Rodrigo Alessandretti

Visual and instrumental shade matching using CIELAB and CIEDE2000 color difference formulas

OBJECTIVES To compare visual and instrumental shade matching performances using two shade guides and three color difference formulas. METHODS One hundred dental students (DS) volunteers (35 males and 65 females) with normal color vision participated in the study. The spectral reflectance of 4 extracted human upper central incisors (UCI) and shade tabs from Vita Classical (VC) and Vita Toothguide 3D-Master (3D) shade guides were measured using a spectroradiometer (SP) under D65 illuminant (diffuse/0° geometry) inside a viewing booth with a gray background. Color coordinates (CIE L*, a*, b*, C* and h°) were calculated according to CIE D65 illuminant and CIE 2° Standard Observer. Color coordinates of UCI were also evaluated using a dental spectrophotometer (EA - Easyshade Advance). DS used VC and 3D to visually select the best shade match for each UCI, under same experimental conditions used for the SP evaluation. Three color difference metrics (CIELAB, CIEDE2000(1:1:1) and CIEDE2000(2:1:1)) were used to calculate the best instrumental shade matching based on minimum color difference. RESULTS The agreement between visual and instrumental shade matching was greater using SP (25-75%) than EA (0-25%). The percentage of best match for the visual assessment was more consistent using VC (23-55%) than 3D (19-34%). Considering the best performance (using SP and VC), the CIEDE2000(2:1:1) color difference formula showed the best estimate to the visual perception from DS. SIGNIFICANCE Within the limitations of this study, combining the use of SP, CIEDE2000(2:1:1) and Vita Classical shade guide most closely represented the visual perception of DS. Instrumental shade determination should be accompanied by experienced human visual assessment.

Zirconia as a Dental Biomaterial

Ceramics are very important in the science of dental biomaterials. Among all dental ceramics, zirconia is in evidence as a dental biomaterial and it is the material of choice in contemporary restorative dentistry. Zirconia has been applied as structural material for dental bridges, crowns, inserts, and implants, mostly because of its biocompatibility, high fracture toughness, and radiopacity. However, the clinical success of restorative dentistry has to consider the adhesion to different substrates, which has offered a great challenge to dental zirconia research and development. This study characterizes zirconia as a dental biomaterial, presenting the current consensus and challenges to its dental applications.

Reliability and mode of failure of bonded monolithic and multilayer ceramics

OBJECTIVES To evaluate the reliability of monolithic and multilayer ceramic structures used in the CAD-on technique (Ivoclar), and the mode of failure produced in ceramic structures bonded to a dentin analog material (NEMA-G10). METHODS Ceramic specimens were fabricated as follows (n=30): CAD-on- trilayer structure (IPS e.max ZirCAD/IPS e.max Crystall./Connect/IPS e.max CAD); YLD- bilayer structure (IPS e.max ZirCAD/IPS e.max Ceram); LDC- monolithic structure (IPS e.max CAD); and YZW- monolithic structure (Zenostar Zr Translucent). All ceramic specimens were bonded to G10 and subjected to compressive load in 37°C distilled water until the sound of the first crack, monitored acoustically. Failure load (Lf) values were recorded (N) and statistically analyzed using Weibull distribution, Kruskal-Wallis test, and Student-Newman-Keuls test (α=0.05). RESULTS Lf values of CAD-on and YZW structures were statistically similar (p=0.917), but higher than YLD and LDC (p<0.01). Weibull modulus (m) values were statistically similar for all experimental groups. Monolithic structures (LDC and YZW) failed from radial cracks. Failures in the CAD-on and YLD groups showed, predominantly, both radial and cone cracks. SIGNIFICANCE Monolithic zirconia (YZW) and CAD-on structures showed similar failure resistance and reliability, but a different fracture behavior.

Loosening torque of Universal Abutment screws after cyclic loading: influence of tightening technique and screw coating

PURPOSE The purpose of this study was to evaluate the influence of tightening technique and the screw coating on the loosening torque of screws used for Universal Abutment fixation after cyclic loading. MATERIALS AND METHODS Forty implants (Titamax Ti Cortical, HE, Neodent) (n=10) were submerged in acrylic resin and four tightening techniques for Universal Abutment fixation were evaluated: A - torque with 32 Ncm (control); B - torque with 32 Ncm holding the torque meter for 20 seconds; C - torque with 32 Ncm and retorque after 10 minutes; D - torque (32 Ncm) holding the torque meter for 20 seconds and retorque after 10 minutes as initially. Samples were divided into subgroups according to the screw used: conventional titanium screw or diamond like carbon-coated (DLC) screw. Metallic crowns were fabricated for each abutment. Samples were submitted to cyclic loading at 106 cycles and 130 N of force. Data were analyzed by two-way ANOVA and Tukeys test (5%). RESULTS The tightening technique did not show significant influence on the loosening torque of screws (P=.509). Conventional titanium screws showed significant higher loosening torque values than DLC (P=.000). CONCLUSION The use of conventional titanium screw is more important than the tightening techniques employed in this study to provide long-term stability to Universal Abutment screws.

Ceramic strengthening by tuning the elastic moduli of resin-based luting agents

OBJECTIVE Resin-based luting agents (RBLAs) with tuned elastic moduli (E) were prepared and their influence on the strengthening, reliability, and mode of failure of luted feldspar ceramic was investigated. METHODS RBLAs with low E (2.6GPa), intermediate E (6.6GPa), and high E (13.3GPa) were prepared and used to coat acid-etched ceramic disks. Positive (untreated ceramic) and negative (acid-etched ceramic) control groups were tested. The response variables (n=30) were biaxial flexural strength (σbf, MPa), characteristic strength (σ0, MPa), and Weibull modulus at the ceramic surface (z=0) and luting agent surface (z=-t2). A 3D finite element analysis simulated the biaxial flexural test. Fractographic analysis and morphology of the bonded interfaces were analyzed using scanning electron microscopy. RESULTS The RBLAs improved σbf and σ0 at z=0, particularly those with intermediate and high E, whereas the mechanical reliability was only affected in the negative control. At z=-t2, differences between all RBLAs were observed but the structural reliability was independent of the RBLA tested. Increasing E of the RBLA was associated with increased stress concentration at the RBLA and reduced stresses reaching the ceramic. Failures originated on the ceramic surface at the ceramic-cement interface. In the high E group, failure sometimes originated from the RBLA free surface. All RBLAs completely filled the ceramic irregularities. SIGNIFICANCE Increased E of the RBLA reduced the variability of strength, the stress reaching the ceramic structure, and sometimes altered the origin of failure. The use of high E RBLAs seems beneficial for luting feldspar ceramics.

Adhesion to Dental Ceramics

All-ceramic restorations are attractive because of their long lasting esthetics and the ability to withstand the oral conditions. However, bonding to ceramics has challenged the dental community for the last few decades. The clinical success of a ceramic restoration is strongly dependent on the quality and durability of the bond between the resin cement and the restoration. This study presents the bonding mechanisms and the mechanical tests to evaluate the adhesive interfaces of resin-bonded ceramic restorations, mainly the zirconia-based restorations, which are the most popular. An adequate bond involves ceramic surface changes for mechanical retention, which can be achieved using primers, such as acids and airborne particle abrasion. Selective etching of high crystalline content ceramics mostly occurs within grain boundaries that offer little micromechanical retention and an insufficient bond to resin. The most popular surface treatment to improve adhesion to high crystalline content ceramics involves the treatment of surfaces with airborne particle abrasion and chemical bonding. Yet, there are reports on new methods to enhance the resin bond to zirconia that need further investigation. This study provides scientific evidences to guide the clinical procedures on bonding ceramic restorations.

Feldspar Ceramic Strength and The Reinforcing Effect by Adhesive Cementation Under Accelerated Aging

This study evaluated the effect of the accelerated artificial aging (AAA) on feldspar ceramic strength and the reinforcing effect promoted by adhesive cementation with resin luting agent. One hundred twenty feldspar ceramic disks were obtained. Sixty disks were acid-etched, silanized, and coated with an experimental resin luting agent simulating the adhesive luting procedures. Four groups were created (n=30): uncoated ceramic (control group), uncoated ceramic submitted to AAA, ceramic coated with resin luting agent, and coated ceramic submitted to AAA. Biaxial flexural testing with ball-on-ring setup was carried out. Biaxial flexural strength (s bf , MPa), characteristic strength (s 0 , MPa), and Weibull modulus (m) were calculated for axial positions z=0 (ceramic surface) and z=-t2 (luting agent surface). Data of s bf at positions z=0 and z=-t2 were separately submitted to statistical analyses (a=0.05). The uncoated ceramic submitted to AAA had no significant difference in s bf and s 0 compared with the control group. Resin coating of the ceramic increased s bf and s 0 at z=0. The AAA increased the s bf and s 0 for the resin-coated ceramic specimens at z=0 and also the s 0 at axial position z=-t2. The structural reliability at z=0 and z=-t2 was not influenced by the variables tested. In conclusion, resin coating improved the mechanical strength of the feldspar ceramic. The AAA procedure was not effective in aging the uncoated or resin-coated feldspar ceramic specimens.

Effect of Surface Coating on Bond Strength between Etched Feldspar Ceramic and Resin-Based Luting Agents

This study evaluated adhesive protocols (silane, silane and unfilled resin, and universal adhesive) of bond strength between feldspar ceramic and resin-based luting agents (RBLAs). Thirty ceramic disks were embedded into acrylic resin, polished, etched, and randomly divided into 6 groups: S-RC: silane (S) and light-cured resin cement (RC) (RelyX Veneer; 3M ESPE); SB-RC: S followed by bond (B) (Clearfil SE Bond, Kuraray) and RC; UA-RC: universal adhesive (UA) (Single Bond Universal; 3M ESPE) and RC; flowable composite resin (F) was used on groups S-F, SB-F, and UA-F, and luting agent cylinders were built. The response variables (n=20) were microshear bond strength (MPa), characteristic strength (σ0, MPa), and Weibull modulus (m). The RC groups presented similar bond strengths regardless of whether or not bond was used. The S-F group with only silane application showed the highest bond strength, while the universal adhesive showed the lowest bond strength. The reliability was only affected in the UA-RC group, which was lower than the S-F group. Silane application is fundamental since the universal adhesive only decreased the bond strength between the feldspar ceramic and the RBLAs. Overall, the use of unfilled resin did not positively influence bond strength.

Tightening techniques for the retaining screws of universal abutment

Purpose This study evaluated the torque maintenance of universal abutment retaining screws using different tightening techniques, and coated or uncoated screws. Material and method The screws were tightened to implants as following: Control – 32 Ncm torque; H20 – holding 32 Ncm torque for 20 s; R – 32 Ncm torque, repeated after 10 min (retorque); and H20+R – combining the two tightening techniques. Titanium and coated screws were also evaluated. Result Statistical analysis showed higher maintained torque for titanium screws (p<0.001). The H20+R technique showed the highest maintained torque (p=0.003), but the H20 technique’s maintained torque was similar. Conclusion Titanium screws associating the two tightening techniques can improve maintained torque.