Michel Fages

Confocal Raman microscopic analysis of the zirconia/feldspathic ceramic interface

OBJECTIVES Esthetic demands and biocompatibility have prompted the development of all-ceramic dental crowns. Yttria tetragonal zirconia polycrystalline (Y-TZP) framework material has the best mechanical properties compared to other all-ceramic systems, but the interface is the weakest component of core veneered restorations. Confocal Raman microscopy possibilities are used to ensure the understanding of the zirconia-feldspathic ceramic relationship, which is not well known. METHODS Bilayered zirconia (Vita In-Ceram(®) YZ) veneer (Vita VM(®)9) blocks were manufactured. Raman analyses were performed using two protocols: (1) single spectra, line scans and images on a sectioned and polished specimen and (2) in depth line scans on unprepared specimen. Single spectra, images and line scans provide information about the crystalline phases, their distribution and the existence of a possible diffusion at the Y-TZP/VM(®)9 interface, respectively. The elemental distribution of zirconium (Zr) and silicon (Si) around this interface were investigated using energy dispersive X-ray spectroscopy (EDS). RESULTS Raman single spectra embodied a unique spectrum (crystalline) on Y-TZP and two spectra (crystalline and amorphous) on VM(®)9; these spectra were clearly distinguished. Raman line scans showed a series of transition spectra across the interface from VM(®)9 to Y-TZP. It emphasized an interdiffusion zone, which was estimated at a maximum of 2 microns, found on 2d Raman images and confirmed by EDS. The elemental distribution with EDS showed a mutual diffusion of Zr and Si and was mainly dominated by Si diffusion in Y-TZP. SIGNIFICANCE Confocal Raman microscopy highlights an interdiffusion zone at the zirconia-feldspathic ceramic interface. The elemental transition layer is estimated and is supported by EDS analysis as a coupling technique.

Dental biomaterials for chairside CAD/CAM: State of the art

The wide use of chairside CAD/CAM restorations has increased the diversity of the restorative material. For the practitioner, the selection of the appropriate material is difficult amongst the variety offered by the market. Information on the characteristics of the products can be difficult to assess due to the lack of up-to-date classification and the lack of reliability of manufacturers advertising. The purpose of this article is to structure the data on restorative materials provided by various sources in order for the practitioner to choose the product most suited to the clinical situation. The objective is to classify chairside CAD/CAM materials and to define their characteristics and indications.

Glass Ceramic CAD/CAM crowns and severely altered posterior teeth: a three levels study

For many practitioners, longevity of full glass ceramic crowns in the posterior area, molars and premolars, remains a real challenge. The purpose of this article is to identify and evaluate the parameters that can significantly influence their resistance when preparing a tooth. The analysis proposed in this article relies on interrelated studies conducted at three levels: in vitro (mechanical tests), in silico (finite elements simulations) and in vivo (clinical survival rates). The in vitro and the in silico studies proved that an appropriate variation of the geometric design of the preparations enables to increase up to 80% the mechanical strength of ceramic reconstructions. The in vivo clinical study of CAD/CAM full ceramic crowns was performed in accordance with the principles stated within the in vitro and the in silico studies and provided a 98.97% success rate over a 6 years period. The variations of geometric design parameters for dental preparation allows for reconstructions with a mechanical breaking up to 80% higher than that of a non-appropriate combination. These results are confirmed in clinical practice.Graphical Abstract

Chairside Computer-Aided Design/Computer-Aided Manufacture All-Ceramic Crown and Endocrown Restorations: A 7-Year Survival Rate Study

PURPOSE The objective of the present study was to analyze the clinical outcomes of 447 monoblock ceramic chairside computer-aided design/computer-aided manufacture (CAD/CAM) reconstructions over a 7-year functional period. Of these reconstructions, 212 were peripheral crowns and 235 were endocrowns. MATERIALS AND METHODS The restorations were placed between 2003 and 2008 in a total of 323 patients. They were created using a chairside CAD/CAM method and the same materials in all cases. All of the crowns were manufactured and glued during the same clinical session by the same practitioner. Data were descriptively analyzed and survival probabilities were calculated using Kaplan-Meier statistics. RESULTS Of the 447 restorations, only 6 failures occurred, resulting in a success rate of 98.66%. All of the failures were the result of a partial ceramic fracture. Of the six ceramic fractures, five appeared on peripheral crowns and one on an endocrown. All fractures appeared in the first 24 months, including two in the first month. Log-rank test comparing incidence rates between crowns and endocrowns showed no significant differences (P = .08). CONCLUSION This survival rate study reinforced the use of CAD/CAM full ceramic crowns and endocrowns on molars, showing a much more favorable survival rate for endocrowns.

Analysis of computerized aided designed and manufactured dental occlusal ceramics with multi-wavelength digital holography

Computerized Aided Design (CAD) and Computerized Aided Manufacturing (CAM) ceramic occlusal veneers are increasingly used as therapeutic options. However, little is known about their mechanical behavior under stress, as the response of the prepared tooth that supports it. The aim of this article is to use for the first time 3D color holography to evaluate the behavior of a molar occlusal veneer under stress and the response of the prepared tooth. The occlusal surface of a lower molar is prepared to receive a specific monolithic ceramic reconstruction manufactured with a chairside CAD/CAM system. Longitudinally cut samples are used to get a planar object observation and to “look inside” the tooth. A digital holographic set-up permits to obtain the contact-less and one-shot measurement of the three-dimensional displacement field at the surface of the tooth sample; stain fields are evaluated with low noise-sensitive computation. The results show an excellent behavior of the restored tooth without areas of excessive stress concentrations, but also a significant involvement of the dentin enamel junction. So, we demonstrate that the ceramic occlusal veneer seems to behave in accordance with the biomechanical concepts ensuring the longevity of the reconstituted tooth. It follows that we demonstrate that 3D holography is a highly recommended method for studying dental biomechanics.

Method to evaluate the noise of 3D intra-oral scanner

In dentistry, 3D intra-oral scanners are gaining increasing popularity essentially for the production of dental prostheses. However, there is no normalized procedure to evaluate their basic performance and enable comparisons among intra-oral scanners. The noise value highlights the trueness of a 3D intra-oral scanner and its capacity to plan prosthesis with efficient clinical precision. The aim of the present study is to develop a reproducible methodology for determining the noise of an intra-oral scanner. To this aim, and as a reference, an ultra-flat and ultra-smooth alumina wafer is used as a blank test. The roughness is calculated using an AFM (atomic force microscope) and interferometric microscope measurements to validate this ultra-flat characteristic. Then, two intra-oral scanners (Carestream CS3500 and Trios 3Shape) are used. The wafer is imaged by the two intra-oral scanners with three different angles and two different directions, 10 times for each parameter, given a total of 50 3D-meshes per intra-oral scanner. RMS (root mean square), representing the noise, is evaluated and compared for each angle/direction and each intra-oral scanner, for the whole mesh, and then in a central ROI (region of interest). In this study, we obtained RMS values ranging between 5.29 and 12.58 micrometers. No statistically significant differences were found between the mean RMS of the two intra-oral scanners, but significant differences in angulation and orientations were found between different 3D intra-oral scanners. This study shows that the evaluation of RMS can be an indicator of the value of the noise, which can be easily assessed by applying the present methodology.

Prosthodontic crown mechanical integrity study using Speckle Interferometry

New trends in dental prosthodontic interventions tend to reach biomimetic behaviour. Evolutions of CAD-CAM techniques enable to build ceramic prosthetic crowns and, above all, to set the cement joint thickness that links crown and remaining dental tissues. CAD is based on “in-mouth” optical print (i.e. shape on which the clone is glued and contact surface of the opposite jaw tooth). Prosthetic crown is then manufactured, using these parameters, from a feldspathic ceramic rod. In this study, the cloning process gives two samples with identical shape for further use: clone and tooth displacements are measured by speckle interferometry.