Michael Sadoun

Resin-composite Blocks for Dental CAD/CAM Applications

Advances in digital impression technology and manufacturing processes have led to a dramatic paradigm shift in dentistry and to the widespread use of computer-aided design/computer-aided manufacturing (CAD/CAM) in the fabrication of indirect dental restorations. Research and development in materials suitable for CAD/CAM applications are currently the most active field in dental materials. Two classes of materials are used in the production of CAD/CAM restorations: glass-ceramics/ceramics and resin composites. While glass-ceramics/ceramics have overall superior mechanical and esthetic properties, resin-composite materials may offer significant advantages related to their machinability and intra-oral reparability. This review summarizes recent developments in resin-composite materials for CAD/CAM applications, focusing on both commercial and experimental materials.

Resin composite blocks via high-pressure high-temperature polymerization

OBJECTIVES The aim of this study was to thermo-polymerize under high pressure four commercially available dental resin composites to obtain and characterize composite blocks suitable for CAD/CAM procedures. METHODS Gradia (GC, Japan), Vita VM LC (Vita Zahnfabrik, Germany), Grandio (VOCO, Germany), and EsthetX (Dentsply, Germany), were selected for this study. Paradigm (3 M ESPE, USA), a CAD/CAM composite block, was included for comparison. Composite blocks were obtained through polymerization at high-temperature high-pressure (HT/HP). Samples for mechanical/physical characterizations were cut from Paradigm and HT/HP composite blocks while control samples were obtained by photo-polymerizing (PP) the materials in molds. Flexural strength (σ(f)), fracture toughness (K(IC)), hardness, and density (ρ) were determined and compared by pairwise t-tests (α=0.05). Fractured surfaces were characterized under a scanning electron microscope. RESULTS The results have shown that HT/HP polymerization resulted in a significant (p<0.05) increase in σ(f), hardness, and ρ for all composites investigated. Even if K(IC) of all materials was increased by HT/HP polymerization, significant increases were detected only for Gradia and EsthetX. The Weibull modulus of HT/HP polymerized composites was higher than that of PP counterparts. HT/HP materials had higher σ(f), Weibull modulus, and K(IC) compared to Paradigm. The most significant SEM observation of fractured K(IC) specimens from all the materials tested was the presence of fewer and smaller voids in HT/HP polymerized composites. SIGNIFICANCE The results of this study suggest that HT/HP polymerization could be used to obtain dental resin composite blocks with superior mechanical properties, suitable for CAD/CAM processing.

Residual stress measurement in veneering ceramic by hole-drilling.

OBJECTIVES Mismatch in thermal expansion properties between veneering ceramic and metallic or high-strength ceramic cores can induce residual stresses and initiate cracks when combined with functional stresses. Knowledge of the stress distribution within the veneering ceramic is a key factor for understanding and predicting chipping failures, which are well-known problems with Yttria-tetragonal-zirconia-polycrystal based fixed partial dentures. The objectives of this study are to develop a method for measuring the stress profile in veneering ceramics and to compare ceramic-fused-to-metal compounds to veneered Yttria-tetragonal-zirconia-polycrystal ceramic. METHODS The hole-drilling method, often used for engineering measurements, was adapted for use with veneering ceramic. Because of the high sensitivity needed in comparison with industrial applications, a high sensitivity electrical measurement chain was developed. RESULTS All samples exhibited the same type of stress vs. depth profile, starting with compressive at the ceramic surface, decreasing with depth and becoming tensile at 0.5-1.0mm from the surface, and then becoming slightly compressive again. The zirconia samples exhibited a stress depth profile of larger magnitude. SIGNIFICANCE The hole drilling method was shown be a practical tool for measuring residual stresses in veneering ceramics.

Influence of cooling rate on residual stress profile in veneering ceramic: Measurement by hole-drilling

OBJECTIVES The manufacture of dental crowns and bridges generates residual stresses within the veneering ceramic and framework during the cooling process. Residual stress is an important factor that control the mechanical behavior of restorations. Knowing the stress distribution within the veneering ceramic as a function of depth can help the understanding of failures, particularly chipping, a well-known problem with Yttria-tetragonal-zirconia-polycrystal based fixed partial dentures. The objective of this study is to investigate the cooling rate dependence of the stress profile in veneering ceramic layered on metal and zirconia frameworks. METHODS The hole-drilling method, often used for engineering measurements, was adapted for use with veneering ceramic. The stress profile was measured in bilayered disc samples 20 mm in diameter, with a 0.7 mm thick metal or Yttria-tetragonal-zirconia-polycrystal framework and a 1.5mm thick veneering ceramic. Three different cooling procedures were investigated. RESULTS The magnitude of the stresses in the surface of the veneering ceramic was found to increase with cooling rate, while the interior stresses decreased. At the surface, compressive stresses were observed in all samples. In the interior, compressive stresses were observed in metal samples and tensile in zirconia samples. SIGNIFICANCE Cooling rate influences the magnitude of residual stresses. These can significantly influence the mechanical behavior of metal-and zirconia-based bilayered systems. The framework material influenced the nature of the interior stresses, with zirconia samples showing a less favorable stress profile than metal.

Influence of zirconia framework thickness on residual stress profile in veneering ceramic: Measurement by hole-drilling

OBJECTIVES Framework design is reported to influence chipping in zirconia-based restorations, which is an important cause of failure of such restorations. Residual stress profile in the veneering ceramic after the manufacturing process is an important predictive factor of the mechanical behavior of the material. The objective of this study is to investigate the influence of framework thickness on the stress profile measured in zirconia-based structures. METHODS The stress profile was measured with the hole-drilling method in bilayered disc samples of 20mm diameter with a 1.5 mm thick veneering ceramic layer. Six different framework thicknesses from 0.5 mm to 3 mm were studied. Two different cooling procedures were also investigated. RESULTS Compressive stresses were observed in the surface, and tensile stresses in the depth of most of the samples. The slow cooling procedure was found to promote the development of interior tensile stresses, except for the sample with a 3mm thick framework. With the tempering procedure, samples with a 1.5 mm thick framework exhibited the most favorable stress profile, while thicker and thinner frameworks exhibited respectively in surface or interior tensile stresses. SIGNIFICANCE The measurements performed highlight the importance of framework thickness, which determine the nature of stresses and can explain clinical failures encountered, especially with thin frameworks. The adequate ratio between veneering ceramic and zirconia is hard to define, restricting the range of indications of zirconia-based restorations until a better understanding of such a delicate veneering process is achieved.

From Artisanal to CAD-CAM Blocks: State of the Art of Indirect Composites.

Indirect composites have been undergoing an impressive evolution over the last few years. Specifically, recent developments in computer-aided design–computer-aided manufacturing (CAD-CAM) blocks have been associated with new polymerization modes, innovative microstructures, and different compositions. All these recent breakthroughs have introduced important gaps among the properties of the different materials. This critical state-of-the-art review analyzes the strengths and weaknesses of the different varieties of CAD-CAM composite materials, especially as compared with direct and artisanal indirect composites. Indeed, new polymerization modes used for CAD-CAM blocks—especially high temperature (HT) and, most of all, high temperature–high pressure (HT-HP)—are shown to significantly increase the degree of conversion in comparison with light-cured composites. Industrial processes also allow for the augmentation of the filler content and for the realization of more homogeneous structures with fewer flaws. In addition, due to their increased degree of conversion and their different monomer composition, some CAD-CAM blocks are more advantageous in terms of toxicity and monomer release. Finally, materials with a polymer-infiltrated ceramic network (PICN) microstructure exhibit higher flexural strength and a more favorable elasticity modulus than materials with a dispersed filler microstructure. Consequently, some high-performance composite CAD-CAM blocks—particularly experimental PICNs—can now rival glass-ceramics, such as lithium-disilicate glass-ceramics, for use as bonded partial restorations and crowns on natural teeth and implants. Being able to be manufactured in very low thicknesses, they offer the possibility of developing innovative minimally invasive treatment strategies, such as “no prep” treatment of worn dentition. Current issues are related to the study of bonding and wear properties of the different varieties of CAD-CAM composites. There is also a crucial need to conduct clinical studies. Last, manufacturers should provide more complete information regarding their product polymerization process, microstructure, and composition, which significantly influence CAD-CAM material properties.

Influence of veneer thickness on residual stress profile in veneering ceramic: Measurement by hole-drilling

OBJECTIVES The veneering process of frameworks induces residual stresses and can initiate cracks when combined with functional stresses. The stress distribution within the veneering ceramic as a function of depth is a key factor influencing failure by chipping. This is a well-known problem with Yttria-tetragonal-zirconia-polycrystal based fixed partial dentures. The objective of this study is to investigate the influence of veneer thickness on the stress profile in zirconia- and metal-based structures. METHODS The hole-drilling method, often used for engineering measurements, was adapted for use with veneering ceramic. The stress profile was measured in bilayered disc samples of 20 mm diameter, with a 1 mm thick zirconia or metal framework. Different veneering ceramic thicknesses were performed: 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm. RESULTS All samples exhibited the same type of stress vs. depth profile, starting with compressive at the ceramic surface, decreasing with depth up to 0.5-1.0 mm from the surface, and then becoming compressive again near the framework, except for the 1.5 mm-veneered zirconia samples which exhibited interior tensile stresses. Stresses in the surface of metal samples were not influenced by veneer thickness. Variation of interior stresses at 1.2 mm from the surface in function of veneer thickness was inverted for metal and zirconia samples. SIGNIFICANCE Veneer thickness influences in an opposite way the residual stress profile in metal- and in zirconia-based structures. A three-step approach and the hypothesis of the crystalline transformation are discussed to explain the less favorable residual stress development in zirconia samples.

High-temperature-pressure Polymerized Resin-infiltrated Ceramic Networks

The aim of this study was to produce composite blocks (CB) for CAD/CAM applications by high-temperature-pressure (HT/HP) polymerization of resin-infiltrated glass-ceramic networks. The effect of network sintering and the absence/presence of initiator was investigated. Mechanical properties were determined and compared with those of Paradigm MZ100 (3M ESPE) blocks and HT/HP polymerized experimental “classic” CB, in which the filler had been incorporated by conventional mixing. The networks were made   from glass-ceramic powder (VITA Zahnfabrik) formed by slip casting and were either sintered or not. They were silanized, infiltrated by urethane dimethacrylate, with or without initiator, and polymerized under HT/HP (300 MPa, 180°C) to obtain resin-infiltrated glass-ceramic network (RIGCN) CB. HT/HP polymerized CB were also made from an experimental “classic” composite. Flexural strength (σf), fracture toughness (KIC), and Vickers hardness were determined and analyzed by one- or two-way analysis of variance (ANOVA), Scheffé multiple-means comparisons (α = 0.05), and Weibull statistics (for σf). Fractured surfaces were characterized with scanning electron microscopy. The mechanical properties of RIGCN CB were significantly higher. Sintering induced significant increases in σf and hardness, while the initiator significantly decreased hardness. The results suggested that RIGCN and HT/HP polymerization could be used to obtain CB with superior mechanical properties, suitable for CAD/CAM applications.

Properties of experimental urethane dimethacrylate-based dental resin composite blocks obtained via thermo-polymerization under high pressure

OBJECTIVES The aim of this study was to use high-pressure high-temperature (HP/HT) polymerization to produce urethane dimethacrylate (UDMA)-triethylene glycol dimethacrylate (TEGDMA) based resin composite blocks (RCB) suitable for dental computer-aided design/manufacture (CAD/CAM) applications and to compare their physical/mechanical properties to those of a commercial dental RCB. The null hypotheses tested were: (1) there are no differences in the physical/mechanical properties between HP/HT polymerized UDMA-TEGDMA RCB and a commercial RCB; (2) volume fraction filler (Vf) does not affect the physical/mechanical properties of HP/HT polymerized RCB. METHODS Four UDMA-based experimental RCB were manufactured under HP/HT conditions. A RCB manufactured under the same HP/HT conditions from a commercial resin composite (Z100) and its commercial counterpart CAD/CAM RCB (Paradigm MZ100) were used as controls. Flexural strength (σf), fracture toughness (KIC), and hardness were determined. The results were analyzed using one-way ANOVA, Scheffé multiple means comparisons (α=0.05), and Weibull statistics (for σf). Scanning electron microscopy was used to characterize fractured surfaces. RESULTS All HP/HT polymerized RCB had superior σf, KIC, and Weibull modulus compared to the commercial dental RCB. The experimental RCB had similar or superior properties compared to HP/HT polymerized Z100 RCB. Fewer and smaller porosities (not quantified) were apparent in HP/HT polymerized RCB. The experimental RCB that contained 65% Vf showed higher porosity, suggesting practical difficulties in filler incorporation beyond a certain Vf. CONCLUSIONS The results of this study suggested that RCB suitable for dental CAD/CAM applications could be obtained by HP/HT polymerization of resin composites based on pure UDMA.

High-temperature high-pressure polymerized urethane dimethacrylate—Mechanical properties and monomer release

OBJECTIVE This study was conducted to determine selected mechanical/physical properties of and monomer release from high-temperature high-pressure (HT/HP) polymerized urethane dimethacrylate (UDMA). METHODS Flexural strength (σf), hardness, fracture toughness (KIC), and density (ρ) were determined for five UDMA resin blocks produced via different polymerization protocols. High performance liquid chromatography (HPLC) was used to determine monomer release from the five polymers. One way ANOVA, Scheffé multiple means comparisons (α=0.05), and Weibull statistics (for σf) were used to analyze the results. RESULTS The results showed that HT/HP polymerization resulted in a significant (p<0.05) increase in σf and ρ, along with an increase in Weibull modulus. No significant differences were found in hardness and KIC between the two HT/HP polymerized materials. A significantly lower (p<0.05) monomer release was detected for the HT/HP polymerized groups. SIGNIFICANCE The results of this study suggest that HT/HP polymerization affects the network structure and leads to UDMA polymers with improved mechanical/physical properties and with dramatically reduced monomer release. The low elution of monomers from HT/HP and HP polymerized materials suggests the achievement of a higher degree of conversion and a lesser degree of inhomogeneity with regards to microgel domains. The results, however, cannot fully explain the dramatic increase in mechanical/physical properties reported previously for RCB, improvements that may be due to a better filler-matrix interaction afforded by HT/HP polymerization.