure. The preparation technique and the metal framework conditioning (silica-coating, sandblasting and electrochemical etching) has varied throughout the duration of the study. Using Kaplan-Meier analysis, the survival rate was determined and an analysis of risk with regard to location factors (anterior, posterior; maxilla, mandible), conditioning and preparation techniques (retentive/non-retentive) was determined using the Cox regression model. The location of the AFPD had no influence on the survival rate. The survival time was determined mainly by the preparation technique. Strict preparation of seating grooves and pin holes made a 95% survival rate possible after 10 years (Kaplan-Meier estimation). Without retention, the risk of failure increased by a factor of 3.7.

Comparison of three types of fiber-reinforced composite molar crowns on their fracture resistance and marginal adaptation

UNLABELLED Three types of fiber-reinforced composite (FRC) molar crowns were tested on their fracture resistance and marginal adaptation under simulated oral stress conditions. Two glass fiber systems, one processed with a vacuum/pressure system, the other by manual fiber adaptation, and a polyethylene fiber system were evaluated. Every group consisted of 12 crowns. All crowns were luted adhesively on human molars and exposed to thermal cycling and mechanical loading (TCML: 6000 x 5 degrees C/55 degrees C; 1.2 x 10(6) x 50N; 1.66Hz). The marginal adaptation was evaluated through dye-penetration and analyzed semi-quantitatively with a scanning electron microscope. The fracture resistance was measured using a Zwick universal testing machine. The highest fracture resistance was observed on the glass-fiber systems (FibreKor/Sculpture 1875N +/- 596; Vectris/Targis 1726+/-542), though statistically, the polyethylene system (belleGlass/Connect 1388+/-620) was not significantly weaker. All systems exceeded the fracture resistance required to withstand the maximum masticatory forces expected in the molar region. The marginal adaptation generally had a tendency towards larger gaps after TCML. The crown/composite-cement bond deteriorated significantly after TCML with the manual fiber adaptation and the polyethylene fiber system. The cement/tooth bond strength depended on which composite-cement/dentin-adhesive system was used. CONCLUSION The fracture resistance of molar crowns made of glass-fiber reinforced composite was higher than those of polyethylene fiber-reinforced composite crowns. However, there was no statistically significant difference. The marginal adaptation seems to depend on the fiber systems and composite-cement/dentin adhesive system used.