Suna Toksavul

Clinical marginal and internal adaptation of CAD/CAM milling, laser sintering, and cast metal ceramic crowns.

STATEMENT OF PROBLEM Metal ceramic crowns are widely used in clinical practice, but comparisons of the clinical adaptation of restorations made with different processing techniques are lacking. PURPOSE The purpose of this study was to compare the clinical marginal and internal adaptation of metal ceramic crowns fabricated with 3 different techniques: computer-aided design and computer-aided manufacturing (CAD/CAM) milling (CCM), direct metal laser sintering (DMLS), and traditional casting (TC). MATERIAL AND METHODS Twenty CCM, 20 DMLS, and 20 TC metal ceramic crowns were fabricated for 42 patients. Before luting the crowns, silicone replicas were obtained to measure marginal gap and internal adaptation that was evaluated at 3 regions: axial wall, axio-occlusal angle, and occlusal surface. Measurements were made with a reflected light binocular stereomicroscope at 20× magnification and analyzed with 1-way analysis of variance (ANOVA) and the Bonferroni post hoc test (α=.05). RESULTS The mean marginal gap values were 86.64 μm for CCM, 96.23 μm for DMLS, and 75.92 μm for TC. The means at the axial wall region were 117.5 μm for the CCM group, 139.02 μm for the DMLS group, and 121.38 μm for the TC group. One-way ANOVA revealed no statistically significant differences among the groups for measurements at the marginal gap (P=.082) and the axial wall region (P=.114). The means at the axio-occlusal region were 142.1 μm for CCM, 188.12 μm for DMLS, and 140.63 μm for TC, and those at the occlusal surface region were 265.73 μm for CCM, 290.39 μm for DMLS, and 201.09 μm for TC. The mean values of group DMLS were significantly higher at the axio-occlusal region and the occlusal surface region than those of other groups (P<.05). CONCLUSIONS CCM, DMLS and TC metal ceramic crowns performed similarly in terms of clinical marginal and axial wall adaptation. The cement film thickness at the occlusal region and axio-occlusal region were higher for DMLS crowns.

Intra‐oral adhesive systems for ceramic repairs: a comparison

The aim of this investigation was to compare the bond strength of restorative composite resin to dental ceramic conditioned with primers and adhesives of various commercial repair kits. Three intra‐oral ceramic repair systems—Silistor (Heraeus Kulzer), Cimara (Voco), Ceramic Repair (Vivadent)—were used on all‐ceramic (IPS Empress 2, Ivoclar‐Vivadent) substrate. Shear bond strength of restorative composite resin to substrate was tested after thermocycling and without thermocycling (n=10). Substrate surfaces of the specimen after loading were examined microscopically (SEM). The highest bond strengths in both water‐stored (7.0±5.7 MPa) and thermocycled conditions (2.5±1.8 MPa) were obtained with the Vivadent repair system, while the lowest values were observed with the Cimara system (0.6±1.4 MPa and 0.0±0.0 MPa, respectively). Shear bond strengths appeared to be significantly affected by thermocycling (ANOVA, P<0.05). It is concluded that there are significant differences in the bond strengths of resin composites and ceramic substrate. The roughened surface does not necessarily provide a better bond strength; the bond strength of composite decreases with storage in water and after thermocycling. Bond strength values were generally low for all of the tested materials.

The evaluation of displacement resistance of glass FRC posts to root dentine using a thin slice push-out test

AIM To investigate and compare the displacement resistance of glass fibre reinforced composite (FRC) posts to root dentine after luting with different adhesive systems. METHODOLOGY A total of 32 noncarious extracted human mandibular premolars were prepared for post-cementation using the FRC Postec system (Ivoclar Vivadent, Schaan, Liechtenstein) and divided into four groups (n = 8). The posts in each group were luted with one or other of the following materials. Group 1: Variolink II/Excite DSC (etch-and-rinse, dual-curing), group 2: Clearfil Esthetic Cement/ED Primer II (self-etch, dual-curing), group 3: Multilink/Multilink Primer (self-etch, chemical-curing) and group 4: Multilink Sprint (self-adhesive, dual-curing). Specimens were sectioned to obtain slices with the post in the centre and with the root dentine overlaid by the autopolymerizing acrylic resin on each side. The displacement resistance was measured using a Universal Testing Machine at a crosshead speed of 0.5 mm min(-1). The displacement resistance of the specimens were calculated and expressed in MPa. Data were analysed with one-way ANOVA and post hoc Tukeys test (P < 0.05). RESULTS Mean (SD) values of displacement resistance data in MPa are as follows: group 1, 12.08 (2.13); group 2, 12.39 (2); group 3, 11.3 (1.23); group 4, 14.29 (1.84). There were statistically significant differences amongst the groups (P = 0.021). A statistically significant difference was observed for the displacement resistance values between groups 3 and 4 (P = 0.015), that is between Multilink/Multilink Primer and Multilink Sprint. CONCLUSIONS Glass FRC posts luted with self-adhesive luting system exhibited higher displacement resistance than when luted with chemical-curing self-etch luting system.

Clinical Marginal and Internal Adaptation of Maxillary Anterior Single All-Ceramic Crowns and 2-year Randomized Controlled Clinical Trial

PURPOSE The aims of this randomized-controlled clinical trial were to compare marginal and internal adaptation of all-ceramic crowns fabricated with CAD/CAM and heat-pressed (HP) techniques before luting and to evaluate the clinical outcomes at baseline and at 6, 12, and 24 months after luting. MATERIALS AND METHODS Fifteen CAD/CAM (CC) and 15 HP all-ceramic crowns were placed in 15 patients. A silicone replica was obtained to measure marginal and internal adaptation of each all-ceramic crown before luting, and they were sectioned buccolingually and mesiodistally. Marginal and internal adaptations were measured using computerized light microscope at 40× magnification. Clinical evaluations took place at baseline (2 days after luting) and at 6, 12, and 24 months after luting. Replica scores were analyzed with Mann-Whitney U and Students t-test (α = 0.05). Survival rate of crowns was determined using Kaplan-Meier statistical analysis. RESULTS The median marginal gap for the CC group was 132.2 μm and was 130.2 μm for the HP group. The mean internal adaptation for the CC group was 220.3 ± 51.3 μm and 210.5 ± 31 μm for the HP group. There were no statistically significant differences with respect to marginal opening (Mann-Whitney U test; p = 0.95) and internal adaptation (Students t-test; p = 0.535) between the 2 groups. Based on modified Ryge criteria, 100% of the crowns were rated satisfactory during the 2-year period. CONCLUSION In this in vivo study, CAD/CAM and HP all-ceramic crowns exhibited similar marginal and internal adaptations. A 100% success rate was recorded for the 15 CAD/CAM and for the 15 HP all-ceramic crowns during the 2-year period.

Clinical evaluation of 121 lithium disilicate all-ceramic crowns up to 9 years.

OBJECTIVE The aim of this prospective clinical study was to evaluate the clinical performance of lithium disilicate allceramic crowns for a period from 12 to 156 months. METHOD AND MATERIALS One hundred and twenty five lithium disilicate all-ceramic crowns were placed in 35 patients between 2001 and 2007. One patient who received four all-ceramic crowns was excluded from the study. The remaining 34 patients received 121 all-ceramic crowns and were recalled. Ninety-eight anterior and 23 posterior crowns were inserted. All crowns were applied on vital teeth except for 11 crowns which were placed on endodontically treated teeth. Follow-up appointments were performed 6 months after insertion, then annually. Replacement of a restoration was defined as failure. Marginal integrity, marginal discoloration, secondary caries, sensitivity, color match, and ceramic surface were evaluated following modified California Dental Association/Ryge criteria. The survival rate of the crowns was determined using Kaplan- Meier statistical analysis and log-rank test (P = .05). RESULTS Ten crowns were fractured. The cumulative survival rate according to Kaplan-Meier was 87.1% after mean 104.6 months (range 12 to 156 months). Location (anterior vs posterior) of all-ceramic crown did not significantly affect the survival rate according to log-rank test (P = .89). Endodontically treated teeth without post-and-core restorations exhibited a higher failure rate after all-ceramic crown application according to log-rank test (P < .001). CONCLUSION In this in vivo study, lithium disilicate all-ceramic crowns exhibited a satisfactory clinical performance with an estimated survival probability of 87.1% over 104.6 months and they can be used clinically in the anterior and posterior region. Restoring endodontically treated teeth with post-and-core restorations should be considered before all-ceramic crown application.

Molecular typing of Candida albicans strains isolated from denture wearers by repetitive sequence-based PCR

Long-term use of prosthesis is the most important risk factor for the colonization of Candida species on the mucosal surfaces, which can lead to the development of denture-related stomatitis (DRS). Some individuals wearing prosthesis develop DRS and others do not. C. albicans strains isolated from both groups were genotypically compared. The purpose of this study was to determine whether the strain causing prosthesis stomatitis was different from the other strains genotypically. The study included 90 individuals wearing different prostheses and 20 control individuals with natural teeth. In the study 109 C. albicans strains were used which were isolated from the saliva samples and the mucosal surfaces of the tongues and palates of 51 individuals and then defined phenotypically. Phenotypic diagnosis of the isolates was genotypically verified by using species-specific PCR. For molecular typing, repetitive extragenic palindromic sequence polymerase chain reaction (REP-PCR) was employed. The results of the study revealed that REP-PCR had the capability to separate 109 C. albicans strains and six reference strains into 44 genotypes. Whereas C. albicans strains showed heterogenic distribution, C. albicans strains isolated from the individuals suffering from prosthesis stomatitis showed no specific genotypes. REP-PCR is a simple, fast and low-cost method and helped work on a great number of samples.

Intraoral versus extraoral cementation of implant-supported single crowns: clinical, biomarker, and microbiological comparisons

OBJECTIVES Implant supported single metal-ceramic crowns cemented either extraorally or intraorally were comparatively evaluated by clinical, radiologic, biomarker, and microbiological parameters. MATERIALS AND METHODS Twelve patients with bilateral single tooth gap in the maxillary posterior region received two locking-taper implants; 4.5 mm width, 8 mm length. Selection of intraoral (IOC) or extraoral cementation (EOC) using screwless titanium abutments was done randomly. Peri-implant crevicular fluid (PICF), gingival crevicular fluid (GCF) samples were collected from the implants, adjacent teeth, and bleeding on probing, soft tissue thickness, keratinized tissue width were recorded before starting the prosthetic procedures (baseline) and 3, 6 months after implant loading. Crestal bone loss was measured on radiographs taken immediately and 6 months after cementation. Cytokine levels, amounts of bacteria were determined in PICF/GCF samples. Data were tested by appropriate statistical analyses. RESULTS Clinical findings were similar in the crowns cemented extraorally or intraorally at all times (P < .05). PICF and GCF data were similar. At 3 month, interleukin-17E and osteoprotegerin levels were lower in the intraorally cemented crowns. CONCLUSION Extraorally and intraorally cemented crowns exhibited similar crestal bone loss after loading. Higher amount of osteoprotegerin at 3 month at the EOC than the IOC sites might bode well for good osseointegration.

Three-dimensional finite element analysis of stress distribution of two-retainer and single-retainer all-ceramic resin-bonded fixed partial dentures.

OBJECTIVE A long-term clinical study previously stated that adhesively luted resin-bonded fixed partial dentures (RBFPDs) with two retainers exhibited two complications (loss of adhesion or fracture between retainer and pontic) when compared to RBFPDs with a single retainer. The reasons for these complications were not reported. The aim of this study was to evaluate the stress distribution of two-retainer and singleretainer zirconium dioxide RBFPDs by using three-dimensional finite element analysis (3D FEA). METHOD AND MATERIALS Two different 3D finite element models were created. Each model contained cortical bone, cancellous bone, periodontal ligament, cement, and enamel. Additionally one of the models contained a two-retainer zirconium dioxide RBFPD while another contained a single-retainer zirconium dioxide RBFPD. A 100 N force was applied at 45 degrees 2 mm below the incisal edge of the palatal surface of the pontic. In each model, Von Mises stress distribution was evaluated. RESULTS Maximum Von Mises stress values in RBFPD with a single retainer and two retainers were 1.13 MPa and 1.23 MPa, respectively. Von Mises stress was concentrated at the interface between pontic and retainer for RBFPD with two retainers. CONCLUSION Zirconium dioxide RBFPD with a single retainer and two retainers exhibited similar stress concentrations between pontic and retainer. However, the use of a single retainer for RBFPDs prevented stress concentration at the interface between retainer and pontic.