Paulo Sérgio Quagliatto

In Vitro Study of Fracture Load and Fracture Pattern of Ceramic Crowns: A Finite Element and Fractography Analysis

PURPOSE This in vitro study investigated the null hypothesis that metal-free crowns induce fracture loads and mechanical behavior similar to metal ceramic systems and to study the fracture pattern of ceramic crowns under compressive loads using finite element and fractography analyses. MATERIALS AND METHODS Six groups (n = 8) with crowns from different systems were compared: conventional metal ceramic (Noritake) (CMC); modified metal ceramic (Noritake) (MMC); lithium disilicate-reinforced ceramic (IPS Empress II) (EMP); leucite-reinforced ceramic (Cergogold) (CERG); leucite fluoride-apatite reinforced ceramic (IPS d.Sign) (SIGN); and polymer crowns (Targis) (TARG). Standardized crown preparations were performed on bovine roots containing NiCr metal dowels and resin cores. Crowns were fabricated using the ceramics listed, cemented with dual-cure resin cement, and submitted to compressive loads in a mechanical testing machine at a 0.5-mm/min crosshead speed. Data were submitted to one-way ANOVA and Tukey tests, and fractured specimens were visually inspected under a stereomicroscope (20×) to determine the type of fracture. Maximum principal stress (MPS) distributions were calculated using finite element analysis, and fracture origin and the correlation with the fracture type were determined using fractography. RESULTS Mean values of fracture resistance (N) for all groups were: CMC: 1383 ± 298 (a); MMC: 1691 ± 236 (a); EMP: 657 ± 153 (b); CERG: 546 ± 149 (bc); SIGN: 443 ± 126 (c); TARG: 749 ± 113 (b). Statistical results showed significant differences among groups (p < 0.05) represented by different lowercase letters. Metal ceramic crowns presented fracture loads significantly higher than the others. Ceramic specimens presented high incidence of fractures involving either the core or the tooth, and all fractures of polymer crown specimens involved the tooth in a catastrophic way. Based on stress and fractographic analyses it was determined that fracture occurred from the occlusal to the cervical direction. CONCLUSIONS Within the limitations of this study, the results indicated that the use of ceramic and polymer crowns without a core reinforcement should be carefully evaluated before clinical use due to the high incidence of failure with tooth involvement. This mainly occurred for the polymer crown group, although the fracture load was higher than normal occlusal forces. High tensile stress concentrations were found around and between the occlusal loading points. Fractographic analysis indicated fracture originating from the load point and propagating from the occlusal surface toward the cervical area, which is the opposite direction of that observed in clinical situations.

Flexural modulus, flexural strength, and stiffness of fiber-reinforced posts

BACKGROUND The radiopacity degree of posts is not enough for adequate visualization during radiographic analyses. Glass fiber post with stainless steel reinforcement has been fabricated in an attempt to overcome this limitation. AIM This study was designed to determine the influence of this metal reinforcement on the post mechanical properties. MATERIALS AND METHODS This study evaluated flexural modulus (E), flexural strength (sigma), and stiffness (S) of five different fiber post systems (n = 5): RfX (Reforpost Glass Fiber RX; Angelus, Londrina, PR, Brazil); RG (Reforpost Glass Fiber, Angelus); RC (Reforpost Carbon Fiber, Angelus); FP (Fibrekor Post; Jeneric Pentron Inc., Wallingford, CT, USA); and CP (C-Post; Bisco Dental Products, Schaumburg, IL, USA), testing the hypothesis that the insertion of a metal reinforcement (RfX) jeopardizes the mechanical properties of a glass fiber post. Posts were loaded in three-point bending using a testing machine with a crosshead speed of 0.5 mm/min. RESULTS The results were statistically analyzed using one-way ANOVA and Tukeys multiple range tests (a = 0.05). Mean and standard deviation values of E (GPa), s (MPa), and S (N/mm) were as follows: RfX: 10.8 +/- 1.6, 598.0 +/- 52.0, 132.0 +/- 21.9; RG: 10.6 +/- 1.0, 562.0 +/- 24.9, 137.8 +/- 5.5; RC: 15.9 +/- 2.4, 680.5 +/- 34.8, 190.9 +/- 12.9; FP: 10.9 +/- 1.4, 586.8 +/- 21.9, 122.4 +/- 17.3; CP: 6.3 +/- 1.7, 678.1 +/- 54.2, 246.0 +/- 41.7. Carbon fiber posts showed the highest mean s values (P < 0.05). In addition, RC showed the highest mean E value and CP showed the highest mean S value (P < 0.05). CONCLUSION The hypothesis was rejected since the metal reinforcement in the glass fiber post (RfX) does not decrease the mechanical property values. Posts reinforced with carbon fibers have a higher flexural strength than glass fiber posts, although all posts showed similar mechanical property values with dentin.

The influence of the cavity preparation design on marginal accuracy of laboratory-processed resin composite restorations

The aim of this study was to evaluate the influence of different cavity preparation designs on marginal accuracy of laboratory-processed resin composite restored teeth. Eighty mandibular human third molars were selected. There were two experimental factors, occlusal isthmus width (narrow vs wide) and cuspal coverage (inlay, one-cusp onlay, two-cusp onlay, and all-cusp onlay), resulting on eight groups (N = 10). Indirect composite restorations (SR Adoro, Ivoclar-Vivadent) were manufactured and positioned over each respective preparation. Marginal accuracy evaluation was accomplished using a stereomicroscope at three points on buccal, lingual, mesial, and distal regions with 40× magnification. The results showed significant differences (P = 0.00) with wide inlay showing the best overall marginal accuracy and narrow inlay the worst one. Two-way analysis of variance (ANOVA) showed significant differences when considering the factor occlusal isthmus width (P = 0.00). In general, preparations with wide occlusal isthmus presented better results than narrow ones, except for wide all-cusp onlays; however, the test failed to show differences when considering the cuspal coverage (P = 0.42) or the interaction between both factors (P = 0.30). The effect of occlusal width extension on marginal accuracy of indirect composite resin restorations is significant, with lower values of gaps width in wide preparations, but since in a clinical situation this would mean greater removal of sound tooth structure, less-aggressive preparations combined with other restorative procedures seem to be more feasible.

Influence of powder/liquid ratio on the radiodensity and diametral tensile strength of glass ionomer cements

Objective To determine the influence of P/L ratio on the radiodensity and diametral tensile strength (DTS) of glass ionomer cements. Material and Methods There were 2 factors under study: P/L ratio (manufacturers recommended P/L ratio and a 50% reduced P/L ratio), and materials (Vitro Molar, Vitro Fil, Vitro Cem conventional GICs and Vitro Fil LC, Ortho Glass LC RMGICs). Five 1-mm-thick samples of each material-P/L ratio were produced for radiodensity evaluation. Samples were x-ray exposed onto Digora phosphor plate and radiodensity was obtained using the software Digora for Windows 2.5 Rev 0. For DTS, five (4.0x8.0 mm) cylinder samples of each material were tested (0.5 mm/min). Data were subjected to one- and two-way ANOVA (5x2) followed by Tukeys HSD test, or Kruskal-Wallis and Dunns method. For paired comparisons, t-test or Mann-Whitney test were used (a=0.05). Results There was a significant interaction (P=0.001) for the studied factors (materials vs. P/L ratio). Reduced P/L ratio resulted in significantly lower DTS for the RMGICs, but radiodensity was affected for all materials (P<0.05). Conclusions Reduced P/L ratio affected properties of the tested glass ionomer cements. RMGICs were more susceptible to lower values of DTS, but radiodensity decreased for all materials following P/L ratio reduction.

Influence of chlorhexidine on dentin adhesive interface micromorphology and nanoleakage expression of resin cements

This study focused on adhesive interface morphologic characterization and nanoleakage expression of resin cements bonded to human dentin pretreated with 1% chlorhexidine (CHX). Thirty‐two non‐carious human third molars were ground flat to expose superficial dentin. Resin composite blocks were luted to the exposed dentin using one conventional (RelyX ARC) and one self‐adhesive resin cement (RelyX U100), with/without CHX pretreatment. Four groups (n = 8) were obtained: control groups (ARC and U100); experimental groups (ARC/CHX and U100/CHX) were pretreated with 1% CHX prior to the luting process. After storage in water for 24 h, the bonded teeth were sectioned into 0.9 × 0.9 mm2 sticks producing a minimum of 12 sticks per tooth. Four sticks from each tooth were prepared for hybrid layer evaluation by scanning electron microscope analysis. The remaining sticks were immersed in silver nitrate for 24 h for either nanoleakage evaluation along the bonded interfaces or after rupture. Nanoleakage samples were carbon coated and examined using backscattered electron mode. Well‐established hybrid layers were observed in the groups luted with RelyX ARC. Nanoleakage evaluation revealed increase nanoleakage in groups treated with CHX for both resin cements. Group U100/CHX exhibited the most pronouncing nanoleakage expression along with porous zones adjacent to the CHX pretreated dentin. The results suggest a possible incompatibility between CHX and RelyX U100 that raises the concern that the use of CHX with self‐adhesive cements may adversely affect resin‐dentin bond. Microsc. Res. Tech. 76:788–794, 2013.

Effects of bleaching agents and adhesive systems in dental pulp: a literature review

The dental pulp may be exposed to several irritants that are potentially noxious to the health and functions of this tissue. Each type of irritant or injury has different effects on the pulp, which are generally characterized by acute inflammation, chronic inflammation or necrosis. Common examples of irritants are dental caries, cavity preparation procedures, traumatic injuries, and chemical substances like bleaching agents and adhesive systems. The present study aimed to review the current knowledge about the effect of bleaching agents and adhesive systems in the human dental pulp. The review covered literature from 2004 to 2009, and only relevant manuscripts were included. Hand search of the references completed the review. Based on literature review, it may be concluded that all dental procedures associated with bleaching agents or adhesive systems involve risks to cause pulp damage. However, these risks can be minimized if the causal factors were known and avoided.