Influence of cyclic loading and luting agents on the fracture load of two all-ceramic crown systems

STATEMENT OF PROBLEM: Inherent mechanical properties, fabrication techniques, luting agents, and intraoral conditions are primary factors attributing to longevity of all-ceramic crowns. Before doing time-consuming and costly clinical studies, preclinical in vitro studies should be conducted to evaluate the durability of these crowns. Purpose This study investigated the influence of different luting agents and cyclic loading under wet conditions on the fracture load of CAD-CAM and pressable all-ceramic crowns. MATERIAL AND METHODS: Ninety-six human premolars were prepared for all-ceramic crowns with the following preparation criteria: 6-degree axial taper, 1.5-mm shoulder finish line placed 0.5 mm occlusal to the CEJ, 2-mm occlusal reduction, and occluso-gingival height of 5 mm. Sixteen unprepared premolars served as controls. Forty-eight crowns were laboratory fabricated from a lithium disilicate glass-ceramic (IPS-Empress 2), while 48 CAD-CAM crowns were directly fabricated using a leucite-reinforced glass-ceramic (ProCAD) and the Cerec 3 CAD-CAM system. Three luting agents (Panavia F, Superbond C&B and ProTec CEM) were used for cementation (n = 16). After 1 week storage in water, half of the specimens of each subgroup (n = 8) were cyclically loaded and thermal cycled under wet conditions for 600,000 masticatory cycles and 3500 thermal cycles (58 degrees C/4 degrees C; dwell time 60 seconds) in a masticatory simulator. All specimens were loaded in a universal testing machine with the compressive load (N) applied along the long axis of the specimen at a crosshead speed of 1 mm/min until fracture. Fracture load was recorded for each specimen. The Kruskal-Wallis test was used first to detect overall significance, followed by Mann-Whitney U tests to identify which pairs of groups had significant differences (P =.05). RESULTS: Cyclic loading significantly decreased the median fracture load of ProCAD crowns luted using Superbond from 987.2 to 786.0 N (P =.014) and those luted using ProTec CEM from 914.4 to 630.7 N (P =.007). Also, the median fracture load of Empress 2 crowns luted using ProTec CEM decreased significantly from 977.3 to 622.9 N (P =.013). However, cyclic loading did not decrease the median fracture load of crowns luted using Panavia F, Empress 2 (P =.431) and ProCAD (P =.128). With the same loading conditions and luting agents, there were no significant differences in the fracture loads of ProCAD and Empress 2 crowns (P >.05). CONCLUSIONS: Cyclic loading reduced the fracture load of ProCAD crowns luted with Superbond C&B and ProTec CEM and of Empress 2 crowns luted with ProTec CEM.     

Influence of different adhesive resin cements on the fracture strength of aluminum oxide ceramic posterior crowns

STATEMENT OF PROBLEM: The influence of different types of adhesive resin cements on the long-term prognosis of aluminum oxide ceramic posterior crowns is unclear. PURPOSE: The purpose of this study was to evaluate the fracture resistance of aluminum oxide ceramic on maxillary posterior crowns cemented with different resin luting agents before and after cyclic thermomechanical loading. Material and methods Forty-eight maxillary first molars were prepared and restored with standardized aluminum oxide ceramic (In-Ceram Alumina) crowns. The test specimens were randomly divided into 3 groups (n=16). The crowns were luted with an acrylic resin cement (Super-Bond C&B, control, Group SB) and 2 composite luting agents (Panavia F, Group PV; and Rely X Unicem, Group RX). Half of the specimens were exposed to thermomechanical fatigue in a masticatory simulator. All specimens were tested for fracture strength (N) using quasistatic loading. The Wilcoxon rank sum test was used to compare the fracture strength (alpha=.05). RESULTS: All specimens survived the exposure to the simulator. The following median fracture strength values were obtained without/with thermomechanical fatigue loading: Group SB, 2726 N/2673 N; Group PV, 2520 N/2083 N; and Group RX, 2036 N/2369 N. The fracture strength in Group PV after thermomechanical fatigue loading was significantly lower compared to the fracture strength in Group PV without artificial aging (P =.016), as well as significantly lower compared to Group SB with artificial aging (P =.003). CONCLUSION: Within the limitations of this study, all tested cements are capable of successfully luting aluminum oxide ceramic crowns. The fracture strength of Group PV after artificial aging was comparatively low.     

Effects of surface finish and fatigue testing on the fracture strength of CAD-CAM and pressed-ceramic crowns.

STATEMENT OF PROBLEM: All-ceramic molar crowns can be fabricated with CAD-CAM or laboratory methods with different materials, and a polished or oven-glazed surface. PURPOSE: This in vitro study determined the fracture strength of various all-ceramic crowns, with and without prior cyclic loading. MATERIAL AND METHODS: Standardized molar crowns were fabricated with a CAD-CAM machine (Cerec 2), software with machinable ceramic materials (Vita Mark II and ProCAD), and also conventional heat-pressed IPS Empress crowns fabricated at 2 dental laboratories. Groups of 40 crowns of each material were manufactured with either a polished or an oven-glazed surface finish. Cyclic loading that simulated oral conditions were performed on half of each group. Afterward, all crowns were loaded until catastrophic failure.Results. Fracture loads of the polished ProCAD crowns without prior cyclic loading was 2120 +/- 231 N, significantly higher than that of the polished Vita Mark II crowns (1905 +/- 235 N), but was not significantly different from the strength of 2 laboratory-fabricated Empress crowns. Oven-glazing of ProCAD crowns improved the fracture strength significantly, up to 2254 +/- 186 N. Prior cyclic loading decreased the strength of all tested crowns significantly, but the reduction was less for the Cerec crowns than the Empress crowns. CONCLUSION: Cerec ProCAD crowns demonstrated significantly greater strength than the Vita Mark II crowns, better resistance to cyclic loading and lower failure probability than the laboratory-fabricated IPS Empress crowns. Prior cyclic loading significantly reduced the strength of all-ceramic crowns, but had less effect on Cerec crowns than on the IPS Empress crowns. Oven-glazing of ProCAD crowns resulted in significantly higher strength and higher resistance to cyclic loading than surface polishing.     

Influence of type of luting cement used with all-ceramic crowns on load capability of post-restored endodontically treated maxillary central incisors

Adhesive luting of the final restorations is supposed to support the overall strength of post-endodontically restored teeth. For evaluating adhesive vs conventional cementation, the load capability of adhesively restored endodontically treated teeth (ETT) with glass fibre-reinforced composite posts (GFRCP), resin composite cores and all-ceramic crowns was determined. Thirty-two caries-free human upper, central incisors were randomly assigned to four groups, endodontically treated and cut 2 mm above the cemento-enamel junction. All teeth were restored with GFRCP, composite core build-ups and all-ceramic crowns. All-ceramic crowns were cemented with zinc phosphate cement (I), glass ionomer cement (II), and a self-adhesive resin cement (III and IV). After thermo-mechanical loading, the specimens were loaded to fracture. Maximum load capability F _max and fracture patterns were compared using non-parametric statistics. Median values for the maximum load capability F _max (minimum/maximum) in [N] were: I = 503 (416/1,038), II = 442 (369/711), III = 502 (326/561) and IV = 518 (416/652). No statistically significant differences were found for F _max (p = 0.761) and fracture patterns (p = 0.094) between the experimental groups. The type of cementation of all-ceramic crowns, whether self-adhesive or conventional, appears to have no impact on the load capability of ETT restored with GFRCP and composite core build-ups.     

Effect of Two Self-Adhesive Cements on Marginal Adaptation and Strength of Esthetic Ceramic CAD/CAM Molar Crowns

Purpose: This study evaluated the effects of adhesive cements on marginal adaptation and fracture resistance of ceramic molar crowns. Materials and Methods: Seventy‐five extracted maxillary molars were selected. The occlusal morphology of 15 molars (control) was scanned and transferred to the crowns in the test groups by CAD/CAM. Sixty molars received full‐coverage crown preparations with 6‐degree axial taper, 1.0‐mm shoulder, and 2.0‐mm occlusal reduction. They were assigned to four groups, and pulpal pressure was simulated. The 15 crowns in each test group were seated with resin‐based self‐adhesive cements, Rely‐X (RX) and Multilink (MS), one multistep bonded adhesive luting composite resin, Variolink (VL), and glass‐ionomer cement, Ketac Cem (KC). Test and control molars were subjected to thermal and mechanical fatigue stress (TMS: 12,000 × 5°C to 50°C; 2.4 million × 49 N) for 18 days in a masticator. Marginal adaptation [“continuous margin%” (CM%)] of the crowns was determined by scanning electron microscopy (200×). Finally, molars were occlusally loaded until fracture in a testing machine, and fracture load (N) was recorded. Marginal adaptation and strength data were statistically analyzed. Results: TMS significantly (p < 0.001) reduced CM% in all groups. After TMS, CM% at the cement‐dentin interface was significantly (p < 0.001) higher for RX than for all other cements. At the crown‐cement interface both self‐adhesive cements MS and RX had significantly better CM% than VL (p < 0.05) and KC (p < 0.001). Fracture resistance of natural untreated molars was significantly (p < 0.001) higher than that of experimental crowns. Fracture resistance of RX cemented crowns was significantly (p < 0.05) higher than that of other crowns. Occlusal morphology significantly influenced fracture resistance (p < 0.05). Conclusions: Self‐adhesive cement RX offers a valid alternative to multistep resin‐based luting composite with respect to marginal adaptation to dentin and fracture resistance. The latter is also influenced by occlusal morphology, necessitating careful monitoring of occlusal contacts.     

In vitro failure of crowns produced by two CAD/CAM systems

Previous laboratory studies have demonstrated satisfactory fracture resistance of all-ceramic crowns placed using a resin-composite luting material and a dentine bonding system. This study investigated the fracture resistance of teeth restored using CAD/CAM technology, namely, Zirconia Based crowns and Cerec produced feldspathic porcelain crowns, both luted with a self adhesive resin luting material (RelyX Unicem Clicker 3M ESPE). Standardized preparations were carried out on two groups often sound, unrestored, maxillary premolar teeth. Ceramic crowns were constructed to have a thickness of 2mm at their midline fissure. Compressive fracture resistance was determined for each group using a Universal Testing Machine. The failure modes were also examined visually and interpreted according to a chosen scale. Mean Compressive fracture resistance of 746 (147)N and 1630 (175)N were recorded for the Cerec and Lava groups respectively; differences were statistically significant (p < 0.001). The fracture resistance of teeth restored with Lava crowns is significantly greater than a similar group of teeth restored with Cerec crowns.     

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 (? 8mm) 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.     

Fatigue resistance and microleakage of CAD/CAM ceramic and composite molar crowns

Purpose: The aim of this study was to determine effect of compressive cyclic loading on fatigue resistance and microleakage of monolithic CAD/CAM molar ceramic and composite crowns. Materials and Methods: Thirty‐two extracted molars were prepared to receive CEREC crowns according to manufacturer's guidelines using a special paralleling device (Parallel‐A‐Prep). Sixteen feldspathic ceramic crowns (VITABLOCS Mark II) (VMII) and 16 resin‐composite crowns (Paradigm‐MZ100 blocks) (PMZ) were milled using a CEREC‐3D machine. Eight crowns of each group were cemented to their respective teeth using self‐etching resin cement (Panavia‐F‐2.0) (PAN), and eight were cemented using self‐adhesive resin cement (RelyX‐Unicem‐Clicker) (RXU). Following storage for 1 week in water, specimens were subjected to uniaxial compressive cyclic loading in an Instron testing machine at 12 Hz for 1,000,000 cycles. Load was applied at the central fossa, and the cycle range was 60–600 N. Specimens were then subjected to microleakage testing. Data were statistically analyzed using factorial ANOVA and Post Hoc (Tukey HSD) tests. Results: All composite crowns survived compressive cyclic loading without fracture, while three ceramic crowns from the subgroup cemented with RXU developed surface cracks at the center of occlusal surfaces, extending laterally. Microleakage scores of ceramic crowns cemented with PAN were significantly lower than those of the other three subgroups (p < 0.05). Conclusions: After 1,000,000 cycles of compressive cyclic loading, PMZ composite molar crowns were more fatigue‐resistant than VMII ceramic crowns. Cement type had a significant effect on fatigue resistance of the ceramic crowns but not the composite ones. Microleakage scores of ceramic crowns cemented with PAN were significantly lower than those of the other subgroups (p < 0.05).     

Fracture resistance of teeth restored with dentin-bonded crowns constructed in a leucite-reinforced ceramic.

OBJECTIVES: Laboratory studies and preliminary clinical data have demonstrated satisfactory fracture resistance of all-ceramic crowns placed using a resin-composite luting material and a dentin-bonding system. This study investigates the fracture resistance of crowns constructed in a leucite-reinforced ceramic when placed using a dentin-bonding system and a dual-cure resin composite luting material and compares this with the fracture resistance of feldspathic porcelain crowns. METHOD: Standardised preparations were carried out on 10 sound, unrestored, maxillary premolar teeth, the mean bucco-palatal width of which did not vary by more than 2.5%. Ceramic crowns (Fortress; Chameleon Dental, KS, US) were constructed using a standardised technique. Their fitting surface was etched with hydrofluoric acid. The crowns were placed using the dentin-bonding system Mirage ABC and the luting system Mirage FLC (Chameleon Dental, KS, US). The restored teeth were loaded in compression at 1 mm/min through a 4 mm steel bar placed along the midline fissure. RESULTS: A mean fracture load of 0.88 kN was recorded. Results from previous work indicate a fracture resistance of 0.77 kN for feldspathic porcelain crowns placed using the same luting systems on similarly standardised preparations. Statistical analysis by one-way ANOVA and Tukey's multiple comparison procedure indicated that there was no significant difference in the mean fracture resistance of the teeth restored using the leucite reinforced ceramic and the teeth restored with feldspathic porcelain. SIGNIFICANCE: Crowns constructed in a leucite-reinforced ceramic and placed using dentin-bonding and dual-cure resin composite luting materials may provide some increase in fracture resistance, but the results may not be significantly different from the feldspathic porcelain.     

Fracture strength of all-ceramic crowns luted using two bonding methods

STATEMENT OF THE PROBLEM: Excellent esthetic quality is one of the major advantages of all-ceramic restorations; however, catastrophic fracture of such restorations is still a disadvantage. Ceramic bonding systems using ceramic primers without the use of hydrofluoric acid have been introduced, but data about the efficiency of these systems are lacking. PURPOSE: This study investigated the influence of 2 bonding procedures on the fracture resistance of low-fusing ceramic and computer aided design-computer aided manufacturing (CAD-CAM) all-ceramic crowns. MATERIAL AND METHODS: Forty-two standardized all-ceramic crowns were fabricated on human maxillary premolars. Seven unprepared maxillary premolars were used as control. Three all-ceramic crown systems were used: 1 low-fusing ceramic (Duceram) and 2 machineable ceramics (Vita Mark II and ProCAD) using the Cerec 3 CAD-CAM system. The intaglio surfaces of fabricated crowns (n=7) were subjected to 2 different conditioning techniques: etching, using 4.9% hydrofluoric acid followed by application of Mirage ABC silane, or cleaning, using 65% phosphoric acid and application of primer (Porcelain Liner-M). The crowns were luted to the teeth using Superbond C&B luting agent. After 24 hours storage in water, specimens were loaded in a universal testing machine with the compressive load applied along the long axis of the specimen at a crosshead speed 1 mm/min until fracture. Fracture loads (N) were recorded. One-way analysis of variance (ANOVA) and the Tukey HSD test (alpha=.05) were used for statistical analysis of the data. RESULTS: The mean fracture load of control specimens (738.3+/-195.3 N) was not significantly different from that of the 2 CAD-CAM crowns (667.7+/-72.3 N, 715.9+/-105.2 N). However, fracture load of natural teeth and the 2 CAD-CAM crowns was significantly higher than the fracture load of the low-fusing ceramic crowns treated with HF acid and silane (465.5+/-101.1 N) and, when cleaned, using phosphoric acid and an application of primer (447.5+/-63.4 N) (P<.05). There was no significant difference in the mean fracture load of each ceramic material when bonded using the 2 different procedures, either treated with HF acid and silane or cleaned using phosphoric acid and application of primer (P>.05). CONCLUSION: The application of a primer (Procelain Liner-M) was an effective method for treating the intaglio surface of all-ceramic crowns before cementation.     

不同粘固剂对全瓷冠边缘完整性影响的研究

目的研究不同粘固剂粘固的全瓷冠边缘完整性。方法全瓷冠修复24颗离体上颌第三磨牙,随机分成3组,每组8个,分别用自酸蚀树脂粘接系统、Compomer粘固剂和磷酸锌粘固剂粘固,用扫描电镜观测标本牙疲劳试验前后边缘完整性及粘固剂表面质量。结果自酸蚀树脂粘接组试验前后完整边缘率均高于95%,Compomer组和磷酸锌粘固剂粘固组完整边缘率分别为16%~19%和5%,组间均有显著性差异（P〈0.001）;自酸蚀树脂粘接组边缘区粘固剂缺损显著小于其它两组（P〈0.05）。结论用自酸蚀树脂粘接系统粘固全瓷冠有优良的边缘完整性和边缘区表面质量。     

A preliminary evaluation of the structural integrity and fracture mode of minimally prepared resin bonded CAD/CAM crowns

Purpose

This study was a preliminary evaluation of two minimal preparation designs proposed for ceramic and composite resin bonded CAD/CAM crowns. It compared the structural integrity and fracture mode of teeth restored with traditionally and minimally prepared resin bonded CAD/CAM crowns fabricated from the same material hypothesizing that teeth restored with minimal resin bonded crowns would demonstrate the same fracture strength to teeth restored with traditional resin bonded crowns.

Materials and methods

Forty intact maxillary molar teeth were used and divided in four groups. Two groups were prepared according to a traditional crown preparation design and two groups were prepared according to minimal preparation designs. A resin composite (Paradigm MZ100, 3M ESPE) and a leucite glass–ceramic (ProCAD, Ivoclar Vivadent) were used for the fabrication of the crowns using CEREC Scan. Crowns of ceramic were cemented using Variolink II (Ivoclar Vivadent) and crowns of composite with Rely X Unicem Aplicap™ (3M ESPE) and loaded until fracture. Load data was analysed using ANOVA comparing crowns of the same restorative material. The mode of fracture was also recorded and analysed (Kruskal–Wallis).

Results

For the composite system the mean fracture load and SD was 1682 N (±315) for the traditional and 1751 N (±338) for the minimal crowns. For the ceramic system the mean fracture load and SD was 1512 N (±373) for the traditional and 1837 (±356) for the minimal crowns. No statistically significant difference was found between the two designs for each system. Nonparametric analysis (Kruskal–Wallis) of the fracture mode showed no statistical significant difference between designs for either material (p > .05).

Conclusion

Within the limitations of this experimental design, it was found that minimally prepared resin bonded CEREC crowns demonstrated equal fracture resistance and mode of fracture to that of crowns bonded to traditionally prepared teeth.     

Computer-aided direct all-ceramic crowns: preliminary 1-year results of a prospective clinical study

The objective of this study was to investigate the clinical performance of: (1) adhesively placed Cerec crowns with reduced stump preparations, and (2) Cerec endo crowns. The crowns were examined at baseline using modified USPHS criteria in 20 patients with 10 Cerec crowns with reduced stump preparations and 10 Cerec endo crowns. All crowns had been produced chairside with the Cerec 3 CAD/CAM method using the function mode. The crowns were machined from Vita Mk II feldspathic ceramic blocks, polished manually, and placed with dual-curing composite luting agent using a functional adhesive. After 1 year, a follow-up examination of the crowns was conducted; all 20 Cerec crowns were rated with a clinically acceptable A or B rating. Fractures or loss of retention were not observed. The method of producing and placing all-ceramic crowns with reduced stump preparations and endo crowns chairside in one appointment can be implemented successfully in private practice.     

Fracture resistance of three all-ceramic restorative systems for posterior applications

STATEMENT OF PROBLEM: The failure loads of all-ceramic crowns are influenced not only by the fracture resistance of the component materials but also by prosthesis geometry and size and location of flaws, thus there is a need for a study that compares the fracture resistance of all-ceramic systems using a simple and reproducible specimen geometry that includes flaws occurring at material interfaces. PURPOSE: The research aim was to compare the in vitro fracture resistance and origin of failure of simulated first molar crowns fabricated using 3 all-ceramic systems, IPS Empress 2, Procera AllCeram, and In-Ceram Zirconia. MATERIAL AND METHODS: Twenty axisymmetric crowns of each system were fabricated to fit a preparation with 1.5- to 2.0-mm occlusal reduction. The center of the occlusal surface on each of 15 specimens per ceramic system was axially loaded to fracture in a universal testing machine, and the maximum load (N) was recorded. Fractured surfaces were examined using optical and electron microscopy to determine the most prevalent origin of failure in each ceramic system. Five crowns per system were sectioned, and thickness of the luting agent, core material, and veneer porcelain layers were measured. The 95% confidence intervals of the Weibull modulus and characteristic failure load were compared between the 3 systems. Two-way multivariate analysis of variance was used to analyze the thickness of the luting agent, ceramic core, and veneer porcelain layers (alpha=.05). RESULTS: The 95% confidence intervals for Weibull modulus were 1.8 to 2.3 (IPS Empress 2), 2.8 to 3.6 (Procera AllCeram), and 3.9 to 4.9 (In-Ceram Zirconia). The 95% confidence intervals for characteristic failure load were 771 to 1115 N (IPS Empress 2), 859 to 1086 N (Procera AllCeram), and 998 to 1183 (In-Ceram Zirconia). The origin of failure was most commonly found at the interface between the ceramic core and veneer porcelain for IPS Empress 2 and between the ceramic core and luting agent layer for the other systems. CONCLUSIONS: There was no significant difference in fracture resistance; however, there was a significant difference in failure origin between the all-ceramic systems studied.     

The influence of different cements on the fracture resistance and marginal adaptation of all-ceramic and fiber-reinforced crowns

PURPOSE: This in vitro study investigated the marginal adaptation and fracture resistance of heat-pressed glass-ceramic and fiber-reinforced composite molar crowns luted with resin, resin-modified glass-ionomer, or zinc-oxide-eugenol-free cements. MATERIALS AND METHODS: A total of 24 heat-pressed all-ceramic and 24 glass fiber-reinforced composite crowns were constructed and cemented using the above-mentioned luting agents (eight crowns per cement). The restorations were thermocycled and mechanically stressed, and fracture resistance was determined. Marginal adaptation was evaluated before and after stress application using semiquantitative analysis in a scanning electron microscope. RESULTS: All-ceramic and fiber-reinforced composite crowns reached the highest fracture resistance after stress application in combination with the resin cement. When luted with resin-modified glass-ionomer or zinc-oxide-eugenol-free cements, the fracture resistance of all-ceramics decreased significantly, while the fiber-reinforced composite crowns maintained their fracture resistance level; the lowest values were found for zinc-oxide-eugenol-free cements. The marginal adaptation remained unchanged after stress for all-ceramics and fiber-reinforced composite restorations if they were luted with resin cements. Luting with resin-modified glass-ionomers significantly deteriorated the marginal adaptation after stress application, with the exception of the crown-cement interface of all-ceramics. CONCLUSION: The highest fracture resistance and marginal adaptation were found for all-ceramic and glass fiber-reinforced composite molar crowns if they were luted with resin cement.     

Marginal discrepancies and leakage of all-ceramic crowns: influence of luting agents and aging conditions

PURPOSE: This study evaluated the marginal discrepancies and leakage of all-ceramic crowns cemented with different luting agents after fatigue tests. MATERIALS AND METHODS: Forty-eight all-ceramic crowns were cemented onto natural molars. Zinc-phosphate cement, compomer cement, and an adhesive composite resin luting system were used in 16 specimens each. Sixteen metal-ceramic crowns were cemented with zinc-phosphate cement as a control. Half of the specimens in each group were fatigued in a chewing simulator for 600,000 loading cycles with 3,500 thermocycles. The others received the 3,500 thermocycles only. An impression-replica technique and SEM were used for evaluation of the marginal discrepancies. Leakage of the specimens was microscopically assessed. RESULTS: There were no significant differences between marginal discrepancies of the groups, with the exception of porcelain shoulder margins in the metal-ceramic group, which had significantly larger discrepancies (P < .01). There was no significant effect of the fatigue tests on marginal discrepancies. However, significant differences of leakage were found between the groups cemented with the different luting agents after both fatigue tests. The adhesive composite resin luting system demonstrated the least leakage. The compomer cement showed an intermediate level of leakage, and the zinc-phosphate cement showed severe leakage that extended through the dentinal tubules to the pulp chambers. No significantly different effect of the two fatigue tests on the leakage was found. CONCLUSION: The adhesive composite resin luting system showed clinically acceptable marginal discrepancies and an excellent ability to minimize leakage of all-ceramic crowns.     

Fatigue damage of monolithic posterior computer aided designed/computer aided manufactured crowns

PurposeTo analyse fatigue damage of monolithic computer-aided-designed/computer-aided-manufactured (CAD/CAM)-materials after loading with high masticatory forces in standardized posterior crowns in a mouth-motion-simulator.MethodsFor manufacturing of test specimens (5 groups, 16 specimens each), two corresponding Standard-Tessellation-Language-(STL)-data-sets (one for the teeth and one for the crowns) were designed. The teeth were CAD/CAM-milled of human third molars and the crowns of three different CAD/CAM composite blocks (Lava Ultimate,‘LU’; Brilliant Crios‘BC’; Cerasmart,‘CS’), one polymer-infiltrated-ceramic network (Vita Enamic,‘VE’) and a control group of lithium disilicate ceramics (IPS e.max CAD,‘EM’). Crowns were adhesively cemented with their corresponding luting system on the human teeth. Half of the specimens were light-cured (‘LC’) and the others were chemical-cured (‘CC’). A mouth-motion-simulator (WL-tec, 2 Hz, 37 °C) applied dynamic cyclic loading between 50–500 N for a period of 1 million cycles. Afterwards, a dye penetration test (aqueous basic-fuchsine) revealed damage of test specimens. Each specimen was sectioned into four equidistant slices and the area without damage was measured with a digital microscope (Zeiss) and radial cracks at the cementation surface were assessed. Data were subjected to Tukey’s test.ResultsAll specimens showed fatigue damage in the occlusal contact area. LU, BC and CS exhibited a significant greater area without damage compared to VE and EM (p < .05). EM and VE showed additional radial cracks at the cementation interface in both curing modes, whereas LU, BC and CS showed only radial cracks with chemical-cured luting cement.ConclusionsMonolithic CAD/CAM composite crowns showed significantly lower fatigue damage, particularly if the luting system was light-cured.     

In vivo fracture resistance of implant-supported all-ceramic restorations

STATEMENT OF PROBLEM: Because of their specific mechanical properties, all-ceramic restorations demonstrate a lower fracture resistance than ceramic restorations supported by metal substructures. However, advances have been made in the fabrication of high-strength all-ceramic abutments for anterior implants. No previous study has compared the fracture loads between 2 different all-ceramic abutments restored by glass-ceramic crowns. PURPOSE: The purpose of this in vitro investigation was to quantify the fracture load of implanted-supported Al(2)O(3) and ZrO(2) abutments restored with glass-ceramic crowns. MATERIALS AND METHODS: Two ceramic abutments were tested: an Al(2)O(3) abutment (CerAdapt) and a ZrO(2) abutment (Wohlwend Innovative). The abutments (n = 10) were placed on Br?nemark dental implants and prepared for restoration with glass-ceramic crowns (IPS Empress). After fabrication, in accordance with the manufacturer's guidelines, the crowns were bonded to the all-ceramic abutments with a dual-polymerizing resin luting agent. The fracture loads (N) were determined by force application at an angle of 30 degrees by use of a computer-controlled universal testing device. The data were analyzed with the unpaired t test (alpha=.05). RESULTS: Statistical analysis showed significant differences between both groups (P=.001) of all-ceramic abutments, with mean fracture load values of 280.1 N (+/- 103.1) for the Al(2)O(3) abutments and 737.6 N (+/- 245.0) for the ZrO(2) abutments. CONCLUSION: Within the limitations of this study, both all-ceramic abutments exceeded the established values for maximum incisal forces reported in the literature (90 to 370 N). The ZrO(2) abutments were more than twice as resistant to fracture as the Al(2)O(3)-abutments.     

An in vitro study to investigate the load at fracture of Procera AllCeram crowns with various thickness of occlusal veneer porcelain

PURPOSE: The aim of this study was to investigate the effect of occlusal veneer porcelain thickness on the load at fracture of Procera AllCeram crowns. MATERIALS AND METHODS: Fifty resin dies were manufactured to incorporate the features of an all-ceramic crown preparation on a premolar tooth. Fifty corresponding crowns were constructed and divided into five groups. Groups 1, 2, 3, and 4 were crowns with 0.6-mm-thick Procera cores and 0.4-mm-thick axial veneer porcelain and occlusal veneer porcelain thicknesses of 0.0 mm, 0.4 mm, 0.9 mm, and 1.4 mm, respectively. Group 5 specimens consisted of 0.6-mm-thick In-Ceram cores with 0.4 mm of axial porcelain and 0.4 mm of occlusal porcelain. The crowns were cemented onto their respective dies with a resin luting agent. Specimens were stored in distilled water at 37 degrees C for 24 hours prior to placing them in a universal testing machine and applying a controlled compressive load at a cross-head speed of 0.1 mm/min until fracture occurred. RESULTS: The mean loads at fracture were 419 N (group 1), 702 N (group 2), 1,142 N (group 3), 1,297 N (group 4), and 732 N (group 5). Statistical analysis revealed significant differences (P < .05) in the load at fracture between the groups, except for between groups 2 and 5. CONCLUSION: Increasing the thickness of the occlusal veneer porcelain increased the load at fracture for Procera AllCeram crowns. There was no significant difference in load at fracture between the Procera and In-Ceram crowns.     

Effect of finish line variants on marginal accuracy and fracture strength of ceramic optimized polymer/fiber-reinforced composite crowns

STATEMENT OF PROBLEM: Ceramic optimized polymer (Ceromer)/fiber-reinforced composite (FRC) crowns have been promoted as alternatives to conventional crowns. However, little is known regarding the ideal tooth preparation for this type of crown. PURPOSE: This in vitro study evaluated the marginal adaptation and fracture strength of ceromer/FRC crowns with respect to the various types of finish lines. MATERIAL AND METHODS: Four metal dies with different finish lines (0.9-mm chamfer, 1.2-mm chamfer, 1.2-mm rounded shoulder, and 1.2-mm shoulder) were prepared. Forty (10 for each finish line) Targis/Vectris crowns were fabricated on duplicated base metal alloy dies. The restorations were stereoscopically evaluated at 56 points along the entire circumferential margin for measuring the margin adaptation before and after cementation with a resin luting agent. The specimens were then compressively loaded to failure using a universal testing machine. The marginal adaptation (microm) was analyzed with the Kruskal-Wallis test and post-hoc Dunnett test (alpha=.05). The fracture load (N) was analyzed with a 1-way analysis of the variance and the Scheffe adjustment (alpha=.05). The fractured surfaces of the crowns were examined with a scanning electron microscope to determine the mode of fracture. RESULTS: The marginal adaptation of crowns with a shoulder finish line was significantly better than crowns with a chamfer finish line before and after cementation (P<.001). The increased marginal gap after cementation was the lowest in the 1.2-mm rounded shoulder group. The fracture strength of the crowns with the 0.9-mm chamfer and crowns with 1.2-mm chamfer was significantly greater than those of the crowns with the 1.2-mm shoulder or rounded shoulder (P=.011, P=.049, respectively). The mean fracture load of all crowns, regardless of the finish line design, was 1646 N. The fractured surface of the crown revealed adhesive failure and 3 types of cohesive failure (fracture of the Targis and Vectris, Targis fracture with a crack in the Vectris layer, and crushing without fracture). CONCLUSION: The marginal gaps were greater for the chamfer finish line specimens than in the shoulder finish line specimens. However, the fracture strength of the chamfer finish line specimens was greater than that of the shoulder finish line specimens.