Influence of Resin Cement Thickness and Elastic Modulus on the Stress Distribution of Zirconium Dioxide Inlay-Bridge: 3D Finite Element Analysis

Fiber-reinforced composite or zirconia in cantilever fixed dental prosthesis? 36-month follow-up clinical study

OBJECTIVES

This clinical study evaluated the survival rate of different designs of single-retainer inlay-retained fixed dental prostheses (IR-FDPs) made from monolithic zirconia (Z) and fiber-reinforced composite (FRC).

METHODS

A total of 40 IR-FDPs (n = 40) were placed for 32 female patients who presented with missing mandibular second premolar teeth. In the current study, the mandibular first molar was selected as a retainer for the cantilever IR-FDPs. The participants were randomly divided into two groups (n = 20) according to the design: lingual coverage (LC) and occlusal coverage (OC). Each group was then divided according to the material used (n = 10 Z and n = 10 FRC). All restorations were bonded with adhesive resin cement and evaluated clinically and radiographically for 36 months following modified FDI (World Dental Federation) criteria. Statistical analysis was conducted using Monte Carlo and the Student (Cochran Q) tests.

RESULTS

All restorations showed non-significant differences (P > 0.05) regarding the clinical behavior with satisfactory final aesthetic, functional, and biological results based on the criteria of modified FDI scores. Over a 36-month observation period, one restoration that belonged to group OC-Z fractured at the connector after 30 months and was replaced. Only one restoration in group LC-Z was debonded after 10 months and re-bonded, and one abutment in group LC-FRC was endodontically treated after 12 months.

CONCLUSIONS

Zirconia and FRC cantilever IR-FDPs demonstrated high survival (97.5 %) and success (96.6 %) rates over 36 months, offering a minimally invasive solution for posterior tooth replacement with improved aesthetics and function.

CLINICAL SIGNIFICANCE

Lingual and occlusal coverage designs significantly enhance the strength and longevity of cantilever IR-FDPs while offering a reliable, minimally invasive solution with function, durability, and aesthetics. These designs effectively withstand occlusal forces when the cantilever pontic has a contact point.

Characteristic Evaluation and Finite Element Analysis of a New Glass Fiber Post Based on Bio-Derived Polybenzoxazine

A new type of glass fiber (GF)-reinforced bio-derived polybenzoxazine (GF/bio-derived PBz) composites suitable for dental post applications was developed. The study assessed the effects of different quantities of GF on the mechanical and thermal characteristics, thermal stability, and flame resistance of the composite samples. Additionally, the feasibility of using GF/bio-derived PBz composites for dental posts was analyzed through finite element analysis (FEA). The stress distribution in a tooth model repaired with the newly developed GF/bio-derived PBz composite posts under oblique loads was compared to models repaired with conventional glass fiber post and gold alloy post. The incorporation of GFs significantly enhanced the flexural properties, thermal stability, and flame resistance of the composite samples, while also reducing thermal expansion in a manner that closely matched that of dentin. The FEA of a tooth model repaired with a composite post derived from GF/bio-based PBz revealed a stress distribution pattern comparable to that of a tooth model repaired using a conventional glass fiber post. Considering the composite's mechanical properties, thermal stability, flame resistance, and its suitability for dental fiber posts as demonstrated by the FEA, the GF/bio-derived PBz holds significant promise for use in dental fiber post applications.

Influence of Deep Margin Elevation Technique With Two Restorative Materials on Stress Distribution of e.max Endocrown Restorations: A Finite Element Analysis

Objective: The impact of the deep margin elevation (DME) technique and its associated materials on the stress distribution in ceramic endocrowns remains to be fully understood. This finite element analysis (FEA) aimed to assess the effects of flowable composite and resin-modified glass ionomer (RMGI) as DME materials on the maximum Von Mises stress (VMS) values and overall stress distribution within ceramic endocrowns and the surrounding tooth structure. Materials and Methods: A mandibular molar featuring a class II mesio occlusal (MO) cavity with the gingival margin of the mesial cavity positioned 2 mm below the cementoenamel junction (CEJ) was prepared and scanned using a Medit i500 scanner. The digital file was then transferred to computer-aided design (CAD) software to create the models. The study generated four scenarios: an intact tooth model (model of intact tooth (MIT)), a prepared tooth model without a DME layer (model without DME (MWD)), a model with a 2 mm DME layer using composite material (model with DME of composite (MDC)), and a model employing RMGI (model with DME of RMGI (MDR)). Stress distribution under axial loads was evaluated based on the Von Mises criterion. Results: The MIT model demonstrated the highest stress concentration at the CEJ region yet exhibited lower stress levels than others. The MWD model showed the highest stress levels. No significant differences in stress distribution patterns were observed between the MDR and MDC models. All models displayed similar stress distributions in the bone. Conclusion: Regardless of the material used, incorporating a DME layer in cavities extending below the CEJ is advisable to achieve uniform stress distribution. Minimizing tooth preparation and preserving tooth structure are recommended. Clinical Significance: Employing a DME layer in cavities with margins below the CEJ is beneficial for reducing stress, irrespective of the material choice.

The effects of optimized microstructured surfaces on bond strength and durability of NPJ-printed zirconia

OBJECTIVES

This study was to investigate the effects of optimized microstructured surfaces on bond strength and bond durability of the latest nanoparticle jetting (NPJ)-printed zirconia.

METHODS

Zirconia microstructured surfaces with different geometries and void volume were analyzed through three-dimensional finite element analysis for surface micromorphology optimization. Zirconia disks and cylinders were additively manufactured by an NPJ 3D printer (N = 128). They were randomly divided into four groups based on surface micromorphology optimization and airborne-particle abrasion (APA) treatment before they were bonded using 10-methacryloloxydecyl dihydrogen phosphate (MDP) containing resin cement (Clearfil SA luting cement). The shear bond strengths (SBSs) were tested before and after 10,000 thermocycles and were analyzed by one-way ANOVA analysis. Failure modes were determined by optical microscopy. Zirconia surfaces were analyzed with X-ray diffraction, scanning electron microscopy, and three-dimensional interference microscopy.

RESULTS

The optimized microstructured surface was characterized by circular microstructures with 60 % void volume, about 20 µm of depths, about 10 µm of undercuts, and consistent beam widths. The optimized microstructured surface combined with APA treatment and MDP-containing resin cement possessed the highest SBSs both before and after thermocycling aging (P＜0.05). The greater reductions of zirconia bond strengths occurred when the zirconia were not treated with APA (P＜0.05).

SIGNIFICANCE

The optimized microstructured zirconia surface with circular microstructures and 60 % void volume fabricated by the latest NPJ printing technology could greatly enhance the zirconia bond strength and durability in combination with APA treatment and application of MDP-containing resin cement, which might be promising for adhesively bonded indirect restorations of NPJ-printed zirconia.

Zirconia single retainer fixed dental prostheses for the posterior region-A novel preparation technique and literature review

The principles of tissue preservation, minimally invasiveness and approaching different clinical situations biologically rather than surgically govern today's dentistry. Thus, different clinical scenarios require procedures that offer the dentist and the patient the possibility to choose the more invasive treatment options later in life. Subsequently, the case reported refers to a minimally invasive technique that treats single tooth edentulism using single partial retainer FDPs fabricated from monolithic zirconia. This approach is conservative, biocompatible, aesthetic, strong, rapidly obtained through CAD/CAM techniques and cost-effective.

Effect of different preparation designs and material types on fracture resistance of minimally invasive posterior indirect adhesive restorations

PURPOSE

To evaluate the impact of various preparation designs and the material type on fracture resistance of minimally invasive posterior indirect adhesive restorations after aging using a digital standardization method.

MATERIALS AND METHODS

One-hundred sixty human maxillary premolars free from caries were assigned into 16 groups (n = 10): bevel design on enamel substrate with mesial box only (VEM), butt joint design on enamel substrate with mesial box only (BEM), bevel design on enamel substrate with mesial and distal box (VED), butt joint design on enamel substrate with mesial and distal box (BED), bevel design on dentin substrate with mesial box only (VDM), butt joint design on dentin substrate with mesial box only (BDM), bevel design on dentin substrate with mesial and distal box (VDD), and butt joint design on dentin substrate with mesial and distal box (BDD). Each group was restored with pressable lithium disilicate (LS2) or disperse-filled polymer composite (DPC) materials. Adhesive resin cement was used to bond the restorations. The specimens were aged for 10,000 thermal cycles (5°C and 55°C), then 240,000 chewing cycles. Each specimen was subjected to compressive axial load until failure. A two-way analysis of variance (ANOVA) test followed by a post hoc Tukey test was used to analyze the data (α = 0.05).

RESULTS

The two-way ANOVA test revealed a significant difference among designs (p < 0.001) and materials (p < 0.001) with no interaction effect (p = 0.07) between the variables. The Post hoc Tukey test revealed that the VEM group exhibited the highest mean fracture resistance value, while the BDM group had the lowest. The LS2 groups showed the highest mean fracture resistance values. The DPC groups showed a restorable fracture pattern compared to the LS2 groups.

CONCLUSIONS

Bevel and butt joint designs with mesial or distal boxes are recommended for conservative posterior indirect adhesive restorations in premolar areas. Enamel substrate improved load distribution and fracture resistance. DPCs have restorable failure patterns, while pressed LS2 may harm underlying structures.

Material properties and finite element analysis of adhesive cements used for zirconia crowns on dental implants

This study aimed to evaluate the material properties of four dental cements, analyze the stress distribution on the cement layer under various loading conditions, and perform failure analysis on the fractured specimens retrieved from mechanical tests. Microhardness indentation testing is used to measure material hardness microscopically with a diamond indenter. The hardness and elastic moduli of three self-adhesive resin cements (SARC), namely, DEN CEM (DENTEX, Changchun, China), Denali (Glidewell Laboratories, CA, USA), and Glidewell Experimental SARC (GES-Glidewell Laboratories, CA, USA), and a resin-modified glass ionomer (RMGI-Glidewell Laboratories, CA, USA) cement, were measured using microhardness indentation. These values were used in the subsequent Finite Element Analysis (FEA) to analyze the von Mises stress distribution on the cement layer of a 3D implant model constructed in SOLIDWORKS under different mechanical forces. Failure analysis was performed on the fractured specimens retrieved from prior mechanical tests. All the cements, except Denali, had elastic moduli comparable to dentin (8-15 GPa). RMGI with primer and GES cements exhibited the lowest von Mises stresses under tensile and compressive loads. Stress distribution under tensile and compressive loads correlated well with experimental tests, unlike oblique loads. Failure analysis revealed that damages on the abutment and screw vary significantly with loading direction. GES and RMGI cement with primer (Glidewell Laboratories, CA, USA) may be suitable options for cement-retained zirconia crowns on titanium abutments. Adding fillets to the screw thread crests can potentially reduce the extent of the damage under load.

Influence of retainer design and number of inlay boxes on the biomechanical behavior of zirconia cantilever resin bonded fixed dental prosthesis

OBJECTIVES

The development of dental adhesives with enhanced bond strength has assisted minimally invasive dentistry. The aim of this study was to evaluate the fracture load and stress distribution pattern of two retainer designs for posterior cantilever resin bonded fixed dental protheses (RBFDPs).

MATERIALS AND METHODS

Forty human mandibular molars were divided into two groups according to the retainer design; lingual coverage (LC) and occlusal coverage (OC) retainers. Each main group was then divided according to the number of inlay boxes (n = 10); one inlay and two inlay boxes. High translucency (3Y) zirconia was used to manufacture all restorations, and a dual-polymerizing adhesive resin cement was used for bonding. All specimens underwent 10,000 cycles of thermocycling (5-55°C), 240,000 cycles of dynamic loading (50 N, descending speed v = 30 mm/second, frequency = 1.6 Hz), and failure load test. Both one-way and two-way ANOVA tests were used to analyze the data. The four models included in the in-vitro study are part of the finite element analysis (FEA). When the restorations failed, maximal principal stress values on restorations, enamel, dentin, and luting resin were investigated.

RESULTS

A statistically significant (p = 0.018) higher failure load was recorded for OC1 (627.00 ± 153.4 N) than the other groups; (548.0 ± 75.6 N, 521.20 ± 11.3 N, and 509.20 ± 14.9 N for LC1, LC2, and OC2, respectively). With regard to failure mode, one inlay box designs showed more favorable failure pattern than those of two inlay boxes. FEA showed higher stress magnitude transmitted to the tooth structure in models LC2 and OC2.

CONCLUSIONS

Lingual coverage and occlusal coverage retainers are promising designs capable to withstand the normal occlusal force for cantilever RBFDP in premolar area. The use of two inlay boxes decreased the fracture load of the two retainer designs and increased the stress transmitted to the tooth and resulted in high incidence of catastrophic failure.

CLINICAL SIGNIFICANCE

Monolithic high translucent zirconia RBFDP could be considered as a viable treatment option to substitute missing posterior tooth, with improved esthetics and biocompatibility.

Cantilever resin-bonded fixed dental prosthesis to substitute a single premolar: Impact of retainer design and ceramic material after dynamic loading

PURPOSE

To evaluate the influence of retainer design and ceramic materials on the durability of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging.

METHODS

One hundred caries-free human mandibular molars were prepared as abutments for all-ceramic cantilevered fixed dental prostheses using the following retainer designs: One wing (OW), Two wings (TW), Inlay ring (IR), Lingual coverage (LC), and Occlusal coverage (OC). Two ceramic materials were used: monolithic high translucent zirconia(z) and zirconia-reinforced lithium disilicate (ZLS2) (n=10). All restorations were adhesively bonded with resin cement. The thermocycling of the specimens were performed between 5°C and 55°C for 10,000 cycles and then exposed to 240.000 cycles of dynamic loading on a chewing simulator. All surviving specimens were loaded onto the pontic until failure using a universal testing machine.

RESULTS

The mean failure load ranged from 124.00 to 627.00 N for the zirconia groups and from 133.30 to 230.00 N for the ZLS2 groups. Regarding the materials, a significantly higher failure load was recorded in the zirconia groups than in the ZLS2 groups (P<0.001), except for OW (P=0.748). Regarding the retainer designs, a significant different failure load was recorded between the different designs except for IR and LC in the zirconia groups, IR and OC, OW and TW, and TW and LC in the ZLS2 groups (P<0.001).

CONCLUSIONS

Zirconia IR, LC, and OC can be used as cantilever RBFDP in the premolar region. The fracture resistance of the ZLS2 design was below the normal bite force and should not be recommended as the first option.

Evaluation of different designs for posterior cantilever zirconia inlay-retained fixed dental prostheses in missing tooth replacement: Stage one results with 18-month follow-up assessment

OBJECTIVES

This clinical study aimed to investigate the outcomes and survival rates of different variations of inlay-retained fixed dental prostheses (IR-FDPs) composed of monolithic zirconia ceramic. The IR-FDPs with a single-retainer design were used for replacing missing mandibular second premolars. The research evaluated the effectiveness and longevity of these prostheses in clinical settings.

METHODS

A total of 30 IR-FDPs (n = 30) were placed for 27 female patients who presented with missing mandibular second premolar teeth. For this study, the mandibular first molar was chosen as a retainer for the cantilever IR-FDPs and the study involved a random assignment of participants into three distinct groups, each comprising 10 individuals (n = 10). The criterion for the grouping was the retainer design: inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC). The three groups included mesial inlay box with the same dimensions (3 mm height, 3 mm width and 2 mm depth). All IR-FDPs were manufactured using monolithic high translucent 3Y zirconia and the connector area to the cantilever pontic was adjusted to dimensions of 3 × 3 mm for all designs. The restorations were bonded using adhesive resin cement. The clinical and radiographic evaluations of the restorations were conducted for a duration of 18 months, following the modified FDI (World Dental Federation) criteria.

RESULTS

The restorations were observed in stage one for a period of 18 months. Only one restoration in group LC was debonded after 10 months and re-bonded. The clinical quality of all crowns and the patient's satisfaction were high. No adverse soft tissue reactions around the crowns were observed and only one abutment in group IR was endodontically treated after 12 months.

CONCLUSIONS

Zirconia cantilever IR-FDPs offer a viable short-term treatment option for replacing missing posterior teeth, providing esthetic and functional benefits while minimizing invasiveness. Over an 18-month observation period, these prostheses have demonstrated a remarkable survival rate of 100% and a success rate of 96.6%. These findings suggest the effectiveness and reliability of zirconia cantilever IR-FDPs as a short-term solution for replacing missing posterior teeth.

CLINICAL SIGNIFICANCE

Zirconia cantilever IR-FDPs could present a practical solution for addressing posterior tooth loss, especially in cases where implant placement is not recommended and conventional fixed dental prostheses entail excessive invasiveness.

Biomechanical behavior of posterior metal-free cantilever fixed dental prostheses: effect of material and retainer design

OBJECTIVE

To study the fracture resistance and stress distribution pattern of translucent zirconia and fiber-reinforced composite cantilever resin-bonded fixed dental prostheses (RPFDPs) with two retainer designs.

MATERIALS AND METHODS

Forty human mandibular molars were divided into two groups according to the retainer design. The restorations included a premolar pontic and 2 retainer designs: (D1) inlay ring retainer and (D2) lingual coverage retainer. Each main group was then divided according to the material used (n = 10): zirconia (Z) or fiber-reinforced composite (FRC) (F). Restorations were cemented using dual polymerizing adhesive luting resin. All specimens were thermo-cycled (5-55 °C for 10,000 cycles), then subjected to dynamic loading (50 N, 240,000, and 1.6 Hz) and fracture resistance test. The finite element analysis includes the two models of retainer designs used in the in vitro test. Modified von Mises stress values on enamel, dentin, luting resin, and restorations were examined when the restorations failed.

RESULTS

A significantly higher failure load was recorded for zirconia groups (505.00 ± 61.50 and 548.00 ± 75.63 N for D1Z and D2Z, respectively) than for FRC groups (345.00 ± 42.33 and 375.10 ± 53.62 N for D1F and D2F, respectively) (P = 0.001). With regard to failure mode, D2 showed a more favorable failure pattern than D1. Model D2 resulted in lower stresses in tooth structure than model D1, and zirconia transmitted more stresses to the tooth structure than FRC.

CONCLUSIONS

The lingual coverage retainer (D2) enhanced the biomechanical performance of the restoration/tooth complex. Considering the failure mode and tooth stress, FRC is a promising treatment option when constructing a cantilever RPFDP.

CLINICAL RELEVANCE

Dentists should be aware of the biomechanical behavior during the selection of the material and for the replacement of a single missing mandibular premolar tooth with minimally invasive RBFDP.

Effect of different designs of minimally invasive cantilever resin-bonded fixed dental prostheses replacing mandibular premolar: Long-term fracture load and 3D finite element analysis

PURPOSE

To evaluate the fracture load and stress magnitude of different retainer designs of minimally invasive cantilever resin-bonded fixed dental prostheses (RBFDPs) after artificial aging.

MATERIALS AND METHODS

Fifty caries-free human mandibular molars were prepared as abutments for cantilever fixed dental prostheses using different retainer designs: one wing (OW), two wings (TW), inlay ring (IR), lingual coverage (LC), and occlusal coverage (OC). Computer-aided design and computer-aided manufacturing were used for milling the RBFDPs using fiber-reinforced composite (FRC), and the restorations were adhesively bonded. The specimens were then subjected to thermomechanical aging and loaded until failure. The 3D finite element analysis (FEA) was performed with five models of retainer designs similar to the in vitro test. Modified von Mises stress values on enamel, dentine, luting resin, and restorations were examined. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (p < 0.001).

RESULTS

A statistically significant difference (p < 0.001) was found between all groups except between IR and LC and between OW and TW designs, with the highest mean failure load detected for OC (534.70 N) and the lowest detected for OW (129.80 N). With regard to failure mode, OW, TW, and LC showed more incidences of favorable failure patterns than IR and OC designs. FEA showed that FRC transmitted low stresses in tooth structure and high stresses to the luting resin.

CONCLUSIONS

LC and OC designs can be used to design cantilever RBFDPs in premolar area. IR design transmitted more stresses to the tooth structure and resulted in 30% catastrophic failure. OW and TW were below the normal occlusal force and should be carefully used.

Effect of resin cement elastic modulus on the biaxial flexural strength and structural reliability of an ultra-thin lithium disilicate glass-ceramic material

OBJECTIVES

Photo- and dual-polymerized resin-based luting agent was evaluated for elastic moduli effects on ultra-thin lithium disilicate (LD) glass-ceramic strengthening, structural reliability, and stress distribution.

MATERIALS AND METHODS

One hundred-sixty LD discs (IPS e.max CAD, Ivoclar/Vivadent) were produced in ultra-thin thicknesses (half with 0.3 mm and the other half with 0.5 mm). The ultra-thin ceramic disks were coated with two different cement types (Variolink Veneer - V and Panavia F 2.0 - P). Two positive control groups were tested following hydrofluoric (HF) acid etching (LDt3, LDt5) and two negative control groups were tested for untreated ceramic (LD 3, LD 5). Biaxial flexural strength (BFS), characteristic strength (σ0) and Weibull modulus (m) were the response variables (n = 20) at the ceramic/resin cement interface (z = 0). Finite element analysis (FEA) was used to calculate maximum principal stress. Data were analyzed using two-way ANOVA, and Tukey's test. Scanning electron microscopy (SEM) was used to analyze the failed specimens using fractography and surface morphology.

RESULTS

The BFS of LD at either thickness was not affected by cement types, as also demonstrated by FEA. Structural reliability significantly improved in the positive control group (LDt5).

CONCLUSION

The cementation of ultra-thin LD with a resin-cement of varying elastic moduli did not influence BFS. LD surface modification by HF acid-etching increased the reliability.

CLINICAL RELEVANCE

Ultra-thin anterior veneer designs made from lithium disilicate have been widely proposed and the apparent success of LD ultra-thin veneers was not influenced by the cement choice in the current studies albeit the elastic moduli luting agents used were of similar values.

Three-Dimensional Finite Element Analysis of Worn Molars With Prosthetic Crowns and Onlays Made of Various Materials

Background/Purpose

Restoration of worn teeth represents a challenge for practitioners in terms of preserving dental tissues, achieving restoration requirements, and choosing the most appropriate material. This study aimed to evaluate the effect of both preparation and restoration type on stress distribution in modeled first mandibular molars when functional and parafunctional occlusal forces were applied.

Materials and methods

The study sample consisted of 40 three-dimensional computer models of restored lower first molars with full crowns (gold, nickel-chrome, lithium disilicate, BruxZir® zirconia, and porcelain fused to metal) and onlays (gold, nickel, chrome, lithium disilicate, and direct and indirect composites). Forces of different intensities and directions were applied, and then finite element analysis was carried out based on the von Mises equivalent stress theory to predict the failure that could occur in the restoring materials and luting cement or bonding agent.

Results

In functional forces groups, zirconia crowns showed the lowest value of the failure risk, while the highest value was in veneering porcelain with values close to the rest of the models. For onlays, gold onlays represented the best stress distribution with the lowest value of the failure risk, in contrast to the composite onlays that had the highest failure risk. In parafunctional forces groups, the preference remained for zirconia and gold crowns, as well as for metal onlays, with greater differences in the values of the failure risk.

Conclusion

Gold alloy exhibited better behavior in the stress distribution. All restorations showed similar behavior when applying functional forces; however, when applying parafunctional forces, both gold and zirconia crowns have shown the best results.