Shear bond strength of glass ionomer and resin-based cements to different types of zirconia

Anterior Esthetic Restorations with the Stratified Stamp Technique: A Case Report

Anterior teeth restoration represents a challenge for dentists, who often rely on the dental technician's wax-up. The proposed Stratified Stamp Technique (SST) allows for clinically reproducing the wax-up in a quick and easy way. A patient with fractures and discoloration on the upper central incisors was treated with resin-based composite direct restorations. Using SST, a 1 mm thick thermoformed polyethylene-terephthalate-glycol (PETG) template, based on the technician's wax-up, was produced. Enamel Selective Area Reduction (SAR) was performed to guarantee adequate space for the restorations, and the fracture margins were rounded and finished. Traditional layering procedures according to the five color dimensions of teeth were performed, except for the final labial layer, which was realized with warm composite loaded inside the template and polymerized through it, in order to ensure accurate tooth morphology reproduction. SST offers a reliable method for transferring technician's wax-up morphology to direct composite restorations in anterior teeth. Compared with other methods, SST allows for better isolation with a rubber dam and permits traditional layering with multiple composite shades, thus leading to satisfactory esthetic outcomes.

Comparison of bond strength of self-adhesive and self-etch or total-etch resin cement to zirconia: A systematic review and meta-analysis

The aim of this study was to systematically compare the bond strength of self-adhesive and self-etch or total-etch resin cement to zirconia. The PubMed, ISI (all), and Scopus databases were searched for the selected keywords up to November 1, 2021, without date or language restrictions. In vitro studies comparing the bond strength of self-adhesive and self-etch or total-etch resin cement to zirconia were eligible for inclusion in the study. The selected articles were divided into four groups based on the type of resin cement and the storage time. Statistical analysis was performed using the Biostat Comprehensive Meta-Analysis Software version 2 (α = 0.05). The effect of conventional cement ( Glass Ionomer (GI), Resin Modified Glass Ionomer (RMGI) and zinc phosphate) was analyzed using descriptive analysis. The initial search yielded 376 articles, of which 26 were selected after a methodological assessment. Two reviewers independently extracted data and assessed the risk of bias. The results showed that the immediate or delay bond strength of the self-adhesive resin cement to zirconia has no significant difference with the bond strength of self-etch resin cement to zirconia. The immediate and delay bond strength of total-etch cement-zirconia was significantly lower than that of self-adhesive cement-zirconia (P = 0.00). A descriptive analysis of the selected articles showed that the bond strength of self-adhesive resin cement to zirconia was significantly higher than total-etch cement. The results of the meta-analysis showed that both self-adhesive and self-etch resin cement (if applied according to their manufacturer's instruction) are suitable for bonding to zirconia.

Translucent Zirconia in Fixed Prosthodontics-An Integrative Overview

Over the past two decades, dental ceramics have experienced rapid advances in science and technology, becoming the fastest-growing field of dental materials. This review emphasizes the significant impact of translucent zirconia in fixed prosthodontics, merging aesthetics with strength, and highlights its versatility from single crowns to complex bridgework facilitated by digital manufacturing advancements. The unique light-conducting properties of translucent zirconia offer a natural dental appearance, though with considerations regarding strength trade-offs compared to its traditional, opaque counterpart. The analysis extends to the mechanical attributes of the material, noting its commendable fracture resistance and durability, even under simulated physiological conditions. Various zirconia types (3Y-TZP, 4Y-TZP, 5Y-TZP) display a range of strengths influenced by factors like yttria content and manufacturing processes. The study also explores adhesive strategies, underlining the importance of surface treatments and modern adhesives in achieving long-lasting bonds. In the realm of implant-supported restorations, translucent zirconia stands out for its precision, reliability, and aesthetic adaptability, proving suitable for comprehensive dental restorations. Despite its established benefits, the review calls for ongoing research to further refine the material's properties and adhesive protocols and to solidify its applicability through long-term clinical evaluations, ensuring its sustainable future in dental restorative applications.

Dental Resin-Based Luting Materials-Review

As cementation represents the last stage of the work involved in making various indirect restorations (metal ceramic crowns and bridges, full ceramic crowns and bridges, inlays, onlays, and fiber posts), its quality significantly contributes to the clinical success of the therapy performed. In the last two decades, the demand for ceramic indirect restorations in everyday dental practice has considerably increased primarily due to the growing significance of esthetics among patients, but also as a result of hypersensitivity reactions to dental alloys in some individuals. In this context, it is essential to ensure a permanent and reliable adhesive bond between the indirect restoration and the tooth structure, as this is the key to the success of aesthetic restorations. Resin-based luting materials benefit from excellent optical (aesthetic) and mechanical properties, as well as from providing a strong and durable adhesive bond between the restoration and the tooth. For this reason, resin cements are a reliable choice of material for cementing polycrystalline ceramic restorations. The current dental material market offers a wide range of resin cement with diverse and continually advancing properties. In response, we wish to note that the interest in the properties of resin-based cements among clinicians has existed for many years. Yet, despite extensive research on the subject and the resulting continued improvements in the quality of these materials, there is still no ideal resin-based cement on the market. The manuscript authors were guided by this fact when writing the article content, as the aim was to provide a concise overview of the composition, properties, and current trends, as well as some future guidelines for research in this field that would be beneficial for dental practitioners as well as the scientific community. It is extremely important to provide reliable and succinct information and guidelines for resin luting materials for dental dental practitioners.

Effect of the Abutment Rigidity on the Wear Resistance of a Lithium Disilicate Glass Ceramic: An In Vitro Study

Lithium disilicate (LDS) glass ceramics are among the most common biomaterials in conservative dentistry and prosthodontics, and their wear behavior is of paramount clinical interest. An innovative in vitro model is presented, which employs CAD/CAM technology to simulate the periodontal ligament and alveolar bone. The model aims to evaluate the effect of the abutment rigidity on the wear resistance of the LDS glass ceramic. Two experimental groups (LDS restorations supported by dental implants, named LDS-on-Implant, or by hybrid ceramic tooth replicas with artificial periodontal ligament, named LDS-on-Tooth-Replica) and a control group (LDS-Cylinders) were compared. Fifteen samples (n = 15) were fabricated for each group and subjected to testing, with LDS antagonistic cusps opposing them over 120,000 cycles using a dual axis chewing simulator. Wear resistance was analyzed by measuring the vertical wear depth (mm) and the volume loss (mm3) on each LDS sample, as well as the linear antagonist wear (mm) on LDS cusps. Mean values were calculated for LDS-Cylinders (0.186 mm, 0.322 mm3, 0.220 mm, respectively), LDS-on-Implant (0.128 mm, 0.166 mm3, 0.199 mm, respectively), and LDS-on-Tooth-Replica (0.098 mm, 0.107 mm3, 0.172 mm, respectively) and compared using one-way-ANOVA and Tukey's tests. The level of significance was set at 0.05 in all tests. Wear facets were inspected under a scanning electron microscope. Data analysis revealed that abutment rigidity was able to significantly affect the wear pattern of LDS, which seems to be more intense on rigid implant-abutment supports compared to resilient teeth replicas with artificial periodontal ligament.

Comparison of the clinical outcomes of resin-modified glass ionomer and self-adhesive resin cementations for full-coverage zirconia restorations

OBJECTIVES

Both resin-modified glass ionomer cement (RMGIC) and self-adhesive resin cement (SAC) may be suitable for cementation of full-coverage zirconia restorations. This retrospective study aimed to investigate the clinical outcomes of zirconia-based restorations cemented with RMGIC and compare them with those cemented with SAC.

METHODS

Cases of full-coverage zirconia-based restorations cemented with either RMGIC or SAC between March 2016 and February 2019 were evaluated in this study. The clinical outcomes of the restorations were analyzed according to the type of cement used. In addition, cumulative success and survival rates were evaluated according to the cement and abutment types. Non-inferiority, Kaplan-Meier, and Cox hazard tests were conducted (α=.05).

RESULTS

A total of 288 full-coverage zirconia-based restorations (natural teeth, 157; implant restorations, 131) were analyzed. Loss of retention occurred in only one case; a single-unit implant crown cemented with RMGIC, which decemented 4.25 years post-restoration. RMGIC was non-inferior to SAC in terms of loss of retention (<5%). For single-unit natural tooth restorations, the four-year success rates in the RMGIC and SAC groups were 100% and 95.65%, respectively (p=.122). For single-unit implant restorations, the four-year success rates in the RMGIC and SAC groups were 95.66% and 100%, respectively (p=.365). The hazard ratios of all the predictor variables, including cement type, were not significant (p>.05).

CONCLUSIONS

Cementation of full-coverage zirconia restorations of both natural teeth and implants using RMGIC and SAC yields satisfactory clinical outcomes. Furthermore, RMGIC is non-inferior to SAC in terms of cementation success.

CLINICAL SIGNIFICANCE

Cementation with RMGIC or SAC for full-coverage zirconia restorations has favorable clinical outcomes in both natural teeth and implants. Both RMGIC and SAC have advantages in the cementation of full-coverage zirconia restorations to abutments with favorable geometries.

Stress distribution in pediatric zirconia crowns depending on different tooth preparation and cement type: a finite element analysis

BACKGROUND

In clinical settings, tooth preparation for prefabricated zirconia crowns (PZCs) in the primary dentition varies widely. However, knowledge about the biomechanical behavior of PZCs in various clinical settings is limited. This study was conducted to evaluate the biomechanical behavior of PZCs in different clinical settings using 3-dimensional finite element analysis.

METHODS

3-dimensional models of the PZC, cement, and tooth with six different conditions were simulated in primary molar teeth, incorporating cement thickness (100, 500, and 1000 μm) and cement type (resin-modified glass ionomer cement and resin cement). A total of 200 N of occlusal force was applied to the models, both vertically and obliquely as representative cases. A general linear model univariate analysis with partial eta-squared (ηp²) was performed to evaluate the relative effects of the variables.

RESULTS

The overall stress of tooth was increased as the cement space increases under oblique loading. The von Mises stress values of the resin cements were significantly higher than those of the resin-modified glass ionomer cements for all cement thicknesses (p < .05). The effect size of the cement type (η_p² = .519) was more dominant than the cement thickness (η_p² = .132) in the cement layer.

CONCLUSIONS

Within the limits of this study, cement type has a greater influence on the biomechanical behavior of PZCs than cement thickness.

Wear Properties of Conventional and High-Translucent Zirconia-Based Materials

This study investigated the two-body wear resistance of a first generation 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP), a second generation 3Y-TZP, a third generation 4 mol% yttria partially stabilized zirconia (4Y-PSZ), a 5 mol% yttria partially stabilized zirconia (5Y-PSZ), and a type III gold alloy (Aurocast 8), performed using opposing antagonistic cusps made out of the same material. Eight cylindrical specimens were prepared for each material (n = 8) for a total of forty specimens (N = 40). Conical cusps were fabricated for each material. Each cylinder−cusp pair was arranged inside a two-axis chewing simulator over up to 360,000 loading cycles. The wear resistance was analyzed by measuring the vertical substance loss (mm) and the volume loss (mm3). The antagonist wear (mm) was recorded before and after the wear test to evaluate the linear difference. Statistical analysis was performed using one-way analysis of variance (ANOVA); multiple comparisons were performed according to Tukey’s method. No statistically significant differences (p > 0.05) among the first generation 3Y-TZP, second generation 3Y-TZP, and 4Y-PSZ wear were found. 5Y-PSZ showed statistically significant higher wear compared to other the zirconias. Aurocast 8 displayed the highest values in terms of vertical wear, antagonist cusp wear, and volumetric loss. Although still not statistically comparable, the wear behavior of the latest 5Y-PSZ was the closest to the widely recognized gold standard represented by the type III gold alloy.

Effect of restoration material on marginal bone resorption around modified anatomic zirconia dental implants: A randomised controlled trial

Objective

The primary aim of this study was to determine the effect of implant-supported porcelain-fused-to-metal (PFM) and indirect-composite-resin (ICR) fixed dental prostheses on peri-implant marginal bone resorption (MBR) in custom-made anatomic modified zirconia dental implants.

Methods

A prospective randomized controlled clinical trial was conducted. Participants with premolars indicated for dental extractions were recruited into this study to receive a single-unit implant-supported fixed dental prosthesis. Modified anatomic zirconia implants with thorny-retentive surfaces were placed and loaded randomly after 3 months with either PFM or ICR crowns. Participants were recalled after 12 and 18 months for radiographic evaluation of peri-implant MBR. Implants survival was also reported.

Results

18 out of 20 zirconia implants were included in all study phases. 18-month survival rate was 90%. After 12 months of implant placement, the mean MBR values were 0.53 (±0.21) mm and 0.60 (±0.14) mm in the ICR group compared to 0.67 (±0.16) mm and 0.61 (±0.27) mm in the PFM group. In the 18-month follow-up, the mean MBR values were 0.61 (±0.27) and 0.67 (±0.16) mm in the ICR group compared to 0.77 (±0.29) and 0.77 (±0.27) mm in the PFM group. No significant differences were found in MBR mean values between study groups at 12- and 18-month follow-up points.

Conclusion

This study showed that PFM and ICR crowns were viable zirconia-implant-supported restorations with no preference regarding MBR after 18 months. Nevertheless, long-term evaluations are warranted.

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Custom-made zirconia implants with new design of their macro-retentive features (thorns) were used in this clinical study.

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They showed success rate of 90% with all failures occurred early before loading.

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Peri-implant marginal bone resorption (MBR) ranged within acceptable values after 12 and 18 months.

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No significant differences in MBRs were seen between implant-supported metal-ceramic and indirect composite restorations.

Do Chemical-Based Bonding Techniques Affect the Bond Strength Stability to Cubic Zirconia?

This study evaluated the effectiveness of chemical-based adhesive techniques on promoting immediate and aged bond strength between zirconia and luting cement. A total of 128 discs of zirconia were divided into 4 groups (n = 32) according to the adhesive treatment: tribochemical silica-coating followed by silane (Silane Primer, Kerr) and bonding (Optibond FL, Kerr), Signum Zirconia Bond (Hereaus), Z-Prime Plus (Bisco), and All-Bond Universal (Bisco). Composite cylinders were cemented on the zirconia sample with Duo-Link Universal (Bisco). Eight specimens per group were subjected to 10,000 thermocycles and subsequently bond strength was tested with shear-bond strength test. ANOVA test showed that artificial aging significantly affected the bond strength to zirconia. Bonferroni test highlighted a significant influence of adhesive treatment (Signum) on bond strength after thermocycling. It was concluded that 10-MDP-based bonding systems showed no improvement in initial bond strength compared with tribochemical treatment. All chemical bonding techniques tested in this study were influenced by thermocycling.