Comparison of failure rates of adhesive-fixed partial dentures for in vivo and in vitro studies

Bonding Performance of Surface-Treated Zirconia Cantilevered Resin-Bonded Fixed Dental Prostheses: In Vitro Evaluation and Finite Element Analysis

Debonding of zirconia cantilevered resin-bonded fixed dental prostheses (RBFDPs) remains the main treatment complication, therefore, the present in vitro study aimed to evaluate the effect of different surface pretreatments on the bonding of zirconia RBFDPs. Eighty milled zirconia maxillary central incisors, with complementary zirconia cantilevered RBFDPs, were randomly subjected to four different surface pretreatments (n = 20): as-machined (AM); airborne-particle abraded (APA); coated with nanostructured alumina coating (NAC); incisor air-abraded and RBFDP coated (NAC_APA). After bonding, half of each group (n = 10) was stored in deionized water (150 days/37 °C), thermocycled (37,500 cycles, 5-55 °C), and cyclically loaded (50 N/1.2 × 10⁶). Load-bearing capacity (LBC) was determined using a quasi-static test. Additionally, finite element analysis (FEA) and fractography were performed. t-test and one-way ANOVA were used for statistical-analysis. Before aging, the NAC group provided superior LBC to other groups (p < 0.05). After aging, the AM specimens debonded spontaneously, while other groups exhibited comparable LBC (p ˃ 0.05). The FEA results correlated with the in vitro experiment and fractography, showing highly stressed areas in the bonding interface, cement layer, and in RBFDP's retainer wing and connector. The NAC RBFDPs exhibited comparable long-term bonding performance to APA and should be regarded as a zirconia pretreatment alternative to APA.

Fracture Load of Different Zirconia Types: A Mastication Simulation Study

PURPOSE

To assess the effect of yttria mol% concentration and material thickness on the biaxial fracture load (N) of zirconia with and without mastication simulation.

MATERIALS AND METHODS

Disk-shaped specimens (N = 120) of 3 mol% yttria-partially stabilized zirconia, 3Y-PSZ (Katana High Translucent, Kuraray Noritake), 4 mol% yttria-partially stabilized zirconia, 4Y-PSZ (Katana Super Translucent Multi Layered) and 5 mol% Yttria-partially stabilized zirconia, 5Y-PSZ (Katana Ultra Translucent Multi Layered) were prepared to thicknesses of 0.7 and 1.2 mm. For each thickness, the biaxial fracture load (N) was measured with and without mastication simulation with 1.2 million cycles at a 110-N load and simultaneous thermal cycling at 5°C to 55°C. The data were analyzed by three-way Analysis of Variance (α = 0.05) and Tukey-Kramer adjusted multiple comparison test.

RESULTS

Yttria mol% concentration and material thickness had a statistically significant effect on the mean biaxial fracture load (F = 388.16, p < 0.001 and F = 714.33, p < 0.001 respectively). The mean biaxial fracture load ranged from the highest to the lowest; 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ (p = 0.012). The mean biaxial fracture load of the 1.2 mm thickness groups was significantly higher than 0.7 mm thickness at any given condition (p = 0.002). Not all specimens survived the mastication simulation protocol. Fifty percent of the 0.7-mm-thick 4Y-PSZ specimens, 70% of the 0.7-mm-thick 5Y-PSZ specimens and 20% of 1.2-mm-thick 5Y-PSZ specimens fractured during mastication simulation. Mastication simulation had no statistically significant effect on the biaxial fracture load (F = 1.24, p = 0.239) of the survived specimens.

CONCLUSIONS

Lowering yttria mol% concentration and increasing material thickness significantly increases the fracture load of zirconia. At 0.7 mm thickness, only 3Y-PSZ survived masticatory simulation. A minimum material thickness of 1.2 mm is required for 4Y-PSZ or 5Y-PSZ.

Influence of microscale expansion and contraction caused by thermal and mechanical fatigue on retentive strength of CAD/CAM-generated resin-based composite crowns

CAD/CAM-generated resin-based composite crowns have been proposed as an inexpensive alternative to conventional crowns. However, concerns have been raised about crown loosening in clinical use. Therefore, the present in vitro study aimed to evaluate the influence of thermal and mechanical cycling (TC and MC) on retentive strength of CAD/CAM resin-based crowns in relation to microscale expansion and contraction caused by fatigue. Eighty standardized dies were produced using a resin-based composite material. Crowns were milled from resin-based composite (n = 40) and glass-ceramic blocks (n = 40; control) using a dental CAD/CAM system. The crowns bonded to the dies were subjected to TC (temperature: 5 and 55 °C, cycles: 50,000) and MC (load: 200 N, cycles: 1.2 million). After fatigue treatment, retentive strength of the crowns was evaluated by a crown pull-off test at a crosshead speed of 1 mm/min. Coefficient of thermal expansion (CTE) and modulus of elasticity (E-modulus) of each material were also analyzed to estimate the microscale expansion and contraction during TC and MC. TC and MC significantly reduced the retentive strength of the CAD/CAM resin-based crowns whereas that of the CAD/CAM ceramic crowns was only affected by TC. In addition, the resin-based crowns showed a higher number of crown loosening during TC than the ceramic crowns. Analyses of CTE and E-modulus indicated that the resin-based crowns would be more deformed during TC and MC than the ceramic crowns. The present study demonstrated that the resistance of crowns to microscale expansion and contraction caused by thermal and mechanical fatigue would play an important role in maintaining retentive strength.

An overview of development and status of fiber-reinforced composites as dental and medical biomaterials

Fibr-reinforced composites (FRC) have been used successfully for decades in many fields of science and engineering applications. Benefits of FRCs relate to physical properties of FRCs and versatile production methods, which can be utilized. Conventional hand lamination of prefabricated FRC prepregs is utilized still most commonly in fabrication of dental FRC devices but CAD-CAM systems are to be come for use in certain production steps of dental constructions and medical FRC implants. Although metals, ceramics and particulate filler resin composites have successfully been used as dental and medical biomaterials for decades, devices made out of these materials do not meet all clinical requirements. Only little attention has been paid to FRCs as dental materials and majority of the research in dental field has been focusing on particulate filler resin composites and in medical biomaterial research to biodegradable polymers. This is paradoxical because FRCs can potentially resolve many of the problems related to traditional isotropic dental and medical materials. This overview reviews the rationale and status of using biostable glass FRC in applications from restorative and prosthetic dentistry to cranial surgery. The overview highlights also the critical material based factors and clinical requirement for the succesfull use of FRCs in dental reconstructions.

Fatigue analysis of computer-aided design/computer-aided manufacturing resin-based composite vs. lithium disilicate glass-ceramic

Resin-based composite molar crowns made by computer-aided design/computer-aided manufacturing (CAD/CAM) systems have been proposed as an inexpensive alternative to metal-ceramic or all-ceramic crowns. However, there is a lack of scientific information regarding fatigue resistance. This study aimed to analyze the fatigue behavior of CAD/CAM resin-based composite compared with lithium disilicate glass-ceramic. One-hundred and sixty bar-shaped specimens were fabricated using resin-based composite blocks [Lava Ultimate (LU); 3M/ESPE] and lithium disilicate glass-ceramic [IPS e.max press (EMP); Ivoclar/Vivadent]. The specimens were divided into four groups: no treatment (NT); thermal cycling (TC); mechanical cycling (MC); and thermal cycling followed by mechanical cycling (TCMC). Thermal cycling was performed by alternate immersion in water baths of 5°C and 55°C for 5 × 10(4) cycles. Mechanical cycling was performed in a three-point bending test, with a maximum load of 40 N, for 1.2 × 10(6) cycles. In addition, LU and EMP molar crowns were fabricated and subjected to fatigue treatments followed by load-to-failure testing. The flexural strength of LU was not severely reduced by the fatigue treatments. The fatigue treatments did not significantly affect the fracture resistance of LU molar crowns. The results demonstrate the potential of clinical application of CAD/CAM-generated resin-based composite molar crowns in terms of fatigue resistance.

Increased tooth mobility because of loss of alveolar bone support: a hazard for zirconia two-unit cantilever resin-bonded FDPs in vitro?

This study evaluates in vitro the impact of increased abutment tooth mobility on survival of zirconia-based two-unit cantilever resin-bonded fixed dental prosthesis (RB-FDP) by long-term dynamic loading in a chewing simulator. Human maxillary central incisors (n = 32) were endodontically treated and alveolar bone loss was simulated: 0% (group B), 25% (group C), and 50% (group D). RB-FDPs were adhesively luted. Zirconia full crown two-unit FDPs served as control (group A). Specimens were exposed to simulated clinical function by two subsequent sequences of thermal-cycling (2 × 3.000) parallel to mechanical loading (1.2 × 10(6) load cycles) (TCML; first sequence: load 1-25 N; second sequence: load 1-50 N). Tooth mobility increased significantly as the simulated bone level decreased (p < 0.001). Log-rank tests revealed no significant differences between experimental groups (p = 0.479). The results support the assumption that zirconia-based two-unit cantilever RB-FDPs may be an appropriate treatment option, even if abutment tooth mobility increase because of alveolar bone loss. However, debonding of zirconia-based two-unit RB-FDPs will be a likely event, whereas fatal failures of the abutment teeth may not occur.

Marginal adaptation and microleakeage of directly and indirectly made fiber reinforced composite inlays

Aim:

This study evaluated in vitro microleakage of inlays made by direct or indirect techique with or without fiber reinforced composite (FRC) substructure.

Materials and Methods:

Standardized mesio-occlusal cavities were prepared and restored using direct-technique with composite resin only or FRC-composite resin, and indirect technique with laboratory composite only or FRC-laboratory composite resin. After thermocycling, teeth were immersed in basic fuchsin dye, sectioned and examined under a stereo-microscope (x40).

Results:

No differences of cement thickness and dye penetration were found in gingival area (p>0.05), whereas microleakage revealed statistical differences between groups (p=0.02) in occlusal area, where FRC-groups had lower microleakage than composite restorations. Thickness of cement layer did not show significant difference between groups with indirect technique (p>0.05).

Conclusion:

The present study suggests that insertion of FRC substructure to the inlay cavity by direct composite filling technique does not increase the marginal leakage compared to that of cementing indirectly made restotorations by composite resin luting cement.

Clinical Significance:

On the basis of the results of this in vitro study, the use of direct FRC technique might be an effective way to decrease the marginal leakage.

In vitro exploration and finite element analysis of failure mechanisms of resin-bonded fixed partial dentures

PURPOSE

The purpose of this study was to explore the debonding mechanisms of two-unit cantilevered and straight and bent three-unit fixed-fixed resin-bonded fixed partial dentures (RBFPDs) and to measure the failure loads needed for debonding.

MATERIALS AND METHODS

Failure load tests were performed using Bondiloy beams simulating both cantilevered and fixed-fixed RBFPDs, luted onto flat-ground buccal surfaces of bovine teeth with RelyX ARC, Panavia F2.0, and UniFix resin cements. The failure loads were recorded, and the debonded surfaces of both the enamel and the restorations were examined for details of interest. Finite element analysis (FEA) was used to calculate the stress concentrations within the cement layers at failure.

RESULTS

Simulated two-unit cantilevered and straight three-unit fixed-fixed RBFPDs showed a significantly higher failure load than the simulated three-unit fixed-fixed RBFPDs with a curved appearance. The FEA models revealed the magnitude and stress locations within the cement layer, resulting in an explanation of the different failure modes.

CONCLUSIONS

The low failure loads for the three-unit bent fixed-fixed RPFPDs, compared with their straight counterparts and the two-unit cantilevered RBFPDs, indicate that clinically a reserved attitude needs to be maintained with regard to three-unit fixed-fixed RBFPDs spanning a clearly curved part of the dental arch. The FEA results make it clear which part of the tooth restoration interface is subject to the highest stress levels, making it possible to design abutment preparations that avoid high interfacial stresses to help prevent debonding.

Fracture frequency of all-ceramic crowns during dynamic loading in a chewing simulator using different loading and luting protocols

OBJECTIVE

The purpose of this laboratory study was to compare the frequency of failures (complete fractures or partial cracks) of molar crowns made of two different all-ceramic materials during dynamic loading in a chewing simulator, as well as the fracture load when subjected to static loading, in relation to different dynamic loading and luting protocols.

METHODS

One hundred and forty-four molar crowns fabricated with IPS Empress or an experimental e.max Press material with high translucency (e.max Press Exp) were luted on CAD/CAM milled PMMA abutments (first lower molar, circular chamfer) either with Variolink or glass-ionomer cement (GIC). All crowns were loaded according to three different loading protocols (n=12 per group) and two force profiles (sinusoidal, rectangular) in a pneumatically driven chewing simulator with a steel stylus (Ø 8 mm) and they underwent simultaneous thermocycling (5 degrees C/55 degrees C). After each phase the crowns were evaluated with regard to fractures or cracks. After dynamic testing, the crowns that did not fail were subjected to compression loading until complete fracture in a universal testing machine (UTM). As control groups, unloaded crowns were also subjected to a UTM. Survival statistics with log-rank tests were applied for the results of the dynamic loading, while ANOVA with post hoc Tukey B was used for the fracture load results and two-way ANOVA was carried out for logarithmically transformed data. Weibull statistics were calculated for pooled fracture load data of the dynamically loaded and control groups.

RESULTS

In the 144 IPS Empress crowns, complete fractures were observed in 9 crowns and partial cracks in another 3 crowns. When the data was pooled, a statistically significant increase in fractures occurred when the sinusoidal force profile was applied compared to a rectangular force profile (log-rank, p<0.05). No fractures occurred in the e.max Press Exp crowns. The two-way ANOVA showed that the type of luting protocol used had the most significant effect on the fracture load of both materials. In conjunction with Empress, however, the luting material influenced the variability twice as much as in e.max Press Exp. There was no statistically significant difference in the fracture load of GIC-luted e.max Press Exp crowns and that of the Variolink luted Empress crowns. The force profile had a significant effect on the fracture load only of the Empress crowns but not of the e.max Press Exp crowns. Weibull statistics revealed a higher scattering of the data of dynamically loaded crowns compared to that of the control groups.

CONCLUSIONS

For testing all-ceramic materials, dynamic loading is indispensable to draw valid conclusions on clinical performance of all-ceramic molar crowns. A sinusoidal profile is advisable, while a gradual increase of the force amplitude does not significantly affect the results.

Retrospective survival analysis of 3-unit fixed-fixed and 2-unit cantilevered fixed partial dentures

To evaluate the cumulative survival (CS) rates of fixed partial dentures (FPDs) retained by full-veneer retainers, and those of resin-bonded FPDs provided by graduating dental students for the replacement of a single missing tooth. In 168 patients, 61 3-unit fixed-fixed FPDs and 25 2-unit cantilevered FPDs retained by full-veneer retainers, and 77 3-unit fixed-fixed resin-bonded FPDs and 47 2-unit cantilevered resin-bonded FPDs, were examined for their retention and integrity. The periodontal health, endodontic status and coronal tissues of all abutment teeth were also evaluated. The survival rates of these various designs were analysed with the Kaplan-Meier method. The mean age of all FPDs was 31 months. At 48 months after their insertion, 3-unit FPDs retained by full-veneer retainers had a CS rate of 82%, followed by 2-unit resin-bonded FPDs at 81%, 2-unit FPDs retained by full-veneer retainers at 77%, and 3-unit resin-bonded FPDs at 63%. No significant difference was found between the four designs (P>0.05). Up to both 48 and 60 months, the most common causes of failure were endodontic for FPDs retained by full-veneer retainers, and dislodgement for resin-bonded FPDs. The 3-unit fixed-fixed FPDs retained by full-veneer retainers had the most favourable prognosis after 48 months for replacing a single missing tooth, but the difference between designs was not statistically significant.

Composite veneering of metal based fixed partial dentures

The aim of this in vitro study was to determine the thermal mechanical properties of veneering composites after polymerization with the appropriate polymerization device. Fracture tests were performed to investigate the effect on fixed partial dentures (FPDs). Dynamic mechanical thermal analysis was used to determine the temperature-dependent mechanical properties. To approximate the clinical situation, the fracture resistance of three-unit metal-based FPDs with different composite veneering was investigated after a simulated 5-year oral wearing period. The restorations were made of a high gold alloy and veneered with three different composites. To determine the influence of fabrication, one composite was used in a light-polymerizing and a heat/pressure-curing version and, in addition, a newly developed heat protection paste was used. After a 5-year simulation period, the fracture resistance was determined. The storage modulus varied between 14268 N mm(-2) (Belleglass) and 6616 N mm(-2) (Sinfony). Adoro showed no significant differences between light curing (9155 N mm(-2)) and heat curing (8184 N mm(-2)) variations. The Adoro-veneering with the heat protection paste showed the highest median fracture strength (1700 N), followed by Adoro LC (1555 N), Belleglass (1051 N), Adoro HP (1150 N) and Sinfony (909 N). The most common failure type occurring in all FPDs was a cracking of the composite, exposing the metal framework. All FPDs showed stress cracking of the composite. The heat protection paste seemed to reduce the crack formation after fabrication and increased the fracture resistance of the composite veneering. Stress cracking after thermal cycling and mechanical loading affected all composites, but all veneered three-unit alloy FPDs showed a fracture resistance sufficient for posterior application.

Marginal adaptation and fracture resistance of adhesively luted glass fibre-composite reinforced molar crowns with different inner crown surfaces

OBJECTIVES

This study compared the influence of different inner crown surfaces on the fracture resistance and marginal adaptation of adhesively fixed glass fibre-reinforced molar crowns.

MATERIALS AND METHODS

Vectris/Targis crowns were constructed with an inner framework of glass fibres (directly on the tooth) or an inner veneering composite layer between the fibre-framework and the tooth-substance. Both groups were sandblasted inside using Al(2)O(3); 50 microm grain size (200 kPa, 20 s) and silane coated. A control group had the inner fibre framework, but was neither sandblasted nor silane coated. The crowns were adhesively cemented on extracted human teeth, and thermally cycled and mechanically loaded (TCML: 6000 x 5 degrees C/55 degrees C; 1.2 x 10(6) x 50 N, 1.66 Hz). The marginal adaptation before and after TCML was evaluated and the fracture resistance was investigated using a Zwick universal testing machine.

RESULTS

After TCML the proportion of 'perfect margin' of the control group decreased significantly at the interface crown/cement. For the variations with an inner fibre framework or inner composite layer the marginal adaptation or fracture resistance did not decrease significantly after ageing. The fracture resistance values were control: 1509N+/-486; inner fibre framework: 1896N+/-342; inner composite layer: 1754N+/-340.

CONCLUSIONS

In the case of the investigated fibre framework and veneering composite, the inner surface of glass fibre-reinforced molar crowns can be covered with a composite layer or with a glass fibre framework. Both methods achieve comparable high fracture strengths and reliable marginal adaptation.

Fixed partial dentures: all-ceramics, fibre-reinforced composites and experimental systems

The aim of this in vitro study was to compare the fracture strength of three-unit FPDs (fixed partial dentures) and three-unit inlay FPDs after a simulated 5-year oral wearing period. The restorations were made of a pressable all-ceramic (Empress 2) and two specially designed, experimentally fixed partial dentures combining ceramics with dental composite. Three-unit FPDs and inlay FPDs were manufactured and were adhesively luted onto human molars. After thermal cycling and mechanical loading in an artificial environment, the fracture strength was determined. Zircon-based milled ceramic (Lava) three-unit FPDs were used as a control. The zircon ceramic and the fibre-based ceramic three-unit FPDs showed median fracture values between 1000 and 1400 N. For composite veneered zircon FPDs a fracture strength of about 800 N and for all-ceramic Empress 2 of about 350 N could be determined. The results for the inlay FPDs were between 1300 N and 1400 N for FRC/ceramic, 1000 N for zircon/composite and 500 N for all-ceramic restorations. The all-ceramic showed higher fracture resistance applied as inlay FPDs. The described hybrid techniques combining ceramics and composites could represent an interesting procedure for further investigations and, eventually, clinical implication.

Glass fiber-reinforced abutments for dental implants. A pilot study

Titanium abutments in dental implants shine through all-ceramic crowns and therefore limit excellent esthetic results. Prototypes of tooth-colored fiber-reinforced abutments were investigated to avoid the shining-through effect. In vitro, the fracture strength was determined after thermal cycling and mechanical loading of all-ceramic single crowns and four-unit bridges made of a fiber-reinforced composite. The suprastructures were adhesively fixed onto fiber-reinforced implant abutments and compared with those fixed on standard titanium abutments. The median of the fracture strength of the titanium-supported all-ceramic crowns was significantly higher than the median of crowns fixed onto the prototypes. But this value was still more than twice as high as the maximum loading force under oral conditions. No statistical difference was found between four-unit bridges made by fiber-reinforced composite inserted onto titanium abutments and those inserted onto fiber-reinforced abutments. Fiber-reinforced abutment prototypes for dental implants avoided the shining-through effect associated with metal abutments. Their load-bearing capacity after in vitro stress simulation was higher than the maximum oral loading force. With some improvements, the fiber-reinforced implant abutments are therefore a promising alternative to titanium abutments.