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Purpose: To investigate the resistance of an implant crown telescopically engaged to a geometrically defined hexagonal abutment with and without cement under compressive dynamic cyclic fatigue loading., Materials and Methods: 40 crowns, 9 mm in height, were cast from prefabricated plastic copings, each telescopically engaged to a 3-mm-high machined hexagonal abutment. 20 crowns were retained with zinc phosphate cement, and 20 crowns were retained with a screw. A vertical load of 15 kg was applied to all samples under oscilla)on. A Periotest was used to measure the mobility of the implant crown in Periotest values (PTV). Test endpoints were defined by the following: fatigue cycles ≥ 20 million; crown PTV > 10; or if samples became visibly loose or component fracture., Results: Cement-retained crowns failed on average at 2.60 x 106 cycles ± 2.27, while screw-retained crown samples failed at 2.17 x 106 cycles ± 1.27 with no significant difference (P > .05). Implant and abutment screw fractures were the most prevalent mode of failure in the cement-retained group, while in the screw-retained group, failures were caused by the loosening of one or both screw joints. The rate of increase in PTV was higher in the screw-retained group than in the cement-retained group., Conclusions: Under the experimental conditions, an implant crown telescopically engaged vertically to a 3-mm-tall hexagonal abutment, under compressive dynamic cyclic fatigue loading with or without cement, demonstrated no differences in resistance or failure outcomes. A cement-retained implant crown with telescopic engagement to the abutment is more rigid, resulting in more implant and abutment screw fractures than loosening.

Statement of Problem: Dental implants are particularly susceptible to occlusal overloading because, unlike natural teeth, they lack a periodontal ligament to help absorb occlusal forces. However, studies evaluating the impact of different crown and luting materials on the damping behavior and strain distribution of implant-supported crowns are lacking., Purpose: The purpose of this in vitro study was to investigate the damping behavior and strain distribution of peri-implant bone associated with 5 different CAD-CAM implant-supported crowns and 3 luting materials., Material and Methods: A titanium implant was embedded in a plastic tube with epoxy resin and 5 different crown materials (polymethyl methacrylate, resin-infiltrated ceramic, lithium disilicate, titanium, and zirconia) luted to prosthetic abutments with 3 different luting materials (zinc oxide non-eugenol cement, zinc phosphate cement, and adhesive resin cement) and an uncemented condition were tested (n=5). Strain gauges were attached at the crestal and apical levels of the implant model. All specimens were load tested from 0 to 200 N. Slopes of load/time, microstrain/time, and time required to reach the maximum load were examined to represent the damping behavior. Absolute maximum strain (AMS) and its occurrence level were examined to represent the strain distribution. Two-way ANOVA, followed by the Tukey HSD test, were used for statistical analysis (α=.05)., Results: All slopes and times to reach the maximum load in each crown material were statistically similar (P>.05), except for the polymethyl methacrylate group, which showed less steepness in all slopes and more time required to reach the maximum load significantly (P<.05). Both the polymethyl methacrylate group (224.5 ±30.2) and the titanium group (224.0 ±24.3) exhibited significantly higher AMS at the crestal level compared with the resin-infiltrated ceramic group (210.6 ±5.0) (P<.05). The lithium disilicate (218.1 ±15.0) and zirconia groups (217.3 ±14.8) demonstrated comparable AMS values with the others (P>.05). The uncemented group demonstrated steeper slopes and less time required to reach the maximum load compared with the adhesive resin group (P<.05), while slopes and times of the zinc phosphate and zinc oxide non-eugenol groups were comparable (P>.05). The uncemented group (242.7 ±25.3) exhibited significantly higher AMS at the crestal level than the other groups (P<.05)., Conclusions: The crown material significantly affected the damping behavior of peri-implant bone, unlike the luting material. Polymethyl methacrylate with a high damping behavior exhibited high strain at the crestal level. In contrast, resin-modified ceramic with a moderate damping behavior exhibited low strain at the crestal level. Strain at the crestal level could be effectively reduced by approximately 13% through cementation., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Adhesive resin-cements are increasingly used in modern dentistry. Nevertheless, released substances from resin materials have been shown to cause cellular toxic effects. Disc-shaped specimens from 12 different resin cements and one conventional zinc phosphate cement were prepared and used for direct stimulation of five different human cell lines via transwell cell culture system or in an indirect way using conditioned cell culture media. Cytotoxicity was determined using LDH and BCA assays. All tested cements led to a decrease of cell viability but to a distinct extent depending on cell type, luting material, and cytotoxicity assay. In general, cements exhibited a more pronounced cytotoxicity in direct stimulation experiments compared to stimulations using conditioned media. Interestingly, the conventional zinc phosphate cement showed the lowest impact on cell viability. On cellular level, highest cytotoxic effects were detected in osteoblastic cell lines. All resin cements reduced cell viability of human cells with significant differences depending on cell type and cement material. Especially, osteoblastic cells demonstrated a tremendous increase of cytotoxicity after cement exposure. Although the results of this in vitro study cannot be transferred directly to a clinical setting, it shows that eluted substances from resin cements may disturb osteoblastic homeostasis that in turn could lead to conditions favoring peri-implant bone destruction. Thus, the wide use of resin cements in every clinical situation should be scrutinized. A correct use with complete removal of all cement residues and a sufficient polymerization should be given the utmost attention in clinical usage.

Aims: The aim of this study was to compare the retention of different luting agents used with implant-supported restorations., Materials and Methods: A total of 90 custom metal frameworks and copings were prepared and divided into six different luting agent groups (n = 15/group): polycarboxylate cement (PC), resin-modified glass-ionomer cement (RMGIC), two self-adhesive resin cements (SARC), copper-ion zinc-phosphate cement (CZPC), and non-eugenol temporary resin cement (TRC). After sandblasting with 50 μm Al 2 O 3 , the copings were cemented on frameworks and stored in artificial saliva for 48 h at 37°C and thermocycled between 5-55°C for 37,500 cycles. Samples were subjected to tensile testing by a universal testing machine, and data were statistically analyzed., Results: The differences between the retention values of types of cement were significant (P < 0.05). The maximum retention value was calculated for CZPC (755,12 ± 55 MPa) while the lowest value was for TRC (311,7 ± 61 Mpa)., Conclusion: Neither of the tested cement had superiority over another to ensuring retention. The types of cement presented were meant to be a discretionary guide for the clinician in deciding the amount of the desired retention between castings and abutments., Competing Interests: None

Statement of Problem: Conventional cast metal posts and cores are fabricated using direct and indirect techniques, both of which need impression materials and considerable laboratory work. Digital techniques have the capacity to substitute for conventional methods in fabricating the posts and cores. However, the accuracy of restorations resulting from a digital workflow is unknown., Purpose: The purpose of this in vitro study was to compare the retention of posts and cores fabricated using full-digital, half-digital, and conventional techniques and to define the accuracy of each technique in terms of the apical gap., Method and Materials: Thirty newly extracted mandibular first and second premolar teeth were selected for this in vitro study. Impressions were made using direct acrylic resin patterns (conventional), indirect silicone impressions of the intracanal which scanned with a 3Shape laboratory scanner (half digital), and intracanal scan posts captured with an intraoral 3Shape scanner (full digital). Casting and milling were conducted for the conventional impression and digital scans. The obtained posts were cemented using zinc phosphate cement. A universal pullout test was used to measure retention at a crosshead speed of 0.5 mm/min. The apical gap of each post in the canals was defined with parallel digital radiography. The data were analyzed using the Kruskal-Wallis test (α=.05) and Mann-Whitney test at the adjusted α=.016., Results: Significant differences were found among the conventional, full-digital, and half-digital techniques in terms of the apical gap (0.11, 0.29, and 0.66 mm; P<.001) and retention (171.6 ±1.9, 107.1 ±5.6 and 91.8 ±6.6 N; P<.001). The correlation between gap and retention in conventional (P=.43), full-digital (P=.09), and half-digital techniques (P=.06) was not statistically significantly different., Conclusions: The conventional technique was more accurate and resulted in higher retention than both the full- and half-digital techniques. However, the retention and gap of all the posts fell within clinical guidelines., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effect of temporary cement cleaning methods on the retention of cemented crowns using zinc phosphate cement and resin-modified glass ionomer cement., Materials and Methods: Forty titanium specimens were fabricated to simulate prepared molars with minimally retentive taper. The Ni-Cr cast crowns were fabricated, temporarily cemented, and separated. The specimens were divided into four groups according to the temporary cement cleaning method (n = 10) as follows: control group (no temporary cementation), orange solvent group, ultrasonic cleaning group, and air-abrasion group. After the cleaning procedures, the specimens were cemented with definitive cements (zinc phosphate cement and resin-modified glass ionomer, RMGI, cement) and subjected to thermocycling (5000 cycles, 5-55°C, dwell time, 10 seconds). The tensile bond strength of each specimen was measured using a universal testing machine, and the results were analyzed using the Kruskal-Wallis and Mann-Whitney U test (α = 0.05)., Results: When cemented with zinc phosphate cement, the statistical analysis showed that the value of the air-abrasion group was significantly higher than those of the other groups (p < 0.01). There was no statistically significant difference among the other groups. When cemented with RMGI cement, the air-abrasion group showed the lowest value, and the control group showed the highest value (p < 0.01). The difference between the ultrasonic cleaning group and the orange solvent group was not statistically significant., Conclusion: The use of temporary cement did not have a significant influence on retention of permanently cemented crowns when zinc phosphate cement was used for permanent cementation. Airborne-particle abrasion after provisional cementation improved retention of crowns cemented with zinc phosphate cement; however, the use of temporary cement significantly decreased retention of permanently cemented crowns when RMGI cement was used regardless of the temporary cement cleaning method., (© 2017 by the American College of Prosthodontists.)

Objective and Background: The correct selections of the cementing agent, the endodontic post material and placement protocol are critical to provide an increased longevity of the teeth that went through endodontic treatment. The irradiation with diode laser before post cementation, can promote an antimicrobial effect. However, there is a lack of information about the effect of 830 nm diode laser on the post bond strength. This study analyzed the effect of dentin root canal irradiation with high-intensity diode laser, at 830 nm, operating in continuous or pulsed mode, on the retention of metal or fiber posts, cemented with self-etching resinous composite (Panavia F) and zinc phosphate cement (ZnPO 4 )., Materials and Methods: Human roots were irradiated with diode laser (continuous and pulsed mode). The fiber posts were luted with Panavia F and the metal posts with Panavia F or ZnPO 4 cement. Specimens were sectioned into three sections (cervical, middle, and apical). The bond strength was measured by a push-out mechanical analysis. For the statistical analysis, a three-way ANOVA test was applied following a Tukey's pairwise comparison with a significance level of p = 0.05., Results: The irradiated groups presented higher bond strength compared with nonirradiated group (p < 0.05), and the cervical and middle thirds presented higher on bond strength than the apical. The association of metal post and Panavia F presented higher bond strength when irradiated on continuous mode (p < 0.05). Fiber post and Panavia F presented higher bond strength associated to pulsed mode. The mode seems not to make a significant difference., Conclusions: These results corroborate the importance of the post bond to dentin and root canal debris removal to increase the tooth longevity. It was shown that the dentin to post bond strength were enhanced by the diode laser irradiation either on continuous or pulsed modes.

Aim: The aim of this study is to evaluate the effect of temperature change on film thickness of both types of cements., Materials and Methods: Totally, 60 samples were prepared with 10 in each subgroup, thus comprising 30 in each group. Materials tested were glass ionomer cement (GIC) type I and zinc phosphate type I. Samples were manipulated with manufacturer's instructions and tested according to American Dental Association (ADA) guidelines., Results: The mean values of film thickness were recorded for both groups I and II. In intragroup comparison of group 1, subgroup III (26.560 ± 0.489 urn) was found to have the highest film thickness followed by subgroup II (24.182 ± 0.576 urn) and the lowest in subgroup I (20.209 ± 0.493 urn). In intragroup comparison of group II, the film thickness recorded in subgroup III (25.215 ± 0.661 urn) was the highest followed by subgroup II (21.471 ± 0.771 urn) and the least in subgroup I (17.951 ± 0.654 urn; p < 0.01). In intergroup comparison of groups I and II, group II (21.545 ± 0.841) was found to have less film thickness than group I (23.650 ± 0.271). The results were found to be statistically significant (p < 0.01)., Conclusion: Both zinc phosphate and GICs can be used satisfactorily for luting purpose. The temperature fluctuations have a direct influence on the film thickness. Zinc phosphate has less film thickness than GIC., Clinical Significance: Zinc phosphate should be preferred over GIC in clinical practice, and more stress should be given in mechanical preparation of crowns for better retentive quality of prosthesis.

Purpose: To determine the effect of the cement type and abutment material on the tensile strength required to dislodge zirconia copings., Materials and Methods: Two experimental groups of abutments were prepared: (1) titanium abutments (n = 30) and (2) zirconia abutments (n = 30). Sixty zirconia copings (custom designed) were fabricated using 3-dimensional computer-assisted design to have a 6-mm projection above the abutment to accommodate a hole, through which a wire was inserted to attach the zirconia coping to a universal testing machine. Each abutment was placed onto an implant analog embedded in acrylic resin blocks to fit onto the universal testing machine. The zirconia copings were cemented onto the abutments with a provisional luting agent, zinc phosphate (ZP) cement, and adhesive resin cement, and after 5500 thermocycles, a tensile force was applied at a crosshead speed of 0.5 mm/min. The removal force was recorded for each specimen. Two-way analysis of variance (ANOVA) and 1-way ANOVA were used for the statistical analysis (P < 0.05)., Results: The mean forces necessary to remove the zirconia copings from titanium abutments were 6.52, 83.09, and 251.18 N for temporary cement, ZP cement, and resin cement, respectively. For zirconia abutments, the required forces were 17.82, 116.41, and 248.72 N., Conclusions: The abutment material had no effect on retention, but the cement type affected the retention of the zirconia copings.

Objectives: To evaluate the effect of thermal cycling and inner surface treatment with aluminum oxide at different granulations on the tensile strength of Ni-Cr copings cemented with different cementing agents., Materials and Methods: Ninety-six metal copings were manufactured and divided into two groups: before and after thermal cycling (n = 48). The copings of both groups were internally treated by sandblasting with aluminum oxide particles of 100 (n = 24) and 320 (n = 24) mesh. The copings were cemented on previously manufactured metal cores using zinc phosphate (n = 8), conventional glass ionomer (CGIC) (n = 8) and resin-modified glass ionomer (RMGIC) (n = 8) cements. The tensile strength before and after thermal cycling was then determined (Newtons)., Results: The tensile strength before and after thermal cycling was significantly higher in copings cemented with RMGIC compared to CGIC (p < 0.05) and was similar to that for zinc phosphate (p > 0.05). Thermal cycling and sandblasting of the inner surface of the metal copings with different granulations did not influence retention (p > 0.05)., Conclusions: Zinc phosphate cements and RMGIC showed similar retention. Additionally, the retention of the cements was not influenced by either thermal cycling or the particle size of the aluminum oxide.

This clinical report describes the structure and characteristics of the biofilm formed under a cemented restoration, confirming the need to develop new cementation protocols to disrupt and minimize the formation of biofilm before cementing definitive restorations., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Bond stability between zirconia crowns and luting cement and between cement and dentin is a main concern; however, only limited evidence is available as to its longevity., Purpose: The purpose of this in vitro study was to measure the retentive strengths of 7 self-adhesive cements (RelyX Unicem Aplicap, RelyX Unicem Clicker, RelyX Unicem 2 Automix, iCEM, Maxcem Elite, Bifix SE, SpeedCem), 2 adhesive cements with self-etch primers (Panavia 21, SEcure), 1 glass ionomer cement (Ketac Cem), 1 resin-modified glass ionomer cement (Meron Plus), and 1 zinc phosphate cement for luting zirconia crowns (LAVA) to extracted teeth after thermocycling with or without 1 year of water storage., Material and Methods: Two-hundred-forty extracted human molars (2 treatments; n=10 per cement) were prepared in a standardized manner. All cements were used according to the manufacturers' recommendations. The intaglios of the crowns were treated with airborne-particle abrasion. After thermocycling (×5000, 5°C/55°C) with or without 1 year of water storage, the cemented ceramic crowns were removed by using a Zwick universal testing device. Statistical analyses were done with the Wilcoxon rank sum and the 2-independent-samples Kolmogorov-Smirnov test., Results: Median retentive strengths [MPa] for specimens thermocycled only/thermocycled with 1 year of water storage were as follows: Panavia 21: 1.7/2.5, SEcure: 3.0/3.0, RelyX Unicem Aplicap: 3.1/3.4, RelyX Unicem Clicker: 4.1/4.2, RelyX Unicem 2 Automix: 3.8/3.1, iCEM: 2.3/2.7, Maxcem Elite: 3.0/3.2, Bifix SE: 1.7/1.7, SpeedCem: 1.3/1.6, Meron Plus: 3.1/2.7, Ketac Cem: 1.4/1.4, and zinc phosphate cement: 1.1/1.6. Statistically significant differences were found only among specimens thermocycled only or thermocycled with 1-year water storage (P<.001)., Conclusions: Significant differences in retentive strengths were observed among cements after thermocycling only or thermocycling with 1 year of water storage, but not for the effect of the additional 1 year of water storage., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Zirconia ceramic disks (Cercon) were fabricated using a computer-aided design/ computer-assisted manufacture system and fitted to hard tooth tissues from freshly extracted bovine mandibular incisors using seven cements (zinc phosphate, zinc polycarboxylate, Eco-Link, Panavia F 2.0, Clearfil SA Cement, MaxCem Elite, and GC Fuji Plus) with various physicochemical and bonding properties. Bond strengths were determined using a universal testing machine (Hounsfield H5KS) with a 5,000-N head and a cutting knife speed of 0.5 mm per minute. The study showed that the strongest bond between zirconia ceramic and hard tooth tissues was obtained with Panavia F 2.0 adhesive cement based on 10 methacryloyloxydecyl dihydrogen phosphate monomer.

Statement of Problem: The constant updating of computer-aided design/computer-aided manufacture (CAD/CAM) systems and the introduction of new systems confirm the need for scientific evidence on internal and marginal adaptation., Purpose: The purpose of this in vitro study was to measure and compare the degree of internal and marginal misfits of zirconia single-unit copings made by using 3 different CAD/CAM systems (Ceramill, Lava 3M, and Neoshape)., Material and Methods: Twenty-four anatomic prefabricated abutments (Neodent) were used to fabricate zirconia copings in Ceramill (n=8), Lava (n=8), and Neoshape (n=8). All copings were cemented and cut with a precision cutting machine to obtain 5 surfaces (mesial, distal, buccal, palatal, and incisal) and angle regions (internal axiogingival and axioincisal angles). Measurements were obtained from images at a magnification of ×100 and ×200 made with a digital camera attached to an optical microscope and adapted with a measuring device. The data were statistically analyzed with the 2-way ANOVA and Tukey honestly significant difference tests (α=.05)., Results: In the internal misfit evaluation, the mean values observed for Ceramill, Lava, and Neoshape were palatal surface 76.5, 65.5, and 77.7 μm (P=.003); angle regions 69.4, 68.6, and 74.5 μm (P=.010); incisal surface 127.7, 97.2, and 182.2 μm (P<.001); and overall mean 72.1, 69.4, and 76.4 μm (P=.003). Significant differences were not found for mesial, distal, or buccal surfaces (P>.05). In the evaluation of marginal misfit (marginal discrepancy and absolute marginal discrepancy), the mean values found were 40.9 and 65.8 μm for Ceramill, 34.2 and 70.0 μm for Lava, and 39.3 and 74.5 μm for Neoshape. No significant differences were found among the 3 systems (P>.05)., Conclusions: Although the Lava system showed a significantly lower value of internal misfit than the Neoshape system, all systems showed clinically acceptable marginal misfit values., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The aim the work was to investigate the effect of varying degrees of luting cement thickness on the strain of the cemented gold alloy crowns under compression. Five dies with their corresponding crowns were fabricated using a lost wax technique. Three gold crowns for each die were fabricated under the control of specific die spacer layers to provide a space of 40 µm (10 layers of die-spacer thickness) and 80 µm (20 layers of die-spacer thickness). The crowns were subsequently cemented using zinc phosphate cement. The crowns were subjected to gradual static compressive loading between 10N to 250N (Newton) and the strain measured simultaneously. The results were statistically analysed using Independent t-test for the different die-spacer thickness at the 95% confidence interval (p = 0.05). It was found that a significant relationship in the three thicknesses. It was concluded that the absence of die-spacer significantly reduced strain response, whereas a very little change in the strain recorded as the die spacer layers has increased. Clinically, decreasing the number of die-spacer layers is advantageous as it provides a lower strain response under static compressive loading that would improve the longevity of the cemented full crowns inside the patient's mouth.

The study aimed to 1) evaluate the cytotoxicity of luting cements: Hoffmann's Zinc Phosphate (Hoffmann's ZP), GC Fuji Plus Resin Modified Glass Ionomer (Fuji Plus RMGI) and 3M ESPE RelyX Unicem Resin Cement (RelyX Unicem RC) and 2) test if pre-washing reduces the cements' cytotoxicity. In vitro human gingival fibroblast (HGF) culture model was chosen. The cytotoxicity was evaluated by MTT test, the cell viability -by staining the cells with AO/EB dye mixture. The means±SD of Cell Survival Ratio (CSR%) were compared among different cement types under two testing conditions, with or without cement pre-washing. The CSR%s were compared by ANOVA and linear multiple regression (LMR). Hoffmann's ZPC was less cytotoxic, while Fuji Plus RMGIC and RelyX Unicem RC were more cytotoxic (ANOVA, p<0.001). The type of cement and cement pre-washing jointly explained 90% of cell survival (LMR, p<0.001, adjusted squared R=0.889). The commonly used luting cements such as Hoffmann's ZP, Fuji Plus RMGI and RelyX Unicem RC may have a cytotoxic potential.

Purpose: The purpose of this study was to analyze the removal of implant-supported crowns retained by three different cements using an air-accelerated crown remover and to evaluate the patients' response to the procedure., Materials and Methods: This controlled clinical trial was conducted with 21 patients (10 women, 11 men; mean age: 51 ± 10.2 years) who had received a total of 74 implants (all placed in the posterior zone of the mandible). Four months after implant surgery, the crowns were cemented on standard titanium abutments of different heights. Three different cements (two temporary: Harvard TEMP and Improv; and one definitive: Durelon) were used and randomly assigned to the patients. Eight months later, one blinded investigator removed all crowns. The number of activations of the instrument (CORONAflex, KaVo) required for crown removal was recorded. The patients completed a questionnaire retrospectively to determine the impact of the procedure and to gauge their subjective perception. A linear regression model and descriptive statistics were used for data analysis., Results: All crowns could be retrieved without any technical complications or damage. Both abutment height (P = .019) and cement type (P = .004) had a significant effect on the number of activations, but the type of cement was more important. An increased total number of activations had no or only a weak correlation to the patients' perception of concussion, noise, pain, and unwillingness to use the device., Conclusions: Cemented implant crowns can be removed, and the application of an air-accelerated device is a practicable method. A type of cement with appropriate retention force has to be selected. The impact on the patients' subjective perception should be taken into account.

Statement of Problem: The effect of the surface treatment of zirconium oxide posts on their push-out bond strength is controversial., Purpose: The purpose of this study was to compare the effects of 2 surface treatments on the bond strength of zirconium oxide posts cemented with different cements and to assess the failure mode., Material and Methods: Seventy extracted human teeth were divided into 7 groups (n=10). Custom zirconium oxide posts (Cercon; Degudent) were fabricated for 6 groups. Posts in 3 groups were airborne-particle abraded (A). Posts in the other 3 groups were tribochemical silica coated (T). Three cements were used. Zinc phosphate cement was used to cement the zirconium oxide posts in groups AZ and TZ, RelyX ARC cement was used in groups ARA and TRA, and RelyX Unicem cement was used in groups ARU and TRU. Group C contained custom metal posts cemented with zinc phosphate cement. Specimens were horizontally sectioned into 3 sections and subjected to a push-out test. A mixed model analysis of variance, 1-way ANOVA, and the Tukey multiple comparison tests were used for statistical analysis., Results: The highest push-out bond strength was recorded for Group ARU (21.03 MPa), and the lowest was recorded for Group ARA (7.57 MPa). No significant difference in push-out bond strength was found among the different surface treatments and root regions (P>.05). The type of cement had a significant effect on the push-out bond strength of zirconium oxide posts (P=.049). RelyX Unicem cement recorded (19.57 ±8.83 MPa) significantly higher push-out bond strength compared with zinc phosphate (9.95 ±6.31 MPa) and RelyX ARC cements (9.39 ±5.45 MPa). Adhesive failure at the post-cement interface was recorded for 75% of the posts cemented with zinc phosphate and RelyX ARC cements, while mixed failure was recorded for 75% of the posts cemented with RelyX Unicem cement., Conclusions: The type of cement used resulted in a statistically significant difference in the push-out bond strength of zirconium oxide posts, while both the surface treatment and root region resulted in no statistically significant effect after artificial aging. RelyX Unicem cement had significantly higher push-out bond strength than did zinc phosphate and RelyX ARC cements., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: To quantify the cement remnants on titanium and zirconia abutment analogs after cement removal by resin and steel scalers., Materials and Methods: Defined areas of titanium or zirconia cylindric samples were covered with thin cement rings of zinc oxide phosphate (ZOP), glass ionomer (GIC), carboxylate (CAB), zinc oxide-eugenol (ZOE), or zinc oxide-eugenol-free (ZOEF). The cements were mixed with liquid-to-powder ratios of 50%, 75%, 100%, and 150% of powder. After setting and aging by thermocycling, each specimen was scaled by a blinded, trained clinician. Standardized digital photos of the scaled areas were analyzed according to a four-point classification scheme for remnants, and the results were analyzed statistically., Results: The main effects of the independent variables "cement type," "abutment material," and "scaler" showed statistically significant differences for all variables. Such differences were also found with regard to the interactions of the variables "cement type" and "material" as well as for the type of cement and scaler. The extent of remnants after scaling differed significantly between titanium and zirconia. Steel scalers achieved statistically significantly better cleaning than resin scalers. The powder-to-liquid ratio of all luting agents significantly influenced the extent of cement surplus after scaling. ZOEF was the only type of cement that could be more successfully removed from titanium than from zirconia., Conclusions: Nearly complete removal of ZOE could be achieved. This luting agent was not as sensitive to aberrant mixing ratios or to resin or steel scaling as the other types of cement. With the exception of ZOEF, zirconia surfaces were easier to clean. After removal of most of the remnant, some cements showed a barely visible thin greasy or powdery layer.

Statement of Problem: Computer-aided design/computer-aided manufacturing (CAD/CAM) titanium ceramic restorations were developed with the potential for replacing expensive, high noble metal ceramic restorations. However, little information exists about the clinical performance of CAD/CAM titanium ceramic single crowns., Purpose: The purpose of this study was to evaluate CAD/CAM titanium ceramic single crowns after 6 years in function., Material and Methods: A total of 41 crowns were fabricated for 21 patients. The titanium copings were CAD/CAM milled (Everest CAD/CAM system), with an even thickness of 0.5 mm and veneered with low-fusing porcelain (Vita Titanium Porcelain) in the powder-build-up technique. All the crowns were cemented with zinc phosphate. The participants were recalled at 12, 24, 36, 48, 60, and 72 months after cementation to document any mechanical and biologic complications and to measure the periodontal parameters, such as probing depth, bleeding on probing, and the plaque index. The success and survival rates were calculated according to the Kaplan-Meier analysis., Results: After 6 years of clinical service, 12 mechanical complications and 1 biologic complication were found, which resulted in a success rate of 67.8%. The cumulative survival rate of the crowns was 91.3% after 6 years. At the end of the follow-up period, the probing depth was 3.21 mm, the percentile of surface with bleeding on probing was 25, and the plaque index was 0.37. No secondary caries or decementation was detected during the 6-year observation period., Conclusions: The clinical performance of the CAD/CAM titanium-ceramic crowns after 6 years was poor because of veneering porcelain problems. Recent CAD software with tools to design proper copings might improve the clinical success., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Cement microfracture, post-and-core dislodgement, and tooth fracture are related to the mechanical properties and deformation of restorations., Purpose: The purpose of this study was to determine which combinations of post-and-core cements provide the most favorable stress distribution upon loading., Material and Methods: Three-dimensional models of teeth were created with the ANSYS program to simulate the different materials used for metal ceramic crowns (nickel-chromium, gold-palladium), posts and cores (Ti, Ni-Cr, Au-Pd), and cement (glass ionomer, composite resin, zinc phosphate, polycarboxylate, Panavia). Models were divided into 2 groups according to the alloys used in the crown restorations. A simulated masticatory force of 400 N was applied to the occlusal surface at a 45-degree inclination in the linguolabial direction to the long axis of the tooth, and von Mises equivalent stress values were calculated., Results: The Ni-Cr metal ceramic crown/Au-Pd post-and-core/glass ionomer cement had the highest residual root von Mises equivalent stress value, whereas the Ni-Cr metal ceramic crown/Ni-Cr post-and-core/glass ionomer cement had the highest post stress value and the Ni-Cr metal ceramic crown/Au-Pd post-and-core/zinc phosphate cement had the highest cement stress value. For each post-and-core alloy, the stress values in the post and core were higher with Au-Pd metal ceramic crowns than with Ni-Cr metal ceramic crowns. The post-and-core material affected the amount of deformation., Conclusions: The use of a post-and-core material with a lower elastic modulus and a cement with a higher elastic modulus led to a reduction in deformation in the residual root, cement, and post and core, and a reduction in stress in the post and core. The Ni-Cr metal ceramic crown/Au-Pd post-and-core/zinc phosphate cement or Panavia may therefore be favorable for post-and-core restorations., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: Occlusal reduction is considered a fundamental step for providing adequate and uniform space for the ceramic prosthesis; however, a flat occlusal surface is usually found. The prosthesis design influences the resistance to deformation and the stress state within the ceramic. This finite element (FE) study analyzes the influence of changing the substructure design on the stress distribution of a metal-ceramic crown in a premolar tooth with three types of occlusal reduction., Materials and Methods: Each part of three-dimensional metal ceramic complete crown models was designed according to the space provided by different levels of occlusal reduction and the same external morphology of the tooth. Three models were designed: (1) correct occlusal reduction with a uniform thickness of the substructure (0.3 mm) and the veneering porcelain (1.5 mm); (2) flat occlusal reduction with different thicknesses of veneering porcelain to produce a uniform substructure; and (3) a flat occlusal reduction with different thicknesses of substructure for a uniform thickness of veneering porcelain., Results: Stress distributions were very similar in the three models. The highest tensile stresses were concentrated immediately below the midline fissure in both the veneering porcelain and the metal alloy substructure. Although models with flat occlusal reduction had lower stress values, this preparation results from a reduction that removes a greater amount of sound tissue, which may increase the probability of dental pulp injury., Conclusions: Occlusal reduction must be anatomic; however, when a flat occlusal reduction already exists, the substructure must reproduce the correct anatomic form to allow a uniform thickness of the veneering porcelain., (© 2014 by the American College of Prosthodontists.)

Background: The purpose of this study is to analyze the tension distribution on bone tissue around implants with different angulations (0°, 17°, and 30°) and connections (external hexagon and tapered) through the use of three-dimensional finite element and statistical analyses., Methods: Twelve different configurations of three-dimensional finite element models, including three inclinations of the implants (0°, 17°, and 30°), two connections (an external hexagon and a tapered), and two load applications (axial and oblique), were simulated. The maximum principal stress values for cortical bone were measured at the mesial, distal, buccal, and lingual regions around the implant for each analyzed situation, totaling 48 groups. Loads of 200 and 100 N were applied at the occlusal surface in the axial and oblique directions, respectively. Maximum principal stress values were measured at the bone crest and statistically analyzed using analysis of variance. Stress patterns in the bone tissue around the implant were analyzed qualitatively., Results: The results demonstrated that under the oblique loading process, the external hexagon connection showed significantly higher stress concentrations in the bone tissue (P <0.05) compared with the tapered connection. Moreover, the buccal and mesial regions of the cortical bone concentrated significantly higher stress (P <0.005) to the external hexagon implant type. Under the oblique loading direction, the increased external hexagon implant angulation induced a significantly higher stress concentration (P = 0.045)., Conclusions: The study results show that: 1) the oblique load was more damaging to bone tissue, mainly when associated with external hexagon implants; and 2) there was a higher stress concentration on the buccal region in comparison to all other regions under oblique load.

Purpose: To assess the sealing properties of four luting materials used for cementation of full cast crowns., Methods: 40 human premolars were prepared with a chamfer finish line. Stone dies were fabricated and copings were waxed, invested and cast in gold. Ten samples (n = 10) were randomly assigned to four groups. In two groups, resin modified glass-ionomer cements were used, ACTIVA BioACTIVE-CEMENT/BASE/LINER and FujiCem2; the third group received the self-adhesive resin cement Embrace WetBond, while the fourth group served as control with a zinc phosphate cement. After cementation, excess cement was removed followed by bench-set for 10 minutes. All samples were stored in water at 37 degrees C and subjected to thermal cycling (x2000 between 5 and 55 degrees C). Subsequently the occlusal surface was reduced exposing the dentin. After sterilization the specimens were subjected to bacterial microleakage with E. faecalis in a dual chamber apparatus for a period of 60 days. Bacterial leakage was checked daily. Data were analyzed using the Kaplan-Meyer survival test. Significant pairwise differences were analyzed using the Log Rank test and the Fishers' exact test at P < 0.05., Results: ACTIVA BioACTIVE-CEMENT/BASE/LINER, FujiCem2 and Embrace WetBond showed the lowest microleakage scores and differed statistically significantly (P < 0.05) from zinc phosphate cement.

Objectives: The primary goal of the present finite element (FE) analysis of a special removable prosthesis, the conical telescopic crown (CTC), was to validate established results based on a rigid model of the CTC and to analyze its characteristic features as a function of the essential material and geometric parameters. Furthermore, the effectiveness of a new element, the composite stop (CS), was investigated., Materials and Methods: The study used an axisymmetric FE model containing the inner and outer crown including resin or ceramic veneer, the CS, the cement layer between the interior crown and the tooth, and the upper part of the tooth itself., Results: For a convergence angle (half-cone angle) α = 4 degrees and a moderate chewing force F = 150 N the loosening force decreased from - 50 N without to - 10 N with CS. Increasing α values yielded a decrease of the loosening force. Adherence between the inner (IC) and outer crown (OC) was achieved for all configurations (α = 2 degrees, 4 degrees, and 6 degrees), except for zirconium crowns with α = 6 degrees. In systems without CS, the maximum tensile stress in the veneer increased proportionally to F, but remained limited in those with CS., Conclusions: The angle a and the coefficient of static friction μ0 emerged as the decisive parameters of the CTC. The computed fitting/loosening behavior agreed well with results of a simple rigid-body model and experiments. The incorporation of a CS allows ceramic veneering of the outer crown., Clinical Relevance: The optimal angle α of the CTC is ascribed to a number of customary material combinations for IC and OC. The CS limits the loosening forces of the CTC to values which guarantee non-traumatic removal of the prosthesis.

Calcium phosphate is known as a major component of biological hard tissues. This study aimed to produce calcium phosphate by recycling kneaded surplus gypsum. β-dihydrate gypsum was derived from commercial dental β-hemihydrate gypsum, which was mechanically powdered and mixed with the liquid component of a commercial zinc phosphate cement. This mixture was fired at 1,200°C and evaluated by XRD analysis, thermal analysis and scanning electron microscopy (SEM). An acceptable ratio of mixing was 4 g of β-dihydrate gypsum powder to 1.5 mL of phosphoric acid liquid. XRD peaks were monotonic below 800°C, but new ß-TCP was formed by firing at 900°C or more, although TG-DTA analysis of synthetic ß-TCP suggested that some residual dihydrate gypsum remained in the sample. SEM images indicated a fused-block bone-like structure covered with phosphorus and calcium. These results suggest that production of synthetic β-TCP is possible through ecological techniques using recycled materials.

This study was to examine the retentive force of crowns to implant abutments with commercial temporary cements. Six different temporary cements were investigated. Cast crowns were cemented to the abutments using each cement and their retentive forces to abutments were determined 7 or 28 days after cementing (n=10). The retentive force of the cements to abutments varied widely among the products [27-109 N (7-day), 18-80 N (28-days)]. The retentive force of all the cements was not reduced as the time elapsed, except for two products tested. The polycarboxylate cements and paste-mixing type eugenol-free cements revealed comparable retentive force after 28 days of storage. The powder-liquid type cements showed a positive correlation (p<0.05) between the retentive force and the shear strength, while a negative correlation (p<0.05) was obtained for paste-mixing type cement between the retentive force and compressive strength. Mechanical strength of temporary cements could not be a prominent predicting factor for retention of the crowns on the abutments.

Introduction: The purpose of this study was to determine and compare the times needed to dislodge prefabricated titanium posts of different luting lengths with various cements., Methods: Eighty-one intact extracted, single-canal human teeth were selected and endodontically treated. Specimens were randomly divided into 9 groups, which were arranged according to the post space length (5, 7, and 9 mm) and cement type (zinc phosphate, glass ionomer, and resin cement). Titanium posts were cemented into the post spaces, and after 1 week of storage they were subjected to ultrasonic vibration. The dislodging times were recorded and analyzed by using the Kruskal-Wallis and Mann-Whitney tests (P < .05)., Results: A significant difference was observed between the dislodging times on the basis of post length and luting agent (P < .001). There were also significant differences between different cements luted with the same length posts (P < .001). Significant differences were observed between the 5-mm posts and both the 7- and 9-mm posts for each cement, but the differences between the 7-mm and 9-mm posts were not significant (P < .05)., Conclusions: Changes in the cement type and post length alter the time required to dislodge a post with an ultrasonic device., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this split-mouth study was to compare macro- and microstructure implant surfaces at the marginal bone level over five years of functional loading., Materials and Methods: From January to February 2006, 133 implants (70 rough-surfaced microthreaded implants and 63 machined-neck implants) were inserted in the mandible of 34 patients with Kennedy Class I residual dentitions and followed until December 2011. Marginal bone level was radiographically determined at six time points: implant placement (baseline), after the healing period, after six months, and at two years, three years, and five years follow-up., Results: Median follow-up time was 5.2 years (range: 5.1-5.4). The machined-neck group had a mean crestal bone loss of 0.5 mm (0.0-2.3) after the healing period, 1.1 mm (0.0-3.0) at two years follow-up, and 1.4 mm (0.0-2.9) at five years follow-up. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (-0.4 to 2.0) after the healing period, 0.5 mm (0.0-2.1) at two years follow-up, and 0.7 mm (0.0-2.3) at five years follow-up. The two implant types showed significant differences in marginal bone levels., Conclusions: Rough-surfaced microthreaded design caused significantly less loss of crestal bone levels under long-term functional loading in the mandible when compared to machined-neck implants., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: Missing teeth may be restored with conventional bridgework. A modified approach to traditional bridge design may be necessary to restore edentulous spaces in the presence of poorly aligned abutment teeth and abutment teeth of guarded prognosis. The coping bridge is a useful technique in the dentist's armamentarium for patients in whom implant-supported or removable prostheses are inappropriate. This paper examines the use of coping-retained bridges as a modification on traditional design and discusses how these appliances may be applied in general practice. A case report is presented describing the application of this design in general practice., Clinical Relevance: Applying a modified approach to bridge design may allow complicated edentulous spaces to be restored successfully in general practice.

Statement of Problem: The failure of fixed dental restorations is commonly associated with caries. The use of conventional luting cements containing antibacterial agents may overcome this problem., Purpose: The purpose of this study was to evaluate the antibacterial activity (ABA), surface roughness (Ra), flexural strength (FS), and solubility (SL) patterns of the conventional dental luting cements zinc phosphate (ZP), zinc polycarboxylate (PC), and glass ionomer (GIC) after the addition of 5% chlorhexidine diacetate/cetrimide (CHX+CT)., Material and Methods: Antibacterial agents with a total concentration of 5% (2.5% CHX+2.5% CT) were added to antibacterial agent-free conventional luting cement powders (ZPC, PCC, and GICC) and designated as experimental groups (ZPE, PCE, and GICE). ABA against Streptococcus mutans (SM) and Lactobacillus casei (LB) was examined by using the agar diffusion test method. Ra, FS, and SL values were obtained after storage in distilled water at 37°C for 24 hours. The Kruskal-Wallis and Mann Whitney U with Bonferroni correction tests were used to test for agar diffusion (α=.05) and 2-way ANOVA and Fisher Least Significant Difference (LSD) test were used to measure Ra, FS, and SL (α=.05)., Results: The control groups exhibited limited ABA. With the exception of PCE>PCC on day 1 for SM, all experimental groups showed significantly greater and longer-lasting protection against SM and LB bacteria for up to 180 days than their controls (P<.05). Ra values decreased (ZPC>ZPE; P>.05, PCC>PCE; P<.05) except that GICE>GICC (P>.05) when compared with their individual controls. Control groups exhibited higher FS values than did the experimental groups (ZPC>ZPE; P<.05, PCC>PCE; P<.05, GICC>GICE; P>.05). The experimental groups exhibited higher solubilities than did their controls in the ZPC (P>.05) and GICC groups (P<.05) but were lower in PCC group (P<.05)., Conclusions: Incorporating a 5% CHX+CT mixture into conventional dental luting cements and altering their Ra, FS, and SL values may provide greater antibacterial protection against SM and LB., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

This study examines the relationship between the retention force and natural frequency of dental posts cemented with zinc phosphate cement. Forty-two decoronated maxillary incisors were collected and embedded in resin blocks. The 7-mm post spaces were prepared for all test samples prior to cementing the 13-mm Para-Posts with zinc phosphate cement. The natural frequency values and retention forces of the zinc phosphate cement-cemented Para-Posts in various liquid/powder mixing ratios were measured. Thereafter, the natural frequency values of the zinc phosphate cement-cemented posts were continuously detected during ultrasonic vibration. Moreover, both the natural frequency values and the dislodgement forces in response to ultrasonic vibrations were measured for the pretreated post samples. Results showed that the natural frequency values of the posts significantly decreased from 8.8 ± 0.8 to 5.0 ± 0.5 kHz (P < 0.05) before and after ultrasound treatment, respectively. The natural frequency values and the dislodgement forces of tested posts had a highly linear relationship (R² = 0.99, P < 0.05). These findings suggest that natural frequency is a variable for monitoring the stability status of zinc phosphate cement-cemented dental posts.

Objective: The aim of this study was to evaluate the retention value of implant-supported zirconium oxide ceramic copings using different luting agents., Method and Materials: Twenty ITI solid abutments of 5.5 mm height and ITI implant analogs were mounted vertically into autopolymerizing acrylic resin blocks. Ninety zirconium oxide copings (Cercon, Degudent) with a loop on the occlusal portion were made. All samples were airborne particle abraded with 110 μm Al₂O₃ and luted using different types of luting agents: resin cements (Clearfil SA, Panavia F2.0, Fuji Plus), conventional cements (Fleck's, Poly F, Fuji I), and temporary cements (Temp Bond, GC free eugenol, TempSpan) with a load of 5 Kg. (N = 10) All copings were incubated at 37°C for 24 h and conditioned in artificial saliva for 1 week, and thermal cycled for 5000 cycles 5-55°C with a 30-s dwell time. The dislodging force of the copings along the long axis of the implant-abutment complex was recorded using universal testing machine with 5 mm/min crosshead speed. Data were subjected to Kruskal-Wallis (α = 0.05) and Mann-Whitney tests with Bonferroni step down correction (α = 0.001)., Results: There was significant difference between the mean rank retention values of different luting agents (P < 0.001). The resin cements showed the highest retention (Clearfil SA, 203.49 ± 52.86; Fuji Plus, 190.61 ± 48.00; Panavia F 2.0, 172.16 ± 70.76 N). The conventional cements had more retention than the temporary cements and glass ionomer cement (P < 0.001)., Conclusion: The retention of zircona ceramic restorations, over ITI solid abutments may be influenced by the type of cement. The application of an MDP-containing resin and resin-modified glass ionomer luting agents increase the retentive value of implant-supported zirconium oxide restorations., (© 2011 John Wiley & Sons A/S.)

Objectives: Fracture strength measured in vitro indicates that most all-ceramic crowns should be able to withstand mastication forces. Nevertheless, fractures are one of the major clinical problems with all-ceramic restorations. Furthermore, the fracture mode of all-ceramic crowns observed in clinical use differs from that found in conventional fracture strength tests. The aim of the present study was to develop and investigate a method that simulates clinical fracture behavior in vitro., Methods: 30 crowns with alumina cores were made to fit a cylindrical model with a molar-like preparation design. These crowns were randomly allocated to 3 tests groups (n=10). The crowns in group 1 were cemented to abutment models of epoxy and subsequently fractured by occlusal loading without contact damage. The crowns in group 2 were fractured by cementation with expanding cement. The crowns in group 3 were cemented on an abutment model of epoxy split almost in two and fractured by increasing the diameter of the model in the bucco-lingual direction. The fractured crowns were analyzed by fractographic methods and compared to a reference group of 10 crowns fractured in clinical use., Results: The fracture modes of all the in vitro crowns were similar to clinical fracture modes. The fracture modes in group 1 were most closely matched to the clinical fractures. These crowns also fractured at clinically relevant loads., Conclusion: Laboratory tests that induce a distortion of the abutment model during occlusal loading without occlusal contact damage can simulate clinical fractures of all-ceramic crowns., (Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

This study evaluated the effect of different ultrasonic vibration protocols on custom cast post-and-cores' retention to the root canal. Post holes were placed in the root canals of human maxillary canines, and post-and-core sets were luted, using zinc phosphate cement. The samples were divided into 5 groups (n = 8). Group 1 (control) received no ultrasonic vibration. For the other samples, the tip of the ultrasonic device was positioned either over the incisal face of the core (Group 2), over the lateral core surfaces and close to the incisal edge (Group 3), over the lateral face of the core but close to the line of cementation (Group 4), or over the lateral face of the core but with the end of the mouth mirror handle positioned on the opposite surface of the core (Group 5). After a tensile test, data were submitted to 2-way ANOVA and Tukey's tests (P < 0.05). The control group showed higher values than all of the groups that were submitted to ultrasonic vibration. Bond strength was similar for Groups 2 and 3. Bond strength was lower in Groups 4 and 5; no statistical difference was observed between these 2 groups. Based on these results, both positioning the tip of the ultrasonic device near the cement line and placing a mouth mirror handle on the opposite surface of the core, are effective ways to reduce the retention of a cast post-and-core within a root canal.

Statement of the Problem: Post retention is crucial factor in restoration survival. Posts are commonly failed due to loss of retention. It is unknown which luting agents would provide the maximum bond strength for Locator overdenture posts., Aim: The aim of this study was to evaluate the bond retentive strengths of Locator overdenture posts cemented with 7 luting agents., Materials and Methods: One hundred and five single rooted human teeth were decoronated and randomly assigned to 7 groups (n = 15). Post spaces were prepared with Locator post drills to the depth of 6 mm. The Locator posts were cemented with Variolink II, RelyX ARC, Multilink N, RelyX Unicem, ParaCore, or MultiCore Flow resin luting agents. Zinc phosphate cement was served as control group. Specimens were stored in water at 37°C for 24 hours. Each specimen was loaded in tension in an Instron universal testing machine. The maximum force required to dislodge each Locator post was recorded. Means and standard deviations were calculated and data were statistically analyzed with one-way analysis of variance (ANOVA)., Results: The highest mean bond strength value for Locator posts was recorded for MultiCore(®) Flow group (mean = 550.1 N), while the lowest mean value was for RelyX Unicem(™) resin cement group (mean = 216.8 N). A statistically significant difference in mean locator overdenture post bond strength was observed between the 7 cement types (p < 0.0001). ParaCore(™) and MultiCore(®) Flow groups had significantly higher bond strength than all other groups, but they were not differed from each other., Conclusion: Bond strength of Locator overdenture posts were influenced by the type of luting agents. MultiCore Flow and ParaCore resin cements offered the greatest retention., Clinical Significance: The type of luting agents had a significant effect on the retention of Locator posts. The use of Core buildup resin cements as luting agent with Locator post demonstrated the greatest retention.

Objectives: The use of all-ceramic restorations has been steadily increasing in the decades since the introduction of high-strength core ceramics as an alternative to metal cores. Even with high-strength ceramic cores, the crowns are susceptible to fractures during clinical function, probably the major concern associated with all-ceramic restorations. The aim of this study was to analyze fracture features of clinically fractured crowns in order to determine crack initiation sites and crack propagation paths., Methods: Fractographic methods were used to analyze 27 all-ceramic full coverage crowns with alumina cores and feldspatic veneering ceramic. The fractured crowns were supplied by dentists in private and public practices with information of type of cement and time in function if available., Results: The fractured crowns comprised 13 incisors, 3 premolars and 11 molars. The results revealed that all fractures initiated in the cervical margin of the crowns and usually from the approximal area close to the most coronally placed curvature of the margin. There was no statistically significant association between the cement used and time in function., Significance: Fractography of clinically failed all-ceramic crowns can provide information on the fracture modes and design considerations. The findings are in contrast to fracture modes from in vitro tests. The results suggest that more clinically relevant in vitro test methods to study the durability of ceramic crowns should be developed., (Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to evaluate the impact of occlusal relief of dies on internal adaptation of metal-ceramic casting copings., Materials and Methods: Standardized preparations were made on 80 extracted third molar teeth. Impressions were made with poly(vinyl siloxane), and stone dies were prepared. Dies were covered with four layers of die spacer, covering the entire preparation together with the occlusal surface excluding the apical 0.5 mm of the preparation in group 1 (40 specimens), and covering the same area excluding the occlusal surface in group 2 (40 specimens). Copings were cast using nickel-chromium-based metal ceramic alloy and cemented using zinc phosphate cement. The specimens were sectioned along the long axis. Internal discrepancies were recorded with a 0.001-mm resolution stereoscope at 6 points: the middle of the occlusal surface (MO), middle of the lingual wall (ML), middle of the buccal wall (MB), middle of the buccal shoulder finish line (MSH), middle of the lingual chamfer finish line (MCH), and middle of the buccal bevel finish line (MBL). Student's t-test was used for statistical analysis. Significance level was set at p < 0.05., Results: The marginal discrepancies of group 1 were higher than those of group 2. Significant differences in discrepancies were found on MO (p < 0.0001), MSH (p = 0.012), and MBL (p = 0.035). The bevel margin showed the least marginal discrepancy following occlusal surface of the die with no relief., Conclusion: Leaving the occlusal part of the die uncovered with the die spacer improved the crown seating considerably in the occlusal surface as well as shoulder and bevel margins., (© 2012 by the American College of Prosthodontists.)

Purpose: The aim of this study was to evaluate the radiopacity of eight contemporary luting cements using direct digital radiography., Materials and Methods: Ten specimens, (5 mm diameter, 1 mm high) were prepared for each material tested (RelyX ARC, RelyX U100, RelyX Unicem, Nexus 2, Nexus 3, Metacem, Breeze, Adhesor zinc phosphate). The specimens were stored in a moist chamber at 37°C until completely set, then radiographed using a Kodak digital sensor and an aluminum step wedge with variable thicknesses (1 to 13 mm in 1-mm increments) used for reference. A Kodak 2100 intraoral X-ray unit was operated at 60 kV, 7 mA, and 0.20 seconds. According to international standards, the radiopacity of the specimens was compared with that of the aluminum step wedge using the equal-density area tool of the Kodak Dental Imaging software (ver. 6.7). Data were analyzed by ANOVA and Tukey's test., Results: Adhesor zinc phosphate cement showed the highest radiopacity of all materials and dentin. Breeze showed the lowest radiopacity (p < 0.05). No significant difference in radiopacity was observed between dentin and RelyX ARC, Nexus 2, or Metacem (p > 0.05). The radiopacities of Nexus 3 and RelyX Unicem were significantly higher than those of other resin cements and dentin (p < 0.05)., Conclusions: All materials showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association. Breeze had less radiopacity than dentin., (© 2012 by the American College of Prosthodontists.)

Introduction: The aim of this study was to evaluate the effects of eugenol-free temporary cement's remnants on the retentive strength of full metal crowns luted via zinc phosphate and resin cement (Maxcem) to the tooth structure., Materials and Methods: Forty complete standardized Ni-Cr crowns in four groups were cemented by two types of permanent cements: zinc phosphate cement and resin cement (Maxcem). In the two groups before permanent cementation of crowns, temporary acrylic crowns were cemented by eugenol-free temporary cement. Crowns' retention was evaluated by Universal testing machine. All data were analyzed by means of one-way ANOVA test in SPSS software version 11.5 (α=0.05)., Results: There was no significant difference in groups with prior using eugenol-free temporary cement and groups with just using two permanents cement (p-value≥0.05)., Discussion: The application of temporary cement before permanent cementation of full metal crowns does not have any adverse effect on retention of full metal crowns, when temporary cements are removed properly.

Statement of Problem: Although cement-retained implant prostheses are widely used, the quantification of optimal retention remains controversial, and new dental luting agents should be evaluated., Purpose: The purpose of this study was to compare, in vitro, the casting retention on implant abutments after cementation with 3 commercially available luting agents and an experimental luting agent (castor oil polyurethane, COP) with variable weight percentages (wt%) of calcium carbonate (CaCO3)., Material and Methods: Seventy-two palladium-silver cast copings were fabricated and divided into 6 groups: Temp Bond interim cement (TB); zinc phosphate cement (ZP); Rely X ARC resin cement (RX); pure COP (COP); COP + 10% wt% CaCO3 filler (COP 10); and COP + 50% wt% CaCO3 filler (COP 50). After cementation, the specimens were stored in distilled water at 37°C for 24 hours and subjected to removal force tests in a universal testing machine (5 kN; 0.5 mm/min). Statistical analyses were performed with the Kruskal-Wallis and Student-Newman-Keuls tests (α=.05)., Results: The median values of casting retention (N) were as follows: TB=57.20 ±10.4; ZP=343.56 ±50.3; RX=40.07 ±9.7; COP=258.98 ±41.4; COP 10=466.57 ±79.3; and COP 50=209.63 ±31.4. The Kruskal-Wallis test showed significant differences among the groups (P<.01). TB and RX had the lowest mean retention values; COP, COP 10, and COP 50 were equal to ZP, and COP 10 had the highest retention., Conclusions: The casting retention on implant-abutments provided by COP was similar to that of copings cemented with zinc phosphate and may be influenced by the addition of calcium carbonate., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Dentists have several treatment options when restoring patients with congenitally missing maxillary lateral incisors. Endosseous implant therapy combined with orthodontics can achieve predictable outcomes while meeting patient expectations. This case report exhibits an interdisciplinary approach involving orthodontics, implant surgery, and prosthodontics to resolve this common dental concern.

Purpose: The clinical performance of three- and four-unit fixed partial dentures (FPDs) with frameworks made of yttria partially stabilized zirconia was determined after a mean observational period of 84 months., Materials and Methods: Seventy-five patients were treated with 99 posterior FPDs. Fifty-one specimens were veneered with an experimental ceramic suitable for titanium and zirconia frameworks; 48 restorations were veneered with a commercially available low-fusing ceramic optimized for zirconia frameworks. All restorations were luted with zinc-phosphate cement. Statistical analysis was performed according to Kaplan-Meier; potential risk factors were analyzed using the Cox regression analysis., Results: Nineteen restorations failed completely: 12 due to technical complications, 6 due to biologic complications, and 1 for unknown reasons. The overall survival rate after 84 months was 83.4%. Thirty-two events required clinical intervention for restoration maintenance, resulting in a time-dependent success rate of 57.9% after 84 months. Nineteen dropouts occurred during the follow-up time. None of the evaluated factors showed an association with survival or success of the restorations., Conclusions: After a mean observational period of 7 years, the survival and success rates of zirconia-based posterior FPDs were inferior to those published for metal-ceramic FPDs. The majority of failures were caused by technical complications (material fractures). The main reasons for clinical intervention to maintain function were fractures of the veneering ceramic and decementations.

Cement-retained restorations allow for a conventional fixed partial denture approach to restoring dental implants. However, inadequate removal of excess cement at the time of cementation may introduce a severe complication: cement-induced peri-implantitis. Radiopaque cements are more easily detected on radiographs and should improve the recognition of extravasated cement at the time of insertion. The purpose of this study was to evaluate the radiopacity of commercially available cements in vitro. Eighteen different cements commonly used for luting restorations to implants were tested at both 0.5- and 1.0-mm thicknesses. The cements examined were zinc oxide eugenol, zinc oxide, zinc polycarboxylate, zinc phosphate, resin-reinforced glass ionomer, urethane resin, resin, and composite resin. Two samples of each cement thickness underwent standardized radiography next to an aluminum step wedge as a reference. The mean grayscale value of each of the nine 1-mm steps in the step wedge were used as reference values and compared to each of the cement samples. Temp Bond Clear (resin), IMProv (urethane resin), Premier Implant Cement (resin), and Temrex NE (resin) were not radiographically detectable at either sample thickness. Cements containing zinc were the most detectable upon radiographic analysis. There are significant differences in the radiopacity of many commonly used cements. Since cementinduced peri-implantitis can lead to late implant failure, cements that can be visualized radiographically may reduce the incidence of this problem.

The aim of this preliminary in vitro study was to compare the retentiveness of a luting agent designed for use with dental implants to luting agents designed for use with tooth-retained restorations. The following luting agents were tested: (1) implant cement, (2) resin-bonded zinc oxide-eugenol cement, (3) zinc phosphate cement, (4) zinc polycarboxylate cement, and (5) glass-ionomer cement. After cementation, each sample was subjected to a pull-out test using a universal testing machine, and the loads required to remove the crowns were recorded. The mean values and standard deviations of cement failure loads were analyzed using analysis of variance and the Bonferroni test. The mean cement failure loads (N) were 333.86 ± 18.91 for implant cement, 394.62 ± 9.76 for resin-bonded zinc oxide-eugenol cement, 629.30 ± 20.65 for zinc phosphate cement, 810.08 ± 11.52 for zinc polycarboxylate cement, and 750.17 ± 13.78 for glass-ionomer cement. The retention provided by polycarboxylate cement was significantly greater than that of all other luting agents; the implant cement showed the lowest retention values. These preliminary in vitro observations need to be confirmed under conditions that more closely approximate the clinical environment.

Aims and Objectives: to evaluate the resistance to displacement of metal intraradicular retainers of different lengths by means of the shear test., Material and Methods: Thirty-six maxillary central incisors were cross-sectioned at 16 mm from the root apex, endodontically treated and randomly divided into three groups that were treated as follows: G1 (control) preparation of 2/3 (10.6 mm) of the total root length; G2: preparation of 1/2 (8 mm) of the total root length and G3: preparation of 1/3 (5.3 mm) of the total root length. After canal preparation, a matrix was made of the coronal and radicular portions using Duralay to obtain metal intraradicular retainers. These retainers were cemented with zinc phosphate cement and subjected to the compression shear test in a Universal Test Machine (EMIC DL 2000) at a crosshead speed of 0.5 mm/minute. The results were subjected to statistical analysis by analysis of variance (ANOVA) and Newman- Keuls, which showed statistically significant difference (P < 0.01)., Results: The means in Newtons and their respective standard deviations were: G1 = 972.05 (±81.36); G2 = 921.15 (±112.25); G3 = 686.66 (±113.02)., Conclusion: It could be concluded that metal retainers of 2/3 and 1/2 the length of the root portion showed higher resistance to displacement values when compared with the group that had been prepared for 1/3 of the root length.

The core finishing of cast posts-and-cores after luting is routine in dental practice. However, the effects of the vibrations produced by the rotary cutting instruments over the luting cements are not well-documented. This study evaluated the influence of the time intervals that elapsed between the cementation and the core-finishing procedures on the tensile strength of cast posts-and-cores luted with zinc phosphate cement. Forty-eight bovine incisor roots were selected, endodontically treated, and divided into four groups (n = 12): GA, control (without finishing); GB, GC, and GD, subjected to finishing at 20 minutes, 60 minutes, and 24 hours after cementation, respectively. Root canals were molded, and the resin patterns were cast in copper-aluminum alloy. Cast posts-and-cores were luted with zinc phosphate cement, and the core-finishing procedures were applied according to the groups. The tensile tests were performed at a crosshead speed of 0.5 mm/min for all groups, 24 hours after the core-finishing procedures. The data were subjected to one-way analysis of variance (ANOVA) and Tukey's test (α = 0.05). No significant differences were observed in the tensile strengths between the control and experimental groups, regardless of the time interval that elapsed between the luting and finishing steps. Within the limitations of the present study, it was demonstrated that the core-finishing procedures and time intervals that elapsed after luting did not appear to affect the retention of cast posts-and-cores when zinc phosphate cement was used.

Objectives: The aim of this report was to evaluate the 5-year clinical performance and survival of zirconia (NobelProcera™) single crowns., Methods: All patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The records were scrutinized for clinical data. Information was available for 162 patients and 205 crowns., Results: Most crowns (78%) were placed on premolars and molars. Out of the 143 crowns that were followed for 5 years, 126 (88%) did not have any complications. Of those with complications, the most common were: extraction of abutment tooth (7; 3%), loss of retention (15; 7%), need of endodontic treatment (9; 4%) and porcelain veneer fracture (6; 3%). No zirconia cores fractured. In total 19 restorations (9%) were recorded as failures: abutment tooth extraction (7), remake of crown due to lost retention (6), veneer fracture (4), persistent pain (1) and caries (1). The 5-year cumulative survival rate (CSR) was 88.8%., Conclusions: According to the present 5-year results zirconia crowns (NobelProcera™) are a promising prosthodontic alternative also in the premolar and molar regions. Out of the 143 crowns followed for 5 years, 126 (88%) did not have any complications. However, 9% of the restorations were judged as failures. Further studies are necessary to evaluate the long-term success., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: According to the ISO, the radiopacity of luting cements should be equal to or greater than that of aluminum. The aim of this in vitro study was to determine the radiopacity of 13 commercially available dental luting cements and compare them with human enamel and dentin., Method and Materials: Five classes of luting cements were evaluated: zinc phosphate (Cegal N and Harvard Zinc Phosphate), zinc polycarboxylate (Harvard Polycarboxylate and Hoffmann's Carboxylate), glass ionomers (Ketac Cem Easymix, Ketac Cem Radiopaque, and Fuji I), resin-modified glass ionomer (Rely X Luting), and resin cements (Multilink Automix, Variolink II, Speed CEM, Rely X Unicem Automix, and three shades of Variolink Veneer). Tooth slices served as controls. Five specimens of each material measuring 8 mm in diameter and 1 mm thick were prepared and radiographed alongside tooth slices and an aluminum stepwedge using a Trophy RVG sensor. The radiopacity values were expressed in mm Al and analyzed by the ANOVA and Tukey tests (P < .05)., Results: All the cements examined except Variolink Veneer had significantly higher radiopacities than that of dentin. Rely X Unicem Automix, glass ionomer, and resin-modified glass-ionomer cements demonstrated radiopacities that were not significantly different with respect to enamel. Zinc phosphate, zinc polycarboxylate, and three of the resin cements presented radiopacity values that were significantly greater than that of enamel., Conclusion: Almost all the investigated materials presented an acceptable radiopacity. Radiopacity of dental cements seems to depend more on the presence of elements with high atomic numbers than on the type of the material.

Background: The Procera AllCeram™ system (Nobel Biocare AB, Göteborg, Sweden) is a valid alternative to metal-ceramic restorations. However, limited long-term data of its use for single crowns on natural and implant-supported abutments are available., Purpose: The present study aimed at evaluating the clinical performances of Procera AllCeram single crowns in both anterior and posterior regions of the oral cavity either on natural tooth or implant abutments over a period of 6 years., Materials and Methods: Two hundred nine single crowns were fabricated and used in 112 patients. Zinc phosphate and resin luting agents were used to cement the restorations. The crowns were evaluated according to the California Dental Association's quality assessment system., Results: Three crowns were lost at follow-up. Of the 206 restorations, which completed the 6-year follow-up, 9 crowns were affected by mechanical complications and 7 crowns failed. All surviving crowns were ranked as either excellent or acceptable. Cumulative survival and success rates of 95.2 and 90.9%, respectively, were recorded., Conclusions: Within the limitations of the present study, Procera AllCeram crowns proved to be a reliable clinical option to restore both anterior and posterior missing teeth either on natural or implant abutments. The resin cement used in the present study performed better than the zinc phosphate luting agent., (© 2009 Wiley Periodicals, Inc.)