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Objectives: To evaluate the influence of microstructure and chemical composition on the optical properties of CAD-CAM lithium disilicate glass-ceramics., Methods: Samples (n = 5; 1.0 mm thickness) of shades A1, A2, and A3 were fabricated from CAD-CAM ceramic blocks (Ivoclar Vivadent): IPS e.max® CAD LT (emLT) and HT (emHT). Samples were polished to 1.0 ± 0.01 mm in thickness. The optical properties (R- reflectance; T- transmittance; μ s ' - reduced scattering and μ a - absorption coefficients) from the post-crystallized samples were determined using the inverse adding-doubling (IAD) method based on integrating-sphere measurements. Additionally, scanning electron microscopy (SEM) and X-ray diffraction (XRD) techniques were used to evaluate the microstructural properties. Energy-dispersive X-ray (EDX) was employed to analyze the chemical composition. The chemical and structural characterization were performed before and after crystallization of the ceramic samples., Results: emLT showed higher values of μ s ' and lower values of μ a and T than emHT for each shade in all wavelengths (p < 0.003). Considering T for emHT, there were no statistical differences for shades A1 and A2 at 488 nm and 514.5 nm (p > 0.003) and shades A1 and A3 at 457.9 nm (p > 0.003). emLT showed particle length ranging from 0.74 to 2.78 µm (mean = 1.57 µm and RF-relative frequency = 28 %) and particle width ranging from 0.21 to 0.74 µm (mean = 0.30 µm and RF = 31 %). emHT showed particle length ranging from 0.83 to 3.08 µm (mean = 1.86 µm and RF = 21 %) and particle width ranging from 0.24 to 1.12 µm (mean = 0.56 µm and RF = 28 %). In comparison with emHT, emLT showed greater vol% for C, K, and Zr and lower vol% for O and Al., Significance: The optical properties of CAD-CAM lithium disilicate glass-ceramics are influenced by the chemical composition and, consequently, by the material microstructure., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To assess the impact of elastic gradients formed among restorative material, cement, and substrate on the fracture resistance of tri-layer restorative systems., Methods: Four CAD/CAM materials were utilized, two glass-ceramics (IPS e.max CAD, Vita Suprinity) and two resin-ceramic hybrids (Vita Enamic, Lava Ultimate). Their fracture resistance was examined by biaxial flexure (n = 8) and Hertzian indentation (n = 10) tests. Statistical analysis was conducted using ANOVA and Tukey tests (p = 5 %). Finite element analysis (FEA) was employed to simulate the Hertzian indentation test and elucidate the stress-fields formed on the intaglio surface below the loading area., Results: The biaxial flexural strength (MPa) of glass-ceramics exceeded the hybrid materials (e.max 417 a , Suprinity 230 b , Enamic 138 c , and Lava Ultimate 183 bc ). Conversely, the load-bearing capacity (N) of the materials bonded to dentin analog demonstrated the opposite trend, with the hybrid materials achieving superior results (e.max 830  C , Suprinity 660 D , Enamic 1822 B , and Lava Ultimate 2593  A ). The stress-fields observed by FEA were coherent with the experimental results for Hertzian flexural stresses (MPa): e.max 501  A , Suprinity 342  C , Enamic 406 B , whereas no tensile stress was observed at the intaglio surface of Lava Ultimate., Significance: Detailed analysis of the fracture resistance of the tri-layer restorative systems showed that the elastic gradients play a more significant role than the flexural strength of the restorative materials. The coherence of the elastic moduli between the restorative material and supporting structures results in reduced tensile stress concentration at the intaglio surface beneath the loading area and enhances the ability to withstand load., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: To evaluate the comprehensive effect of translucency, thickness, cement shades, and background color on the masking ability of resin-matrix ceramic veneer restorations., Methods: Resin-matrix ceramic specimens with 2 translucencies (LT, HT) and 3 thicknesses (0.5, 1.0, and 1.5 mm) were made of Upcera Hyramic (A2 shade). Cement specimens were made of Variolink N in 4 shades (yellow, white, transparent, and bleach XL). Five background specimens were made of IPS Natural Die Material in 5 shades (ND1, ND2, ND3, ND4, and ND5). Color coordinates of 120 subgroups (n = 5) of combined specimens composed of different ceramic, cement, and background specimens were obtained using a spectroradiometer. Color difference (ΔE 00 ) compared with a 4-mm thick specimen of LT and HT ceramics was calculated and four-way ANOVA was used for statistical analysis (α = 0.05)., Results: Translucency, thickness, cement shade, background color, and their interaction had significant effects on ΔE 00 (p < 0.001). ΔE 00 values of HT groups were always higher than that of LT groups and were greater than 1.8 against all background colors. ΔE 00 values of LT groups could be achieved to be less than 1.8 with appropriate thickness and cement shade. ΔE 00 value decreased with increasing ceramic thickness. The effect of cement shade on ΔE 00 had no obvious regularity, but ΔE 00 values of bleach XL cement shade group were always lower than other cement shade groups under ND3 and ND5 background color., Conclusions: The masking ability of CAD-CAM resin-matrix ceramics can be simultaneously affected by translucency, thickness, cement shade, and background color. Resin-matrix ceramics with low translucency has a better masking ability than that with high translucency. The masking ability of CAD-CAM resin-matrix ceramics increase with increasing thickness. Cement shade has less impact on the final color of resin-matrix ceramic restorations., (© 2024. The Author(s).)

Objective: Endocrowns can be fabricated from various materials as a treatment option for endodontically treated teeth. This mixed cohort study aimed to demonstrate the clinical efficacy of Endocrowns made of feldspathic, zirconia lithium silicate, and lithium disilicate ceramics using a chairside CAD/CAM system., Methods: The present study compared the clinical outcomes of 141 Endocrown restorations in posterior teeth of 85 patients in a two-year follow-up. The efficacy of restorations was evaluated in three aspects: esthetics, biological response, and function, with the aid of the FDI guideline, and presented as descriptive analyses. Additionally, the data were analyzed using Chi-square and Spearman correlation tests. The significance level was set at p = 0.05., Results: The study findings revealed that the type of restorations (feldspathic ceramic, zirconia lithium silicate, and lithium disilicate) (p > 0.05) and underlying teeth (molars and premolars) (p > 0.05) play no part in restorations' failure. Caries' recurrence is primarily responsible for the failure of the endocrowns. Secondary caries and radiolucency were observed in four teeth (2.83 %). The clinical efficacy of 126 restorations (89.36 %) fell into the category of "clinically excellent" and "clinically good." Ten restorations (7.09 %) were classified as "clinically sufficient/satisfactory," and only five restorations (3.54 %) needed replacement due to having "clinically unsatisfactory" and "clinically poor" quality., Conclusions: Endocrowns showed a high success rate and durability in the short term, therefore can be considered a safe choice for restoring endodontically treated teeth. It is worth noting that caries were the most common reason for the failure of the restorations., Clinical Significance: Endocrowns made of different ceramics have been proven reliable restorations for endodontically treated molars and premolars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The present work aims to develop a production method of pre-sintered zirconia-toughened-alumina (ZTA) composite blocks for machining in a computer-aided design and computer-aided manufacturing (CAD-CAM) system. The ZTA composite comprised of 80% Al 2 O 3 and 20% ZrO 2 was synthesized, uniaxially and isostatically pressed to generate machinable CAD-CAM blocks. Fourteen green-body blocks were prepared and pre-sintered at 1000 °C. After cooling and holder gluing, a stereolithography (STL) file was designed and uploaded to manufacture disk-shaped specimens projected to comply with ISO 6872:2015. Seventy specimens were produced through machining of the blocks, samples were sintered at 1600 °C and two-sided polished. Half of the samples were subjected to accelerated autoclave hydrothermal aging (20h at 134 °C and 2.2 bar). Immediate and aged samples were characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD). Optical and mechanical properties were assessed by reflectance tests and by biaxial flexural strength test, Vickers indentation and fracture toughness, respectively. Samples produced by machining presented high density and smooth surfaces at SEM evaluation with few microstructural defects. XRD evaluation depicted characteristic peaks of alpha alumina and tetragonal zirconia and autoclave aging had no effect on the crystalline spectra of the composite. Optical and mechanical evaluations demonstrated a high masking ability for the composite and a characteristic strength of 464 MPa and Weibull modulus of 17, with no significant alterations after aging. The milled composite exhibited a hardness of 17.61 GPa and fracture toughness of 5.63 MPa m 1/2 , which remained unaltered after aging. The synthesis of ZTA blocks for CAD-CAM was successful and allowed for the milling of disk-shaped specimens using the grinding method of the CAD-CAM system. ZTA composite properties were unaffected by hydrothermal autoclave aging and present a promising alternative for the manufacture of infrastructures of fixed dental prostheses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To assess the effect of preheating resin-based materials and ultrasound application on the failure load of a lithium disilicate glass-ceramic., Materials and Methods: Ninety ceramic specimens were produced (14×12×1.0 mm) and divided into 9 groups (n = 10) to be bonded to a dentin analog (Nema G10) with light-cured luting agent (LC), flowable resin composite (FL), and supra-nano filled resin composite (SN), as follows: LC/R - LC at room temperature; LC/P - preheated LC; LC/P/U - preheated LC and Ultrasound; FL/R - FL at room temperature; FL/P - preheated FL; FL/P/U - preheated FL and Ultrasound; SN/R - SN at room temperature; SN/P - preheated SN; SN/P/U - preheated SN and Ultrasound. The failure load test was performed in a universal testing machine with the aid of acoustic detection. The data was analyzed with two-way ANOVA (for failure load) and Weibull statistics (Weibull modulus - m and characteristic strength, based on 95% confidence intervals - CI)., Results: The analyses of failure load revealed no statistically significant difference among groups considering the type of luting agent (P = 0.075; F = 2,673), the application method (P = 0.772; F = 2,259), and the interaction between them (P = 0.297; F = 1,248). The characteristic strength did not show differences among groups (95% CI). The m, which indicates structural reliability, showed lower values for SN/P/U and SN/P, with a difference from other selected groups (95% CI)., Conclusion: Preheating of resin-based materials and ultrasound application did not affect the failure load of lithium disilicate glass-ceramic. Lower reliability was observed with supra-nano filled resin composite., (© 2023 by the American College of Prosthodontists.)

Background: The aim of the study was to determine and compare the biaxial flexural strength (BFS) and Vickers hardness (VHN) of additive and subtractive manufactured permanent composite-based restorative materials, before and after thermal aging., Methods: A total of 200 specimens were prepared; 100 disc-shaped specimens (diameter 13 × 1.2 mm) for the BFS test and 100 square specimens (14 × 14 × 2 mm) for the VHN test. The specimens were made from various materials: two subtractive composite-based blocks (Cerasmart 270 [CS], Vita Enamic [VE]), two additive composite-based resins used for two different vat polymerization methods (digital light processing [DLP]; Saremco Print Crowntec [SC] and stereolithography [SLA]; Formlabs Permanent Crown Resin [FP]), and one feldspathic glass-matrix ceramic block (Vita Mark II [VM]) as the control group. Specimens of each material were divided into two subgroups: thermal cycled or non-thermal cycled (n = 10). BFS and VHN tests were performed on all groups. Data were analyzed with two-way ANOVA and post hoc Tukey test (α = 0.05)., Results: The type of restorative material used for the specimen had a statistically significant influence on both BFS and VHN values. However, thermal cycling did not affect the BFS and VHN values. After thermal cycling, the results of the BFS test were ranked from best to worst as follows: CS, FP, SC, VE, then VM. For the VHN values, the order from best to worst was as follows: VM, VE, CS, FP, then SC., Conclusions: 3D printed and milled composite groups showed higher BFS than feldspathic ceramics. When the VHN results were examined, it was seen that the 3D resin groups had the lowest VHN values. Furthermore, it was observed that the thermal cycle had no effect on BFS or VHN., (© 2024. The Author(s).)

Objective: To evaluate the translucency of several monolithic zirconias (MZ) processed in various sintering ovens designed for single-visit, chairside use., Methods: Discs (n = 40) from zirconia blocks were fabricated for each MZ at manufacturer-recommended minimal thicknesses, as provided in each material's instructions for use: IPS e.max ZirCAD LT (ZLT); CEREC Zirconia+ (CZ+); 3M Chairside (3M); KATANA Zirconia (KT). Groups (n = 10) were sintered following manufacturer instructions for each oven: CEREC SpeedFire, Ivoclar CS4, Ivoclar CS6, and Ivoclar S2 (laboratory furnace control). Specimens were highly polished on one side and glazed on the other. Each side was measured with a spectrophotometer against white and black backgrounds to determine translucency parameter (TP) and contrast ratio (CR) values. Results for TP and CR for each material and oven combination were compared with a linear mixed model. Oven precision was evaluated using the Kruskall-Wallis test., Results: Glazed specimens were more translucent than polished ones (p < 0.001). ZLT and CZ+ were more translucent than 3M and KT regardless of the sintering oven (p < 0.01). Several oven/material combinations reached or exceeded the S2 oven TP: CS4 with CZ+ and 3M; CS6 with ZLT and KT (p < 0.01). SpeedFire was significantly less precise (p < 0.05) and produced lower TP values for ZLT, CZ+, and KT (p < 0.01). Results for TP and CR were highly correlated., Conclusions: MZ surface finish, material thickness, and oven used all had a significant effect on translucency. Some chairside-oriented solutions produced results with translucency equal to conventionally processed zirconia., Clinical Significance: The translucency of a ceramic restoration is an important factor in determining its esthetics. Clinicians desiring the most esthetic outcomes with monolithic zirconia should be aware of the significant effects that surface finishing, material thickness, and the sintering oven used can have on restoration translucency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials., Purpose: This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling., Materials and Methods: Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05)., Results: Post-intervention marginal gap was statistically significantly lower in group EX (110.8 μm) which was statistically significant compared with group SF (112.5 μm) (mean difference=-1.768, P = .007) and group BR (113 μm) (mean difference=-2.272, P = .001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P = .770)., Conclusions: Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation., Clinical Implications: The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth., (© 2023. The Author(s).)

Purpose: This in vitro study aimed to evaluate the effects of restorative materials and scanning aid conditions on the accuracy and time efficiency of intraoral scans., Materials and Methods: Identical anatomic contour crowns were fabricated using the following materials: hybrid ceramic, 3 mol% yttria-stabilized tetragonal zirconia, 4 mol% yttria-partially stabilized zirconia, 5 mol% yttria-partially stabilized zirconia, cobalt-chromium (Co-Cr), resin, lithium disilicate, and feldspathic ceramic. The models were digitized and analyzed for accuracy (n = 10) under three scanning aid conditions (powder-based, liquid-based, and none). Additionally, the effect of metal restorations on the scan accuracy of other crowns was investigated. The scan time for complete arches was also recorded. One-way analysis of variance, Welch analysis of variance, and post-hoc comparison or independent t-tests were used for trueness analysis, and the F-test was used to examine precision (α = 0.05)., Results: Significant differences were observed in the trueness of the different restorative materials under the no-scanning aid condition (P < 0.05). In contrast, no statistically significant difference among the groups was observed with the powder- or liquid-based scanning aid. For each restorative material, the no-scanning aid condition showed significantly lower trueness than that with powder- or liquid-based scanning aids. The presence of a Co-Cr crown did not affect the trueness of other restorations in the arch. The scan time efficiency significantly increased on applying a powder- or liquid-based scanning aid., Conclusions: Using a scanning aid was effective to improve the scan accuracy of the tested restorative materials and scan time efficiency. Applying scanning aids to existing intraoral restorations can help improve prosthesis quality and reduce the need for clinical adjustment at the occlusal or proximal contacts., (© 2023 by the American College of Prosthodontists.)

Purpose: Removal of zirconia restorations can be challenging and time consuming, requiring dental burs with optimal cutting efficiency to minimize iatrogenic complications. Yet, there are very few burs marketed for this purpose and little evidence of their comparative benefit. This study evaluated one specialized bur and compared its cutting efficiency with three general-purpose burs (one single use and two multiple uses)., Materials and Methods: This study was designed to assess the cutting efficiency of 4 burs on a high-strength zirconia substrate. One of these burs is a multiple-use bur marketed for high-strength ceramics (Komet 4ZR), another is a single-use general-purpose bur (Piranha 837.012 coarse), and two are multiple-use general-purpose burs (Brassler 6837.31.012C coarse and Komet 6837.314.012 coarse). The cutting efficiency of each bur was determined by measuring the time taken to perform serial 2 mm cuts into a block of zirconia. Ten burs in each group were tested with repeated cuts until the time taken for a 2 mm cut was twice that of the first 2 mm cut (50% loss of efficiency). This study was performed under reproducible conditions using a custom-designed and fabricated rig assembly., Results: The results demonstrated a statistically significant difference in the cutting efficiency between bur types. The single-use general-purpose bur (Piranha 837.012) was the most efficient for all cut numbers p <2.2 × 10 -16 . The performance of all burs decreased with each cut, with cutting efficiency dependent on time point/cut number (p = 0.02). The rate of deterioration varied between burs, but this difference was not sufficient to be statistically significant., Conclusions: This study demonstrated that a single-use bur is more efficient than 3 multiple-use burs. The cutting efficiency of a single-use general-purpose bur (Piranha 837.012 coarse) on Cerec Zirconia Mono L was statistically superior to that of multiple patient use burs in this study, including one marketed for use on high-strength ceramics. Because single-use burs are comparatively inexpensive and require no sterilization, they should be strongly considered for the removal of zirconia restorations., (© 2022 by the American College of Prosthodontists.)

The characteristics of dental ceramics have been extensively studied over the years to provide highly qualified materials for use in prosthetic restorations. The ability to adhere to dental substrates, outstanding aesthetics (translucency, color, and substrate masking ability) and improved mechanical properties provide these materials with optical features and high strength to withstand masticatory stimuli. Different classifications are adopted, and it is generally considered that glass-ceramics have better optical characteristics due to the high glass content, and polycrystalline ceramics have superior strength favored by their densified and organized crystals, hampering crack growth. This knowledge was largely built-up during years of scientific research through different testing methodologies, but mainly employing static loads. It is important to not only take into account the intensity of loads that these materials will be exposed to, but also the effect of the intermittence of cyclic load application leading to mechanical fatigue and the influence of factors related to the crack origin and their propagation under this condition. Furthermore, the bonding surface of ceramic restorations requires surface treatments that improve the bond strength to luting agents; however, these treatments require caution because of their potential to produce defects and affect the structural behavior. Moreover, ceramic restorations often require internal adjustments for proper seating or external adjustments for fitting the occlusal contact with the antagonist. In this sense, finishing/polishing protocols may alter the defect population, as luting agents may also interact by filling in the superficial defects on the restoration intaglio surface. Thus, the balance among all these factors will define the performance of a restorative setup, as well as the posterior exposure to the humid environment and the masticatory stimuli (cyclical loading), which may favor developing slow and subcritical growth of cracks in ceramic materials and the degradation of the bond interface. Therefore, it is essential that the concepts which explain the fatigue mechanism are understood, as well as the crack propagation and failure patterns of restorative ceramic materials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the influence of the thickness and type of computer-aided design and computer-aided manufacturing (CAD-CAM) material on the fatigue resistance and failure mode of endodontically treated teeth (ETT) restored with occlusal veneers (OV)., Materials and Methods: Seventy-five (N = 75) ETT were restored with Herculite XRV in the endodontic access. Five experimental groups (n = 15) were tested. Four groups had two different thicknesses (0.6-0.7 mm or 1.4-1.6 mm) and two different CAD-CAM materials: zirconia-reinforced lithium-silicate (LS/Celtra Duo) and composite resin (RC/Cerasmart). The fifth group (control) did not have occlusal veneers. All the specimens were subjected to accelerated fatigue (5 Hz frequency) with an occlusal load increasing up to 1800 N and 131,000 cycles. The number of cycles was recorded when the machine stopped or at the completion of the test. Fatigue resistance was analyzed using the Kaplan-Meier survival test (95% significance level, log-rank post hoc pairwise comparisons). The samples were categorized according to failure mode. The CAD-CAM materials were examined through scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS)., Results: No differences were found between the thicknesses, regardless of the type of the CAD-CAM material. The thick LS OV outperformed the RC and control groups. The thin RC OV and control groups showed a higher percentage of repairable and possibly repairable failures than the other groups. LS was more homogeneous under SEM, and the EDS analysis detected Si and Zr, but not Li., Conclusions: A larger thickness did not improve the resistance of the CAD-CAM materials. Thick LS showed a higher cumulative survival rate to fatigue than the RC and control groups. The direct composite alone (control) survived similarly to the experimental groups, except for the thick LS., (© 2022 The Authors. Journal of Prosthodontics published by Wiley Periodicals LLC on behalf of American College of Prosthodontists.)

Background: Erosive acids might create surface flaws and deteriorate the mechanical properties of CAD-CAM materials. This invitro study aimed to investigate the effect of simulated gastric HCl and extrinsic erosive acids on surface microhardness and fracture toughness of CAD-CAM materials., Methods: 400 bar-shaped specimens (17×4×2 mm 3 ) were prepared from 4 different CAD-CAM dental materials (n = 100/group); monolithic zirconia (Ceramill Zolid HT+, Amanngirbach, Austria), lithium disilicate ceramic (IPS e.max CAD, Ivoclar Vivadent, Liechtenstein), nanohybrid resin composite (Grandio Blocs, VOCO) and polymer-infiltrated glass network (Vita Enamic, VITA Zahnfabrik). Specimens from each material type were further subdivided into 5 groups (n = 20) according to the erosive media applied (simulated gastric HCl, white wine, Coca-Cola®, orange juice, and artificial saliva that served as a control). Specimens were immersed for 24 h in an incubator at 37 ℃, then ultrasonically cleaned in distilled water and air-dried. Half of the specimens were tested for Vickers microhardness (VHN) at parameters of 500 gf for 10 s, while the rest of the specimens underwent 3-point flexure till fracture. Fractured surfaces were examined under a scanning electron microscope (SEM) for fracture toughness (K IC ) calculation using the quantitative fractographic analysis method. Data collected were statistically analyzed using two-way analysis of variance (α = 0.05) after verification of data normality and homogeneity of variances., Results: Erosive media created surface flaws that lowered the surface microhardness of the material and initiated the fracture pattern under different loads according to material type. The material type was a more predominant factor than erosive media that affected either the microhardness or the fracture toughness of CAD-CAM dental materials. The highest VHN and K IC values were found among Ceramill Zolid HT+ groups followed by IPS e.max CAD and Grandio Blocs regardless of the erosive media employed. Erosive media significantly reduced the VHN and K IC in Vita Enamic specimens compared to the rest of the material types., Conclusion: All CAD-CAM materials used, except Vita Enamic, showed high resistance against the erosive acids indicating higher longevity of the material in patients frequently exposed to either extrinsic or intrinsic acid., (© 2022. The Author(s).)

A review of the main additive manufacturing technologies including vat-polymerization, material extrusion, material jetting, binder jetting, powder-based fusion, sheet lamination, and direct energy deposition is provided. Additionally, the dental applications of polymer, metal, and ceramic printing technologies are discussed., (© 2022 by the American College of Prosthodontists.)

Objective: To review the ultrastructural characteristics of novel lithium disilicate based glass ceramics (LDC), how their manufacturing process influences their structure and their clinical use., Overview: Lithium disilicate based glass ceramic has been successfully used for indirect restorations ranging from partial tooth coverage up to tooth replacement for over 20 years. It combines esthetic and mechanical properties, unlike any other indirect material which makes it an indispensable part of esthetic and restorative dentistry. Recently, novel LDCs have been introduced to the market. Parameters for their use and their microstructure are still not been widely known. This article will review these materials and highlight with high-resolution scanning electron microscopic images their structural aspects and their resulting clinical relevance., Conclusion: Restorations made from LDCs are reliable and can be predictably used only when proper guidelines and protocols during manufacturing and clinical use are followed. For novel LDCs manufacturing and long-term bonding protocols still must be established. Moreover, novel LDCs machinable blocks should be crystallized or heat-treated after milling for superior performance., Clinical Significance: With more and newer etchable LDC materials entering the market, clinicians and technicians need to be aware of the differences in manufacturing and the resulting microstructure to ensure a successful treatment outcome that will last., (© 2022 Wiley Periodicals LLC.)

Objectives: This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems., Data/sources: An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers., Study Selection: The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included., Conclusions: After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations., Clinical Significance: . As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The study aims to quantify the viscoelastic properties of representative dental CAD/CAM resin-based composites (RBC) and to determine the effects of loading frequencies on the viscoelastic material response in comparison to clinically established CAD/CAM glass ceramics., Methods: Eight RBCs, one leucite-reinforced, and one lithium disilicate glass-ceramics were selected. The quasi-static (indentation hardness H IT , indentation modulus, E IT ) and viscoelastic (storage modulus E', loss modulus E″, loss factor tan δ) material behavior was monitored by a depth-sensing indentation test equipped with a DMA module. A low-magnitude oscillating force was therefore superimposed onto a quasi-static force (F max  = 1000 mN) at 20 different frequencies in the range 1-50 Hz. One and multiple-way analysis of variance (ANOVA), the Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), and a Pearson correlation analysis were used for data analysis., Results: The quasi-static parameters increased with the crystalline phase in glass ceramics and with the amount of inorganic filler in RBCs. The tan δ, which is related to the damping capacity of a material, increased with the increasing amount of glass phase in glass ceramics or with the amount of organic phase in RBCs. A pronounced influence of the frequency on the measured parameters and their patterns of variation was observed. H IT was up to ten time higher in glass ceramics compared to RBCs and highest at the lowest frequency (1 Hz). Parameters E IT and E' differ less and were lowest at the lowest frequency. E″ distinguished three different patterns of variation with frequency. The tan δ decreased rapidly with frequency in glass ceramics, while the decrease in RBCs was gradually. Frequency influenced stronger tan δ (p < 0.001, η P 2  = 0.85), followed by E' (p < 0.001, η P 2  = 0.773), E IT (p < 0.001, η P 2  = 0.772), and E″ (p < 0.001, η P 2  = 0.714), and less H IT (p < 0.001, η P 2  = 0.384)., Conclusions: All materials sowed viscoelastic behavior related to their microstructure and the internal friction created by grain or interphase boundary relaxation. RBCs have better damping capabilities over a wider frequency range. The deviations from the ideal elasticity were significantly lower in the glass ceramics than in the RBCs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the effects of 1-year water storage and surface treatments on shear bond strength (SBS) of two composite cements bonded to resin matrix CAD-CAM ceramics (RMCs) and on the mechanical properties of RMCs., Materials and Methods: Three types of RMCs were tested: 1. polymer-infiltrated hybrid ceramic (PIHC, Enamic, VITA Zahnfabrik); 2. resin nanoceramic (RNC, Lava Ultimate, 3M Oral Care); and 3. flexible hybrid ceramic (FHC, Cerasmart, GC). One indirect laboratory composite (ILC, Epricord, Kuraray Noritake) was used as control. For each material, 60 plates (14 x 7 x 1 mm) were prepared for the SBS test and submitted to three different surface treatments: following manufacturer's instructions, non-thermal atmospheric plasma application (30 s), and plasma + bonding agent. Two composite cements were tested: RelyX Ultimate (3M Oral Care) and Panavia V5 (Kurarary Noritake). Two resin cylinders (1.5 mm diameter x 1.5 mm height) were bonded to each plate (n = 10), with one tested after 24-h storage in distilled water and the other after 1 year of storage in distilled water. Twenty rectangular bars (12 x 2 x 1 mm) of each indirect material were prepared and submitted to the 3-point flexural test after 24-h or 1-year water storage to determine the elastic modulus (EM) and flexural strength (FS) (n = 10). Fractured samples were also examined with SEM and energy dispersive x-ray spectroscopy (EDS). SBS data were analyzed by four-way ANOVA, and EM and FS data by two-way ANOVA, followed by Tukey's post-hoc test (α = 0.05)., Results: Groups treated in accordance with manufacturer's instructions exhibited higher SBS than did plasma and plasma + bonding agent groups for all indirect materials, composite cements, and storage periods tested. In general, RelyX Ultimate displayed higher mean SBS than did Panavia V5, except for some groups of ILC where manufacturer's instructions were followed. After 1-year storage in water, all groups exhibited a significant reduction in SBS, except for some groups that following manufacturer's instructions. ILC showed the lowest values of EM and FS. Among the CAD-CAM materials, FHC exhibited the lowest EM and highest FS means, while PIHC possessed the highest EM and lowest FS means for both storage periods., Conclusions: In general, following the respective manufacturer's instructions yielded the best bond strength results. For most materials, 1-year water storage decreased bond strength of composite cements to RMCs, as well as their FS, while increasing their EM. Microstructure and composition influenced the mechanical properties studied.

Objective: To compare the shear bond strength of resin cement to zirconia-based monolithic CAD-CAM materials subjected to different surface treatments., Methods: 2 brands of monolithic zirconia blocks (Vita YZ HT, Sirona inCoris TZI), yttrium-stabilized tetragonal zirconia (IPS e.max ZirCAD) and zirconia-reinforced lithium silicate ceramic (Vita Suprinity) were divided into six groups according to the surface treatment received: no treatment (control), HF acid etching, sandblasting, sandblasting + Er:YAG laser irradiation, Er:YAG laser irradiation and CoJet. Composite resin cylinders were bonded to blocks with self-adhesive resin cement (Theracem). Shear bond strength was evaluated after thermocyling. Failure modes were examined using SEM. Data was analyzed statistically by using 2-way ANOVA and post-hoc Tukey's test (P < 0,05)., Results: The bond strength was significantly affected by the surface treatment and the type of CAD-CAM blocks (P < 0,001). Surface treatment with CoJet revealed significantly higher bond strength compared to sandblasting in Y-TZP and monolithic zirconia specimens., Conclusions: Monolithic zirconia blocks showed higher bond strength values compared to Y-TZP zirconia block in sandblasting and CoJet groups. HF acid etching is more effective than sandblasting and CoJet for Vita Suprinity., Competing Interests: None

Objectives: To evaluate the relative translucency parameter (RTP) values of computer-aided design (CAD)-computer-aided manufacturing (CAM) materials after UV aging., Materials and Methods: 70 specimens (n = 10) of Bruxzir Anterior (BA); E.max Cad (EC); Lava Ultimate (LU); Cerasmart (CE); Vita Enamic (VE); Vita Suprinity (VS); Vita Mark II (VM) were prepared (1 mm ± 0.01 mm). Color measurements were performed using a spectrofotometer (VITA Easyshade). RTP values of the specimens before (RTP 1 ) and after UV aging (RTP 2 ) were evaluated. Statistical analyses were done with repeated measurements of two-way-ANOVA with Bonferroni test (P < 0.05)., Results: Evaluating RTP 1 and RTP 2 values; significant differences were found (P < 0.05). There were no significant difference between the RTP 1 values of CE and VS (P = 0.779); EC and VM (P = 0.952); VM and LU (P = 0.995); EP and LU (P = 0.653). Evaluating RTP 2 values; VE and BA were found significantly different from the others (P < 0.05). For all evaluated groups TP values decreased after UV aging (P < 0.05). The most RTP reduction was observed for LU; while VM and EC were less affected., Conclusion: Glass ceramic VE showed the highest RTP and zirconia-based BA was the most opaque restorative CAD-CAM material. UV aging caused the CAD-CAM materials get more opaque., Clinical Significance: In cases where translucency is needed chosing VE would give better esthetic results; while zirconia-based BA should be used if more opaque restoration is needed. Clinicians should be aware of that restorations get more opaque after usage., (© 2019 Wiley Periodicals, Inc.)

Objective: To compare the effect of material and thickness on the color stability and relative translucency parameters (RTP) for monolithic ceramics subjected to coffee thermocycling., Methods: Four specimens each at thicknesses of 0.5, 0,7 and 1 mm were sectioned from monolithic ceramics [preshaded monolithic zirconia (MonZr), lithium disilicate (LDS) and zirconia reinforced lithium silicate (ZLS)]. The specimens were glazed and subjected to 5000 coffee thermocycling. The color coordinates of specimens were determined with a spectroradiometer and color differences and RTP values were calculated with CIEDE2000 color difference and TP CIEDE2000 formulas. ANOVA was used to analyze CIEDE2000 color difference and RTP values (α = .05)., Results: For the color difference data, the 2-way ANOVA revealed a significant interaction between material and different thickness (P = .002). Except for 0.5 mm thick ZLS material, all materials in all thicknesses studied presented color changes within the clinically acceptable limits after coffee thermocycling. For the RTP data, the 3-way ANOVA revealed a highly significant interaction between material and different thicknesses (P < .001)., Conclusions: Material type and thickness can be expected to affect color change and relative translucency of the restorations made with preshaded MonZr, LDS and ZLS materials. Except for 0.5 mm thick ZLS material, color changes of all studied materials were within the clinically acceptable limits. Except ZLS material, color changes of other materials were not significantly affected by thickness. Staining in coffee was not found to affect translucency, and the materials' translucency parameters were ranked from high to low as LDS, ZLS and MonZr at each thickness studied., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To determine the clinical and patient-reported outcomes of bi-layered, all-ceramic posterior single crowns (SCs) supported by zirconia implants in an uncontrolled, prospective, multicenter study., Methods: In two centers, 60 patients received 71 one-piece zirconia oral implants to be restored with either SCs (n=49) or three-unit fixed dental prostheses (n=11). Of these patients, 45 implants were restored with all-ceramic, zirconia-based posterior SCs (one per patient). Survival rates of implants and reconstructions were assessed, and technical success was evaluated according to modified U.S. Public Health Service (USPHS) criteria. Furthermore, patient-reported outcome measures (PROMs) were assessed by applying visual analog scales (VAS). Kaplan-Meier (KM) plots and log-rank tests were used for success/survival analyses. The Wilcoxon matched-pairs signed-rank test was used to evaluate time effects on response variables (PROMs, USPHS criteria)., Results: Forty patients with 40 SCs could be evaluated after 36.7±1.2months. No SC was replaced, resulting in 100% survival. The KM success estimate was 87.5% (two chippings, one restoration margin, and one contour were rated Charlie). In general, the incidence of chipping (p=.0005) and occlusal roughness (p=.0003) was frequent. Compared with the pre-treatment patient surveys (67-93%), all surveys at prosthetic delivery except for speech (p=.139) showed significantly improved VAS scores (81-94%; p<.0001). Thereafter, no decrease in satisfaction could be observed over time until the 3-year follow-up (86-93%; p≥.390)., Conclusion: Veneered, zirconia-based SCs supported by zirconia implants satisfied patients' needs highly. However, significant incidence of chipping and roughness of the veneering ceramic may compromise the clinical long-term outcome for this indication., Clinical Significance: Posterior, zirconia-based SCs supported by zirconia oral implants entirely survived the follow-up period of 3 years, but two major chippings, one a significant marginal opening and one pronounced over-contouring, resulted in a reduced KM success estimate of 87.5% after 36 months of observation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: All-ceramic bilayer systems suffer from technique-sensitivity, resulting in increased technical complication rates. This might be overcome by monolithic reconstructions, facilitating digital workflows., Purpose: To evaluate the clinical and patient-reported outcome of CAD/CAM-fabricated implant-supported single crowns (ISCs) made of lithium disilicate (LS 2 ) cemented on ceramic implants 5 years after implant installation., Materials and Methods: Twenty-four patients were included in the study. All participants received a one-piece ceramic implant in anterior (4 incisors) and posterior regions (10 premolars, 10 molars). LS 2 crowns were computer-aided designed (CAD), manufactured (CAM) and adhesively luted onto the implants. Follow-ups were performed yearly up to 60 months after implant installation. The survival/success rates of the restorations were calculated according to modified US Public Health Service criteria as follows: Clinically relevant defects that could be repaired intraorally were accepted for survival, whereas small-area chippings, roughness (ø < 2 mm), slightly soundable marginal gaps, minimal undercontours/overcontours, and tolerable color deviations were accepted for success. Kaplan-Meier plots were used for the success/survival analyses. Furthermore, patient-reported outcome measures (PROMs) were assessed by applying visual analog scales (VAS). Linear (PROMs) and logistic (USPHS criteria) mixed models were fitted to evaluate time effects on response variables., Results: Twenty-two ISCs could be evaluated 55.2 ± 4.2 months after prosthetic delivery. Two patients were reported as drop-outs (1 died, 1 moved abroad). No failures were observed, resulting in 100% survival. At two ISCs, a major-roughness had to be treated. This resulted in a Kaplan-Meier success estimate of 91.7% (95%CI: 70.6%-97.9%). Compared with pretreatment, all surveys at prosthetic delivery except for self-esteem (P = .375) showed significantly improved VAS scores. No decrease in satisfaction could be observed over time until the end of follow-up (P ≥ .056)., Conclusion: Concerning survival/success rates and PROMs, the evaluated crown-implant system showed favorable mid-term results. To date, there are no comparable data available for implant-supported ISCs made of LS 2 ., (© 2017 Wiley Periodicals, Inc.)

Background: Because no information was found in the dental literature regarding the fracture resistance of all-ceramic crowns using CEREC (Sirona) computer-aided design and computer-aided manufacturing (CAD-CAM) system on solid abutments, the authors conducted a study., Methods: Sixty synOcta (Straumann) implant replicas and regular neck solid abutments were embedded in acrylic resin and randomly assigned (n = 20 per group). Three types of ceramics were used: feldspathic, CEREC VITABLOCS Mark II (VITA); leucite, IPS Empress CAD (Ivoclar Vivadent); and lithium disilicate, IPS e.max CAD (Ivoclar Vivadent). The crowns were fabricated by the CEREC CAD-CAM system. After receiving glaze, the crowns were cemented with RelyX U200 (3M ESPE) resin cement under load of 1 kilogram. For each ceramic, one-half of the specimens were subjected to the fracture resistance testing in a universal testing machine with a crosshead speed of 1 millimeter per minute, and the other half were subjected to the fractured resistance testing after 1,000,000 cyclic fatigue loading at 100 newtons., Results: According to a 2-way analysis of variance, the interaction between the material and mechanical cycling was significant (P = .0001). According to a Tukey test (α = .05), the fracture resistance findings with or without cyclic fatigue loading were as follows, respectively: CEREC VITABLOCKS Mark II (405 N/454 N) was statistically lower than IPS Empress CAD (1169 N/1240 N) and IPS e.max CAD (1378 N/1025 N) (P < .05). The IPS Empress CAD and IPS e.max CAD did not differ statistically (P > .05). According to a t test, there was no statistical difference in the fracture resistance with and without cyclic fatigue loading for CEREC VITABLOCS Mark II and IPS Empress CAD (P > .05). For IPS e.max CAD, the fracture resistance without cyclic fatigue loading was statistically superior to that obtained with cyclic fatigue loading (P < .05)., Conclusions: The IPS Empress CAD and IPS e.max CAD showed higher fracture resistance compared with CEREC VITABLOCS Mark II. The cyclic fatigue loading negatively influenced only IPS e.max CAD., Practical Implications: The CEREC VITABLOCS Mark II, IPS Empress CAD, and IPS e.max CAD ceramic crowns cemented on solid abutments showed sufficient resistance to withstand normal chewing forces., (Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare fatigue resistance and fracture mode of metal-ceramic crowns with all-ceramic crowns containing yttria tetragonal zirconia polycrystal (Y-TZP) frameworks under compressive cycling loading in water., Methods: Twenty specimens of ivory were randomized and individually prepared to receive anatomically shaped metal-ceramic (n=10) or veneered Y-TZP all-ceramic crowns (n=10). All steps in production were equivalent to clinical situations. Resistance to fatigue fracture was tested under compressive cyclic loading using a universal testing machine, with a loading frequency of 12Hz using a spherical tungsten carbide indenter (6mm diameter) in distilled water. The maximum compressive load was increased as the number of cycles increased (600,000 cycles at 400N, 200,000 cycles at 600 N, 200,000 cycles at 800 N and 200,000 cycles at 1000 N). The specimens were inspected after each loading sequence for initial failures such as infractions. Final failure was considered as any loss of material which automatically ended the test and the number of cycles until final failure was recorded. Fractographic analysis of the fractured specimens was performed with scanning electron microscopy (SEM)., Results: The two types of crowns exhibit similar fatigue resistance (P=0.87) to compressive cycling loading under wet conditions. The failure modes as observed with SEM were similar in the two groups and were found in the veneer ceramic, except that three veneered Y-TZP all-ceramic crowns displayed a complete framework fracture., Conclusions: Within the limitation of this study using simulated oral masticatory function, the results revealed that the fatigue resistance was similar for the two crown types., Clinical Significance: In this study metal-ceramic crowns and veneered Y-TZP all-ceramic crowns showed similar fracture resistance to compressive cycling loading in water. The test conditions were simulating clinical conditions. Thus, the result may predict the long-term clinical performance of these types of crowns., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: Recently all-ceramic restorative systems have been introduced that use CAD/CAM technology to fabricate both the Y-TZP core and veneer-ceramic layers. The aim was to identify whether the CAD/CAM approach resulted in more favourable stressing patterns in the veneer-ceramic when compared with a conventionally sintered Y-TZP core/veneer-ceramic., Methods: Nominally identical Vita VM9 veneer-ceramic disc-shaped specimens (0.7mm thickness, 12mm diameter) were fabricated. 20 specimens received a surface coating of resin-cement (Panavia 21); 20 specimens were bonded with the resin-cement to fully sintered Y-TZP (YZ Vita Inceram Vita) discs (0.27mm thickness, 12mm diameter). A final series of 20 Y-TZP core/veneer-ceramic specimens were manufactured using a conventional sintering route. Biaxial flexure strength was determined in a ball-on-ring configuration and stress at the fracture origin calculated using multilayer closed-form analytical solutions. Fractography was undertaken using scanning electron microscopy. The experimental test was simulated using Finite Element Analysis. Group mean BFS were compared using a one-way ANOVA and post hoc Tukey tests at a 95% significance level., Results: Resin cement application resulted in significant strengthening of the veneer-ceramic and further significant strengthening of the veneer-ceramic (p<0.01) occurred following bonding to the Y-TZP core. The BFS calculated at the failure origin for conventionally sintered specimens was significantly reduced when compared with the adhesively bonded Y-TZP/veneer-ceramic., Conclusions: Under the test conditions employed adhesive cementation between CAD/CAM produced Y-TZP/veneer-ceramic layers appears to offer the potential to induce more favourable stress states within the veneer-ceramic when compared with conventional sintered manufacturing routes., Clinical Significance: The current investigation suggests that the stressing patterns that arise in all-ceramic restorations fabricated using CAD/CAM for both the core and veneer-ceramic layers differ from those that occur in conventionally sintered bilayer restorations. Further work is required to ascertain whether such differences will translate into improved clinical outcomes., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: Processing parameters (powder granulation, compaction, debinding, greenbody shaping, sintering) and post-sinter rough, even fine grinding are influencing the final mechanical properties of 3Y-TZP. The hypothesis of this study was that post-sinter hot isostatic pressing (post-HIP) would be beneficial for improving reliability and strength of both sintered and coarse ground sintered zirconia by closing or reducing surface and/or small volume defects., Methods: 75 sintered bars of an experimental 3Y-TZP (3mm×4mm×45mm) with chamfered edges and 15μm diamond surface finish were provided by the manufacturer (Ivoclar Vivadent) and randomly distributed in five groups of N=15 each. G1 served as control (as received); G2 was post-HIPed at 1400°C and G3 at 1350°C, both using a pressure of 195MPa in Ar for 1h; G4 was coarse ground with 120μm diamond disk grain size; G5 was ground 120μm and post-HIPed at 1350°C at 195MPa, 1h in Ar. The specimens were fractured in air in 4 point-bending. Weibull characteristic strength (σ0) in MPa, m parameter (reliability) and confidence intervals (CI) at 90% confidence level are reported. Identification of the critical flaw was performed by SEM on the fractured surface of all specimens and XRD performed in all groups., Results: G1: σ0=973 (932-1016), m=10.6 (7.45-15.1); G2: σ0=930 (871-995), m=6.9 (4.87-9.9); G3: σ0=898 (848-952), m=7.94 (5.6-11.4); G4: σ0=921 (857-991), m=6.35 (4.48-9.11); G5: σ0=881 (847-918), m=11.4 (8.03-16.3). G5 had a significantly lower σ0 than G1. No significant differences were seen in the reliability (m) among the groups. Fractography revealed critical intrinsic subsurface flaws of 10-60μm present in all groups resulting from the processing parameters. No "healing" (i.e. closing of defects by densification) resulted after post-HIP. Grinding sintered zirconia with 120μm diamond disks induced radial cracks of 10-20μm and an important pseudo-cubic phase transformation (56wt%) that was not completely removed after post-HIP. Post-HIP increased slightly the relative density by 0.1% but without improving the strength and reliability., Significance: Post-HIP was not efficient in closing large (10-60μm) subsurface (volume) processing defects., (Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

The coloring process of monolithic dental zirconia caused considerable debate on the possible effects of different coloring methods. The main objective of this study was to investigate the influence of pigments in 3 multilayer 5-mol% yttria partially stabilized zirconia (5Y-PSZ) disks (Lava Esthetic A2 [Zr-AGG_A2] and Bleach [Zr-AGG_BL], both 3M Oral Care, and Katana STML A2 [Zr-NoAGG], Kuraray Noritake). The influence of pigment addition on the translucency parameter (TP00), fracture toughness, Vickers hardness, biaxial strength, and hydrothermal stability was assessed and correlated with the microstructure and phase composition. The pigment composition and distribution were evaluated by light and fluorescence microscopy, electron probe microanalysis, and nano–scanning electron microscopy. The chemical and phase composition and aging behavior were assessed using X-ray fluorescence and X-ray diffraction, respectively, while the aging sensitivity of the pigments was evaluated using micro-Raman spectroscopy. In contrast to Zr-NoAGG, possessing a typical 5Y-PSZ microstructure, the pigment additions in both Zr-AGG_A2/BL zirconia resulted in large yellow and blue fluorescent Er-, Hf-, and Al-containing agglomerates composed of small grains (0.57 µm and 0.38 µm, respectively, vs. 0.92 µm for the surrounding grains) with lower Y2O3 content. Zr-AGG_A2 had the lowest aging resistance, with transformation degradation occurring exclusively within the pigment agglomerates. All zirconia grades had a high Y2O3 content (4.2%–5.7 mol%) tetragonal ZrO2 phase and a high (42%–55 wt%) cubic ZrO2 phase content. Although no statistical differences were measured for hardness and toughness, Zr-NoAGG had a significantly higher TP00, higher flexural strength, and lower mechanical reliability compared to both Zr-AGG_A2/BL zirconia. The rare-earth oxide-containing zirconia agglomerates that were added as pigments to the multilayered monolithic Zr-AGG_A2/BL zirconia are the cause for their lower optical and mechanical properties and reduced aging resistance. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant‐supported single crowns with external connections under mechanical cycling. Materials and Methods: Fifty specimens were divided into groups: (1) metal–ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. Results: The failure‐related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all‐ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). Conclusions: Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. Clinical Significance: The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer‐aided design and computer‐aided manufacturing monolithic zirconia. [ABSTRACT FROM AUTHOR]

Background: Lithium disilicate can be reliable when restoring implants in the esthetic zone. However, it has a high elastic modulus. This might increase the amount of forces transmitted to the crestal bone. Aim of the Study: To evaluate the crestal bone loss and peri‐implant periodontal parameters of polymer infiltrated ceramic network compared to lithium disilicate implant‐supported hybrid abutment crowns after 12 months of follow‐up. Methodology: 44 patients were enrolled. They were randomly assigned into two groups (n = 22). The first group received 22 implants restored with polymer‐infiltrated ceramic network (Vitaenamic) hybrid abutment crowns. The second group received 22 implants restored with lithium disilicate (e.max) hybrid abutment crowns over immediately placed implants in the esthetic zone. Periapical radiographs were taken immediately after prosthetic placement and 1 year later utilizing a parallel technique, to assess crestal bone loss. Periodontal parameters were assessed after 1 year. Results: Regarding crestal bone loss, a comparison between group I (Vitaenamic) and group II (e.max) was made by using an Independent t‐test, which showed an insignificant difference between them (p > 0.05). A comparison between groups I and II revealed insignificant differences regarding periodontal parameters (probing depth, bleeding on probing, visible plaque, and suppuration). Conclusions: Regarding bone stability and periodontal parameters, polymer infiltrated ceramic network and lithium disilicate hybrid abutment crowns showed comparable results. Both materials showed clinically acceptable hard and soft tissue responses. [ABSTRACT FROM AUTHOR]

Abstract Background Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials. Purpose This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling. Materials and methods Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05). Results Post-intervention marginal gap was statistically significantly lower in group EX (110.8 μm) which was statistically significant compared with group SF (112.5 μm) (mean difference=-1.768, P = .007) and group BR (113 μm) (mean difference=-2.272, P = .001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P = .770). Conclusions Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation. Clinical implications The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth.

Endocrowns have emerged as a promising option for restoring endodontically treated teeth, offeringa restorable fracture scenario. However, regarding the choice of material and its fracture resistance, there are gaps in the literature regarding the best indication. The objective of this research was to evaluate and compare the effect of restorative materials for CAD-CAM in the manufacture of endocrown restorations, through an in Vitro study on hardness and fracture resistance. For the study, CAD-CAM blocks were transformed into discs 12 mm in diameter and 1.2 mm thick (specimens). Three restorative materials were evaluated and distributed into experimental groups (N=12 specimens): Leucita-Reinforced Ceramic/IPS Empress CAD (MRleu), Lithium Disilicate/IPS Emax CAD (MRdis) and Nanoceramic Resin/Lava Ultimate (MRres). These restorative materials were evaluated for morphology (N=1) by Scanning Electron Microscopy (SEM) and surface chemistry (N=1) by dispersive energy spectroscopy (EDS). The specimens were evaluated when the Vikers micro hardness (N=1) with a load of 1kg and 10 indentations, as well as the resistance to biaxial flexion (N=10) at a test speed of 0.5 mm/min. After the fracture occurred, the fragments were examined under a stereomicroscope. The results were tabulated and analyzed using the Minitab statistical program. The results showed that the MRdis material demonstrated superior results in relation to hardness (P=0.000) and biaxial bending resistance (P=0.000), followed by MRleu andfinally the MRres. The presence of inorganic particles on an organic matrix and the presence of Zirconium (Zr) stands out in Lava Ultimate. It was concluded that restorative materials for CAD-CAM in the manufacture of Endocrowns restorations have a significant effect on hardness and mechanical strength. [ABSTRACT FROM AUTHOR]

The development and popularization of surgical techniques associated with dental materials led to the transformation of oral health conditions into aesthetic rehabilitation. The aim of this study was to review the literature on the use of lithium disilicate and cubic phase stabilized zirconia in monolithic restorations. The databases used were Lilacs, Pubmed/Medline, Scielo and ScienceDirect, crossing the following descriptors in English: "Zirconium", "Yttrium", "CAD-CAM", "Ceramics", "Dental Porcelain" and “Material Resistance”. Monolithic indirect restorative techniques with dental ceramics coupled with the use of CAD/CAM technology have several short-and long-term advantages. Lithium disilicate and high translucency zirconia stabilized in the cubic phase are current materials and constantly evolving in dental research due to their mechanical behavior, biological, optical and aesthetic aspects, ensuring their use as materials of excellence in aesthetic and functional rehabilitation.

Chemical and mechanical fatigue degradation in ceramic materials is generally inconspicuous yet ubiquitous, to the effect that clinical fractures still consist of the main cause of failure in all-ceramic restorations. Implications of this span wide, from a reduced survival prognosis for the affected teeth, including more frequent and increasingly invasive procedural interventions, to the financial burden borne by individuals and health care systems. To suffice as an effective corrective, restoration lifetimes need only to be extended so to outlive the patient. That opens a box of problems from a materials science standpoint, entailing inherent deficiencies of brittle materials to resist mechanical and environmental challenges. Efforts in developing more damage-tolerant and fatigue-resistant restoratives go thus hand in hand with understanding intrinsic mechanisms of crack growth behavior under conditions that simulate the oral environment. Here we developed experiments using size-relevant sharp precracked specimens with controlled size and geometry (truncated semielliptical crack in the surface-crack-in-biaxial-flexure method) to establish a relationship between crack size and strength. The tangent method was used to construct envelopes for the quasi-static resistance curves (R-curves), which served as template for deriving residual cyclic R-curve analogs. By means of experimentally obtained stress–cycle curves, lifetime and fatigue parameters were employed within a mechanistic framework to reveal constitutive toughening mechanisms during subcritical growth under cyclic loading in a wet environment. Using 3 modern dental lithium disilicate glass–ceramics, we demonstrate the extent of R-curve degradation up to a threshold of 10 million cycles (~30 y in service) and draw parallels between the scope of fatigue degradation and the size of the microstructural units responsible for toughening mechanisms in glass–ceramic materials. Our results indicate that larger microstructural elements endow glass–ceramics with a higher reaching quasi-static R-curve at the onset but degrading more rapidly to comparable levels of lithium disilicates having submicrometric and nanometric crystal phases. [ABSTRACT FROM AUTHOR]

Statement of the Problem: By development of adhesive dentistry and noble mechanical strength of ceramics, reconstruction of posterior teeth with partial coverage restorations such as ceramic endocrowns is possible. Different ceramics may show different mechanical properties which should be investigated. Purpose: The aim of this experimental in vitro study was to compare the tensile bond strength of endocrowns made by CAD-CAM using 3 types of ceramics. Materials and Method: In this in vitro study, 30 fresh extracted human molars were prepared to evaluate the tensile bond strength of endocrowns made by IPS e.max CAD, Vita Suprinity, and Vita Enamic blocks (n=10). The specimens were mounted and endodontically treated. Standard preparations were done with 4.5±0.5 mm intracoronal extensions into the pulp chamber and the restorations were designed and milled by CAD-CAM technique. All specimens were cemented with a dual polymerizing resin cement according to the manufacturer's instructions. The specimens were incubated for 24 hours and then thermocycled for 5000 cycles at 5-55°C and underwent the tensile strength test by universal testing machine (UTM). Shapiro-Wilk and one-way ANOVA test were used to statistically analyzed (α= 0.05). Results: The highest tensile bond strength values were achieved in IPS e.max CAD (216.39 ±22.67N) and Vita Enamic (216.22±17.72N) followed by Vita Suprinity (211.54±20.01N). There was no significant statistical difference between retention of endocrowns made by CAD-CAM technique among ceramic blocks (p= 0.832). Conclusion: Within the limitation of this study, there was no significant difference between retention of endocrowns made by IPS e.max CAD, Vita Enamic, and Vita Suprinity as ceramic blocks.

Purpose: To investigate the effects of 1-year water storage and surface treatments on shear bond strength (SBS) of two composite cements bonded to resin matrix CAD-CAM ceramics (RMCs) and on the mechanical properties of RMCs. Materials and Methods: Three types of RMCs were tested: 1. polymer-infiltrated hybrid ceramic (PIHC, Enamic, VITA Zahnfabrik); 2. resin nanoceramic (RNC, Lava Ultimate, 3M Oral Care); and 3. flexible hybrid ceramic (FHC, Cerasmart, GC). One indirect laboratory composite (ILC, Epricord, Kuraray Noritake) was used as control. For each material, 60 plates (14 x 7 x 1 mm) were prepared for the SBS test and submitted to three different surface treatments: following manufacturer's instructions, non-thermal atmospheric plasma application (30 s), and plasma + bonding agent. Two composite cements were tested: RelyX Ultimate (3M Oral Care) and Panavia V5 (Kurarary Noritake). Two resin cylinders (1.5 mm diameter x 1.5 mm height) were bonded to each plate (n = 10), with one tested after 24-h storage in distilled water and the other after 1 year of storage in distilled water. Twenty rectangular bars (12 x 2 x 1 mm) of each indirect material were prepared and submitted to the 3-point flexural test after 24-h or 1-year water storage to determine the elastic modulus (EM) and flexural strength (FS) (n = 10). Fractured samples were also examined with SEM and energy dispersive x-ray spectroscopy (EDS). SBS data were analyzed by four-way ANOVA, and EM and FS data by two-way ANOVA, followed by Tukey's post-hoc test (a = 0.05). Results: Groups treated in accordance with manufacturer's instructions exhibited higher SBS than did plasma and plasma + bonding agent groups for all indirect materials, composite cements, and storage periods tested. In general, RelyX Ultimate displayed higher mean SBS than did Panavia V5, except for some groups of ILC where manufacturer's instructions were followed. After 1-year storage in water, all groups exhibited a significant reduction in SBS, except for some groups that following manufacturer's instructions. ILC showed the lowest values of EM and FS. Among the CAD-CAM materials, FHC exhibited the lowest EM and highest FS means, while PIHC possessed the highest EM and lowest FS means for both storage periods. Conclusions: In general, following the respective manufacturer's instructions yielded the best bond strength results. For most materials, 1-year water storage decreased bond strength of composite cements to RMCs, as well as their FS, while increasing their EM. Microstructure and composition influenced the mechanical properties studied. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of hydrofluoric acid (HF) concentration and etching time on the microshear bond strength (µSBS) of RelyX Unicem 2 (3M Oral Care) to VITA Suprinity (Vita Zahnfabrik; zirconia-reinforced lithium-silicate glass ceramic: ZLS) and IPS e.max CAD (Ivoclar Vivadent; lithium-disilicate glass ceramic: LD). Materials and Methods: Forty-eight bars each were fabricated of ZLS and LD with Cerec InLab MC-XL. For each material, 8 groups were formed with respect to etching time (20, 40, 60, 120 s) and HF concentration (4.9% and 9.5%). In each group, after etching and silanization, 15 cylindrical specimens of RelyX Unicem 2 were built up for µSBS testing with a special device. Data were analyzed using three-way ANOVA. Failure modes were assessed using an optical stereomicroscope, classified as adhesive, cohesive in resin or ceramic, or mixed. Failure modes were statistically analyzed using Fisher's Exact Test. One bar per group was prepared for SEM observation of the etched surface. Results: ZLS showed significantly higher bond strengths than LD (p < 0.001). Etchant concentration was an influential factor with superior strengths after 4.9% HF etching (p = 0.009). Etching time did not significantly affect adhesion (p = 0.066). The material-etching interaction was statistically significant (p = 0.004). Particularly for ZLS, 4.9% HF etching obtained significantly higher bond strengths than did 9.5%. By using 4.9% HF, adhesion was significantly higher on ZLS than on LD. Conclusion: Material and HF concentration influenced the adhesion between RelyX Unicem 2 composite cement and lithium-silicate glass ceramics. Etching time was not an influential factor. The use of 4.9% HF for 20 s proved to be the most effective etching treatment of the intaglio surface. [ABSTRACT FROM AUTHOR]

The purpose of the present study is to evaluate the fracture resistance and the fit of CAD-CAM produced inlay-retained fixed partial dentures. Eighteen experimental groups were generated according to different CAD-CAM ceramic materials (zirconia, lithium disilicate, and zirconia-reinforced lithium silicate), different connector dimensions (12, 14, and 16 mm2), and application of thermomechanical-aging (1,200,000 cycles of cyclic loading with simultaneous thermal cycling). Gap values of thermomechanicallyaged groups were measured by using periapical radiographs. Then, the specimens were tested for fracture resistance and failure types were examined. The results were statistically analyzed (α=0.05). Higher gap values were observed after aging. Zirconia showed the highest fracture resistance values among the most of the experimental groups. In non-aged groups, the most frequent failure type was decementation in zirconia group. In the aged groups, the most frequent failure type was molar connector fracture. Thermomechanicalaging increased the gap values and decreased the fracture resistance values. [ABSTRACT FROM AUTHOR]

Traditional load-to-failure tests fail to recreate clinical failures of all-ceramic restorations. Experimental fabrication, similar to prosthetic laboratory and clinical procedures, best predicts future clinical performance. A hybrid ceramic adherend, mechanically similar to a human tooth, was tested by comparing the shear bond strength (SBS) and fracture mode of four restorative materials adhered with a dual-cure adhesive cement. Surface energy, shear bond strength (SBS), and fracture mode were assessed. Vita Enamic (ENA), Vita Suprinity (SUP), Vita Y-TPZ (Y-ZT), and a nanohybrid composite (RES) (control group) cylinders, adhered with RelyX Ultimate to ENA blocks were assembled in experimental specimens simulating a 3-unit resin-bonded dental bridge. The ENA adherend was ground or treated with 5% hydrofluoric acid for 60 s. Monobond Plus was used as the coupling agent. Mean shear stress (MPa) was calculated for each group. Forest plots by material elaborated after calculating the difference in means and effect size (α = 0.05; 95% CI; Z-value = 1.96) revealed significant differences in the shear force behavior between materials (p < 0.01). RES (69.10 ± 24.58 MPa) > ENA (18.38 ± 8.51 MPa) > SUP (11.44 ± 4.04 MPa) > Y-ZT (18.48 ± 12.12 MPa). Y-ZT and SUP exhibited pre-test failures. SBS was not related to surface energy. The failure mode in the Y-ZT group was material-dependent and exclusively adhesive. ENA is a potential adherend for dental materials SBS tests. In this experimental design, it withstood 103 MPa of adhesive stress before cohesive failure. [ABSTRACT FROM AUTHOR]

This study evaluated the shear bond strength (µSBS) and failure mode of CAD/CAM polymer-infiltrated ceramic network (PICN – Vita Enamic) and nanoceramic resin (NCR – Lava Ultimate) submitted to alternative surface treatments. 40 plates of each material were submitted to (n = 10) conventional (manufacturer’s indications): Sandblasting with Al2O3 (SAND) and 5% hydrofluoric acid etching (5% HF), or alternative treatments: 10% HF (10% HF) and Sandblasting + silanization (SAND/SIL). A self-etching adhesive system (Scotchbond Universal Adhesive, 3M Oral Care) was applied, and resin cement cylinders were built on the specimen’s treated surface and tested in µSBS after 24 h, or after water storage for 1 year. Data were evaluated by three-way repeated-measures ANOVA and Tukey test (α = 0.05). Failure mode was evaluated under scanning electron microscopy (SEM). At 24 h, HF etching (5% or 10%) promoted higher µSBS for PICN, while SAND and 5% HF promoted higher µSBS for NCR than SAND/SIL (p > 0.05). After storage for 1 year, all treatments decreased PICN’s bond strength, but 10% HF exhibited higher µSBS than 5% HF (p < 0.05). Also, 5% HF and SAND/SIL maintained µSBS of NCR, and in general, NCR exhibited higher µSBS than PICN. Failure mode was predominantly mixed after 24 h and mostly adhesive after 1-year storage. In conclusion, the surface treatments influenced the bond strength of PICN and NCR and 1-year storage decreased the bond strength for most groups. 10% HF is the treatment option for PICN while 5% HF-etching is an alternative to sandblasting for NCR. [ABSTRACT FROM AUTHOR]

Various Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) restorative materials are currently available in the dental market. It is claimed that the new materials meet patients' esthetic expectations and mechanical requirements. However, most of these materials are still inadequately tested by research. The purpose of this research was to study the effect of low-grade hydrothermal aging on flexural strengths of three commercially available dental ceramic materials; IPS e.max Cad (E-group), Vita Suprinity (S-group) and Ceramill zolid ht+ (Z-group) under ISO standards. Using computer-aided machining, disc-shaped specimens (n=180) were designed and sliced from prefabricated blocks of the tested materials. Specimens in each group were subdivided into two halves; the first half (n=30) were loaded until fracture without aging and the other half were subjected to a low-grade hydothermal aging, then were loaded until failure. A universal testing machine was used to determine the flexural strength for the various ceramic discs. Before-and after-aging data were compared and analyzed for the various groups. One-Way_ANOVA and Post-Hoc (Bonferroni) tests were used for multiple comparisons across the groups at a significance level of p-value < 0.05. The mean ±SD flexural strength values were 228.18 ±73.83, 242.74 ±52.85 and 589.84±96.48 for E group, S group and Z group respectively. A statistically significant reduction in the flexural strength was seen in the S and Z groups whereas E group' strength was not significantly influenced by the aging process. Monolithic zirconia had the highest flexural strength, however, this strength was significantly reduced by exposure to low-grade hydrothermal aging. Hence, the addition of Zirconia particles to lithium crystals improved their flexural strength but lowered their resistance to hydrothermal aging. [ABSTRACT FROM AUTHOR]

PURPOSE. The aim of this study is to evaluate the effect of resin cement color, cement thickness, and thermocycling on the final color of monolithic lithium disilicate crowns. MATERIALS AND METHODS. A total of ninety prepared central incisors of typodont teeth were restored with lithium disilicate crowns which have different cement thicknesses (40 µm, 80 µm, and 120 µm) and cement shades (clear, yellow, and white). Color parameters of restorations were measured with a spectrophotometer in three different steps 1) before cementing 2) after cementing and 3) after thermocycling with 10000 cycles. Color differences (ΔE00) were calculated with the CIEDE2000 formula and evaluated according to perceptibility (0.8) and acceptability (1.8) thresholds. The ΔE00 data were analyzed by using two-way ANOVA before and after thermocycling (a = .05). RESULTS. There was no interaction between the cement shade and the cement thickness factors. After cementation, the mean ΔE00 was under the perceptibility threshold in the group of 40 µm cement thickness and clear cement while it was between the perceptibility and acceptability thresholds (0.8 < ΔE00 < 1.8) for all other groups. After thermocycling, the ΔE00 values were between the perceptibility and acceptability thresholds for all experimental groups. Although there were no significant differences among the groups, thermocycling increased the color difference values. CONCLUSION. The cementation of restorations with clear, yellow, and white resin cements resulted in color differences with uncemented restorations except for the group cemented with clear cement in 40 µm cement thickness. All study groups revealed perceptible color change after thermocycling. [ABSTRACT FROM AUTHOR]

Statement of the Problem: By development of adhesive dentistry and noble mechanical strength of ceramics, reconstruction of posterior teeth with partial coverage restorations such as ceramic endocrowns is possible. Different ceramics may show different mechanical properties which should be investigated. Purpose: The aim of this experimental in vitro study was to compare the tensile bond strength of endocrowns made by CAD-CAM using 3 types of ceramics. Materials and Method: In this in vitro study, 30 fresh extracted human molars were prepared to evaluate the tensile bond strength of endocrowns made by IPS e.max CAD, Vita Suprinity, and Vita Enamic blocks (n=10). The specimens were mounted and endodontically treated. Standard preparations were done with 4.5±0.5 mm intracoronal extensions into the pulp chamber and the restorations were designed and milled by CAD-CAM technique. All specimens were cemented with a dual polymerizing resin cement according to the manufacturer's instructions. The specimens were incubated for 24 hours and then thermocycled for 5000 cycles at 5-55°C and underwent the tensile strength test by universal testing machine (UTM). Shapiro-Wilk and one-way ANOVA test were used to statistically analyzed (α= 0.05). Results: The highest tensile bond strength values were achieved in IPS e.max CAD (216.39 ±22.67N) and Vita Enamic (216.22±17.72N) followed by Vita Suprinity (211.54±20.01N). There was no significant statistical difference between retention of endocrowns made by CAD-CAM technique among ceramic blocks (p= 0.832). Conclusion: Within the limitation of this study, there was no significant difference between retention of endocrowns made by IPS e.max CAD, Vita Enamic, and Vita Suprinity as ceramic blocks [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of different surface treatments combined with laser irradiation on the shear bond strength of different CAD-CAM ceramics to composite resin. A total of hundred forty-seven ceramic specimens with thicknesses of 2.5 mm were prepared from three different CAD-CAM ceramics (an yttrium oxide partially stabilized tetragonal zirconia polycrystal (Y-TZP); a zirconia-reinforced lithium silicate glass ceramic (ZLS); and a lithium disilicate–strengthened lithium aluminosilicate glass ceramic (LD-LAS)) and subjected to seven groups of treatment (n = 7): (1) control (no treatment), (2) Er:YAG laser irradiation, (3) Nd:YAG laser irradiation, (4) etching with hydrofluoric acid (HFA), (5) Er:YAG + HFA, (6) Nd:YAG + HFA, and (7) sandblasting. After surface treatment procedures, a ceramic primer (Clearfil Ceramic Primer Plus, Kuraray, Japan) was applied to the ceramics. Bonding agent (Single Bond Universal Adhesive, 3 M ESPE, USA) was then applied, and the composite resin (Estelite Sigma Quick, Kuraray, Japan) was layered on the ceramic surfaces. The shear bond strength test was performed using a universal testing machine at a load of 0.5 mm/min. Data were analyzed by 2-way analysis of variance (ANOVA), and the Bonferroni correction was used for pairwise comparisons (α = 0.05). Compared to the bond strength of the control group, irradiation by Er:YAG and Nd:YAG lasers alone improved the bond strength of the composite resin to the Y-TZP (P < 0.001) but did not change the bond strength of composite resin to the ZLS and LD-LAS (P > 0.05). Compared to the bond strength of the control group, etching with HFA alone increased the bond strength of the composite resin to the ZLS and LD-LAS (P < 0.001) but did not affect the bond strength of the composite resin to the Y-TZP (P > 0.05). The highest bond strength of ZLS was obtained using HFA + Er:YAG, and the highest bond strength for LD-LAS was obtained using HFA + Nd:YAG. It was concluded that Er:YAG and Nd:YAG laser treatments presented the highest repair bond strength between the composite resin and Y-TZP ceramics. Er:YAG and Nd:YAG laser treatments in conjuction with HFA presented the highest repair bond strength between the composite resin and the glassy ceramics, ZLS, and LD + LAS. [ABSTRACT FROM AUTHOR]

Elizabeth Dianne Rekow, BSME, MSME, MBA, DDS, MS, Certificate in Orthodontics, and PhD (1944–2022), was a dental science futurist pursuing brave new paths during her career. She was one of the pivotal scientists who initiated the CAD/CAM movement in the 1980s and went on to focus on digital dentistry for the rest of her career. Her professional contributions involved seven patents, 92 peer-reviewed publications, 10 book contributions, 31 proceeding contributions, and well over 100 national and international presentations. She was an avid supporter of women in science. Her greatest contribution was her expansive imagination. She served as 35th president of the American Association for Dental, Oral, and Craniofacial Research in 2006–2007 and 88th president of the International Association for Dental Research in 2011–2012. The present article reviews key elements of her career and includes testimonies from friends about her special relationships. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the deflection and stress distribution in endodontically treated molars restored by endocrowns from different materials available for the computer-aided design/computer-aided manufacturing (CAD/CAM) technique using three-dimensional finite element analysis. The models represented extensively damaged molars restored by endocrowns from the following materials: translucent zirconia; zirconia-reinforced glass ceramic; lithium disilicate glass ceramic; polymer-infiltrated ceramic network (PICN) and resin nanoceramic. Axial and oblique loadings were applied and the resulting stress distribution and deflection were analyzed. The Mohr–Coulomb (MC) ratio was also calculated in all models. The translucent zirconia endocrown showed the highest stress concentration within it and the least stress in dental structures. The resin nanoceramic model was associated with the greatest stress concentration in dental tissues, followed by the PICN model. Stress was also concentrated in the distal region of the cement layer. The MC ratio in the cement was higher than 1 in the resin nanoceramic model. Oblique loading caused higher stresses in all components and greater displacement than axial loading, whatever the material of the endocrown was. The translucent zirconia model recorded deflections of enamel and dentin (38.4 µm and 35.7 µm, respectively), while resin nanoceramic showed the highest stress concentration and displacement in the tooth–endocrown complex. [ABSTRACT FROM AUTHOR]

Background: This randomized clinical trial was conducted to assess whether sleep bruxism (SB) is associated with an increased rate of technical complications (ceramic defects) in lithium disilicate (LiDi) or zirconia (Z) molar single crowns (SCs). Methods: Adult patients were classified as affected or unaffected by SB based on structured questionnaires, clinical signs, and overnight portable electromyography (BruxOff) and block randomized into four groups according to SB status and crown material (LiDi or Z): LiDi-SB (n = 29), LiDi-no SB (n = 24), Z-SB (n = 23), and Z-no SB (n = 27). Differences in technical complications (main outcome) and survival and success rates (secondary outcomes) one year after crown cementation were assessed using Fisher's exact test with significance level α = 0.05. Results: No technical complications occurred. Restoration survival rates were 100% in the LiDi-SB and LiDi-no SB groups, 95.7% in the Z-SB group, and 96.3% in the Z-no SB group (p > 0.999). Success rates were 96.6% in the LiDi-SB group, 95.8% in the LiDi-no SB group (p > 0.999), 91.3% in the Z-SB group, and 96.3% in the Z-no SB group (p ≥ 0.588). Conclusions: With a limited observation time and sample size, no effect of SB on technical complication, survival, and success rates of molar LiDi and Z SCs was detected. [ABSTRACT FROM AUTHOR]

Background and Objectives: There are limited data regarding the behavior of resin matrix ceramics for current CAD-CAM materials. Further studies may be beneficial and can help clinicians planning to use these materials during prosthodontic rehabilitation. The aim of this study was to evaluate and compare the flexural strength and strain distributions, filler content, wear, and reliability of two resin matrix ceramic CAD-CAM materials. Materials and Methods: Two resin matrix ceramics, Ambarino High-Class (AH) and Vita Enamic (VE), were tested for flexural strength (n = 24), wear (n = 10), and reliability (n = 18). Thermogravimetric analysis was used to determine the percentage of filler by weight, and digital image correlation (DIC) was used for strain analysis in flexural strength test. Reliability of each resin matrix ceramic was compared after accelerated lifetime testing of crowns using a two-parameter Weibull distribution. Data of flexural strength, wear, and thermogravimetry were analyzed by independent t-tests with significance level at 5%. Results: The results of DIC analysis were analyzed by a qualitative comparison between the images obtained. The materials tested showed different flexural strength (p < 0.05) and strain distributions. The filler content was the same as informed by manufacturers. No difference was observed in the wear or reliability analysis (p > 0.05). The flexural strength of material AH was superior to VE, and the strain distribution was compatible with this finding. Conclusions: The two resin matrix ceramics tested showed similar behavior in wear and reliability analysis. Both can provide safe use for dental crowns. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review and meta‐analysis was to evaluate the effect of using additive manufacturing (AM) for dental ceramic fabrication in comparison with subtractive manufacturing (SM), and to evaluate the effect of the type of AM technology on dental ceramic fabrication. Materials and methods: A search was conducted electronically in MEDLINE (via PubMed), EBSCOhost, Scopus, and Cochran Library databases, and also by other methods (table of contents screening, backward and forward citations, and grey literature search) up to February 12, 2022, to identify records evaluating additive manufacturing of ceramics for dental purposes in comparison with subtractive manufacturing. A minimum of 2 review authors conducted tstudy selection, quality assessment, and data extraction. Quality assessment was performed with Joanna Briggs Institute tool, and the quantitative synthesis was performed with the Comprehensive Meta‐Analysis program (CMA, Biostat Inc). Hedges's g for effect size was calculated, with 0.2 as small, 0.5 as medium, and 0.8 as large. Heterogeneity was assessed with I2 and prediction interval (PI) statistics. Publication bias was investigated with funnel plots and grey literature search. Certainty of evidence was assessed with the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) tool. Results: A total of 28 studies were included for the qualitative and quantitative synthesis; 11 in vitro studies on accuracy, 1 in vivo study on color, and 16 in vitro studies on physical and mechanical properties. Meta‐analysis showed overall higher accuracy for SM compared with AM, with medium effect size (0.679, CI: 0.173 to 1.185, p = 0.009) and also for marginal (g = 1.05, CI: 0.344 to 1.760, p = 0.004), occlusal (g = 2.24, CI: 0.718 to 3.766, p = 0.004), and total (g = 4.544, CI: –0.234 to 9.323, p = 0.062) with large effect size; whereas AM had higher accuracy than SM with small effect size for the external (g = –0.238, CI: –1.215 to 0.739), p = 0.633), and internal (g = –0.403, CI: –1.273 to 0.467, p = 0.364) surfaces. For technology, self‐glazed zirconia protocol had the smallest effect size (g = –0.049, CI: –0.878 to 0.78, p = 0.907), followed by stereolithography (g = 0.305, CI: –0.289 to 0.9, p = 0.314), and digital light processing (g = 1.819, CI: 0.662 to 2.976, p = 0.002) technologies. Flexural strength was higher for ceramics made by SM in comparison to AM with large effect size (g = –2.868, CI: –4.371 to –1.365, p < 0.001). Only 1 study reported on color, favoring ceramics made through combined AM and SM. Conclusions: Subtractive manufacturing had better overall accuracy, particularly for the marginal and occlusal areas, higher flexural strength, and more favorable hardness, fracture toughness, porosity, fatigue, and volumetric shrinkage; whereas AM had more favorable elastic modulus and wettability. Both methods had favorable biocompatibility. All studies on accuracy and mechanical properties were in vitro, with high heterogeneity and low to very low certainty of evidence. There is a lack of studies on color match and esthetics. [ABSTRACT FROM AUTHOR]