Influence of Preparation Depth and Design on Stress Distribution in Maxillary Central Incisors Restored with Ceramic Veneers: A 3D Finite Element Analysis

Stress distribution on teeth restored with veneers using various incisal preparation designs: A 3D finite element analysis study

STATEMENT OF PROBLEM

The type of veneer preparation is often chosen according to the patient's tooth structure and occlusion. Taking biomechanics into account in this decision-making process provides the clinician with more technical information on how to improve the clinical longevity of restorations. However, biomechanical analyses of veneer preparation designs are sparse.

PURPOSE

The purpose of this 3-dimensional (3D) finite element analysis with microcomputed tomography (µCT) data obtained from realistic models was to assess the influence of different preparations for ceramic and composite resin veneers on restoration and resin layer stress distribution.

MATERIAL AND METHODS

Four replicas of a central incisor were printed and prepared for laminate veneers with 4 different incisal edge designs: shoulder (SH), palatal chamfer (PC), palatal chamfer and oblique fracture involving the distal angle (OF-PC), and palatal chamfer involving horizontal incisal fracture (IF-PC). After fabrication and cementation of the veneers, the restored replicas were assessed with µCT, and 3D finite element models were built. A 100-N load was applied on the palatal surface at 60 and 125 degrees relative to the longitudinal axis. Maximum principal stress and stress distribution on the veneers, cement layer, and tooth structure were calculated and analyzed.

RESULTS

The SH preparation exhibited better stress distribution than the PC preparation, and the cement layer and the veneer were subjected to lower stress. The IF-PC preparation had better stress distribution than the OF-PC. The shoulder and IF-PC showed higher stress on laminate veneers, but lower stress on the cement layer. Ceramic veneers exhibited lower stress than composite resin veneers.

CONCLUSIONS

The different incisal preparations for laminate veneers influenced stress distribution on restorations and on the resin cement layer. The shoulder type preparation showed better stress distribution and the composite resin veneers showed unfavorable results compared with the ceramic veneers.

Effect of a modified laminate veneer preparation design on absolute margin discrepancy and marginal overhang

STATEMENT OF PROBLEM

Veneer preparation designs impact veneer accuracy. However, whether a modified design could reduce absolute margin discrepancy and marginal overhangs is unclear.

PURPOSE

The purpose of this in vitro study was to investigate whether a modified veneer preparation design enhances the absolute margin discrepancy and marginal overhang.

MATERIAL AND METHODS

The absolute margin discrepancy and the marginal overhang of 3 different veneer preparation designs on a typodont tooth (n=20): feather edge, shoulder, and shoulder with wings were measured. The feather edge design was prepared first and subsequently modified to create the shoulder and shoulder with wings preparations. Ceramic veneers were fabricated using computer-aided design and computer-aided manufacture with each veneer assessed for fit before cementation. Ten specimens were cut vertically, and 10 were cut horizontally in each group. The absolute margin discrepancy and marginal overhangs were measured for each cross-section with scanning electron microscopy. Descriptive data analysis and hypothesis testing were conducted using the nonparametric Kruskal Wallis test (α=.05).

RESULTS

On the vertical sections, the shoulder with wings preparation had the best absolute margin discrepancy and overhang. The design was also best for mesial overhang and mesial absolute margin discrepancy when measuring horizontally.

CONCLUSIONS

The shoulder with wings preparation design produced the smallest cervical absolute margin discrepancy and overhang. This design also produced absolute margin discrepancy and overhangs comparable with those of the shoulder design in the proximal areas.

The Influence of a Novel, Crenelated Design of CAD-CAM Ceramic Veneers on the Debonding Strength

(1) Background: Aesthetic dentistry has become one of the most dynamic fields in modern dental medicine. Ceramic veneers represent the most appropriate prosthetic restorations for smile enhancement, due to their minimal invasiveness and highly natural appearance. For long-term clinical success, accurate design of both tooth preparation and ceramic veneers is of paramount importance. The aims of this in vitro study were to assess the stress in anterior teeth restored with Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) ceramic veneers and compare the resistance to detachment and the fracture of ceramic veneers prepared using two different designs. (2) Methods: Sixteen lithium disilicate ceramic veneers were designed and milled using the CAD-CAM technology and divided into two groups according to the preparations (n = 8): Group 1, conventional (CO), with linear marginal contour and Group 2, crenelated (CR), the latter with our novel (patented) sinusoidal marginal design. All samples were bonded to anterior natural teeth. The mechanical resistance to detachment and fracture was investigated by applying bending forces on the incisal margin of the veneers in order to determine which type of preparation leads to better adhesion. An analytic method was employed, as well, and the results of the two approaches were compared. (3) Results: The mean values of the maximum force recorded at the veneer detachment were 78.82 ± 16.55 N for the CO group and 90.20 ± 29.81 N for the CR group. The relative increase, equal to 14.43%, demonstrated that the novel CR tooth preparation provided higher adhesive joints. In order to determine the stress distribution within the adhesive layer, a finite element analysis (FEA) was performed. The statistical t-test showed that the mean value of the maximum normal stresses is higher for the CR-type preparations. (4) Conclusions: The patented CR veneers represent a practical solution to augment the adhesion and mechanical properties of ceramic veneers. The obtained results demonstrated that CR adhesive joints triggered higher mechanical and adhesive forces, which subsequently led to a higher resistance to detachment and fracture.

Thickness and yttria percentage influences the fracture resistance of laminate veneer zirconia restorations

OBJECTIVES

Mechanical properties are cardinal for the long-term clinical success of laminate veneer restorations but the selection of new restorative materials should ideally be based on clinical evidence, therefore, in vitro testing of dental materials is a good alternative to evaluate their properties and understand their behavior so this study aimed to compare and evaluate the effect of two different thicknesses and yttria percentage on the fracture resistance of laminate veneer zirconia restorations.

MATERIALS AND METHODS

Forty laminate veneer restoration prepared from partial sintering zirconia of 3Y (yttria), 5Y (yttria), combined 3Y&5Y (yttria), and lithium disilicate. Specimens were assigned into four main groups according to their percentage of yttria content (n = 10) and subgrouped into two thicknesses (0.5 mm thickness and 0.3 mm thickness) (n = 5) as follows: Group I, II, III, and IV (Group I for lithium disilicate (control), Group II for 3Y zirconia, Group III for 5Y zirconia, and Group IV for combined 3Y&5Y zirconia), each of them subdivided according to their thickness into two subgroups (n = 5 for each one) and resistance to fracture for each restoration was evaluated using a universal testing machine. Data were analyzed using a one-way analysis of variance and Duncan's tests at a 5% level of significance.

RESULTS

The thickness of laminate veneer restoration significantly affects the fracture resistance value of all type of laminate veneers restorations (fracture resistance mean value was highest for 0.5 mm thickness and lower for 0.3 mm thickness restorations) and yttria percentage significantly affect fracture resistance value of zirconia laminate veneer restorations (fracture resistance mean value was highest for 0.5 mm thickness of 3Y zirconia [865 N] and combined 3Y&5Y zirconia [846 N]).

CONCLUSIONS

Reducing the thickness of laminate zirconia veneer restorations to 0.3 mm reduces its fracture resistance and increasing yttria percentage had an adverse effect on fracture resistance of zirconia laminate veneer restorations.

Comparison of Two Types of Preparation for Laminate Veneer with Three Types of All-Ceramic Materials

OBJECTIVE

 The objective of this study was to compare types of veneer preparations and their combination with three materials.

MATERIALS AND METHODS

 Two finite element models were specially prepared used representing window and wrap around preparation for veneers. The "central incisor" tooth geometry was acquired using a laser scanner, and then its surface was adjusted to form a solid model prior to the removal of each preparation separately. Three materials (Lava Ultimate, IPS e-max, and Celtra) were tested in combination with the preparation type. Bone geometry was simplified as two coaxial cylinders in all models. Each model was subjected to two loading conditions of occlusion (edge-to-edge bite and normal bite).

STATISTICAL ANALYSIS AND RESULTS

 It was observed that cortical, cancellous bone, and periodontal ligament are insensitive to preparation or materials. Their stresses and deformation were within physiological limits. Significant changes appeared on the central incisor tooth structure, cement layer, and veneer layer stresses and deformations under loading cases.

CONCLUSIONS

 Edge-to-edge bite stresses are severe with window-type preparation, and normal bite did not show any critical values on tooth structure, cement layer, or veneer layer. Veneer layer finish line and its contact with the cement layer and tooth structure play a role in the loading transfer mechanism. Preparation type alters the values of stresses on tooth structure, cement, and veneer layers. With window preparation, extreme stresses appear at finish line, while stresses appear under the loading site with wrap around preparation. Veneer and cement layers withstand the load energy with wrap around preparation and reduce tooth structure stresses. Thus, the lifetime of veneer and cement layers might be longer with window preparation.

Comparative Evaluation of Stress Acting on Abutment, Bone, and Connector of Different Designs of Acid-Etched Resin-Bonded Fixed Partial Dentures: Finite Element Analysis

Background: Finite element analysis (FEA) is one of the best methods for evaluating the stress distribution of restorations, such as fixed partial dentures. The development of resin cement has transformed prosthesis bonding and retention properties. Resin-bonded fixed partial dentures (RBFPD) have been considered minimally invasive treatment options for the prosthetic rehabilitation of single missing teeth.

Objectives: The aim of this study was to evaluate the stress load and distribution in four different designs of acid-etched RBFPDs using FEA.

Materials and Methods: The designs included standard tooth preparation principles and additional features. The first premolar and first molar abutments replaced the missing second premolar. Designs 1, 2, 3, and 4 included (1) lingual wings and occlusal rests; (2) wings and proximal slices; (3) wings, rests, and grooves; and (4) wings, rests, grooves, and occlusal coverage. The prepared models were restored with RBFPDs. A load of 100 N was applied to the central groove of the pontic to simulate occlusal forces. The materials used in the models were considered to be isotropic, homogeneous, and linearly elastic. FEA was used to reveal stresses acting on the abutment, bone, and connector in all prosthesis designs.

Results: The stresses transmitted to the abutment and bones were lowest for design 3, using wings, rests, and grooves. The stresses acting on the connector were the weakest in design 2. The stresses transmitted to the abutment and bone were highest in designs 1 and 4. The stresses transmitted to the connector were highest in design 3.

Conclusion: The wings, rests, and grooves design is possibly the ideal and conservative tooth preparation design to receive a posterior RBFPD. This design transmits less stress to the abutments and less bone resorption in the FEA. It is most likely to be successful in the clinical provision and ensures the longevity of the prosthesis.

Biomechanical Evaluation and the Assisted 3D Printed Model in the Patient-Specific Preoperative Planning for Thoracic Spinal Tuberculosis: A Finite Element Analysis

Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability for the treatment of thoracic spinal tuberculosis. However, the process of selecting the appropriate spinal fixation method remains controversial, and preoperative biomechanical evaluation has not yet been investigated. In this study, we aimed to analyze the application of the assisted finite element analysis (FEA) and the three-dimensional (3D) printed model for the patient-specific preoperative planning of thoracic spinal tuberculosis. An adult patient with thoracic spinal tuberculosis was included. A finite element model of the T7−T11 thoracic spine segments was reconstructed to analyze the biomechanical effect of four different operative constructs. The von Mises stress values of the implants in the vertical axial load and flexion and extension conditions under a 400-N vertical axial pre-load and a 10-N⋅m moment were calculated and compared. A 3D printed model was used to describe and elucidate the patient’s condition and simulate the optimal surgical design. According to the biomechanical evaluation, the patient-specific preoperative surgical design was prepared for implementation. The anterior column, which was reconstructed with titanium alloy mesh and a bone graft with posterior fixation using seven pedicle screws (M+P) and performed at the T7–T11 level, decreased the von Mises stress placed on the right rod, T7 pedicle screw, and T11 pedicle. Moreover, the M+P evaded the left T9 screw without load bearing. The 3D printed model and preoperative surgical simulation enhanced the understanding of the patient’s condition and facilitated patient-specific preoperative planning. Good clinical results, including no complication of implants, negligible loss of the Cobb angle, and good bone fusion, were achieved using the M+P surgical design. In conclusion, M+P was recommended as the optimal method for preoperative planning since it enabled the preservation of the normal vertebra and prevented unnecessary internal fixation. Our study indicated that FEA and the assisted 3D printed model are tools that could be extremely useful and effective in the patient-specific preoperative planning for thoracic spinal tuberculosis, which can facilitate preoperative surgical simulation and biomechanical evaluation, as well as improve the understanding of the patient’s condition.

Management of Discolored Failure Root Canal-Treated Upper Lateral Incisor

Root canal treatment failure can be determined based on a patient’s complaint and on the basis of clinical examination and radiographic findings. Most of the signs and symptoms for the failure are pain and discomfort, swelling and sinus formation at the surrounding soft tissue, and discoloration of the subjected tooth. Factors such as mechanical perforation during the procedures, overfilled or underfilled root canal, and missed or unfilled canals are the main factors for the failure outcome. This case report presents a discolored and infected upper lateral incisor which was previously root canal treated. The tooth was successfully managed under nonsurgical and surgical retreatment followed by an internal bleaching and full porcelain veneer. Apical tissue healing and acceptable tooth appearance was observed during a 12-month review.