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Gierthmuehlen PC, Spitznagel FA, Koschate M, Bonfante EA, Prott LS. Influence of ceramic thickness and dental substrate on the survival rate and failure load of non-retentive occlusal veneers after fatigue. J ESTHET RESTOR DENT 2024; 36:373-380. [PMID: 37605963 DOI: 10.1111/jerd.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/26/2023] [Accepted: 06/27/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To investigate the effect of ceramic thickness and dental substrate (enamel vs. dentin/enamel) on the survival rate and failure load of non-retentive occlusal veneers. MATERIALS AND METHODS Human maxillary molars (n = 60) were divided into five test-groups (n = 12). The groups (named DE-1.5, DE-1.0, DE-0.5, E-1.0, E-0.5) differed in their dental substrate (E = enamel, DE = dentin/enamel) and restoration thickness (standard: 1.5 mm, thin: 1.0 mm, ultrathin: 0.5 mm). All teeth were prepared for non-retentive monolithic lithium-disilicate occlusal veneers (IPS e.max Press, Ivoclar). Restorations were adhesively cemented (Syntac Classic/Variolink II, Ivoclar) and exposed to thermomechanical fatigue (1.2 million cycles, 1.6 Hz, 49 N/ 5-55°C). Single load to failure was performed using a universal testing-machine. A linear-regression model was applied, pairwise comparisons used the Student-Newman-Keuls method (p < 0.05). RESULTS Three dentin-based occlusal veneers (one DE-1.0, two DE-0.5) revealed cracks after fatigue exposure, which corresponds to an overall-survival rate of 95%. Load to failure resulted in the following ranking: 2142 N(DE-0.5) > 2105 N(E-1.0) > 2075 N(E-0.5) > 1440 N(DE-1.5) > 1430 N(DE-1.0). Thin (E-1.0) and ultrathin enamel-based occlusal veneers (E-0.5) revealed high failure loads and surpassed the standard thickness dentin-based veneers (DE-1.5) significantly (p = 0.044, p = 0.022). CONCLUSION All tested monolithic lithium disilicate occlusal veneers obtained failure loads above physiological chewing forces. Thin and ultrathin enamel-based occlusal veneers outperformed the standard thick dentin-based occlusal veneers. CLINICAL SIGNIFICANCE Minimally invasive enamel-based occlusal veneer restorations with non-retentive preparation design may serve as a conservative treatment option.
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Affiliation(s)
- Petra C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Frank A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - Lea S Prott
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Pala K, Reinshagen EM, Attin T, Hüsler J, Jung RE, Ioannidis A. Masking capacity of minimally invasive lithium disilicate restorations on discolored teeth-The impact of ceramic thickness, the material's translucency, and the cement color. J ESTHET RESTOR DENT 2024; 36:107-115. [PMID: 37933738 DOI: 10.1111/jerd.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate minimally invasive restorations' capacity to mask discolored teeth and explore the impact of ceramic thickness, translucency, and cement color. MATERIALS AND METHODS Twenty-four assessment pairs of naturally colored and discolored bovine dentin samples were formed, using lithium disilicate specimens in six different thicknesses (0.3-0.8 mm), two different translucencies (high, low), and two cements (transparent, tooth-colored). Evaluators assessed the color differences in each assessment pair, and the threshold for detecting a color difference was determined using sequential testing and the Bonferroni-Holm method. RESULTS A thickness of 0.6 mm effectively masked color differences using high translucent ceramic with transparent cement, detectable differences were still observed at 0.7/0.8 mm. A threshold thickness of 0.4 mm was seen using high translucent ceramic and tooth-colored cement, with color differences still discernible at 0.5 and 0.8 mm. A threshold thickness of 0.4 mm was detected using low translucent ceramic and transparent cement, while detectable differences persisted at 0.5, 0.7, and 0.8 mm. A 0.5 mm threshold thickness was observed when using low translucent ceramic and tooth-colored cement, and no detectable color differences were detected beyond this thickness. CONCLUSIONS Masking can be achieved with a thickness of 0.4-0.5 mm using a low translucent material and tooth-colored cement. CLINICAL SIGNIFICANCE Understanding the impact of ceramic thickness, translucency, and cement color can aid clinicians in making informed decisions for achieving the best esthetic outcomes while preserving tooth structure. Effective masking can be accomplished with ceramic thicknesses starting at 0.4 mm, especially when employing a low translucent material and tooth-colored cement. However, clinicians should be aware that discolorations may still be detectable in certain scenarios when using minimally invasive lithium disilicate restorations.
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Affiliation(s)
- Kevser Pala
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Maria Reinshagen
- Doctoral Student at the Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Department of Mathematical Statistics, University of Bern, Bern, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Alexis Ioannidis
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Abdelraouf RM, Moussa TA, Hamdy TM, Abuhaimed RA, Alotaibi AM, Jurado CA, Alhotan A, Alhelal B, Habib NA. Effect of Ceramic Thickness and Technician Variability on the Shade Duplication of Dental Ceramo-Metallic Restorations. J Funct Biomater 2023; 15:12. [PMID: 38248679 PMCID: PMC10816963 DOI: 10.3390/jfb15010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Ceramic thickness and technicians' manipulative variables are critical factors affecting the resultant shade of dental ceramo-metallic restorations. This study investigated the effect of the following variables on shade duplication of ceramo-metallic specimens: (a) ceramic thickness; (b) differences between several technicians (inter-technician variability); and (c) the ability of each technician to repeat the resultant shade (intra-technician variability). Ninety ceramo-metallic specimens were prepared and divided into three main groups (n = 30/gp) according to the different technicians who built up the veneering ceramic of the specimens. Each group was further subdivided into three subgroups (n = 10/subgroup) according to the thickness of the ceramic (1, 1.5, and 2 mm built over a 0.5 mm-thick metal substructure). Three different technicians were asked to follow the same protocol as regards the same ceramic batch (Shade 3M2, Vita VM13, Zahnfabrik, Germany), firing temperature, and number of firing cycles. Meanwhile, each technician followed his own protocol with regard to other ceramic manipulative variables. The duplicated shades of the specimens were investigated using the Vita Easyshade spectrophotometer by using the verify shade mode. Color difference (∆E) values were calculated between the target shade (3M2) and the duplicated shades of the specimens automatically by the Vita Easyshade spectrophotometer (Vita, Zahnfabrik, Germany). The effect of ceramic thickness and inter- and intra-technician variability on the duplication of the target shade was investigated. The results showed that the effect of ceramic thickness on the duplicated shades depended on inter-technician variability. High inter-technician variability (∆E = 2-6.4) was noticed in contrast to low intra-technician variability (∆E = 0.2-1.5). It could be concluded that proper shade-duplication of ceramo-metallic restoration was a cumulative technique intimately related to manipulative variables and ceramic thickness.
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Affiliation(s)
- Rasha M. Abdelraouf
- Biomaterials Department, Faculty of Dentistry, Cairo University, Cairo 11553, Egypt; (R.M.A.); (T.A.M.); (N.A.H.)
| | - Taheya A. Moussa
- Biomaterials Department, Faculty of Dentistry, Cairo University, Cairo 11553, Egypt; (R.M.A.); (T.A.M.); (N.A.H.)
| | - Tamer M. Hamdy
- Restorative and Dental Materials Department, Oral and Dental Research Institute, National Research Centre (NRC), El Bohouth St., Dokki, Giza 12622, Egypt;
| | - Reem A. Abuhaimed
- Dental Interns, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia; (R.A.A.); (A.M.A.); (B.A.)
| | - Alanoud M. Alotaibi
- Dental Interns, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia; (R.A.A.); (A.M.A.); (B.A.)
| | - Carlos A. Jurado
- Department of Prosthodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA 52242, USA;
| | - Abdulaziz Alhotan
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 12372, Saudi Arabia
| | - Bushra Alhelal
- Dental Interns, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia; (R.A.A.); (A.M.A.); (B.A.)
| | - Nour A. Habib
- Biomaterials Department, Faculty of Dentistry, Cairo University, Cairo 11553, Egypt; (R.M.A.); (T.A.M.); (N.A.H.)
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Soares PM, Pereira GKR, Bacchi A. Resin composite layering on discolored substrates ensures masking ability for monolithic ceramics. J ESTHET RESTOR DENT 2023; 35:860-868. [PMID: 37209028 DOI: 10.1111/jerd.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE the aim of this study was to evaluate the effect of resin composite layering on discolored substrates to obtain masking ability with monolithic ceramics. MATERIALS AND METHODS Four groups (n = 8) of computer-aided design/computer aided manufacturing (CAD/CAM) monolithic ceramics, shade A1, with thicknesses of 1.0 and 1.5 mm, were tested: feldspathic (FC), leucite-reinforced (LC), lithium disilicate-reinforced (LD), and translucent zirconia (5YSZ). Five substrates were used: A1 (used as reference), A3.5, C4, and coppery and silvery metals. The substrates were separated as non-layered or layered (with flowable opaque resin composite (FL), white opaque restorative resin composite (WD), and A1-shaded opaque restorative resin composite (A1D)). Resin composite layers of 0.5 and 1.0 mm were tested. The try-in paste, shade A1, was used as a luting agent. Translucency parameter (TP00 ) was assessed for the ceramics. Color differences (∆E00 ) were assessed for the restorative ceramics and resin composite layers over discolored substrates with the CIEDE2000 formula. The results were compared statistically, and descriptively with acceptability (AT, 1.77) and perceptibility (PT, 0.81) thresholds. RESULTS Feldspathic showed the highest TP00 (for both ceramic thicknesses) and LD the lowest (for 1.5 mm of ceramic thickness) (P < 0.001). For substrate A3.5, layering with 1.0 mm of A1D or WD ensured ∆E00 below PT for all ceramics tested (P < 0.001). The use of 0.5 mm of FL or 1.0 mm of A1D associated with ceramics LC, LD, and 5YSZ ensured ∆E00 below AT for substrates C4 and coppery metal (P < 0.001). Silvery background layered with 0.5 mm of FL presented ∆E00 below AT for all ceramics and ∆E00 below PT for lithium disilicate of 1.0 mm of thickness (∆E00 = 0.72). CONCLUSIONS Layering severely discolored substrates with selected opaque resin composites ensures masking ability for restoration with CAD/CAM monolithic ceramics. CLINICAL SIGNIFICANCE Severely discolored substrates are predictably restored with monolithic CAD/CAM ceramics by performing a previous layering of the substrate with opaque resin composite.
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Affiliation(s)
- Pablo Machado Soares
- Post-Graduate Program in Oral Sciences (Prosthodontics Units), Faculty of Odontology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Gabriel Kalil Rocha Pereira
- Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Odontology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Atais Bacchi
- MSciD Post-Graduate Program in Dentistry, Paulo Picanço School of Dentistry (FACPP), Fortaleza, Brazil
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Gierthmuehlen PC, Jerg A, Fischer JB, Bonfante EA, Spitznagel FA. Posterior minimally invasive full-veneers: Effect of ceramic thicknesses, bonding substrate, and preparation designs on failure-load and -mode after fatigue. J ESTHET RESTOR DENT 2022; 34:145-153. [PMID: 34989466 DOI: 10.1111/jerd.12861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of ceramic thicknesses, bonding surface (enamel vs. dentin), and preparation design (box vs. no box) on the fatigue survival and failure load of minimally invasive full-veneer restorations. MATERIALS AND METHODS Human-premolars (n = 60) were divided into five test groups (n = 12). All teeth received full-veneer preparation with the following occlusal/labial thicknesses: standard: 1.5/0.8 mm; thin: 1.0/0.6 mm; ultrathin 0.5/0.4 mm. Preparations for each ceramic thickness were refined in enamel (E-1.0 and E-0.5) or dentin (D-1.5, D-1.0, and D-0.5). Control groups DB-1.5, EB-1.0, and EB-0.5 received box preparations. Monolithic lithium disilicate restorations (IPS-e.max-Press, Ivoclar Vivadent) were adhesively cemented (Syntac-Classic/Variolink-II, Ivoclar Vivadent) and subjected to cyclic mechanical loading (F = 49 N, 1.2 million cycles) with simultaneous thermocycling (5-55°C). All specimens were exposed to single load-to-failure. Pair-wise differences were calculated by using a linear regression model and Student-Newman-Keuls method (p < 0.05). RESULTS All full-veneers of group D-1.5, E-1.0, E-0.5, DB-1.5, EB-1.0, and EB-0.5 survived fatigue. Two full-veneers (D-1.0 and D-0.5) revealed cracks during fatigue, resulting in an overall fatigue survival rate of 98.1%. Mean load-to-failure values (N) were as followed: 1005 (D-1.5); 866 (D-1.0); 816 (D-0.5); 1495 (E-1.0); 1279 (E-0.5); 1129 (DB-1.5); 1087 (EB-1.0); and 833 (EB-0.5). Irrespective of ceramic thicknesses, enamel-based full-veneers resulted in higher failure loads than dentin-based restorations. Box preparation reduced the failure loads of thin and ultrathin enamel-based restorations. CONCLUSION All tested monolithic lithium disilicate full-veneer restorations exceeded physiological masticatory forces. Minimally invasive full-veneer restorations with enamel as a bonding surface and a non-retentive preparation design showed superior performance. CLINICAL SIGNIFICANCE Enamel-based non-retentive full-veneers made of monolithic lithium disilicate may serve as a reliable and esthetical minimally invasive treatment option for premolars.
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Affiliation(s)
- Petra C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Annika Jerg
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - Frank A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Tamam E, Güngör MB, Nemli SK. How are the color parameters of a CAD/CAM feldspathic ceramic of the material affected by its thickness, shade, and color of the substructure? Niger J Clin Pract 2020; 23:523-533. [PMID: 32246660 DOI: 10.4103/njcp.njcp_517_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives The purpose of this study was to evaluate the effect of the tooth color, ceramic color, and ceramic thickness on the final color parameters of a feldspathic computer-aided design (CAD)/computer-aided manufacturing (CAM) ceramic material. Materials and Methods Resin specimens (12 × 14 × 4 mm) were prepared from six shades, namely, 0M1S, 1M1S, 2M3S, 3M2S, 4M3S, and 5M3S, to simulate tooth color. Ceramic slices with thicknesses of 0.3, 0.5, 0.7, and 1 mm were sectioned from Vitablocs Mark II (12 × 14 × 18 mm) in 10 shades-OM1C, 1M1C, 1M2C, 2M1C, 2M2C, 2M3C, 3M1C, 3M2C, 3M3C, and 4M2C. An intraoral spectrophotometer was used and three axes of Commission Internationale de l'Eclairage (CIE) LAB color space (CIE L* a* b*) and chroma (C) and hue (H) values were obtained. Results The a* and b* values showed a decrease with increasing thickness. Generally, C decreased with the increasing ceramic thickness. The effect of ceramic thickness on H changed depending on the block and substructure color. The change of ceramic thickness resulted in changes in the lightness parameter (L*) of the ceramics. Generally, with an increase in the thickness, the L* value increased. The univariate analysis of variance (ANOVA) indicated a significant interaction between ceramic thickness and substructure color (P <. 005) and ceramic thickness and ceramic color (P <. 005). Conclusion The final color parameters of a feldspathic CAD/CAM block were significantly affected by the changes in the ceramic thickness and substructure color.
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Affiliation(s)
- E Tamam
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - M B Güngör
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - S K Nemli
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Öztürk E, Bolay Ş, Hickel R, Ilie N. Effects of ceramic shade and thickness on the micro-mechanical properties of a light-cured resin cement in different shades. Acta Odontol Scand 2015; 73:503-7. [PMID: 25643983 DOI: 10.3109/00016357.2014.996185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the micro-mechanical properties of a light-cured resin cement in four different shades when polymerized through a leucite-reinforced glass-ceramic in different shades and thicknesses. MATERIALS AND METHODS A light-cured resin cement in four different shades (HV+1, HV+3, LV-1 and LV-3) was selected for this study. The specimens were cured by using a LED-unit (Bluephase®, IvoclarVivadent) for 20 s under a leucite-reinforced glass-ceramic (IPS Empress® CAD, IvoclarVivadent) in two different shades (A1 and A3) of different thicknesses (1 and 2 mm). Specimens cured directly, without an intermediate ceramic, served as control. The specimens were stored after curing for 24 h at 37°C by maintaining moisture conditions with distilled water. Micro-mechanical properties (indentation modulus, E; Hardness, HV; creep, Cr) of the resin cements were measured with an automatic microhardness indenter (Fisherscope H100C, Germany). Twenty groups were included (n = 3), while 10 measurements were performed on each specimen. Data were statistically analyzed by using one-way ANOVA and Tukey's post-hoc test, as well as a multivariate analysis to test the influence of the study parameters. RESULTS Significant differences were observed between the micromechanical properties of the tested resin cements (p < 0.05). The resin cement shade showed the highest effect on the micromechanical properties (Partial-eta squared (ηP(2))-E = 0.45, ηP(2)-HV = 0.59, ηP(2)-Cr = 0.29) of the resin cement, followed by ceramic thickness (ηP(2)-E = 0.38, ηP(2)-HV = 0.3, ηP(2)-Cr = 0.04) and ceramic shade (ηP(2)-E = 0.2, ηP(2)-HV = 0.26). CONCLUSIONS Resin cement shade is an important factor influencing the mechanical properties of the material. Light shades of a resin cement express higher E and HV as well as lower Cr values compared with the darker ones.
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Affiliation(s)
- Elif Öztürk
- Department of Restorative Dentistry, Faculty of Dentistry, Hacettepe University , Ankara , Turkey
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