Search Results (29)

Background: Prophylactic polishing pastes (PPPs) are widely used to clean teeth and dental restorations; however, their effects on restorative materials are crucial for clinical outcomes. This study investigates the impact of PPPs on the susceptibility of CAD/CAM restorative materials to staining and the relationship between surface roughness and discoloration. Methods: Samples of tested materials (resin nanoceramic, hybrid ceramic, feldspathic ceramic, and lithium disilicate-reinforced glass ceramic) were treated with various PPPs (Cleanic, CleanJoy, Detartrine, Proxyt). Surface roughness and color parameters were recorded before and after the PPP application and following coffee immersion for 12 days. Initial measurements of surface roughness (Ra1) and color were taken. The specimens were divided into groups based on the PPP applied. After PPP application, secondary roughness (Ra2) and color values were measured. Changes in roughness (ΔRa), color (ΔE*ab, ΔE00), and whiteness index (ΔWID) were calculated post-application and after coffee immersion. Data normality was tested with the Shapiro–Wilks test. Two-way ANOVA evaluated the effects of material type and PPP on ΔE, ΔWID, and ΔRa. One-way ANOVA, Tukey HDS test, and Pearson correlation were used for further analysis, with significance set at p < 0.05. Results: The Vita Enamic–Detartrine group showed the highest ΔEab 1 and ΔE001 values, while Cerasmart–control showed the lowest. The Vita Enamic–Proxyt group had the lowest ΔWID1, and Vita Enamic–Cleanjoy exhibited the highest values of ΔEab 2, ΔE002, and ΔWID2. The E.MAX–control group had the lowest values for these metrics. No significant correlation was found between ΔRa and color changes (ΔE*ab 2, ΔE002, ΔWID2); however, a moderate positive correlation was found between values of ΔE1 and ΔE2. Conclusions: These findings indicate that PPPs significantly affect the discoloration and surface features of CAD/CAM materials, with both types of PPPs and materials. Full article

Background: The durability of computer-aided design/computer-aided manufacturing (CAD/CAM) resin nanoceramics in the oral environment is influenced by aging factors such as thermocycling and ultraviolet (UV) exposure. This study investigates the impact of these aging processes on surface characteristics and repair bond strength. Methods: CAD/CAM resin nanoceramic samples were divided into the following five groups: control (non-aged), 1-year and 5-year thermocycling, and 1-year and 5-year UV aging (n = 12). For the thermocycling procedure, the parameters employed were a temperature range of 5–55 °C with dwell times of 20 s per bath and 10,000 and 50,000 cycles; for the ultraviolet aging process, the parameters were established at a wavelength of 340 nm, an intensity of 0.55 W/m², and durations of 300 h and 1500 h. Surface roughness, microhardness, and repair bond strength were analyzed through profilometry, Vickers microhardness testing, and shear bond strength assessment, respectively. SEM, AFM, and XRD analyses were performed for structural evaluation. Results: Both thermocycling and UV aging significantly increased surface roughness (p < 0.001) while reducing microhardness and repair bond strength (p < 0.001). UV aging had a more pronounced effect, particularly after five years, leading to the highest surface roughness (Ra: 61.77 μm; Rz: 271.57 μm) and lowest microhardness properties (63.13). EDAX analysis indicated matrix degradation and an increase in inorganic filler exposure. Conclusions: Aging significantly affects the surface characteristics of CAD/CAM resin nanoceramics, with UV aging exhibiting the most detrimental impact. These findings highlight the necessity of considering long-term material stability in dentistry. Full article

To assess the biomechanical behaviors of endodontically treated molars (ETMs) restored with endocrowns composed of different materials, forty mandibular molars were assigned to five groups (n = 8 each). Untreated molars constituted the control group (group C); the rest of the teeth that underwent root canal therapy were restored with endocrowns composed of polycrystalline ceramics (ST zirconia^®, UPCERA) in group ZR, lithium disilicate glass ceramics (UP.CAD^®, UPCERA) in group LD, resin-based nanoceramics (Hyramic^®, UPCERA) in group NC, and feldspathic ceramics (CEREC Blocs^®, Sirona) in group FC. All teeth were axially loaded until fracture. The process was recorded using a high-speed camera system, and fractographic analysis was conducted. The results showed that fracture loads did not significantly differ among groups C, LD, and NC; the loads were significantly lower than the load in group ZR but higher than the load in group FC. The mean time from the initial crack to complete tooth fracture varied. Group C had the longest time, followed by group NC; groups ZR, LD, and FC had the shortest time. Similar failure patterns were observed in groups ZR and LD, which were more regular than the pattern in group NC; group FC exhibited the roughest fracture surfaces. Fracture resistance testing combined with a high-speed camera system and fractographic analysis provides a promising modality for studying the biomechanical behaviors of restored teeth. Endocrowns composed of lithium disilicate glass ceramics or resin-based nanoceramics offer alternative restorations for ETMs with extensive coronal loss. Full article

Objective: This study aimed to determine the status of the scientific literature on CAD-CAM resin blocks by mapping the available evidence and identifying knowledge gaps. Data/Source: A systematic search of studies investigating CAD-CAM resin blocks was conducted. Risk of bias was assessed, and data on study designs, level of evidence, compositional classification, manufacturer, commercial brand, and properties investigated were extracted. This review followed Arksey and O’Malley’s five-stage framework and utilized Medline (OVID), EMBASE, and Scopus (Elsevier) databases. Study Selection: Study selection resulted in 27 studies for data extraction out of 209 studies screened from an initial pool of 529 studies. High sampling bias related to sample size and randomization was observed in almost all studies. Most studies (99%) were conducted in vitro, with low levels of evidence. The most common composition was “nano-ceramic”. 3M ESPE was the manufacturer with the most investigated blocks, and their product, 3M™ Lava™ Ultimate Restorative, was predominant in the selected investigations. Methodological heterogeneity was extensive among the studies, with mechanical properties (38%) and bond strength (35%) being the most commonly investigated outcomes. Conclusion: This scoping review indicates an increasing trend in dental research assessing CAD-CAM resin blocks. However, the overall level of evidence derived from these studies is low, predominantly consisting of in vitro investigations. Clinical Significance: The findings underscore the need for clinical trials to augment the level of evidence and enable long-term assessment of CAD-CAM resin blocks. Dentists should be cautious while interpreting the findings from in vitro studies, as the outcomes may not directly translate to clinical success. Full article

This study aims to evaluate the repair micro-shear bond strength of the CAD/CAM resin nanoceramic block treated using four different surface treatments and composite resins of different viscosities. For the current study, 96 samples with dimensions of 14 × 12 × 2 mm were obtained from a CAD/CAM resin nanoceramic block (Cerasmart) with a low-speed precision cutting saw under water cooling. The relevant samples were randomly divided into four groups according to the surface treatment processes: grinding with diamond bur, aluminum oxide airborne-particle abrasion, long-pulse laser, and short-pulse laser. Following silane application, universal adhesive was applied to all surface-treated samples and cured with an LED for 10 s. The samples prepared for the repair procedure were divided into two subgroups (microhybrid composite and injectable composite) according to the viscosity of the repair material to be used (n = 12). After the repair procedure, care was taken to keep the samples in distilled water in an incubator at 37 °C for 24 h. The repair micro-shear bond strength values (μSBSs) of CAD/CAM resin nanoceramic-composite resin complexes were tested. In addition, randomly selected samples from each group were examined with a scanning electron microscope to evaluate the surface topography after both surface treatments and the micro-shear bond strength test. Data were analyzed by two-way ANOVA and Bonferroni test. It was determined that the surface treatment preferred in the repair protocol significantly affected the μSBS value (p < 0.001). While the highest μSBS value was obtained with the short-pulse laser airradiation group, the lowest μSBS values were found in samples with long pulse laser irradiation. However, samples grinded with a bur and airborne-particle abrasion showed similar μSBS values (p > 0.05). The preferred composite viscosity in the repair procedure has a significant effect on the μSBS value (p < 0.001). However, the interaction between the surface treatment and the viscosity of the repair composite does not affect the μSBS values in a statistically significant way (p = 0.193). It may be recommended to clinicians to repair CAD/CAM resin nanoceramic restoration surfaces with injectable composites or after treatment with short-pulse lasers. Full article

Fracture resistance is an important parameter used to predict the performance of indirect dental restorations. The purpose of this in vitro study was to assess the fracture load of posterior milled nanoceramic crowns, in comparison with the lithium disilicate crowns, after fatigue loading, for two different restoration occlusal thicknesses. Forty test metal dies were fabricated by duplicating a master metal model consisting of an anatomic abutment preparation of the maxillary first premolar for a single crown. The dies were divided into two groups of 20 each for the fabrication of nanoceramic (Lava Ultimate) and lithium disilicate (IPS e.max CAD) single crowns. Each material group was further divided into two sub-groups of 10 dies each, based on crown occlusal thickness, of 0.5-mm and 0.75-mm (n = 10). Dental Type V stone dies poured from polyvinyl siloxane impressions of the test metal dies were laboratory scanned in order to design and mill 40 ceramic crowns. The crowns were cemented on to the test metal dies with a self-adhesive resin luting cement. All crowns were thermocycled (2500 cycles) and mechanically loaded (250,000 cycles) in a chewing simulator followed by static loading until failure, and the values noted. The data were statistically analyzed by 2-way ANOVA and Tukey HSD post-hoc multiple comparison tests (α = 0.05). The mean fracture loads ranged from 1022 to 1322 N for nanoceramic crowns and from 1145 to 1441 N for the lithium disilicate crowns. Two-way ANOVA revealed insignificant differences between the nanoceramic and lithium disilicate crowns (p > 0.05) in terms of fracture load. Significant differences were noted in the fracture resistance of crowns based on occlusal thickness (303 N; p = 0.013) regardless of the material used. Multiple comparisons by Tukey HSD post-hoc test showed insignificant differences between the four material-occlusal thickness groups (p > 0.05). The nanoceramic crowns were found to be comparable with lithium disilicate crowns in terms of fracture load. The mean fracture loads of all of the tested crowns were within the normal physiological masticatory load limits. Based on the fracture-resistance results, nanoceramic crowns seem to be suitable for clinical use for the tested occlusal thicknesses. Full article

Ensuring optimum bond strength during cementation is vital for restoration success, with the practicality of the process being crucial in clinical practice. This study analyzed the effect of a single-step self-etching ceramic primer (MEP) and various surface treatments on the microshear bond strength (µSBS) between resin cement and glass-ceramic or polymer-based ceramic CAD/CAM materials. Specimens were fabricated from leucite-based glass-ceramic (LEU), lithium disilicate glass-ceramic (LDC), resin nanoceramic (RNC), and polymer infiltrated ceramic network (PICN) (n = 160). They were then classified based on the surface treatments (n = 10): control (no treatment); sandblasting with Al₂O₃ (AL); etching with hydrofluoric acid (HF); and MEP application. Scanning electron microscopy was used to evaluate the surface topography. µSBS was measured after cementation and thermocycling procedures. Failure modes were examined with a stereomicroscope. Statistical analysis involved two-way analysis of variance and Tukey HSD tests with a significance level of 0.05. µSBS was significantly influenced by both surface treatment and CAD/CAM material type. The most enhanced µSBS values for each material, regarding the surface treatment, were: LEU and LDC, HF; RNC, AL; PICN, AL or HF. MEP significantly increased the µSBS values of CAD/CAM materials except RNC, yet it did not yield the highest µSBS values for any of them. Full article

Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with the appropriate optical properties of lithium disilicate and the enhanced mechanical strength of zirconia. A thorough understanding of ZLS materials is essential for both clinicians and dental technicians. At present, the mechanical behavior and optical properties of the ZLS ceramic system have not been extensively researched, and there is still a lack of consensus regarding the fabrication process and clinical behavior of ZLS all-ceramic restorations. The aim of the present study was to present a selection of comprehensive information concerning zirconia-reinforced lithium silicate ceramics and their optical and mechanical properties, as well as to assess data regarding cementation procedures and clinical outcomes for ZLS all-ceramic restorations. Three electronic databases (PubMed, Web of Science, and the Cochrane Library) were used for the research by two independent reviewers. The search was limited to articles published in the English language, as well as clinical and in vitro studies of color and studies on mechanical behavior and the cementation procedures of ZLS restorations. The exclusion criteria comprised abstracts, questionnaire-based studies, case reports, literature reviews, and studies that were not available in English. Zirconia-reinforced lithium-silicate-based ceramic presents a unique and complex microstructure that increases mechanical resistance but decreases aesthetic appearance, especially its translucency, due to tetragonal zirconia content. A material’s thickness, the color of the underlying tooth structure, and the resin cement shade are important factors that influence the final shade and aesthetic appearance of ZLS restorations. Mechanical properties, which are defined by the fracture toughness, flexural strength, elastic modulus, and hardness of ZLS ceramic are higher compared to feldspathic, lithium disilicate, and hybrid ceramics, as well as resin nanoceramics; however, they are lower than translucent or high-translucency zirconia. Acid etching, sandblasting, and laser etching represent the most used methods to prepare the ZLS restoration surfaces for proper bonding procedures. Full article

This study aimed to investigate the effects of different powers of Er:YAG laser irradiation on the shear bond strength (SBS) of repaired CAD/CAM resin-based composite materials. A total of 180 CAD/CAM resin-based composite specimens (5 × 5 × 2 mm) were obtained (Shofu Block HC—SB; Grandio Blocs—GB). They were allocated into six groups according to surface pretreatment methods: no surface pretreatment (control), hydrofluoric acid (HF), diamond bur and 3 W, 5 W, and 7 W Er:YAG lasers (20 Hz) (n = 15). Silane and universal adhesive were applied. The repair procedure was completed with nano-ceramic composite resin (Ceram-X Sphere TEC-One). The samples were thermocycled for 10,000 cycles (5–55 °C). The SBS was evaluated with a universal test machine (1 mm/min). A 3D optic profilometer was used to assess the surface topography. Statistical analysis was performed with a two-way ANOVA and Bonferroni tests (p < 0.05). For SB samples, HF and diamond bur caused significantly higher SBSs than 3 W and 7 W lasers, while for GB samples, they led to a significantly higher SBS than all laser treatments. For SB samples, the 5 W laser led to the highest SBS, while for GB samples, the 7 W laser caused the highest SBS (p < 0.05). For both blocks, adhesive failure was more common for the 3 W laser, and a decrease in adhesive failures and an increase in mixed failures were observed with increasing laser irradiation. The 3D optic profilometer revealed that smoother surfaces were obtained with the 3 W laser than other laser irradiation at different powers. Pretreatment with increasing Er:YAG laser powers led to similar bond strengths to hydrofluoric-acid- and diamond-bur-treated CAD/CAM resin-based composite materials. A more powerful laser treatment is required to provide a higher bond strength for restorative materials containing a higher inorganic ceramic content. Full article

The purpose of this study is to evaluate the changes in physical properties and biocompatibilities caused by thermocycling of CAD/CAM restorative materials (lithium disilicate, zirconia reinforced lithium silicate, polymer-infiltrated ceramic network, resin nanoceramic, highly translucent zirconia). A total of 225 specimens were prepared (12.0 × 10.0 × 1.5 mm) and divided into three groups subjected to water storage at 37 °C for 24 h (control group), 10,000 cycles in distilled water at 5–55 °C (first aged group), and 22,000 cycles in distilled water at 5–55 °C (second aged group) [(n= 15, each]). The nanoindentation hardness and Young’s modulus (nanoindenter), surface roughness (atomic force microscopy (AFM)), surface texture (scanning electron microscopy (FE-SEM)), elemental concentration (energy dispersive spectroscopy (EDS)) and contact angle were evaluated. The morphology, proliferation and adhesion of cultured human gingival fibroblasts (HGFs) were analyzed. The data were analyzed using one-way ANOVA and Tukey’s test (p < 0.05). The results showed that the nanoindentation hardness and Young’s modulus were decreased after thermocycling aging. Cell viability and proliferation of the material decreased with aging except for the highly translucent zirconia. Zirconia-reinforced lithium silicate exhibited significantly lower cell viability compared to other materials. The surface roughnesses of all groups increased with aging. Cell viability and Cell adhesion were influenced by various factors, including the surface chemical composition, hydrophilicity, surface roughness, and topography. Full article

(1) Background: The purpose of this study was to determine the effect of commonly consumed beverages on the bond strength of three different computer-aided design-computer-aided manufacturing (CAD/CAM) resin–ceramic hybrid materials repaired with resin-based composite (RBC) materials. (2) Materials and Methods: Rectangular prism specimens (N = 138) measuring 6 mm × 5 mm × 2 mm were obtained from GC Cerasmart (GC), Lava Ultimate (LU), and Vita Enamic (VE) blocks. These blocks were polished and then subjected to thermal cycling (10,000 cycles, 5 °C to 55 °C). After the surface treatment was applied, the average surface roughness value was measured. All the surfaces were repaired with RBC. Thermal cycling was performed for the second time. Each group was then distributed into three subgroups according to the beverage used: tea (t), cola (c), and distilled water (0) (n = 15). The specimens were stored in these solutions for 28 days and then subjected to the shear bond strength (SBS) test. Statistical analysis was performed using a two-way ANOVA test with Bonferroni adjustment. (3) Results: The surface roughness of the materials presented no significant difference after different surface treatments (p > 0.05). No significant difference was observed among the materials (p > 0.05). Tea and cola presented similar SBS values (p > 0.05). Both were significantly lower than distilled water (p < 0.001, p < 0.001, respectively). (4) Conclusions: Consumption of beverages reduces the bond strength in surfaces repaired with RBC to CAD/CAM resin–ceramic hybrid materials. (5) Clinical Significance: Repairing damaged resin matrix dental restorations with RBC is advantageous in terms of time and cost by achieving adequate bond strengths. Frequently consumed beverages reduce the bond strength of repaired CAD/CAM resin–ceramic hybrid materials. Full article

Introduction: Today’s dentistry frequently employs bonded partial restorations, which are usually fabricated in ceramic materials. In the last decade, hybrid materials have emerged that attempt to combine the properties of composites and ceramics. Objectives: To evaluate in vitro, by means of a microtensile test, the bond strength between CAD-CAM restorative materials and the cement recommended by their manufacturer. Material and Method: From blocks of CAD-CAM restorative material bonded to composite blocks (Filtek 500^®), beams with a bonding area of approximately 1 mm² were made and divided into four groups: EMAX (IPS e.max CAD^® lithium disilicate), VE (VITA Enamic^® polymer-infiltrated ceramic matrix), LUA (Lava Ultimate^® nano-ceramic resin with sandblasting protocol) and LUS (Lava Ultimate^® nano-ceramic resin with silica coating protocol). In each group, perimeter (external) or central (internal) beams were differentiated according to the position in the block. The samples were tested on the LMT 100^® microtensile machine. Using optical microscopy, the fractures were categorized as adhesive or cohesive (of the restorative material or composite), and the data were analysed with parametric tests (ANOVA). Results: The LUS group had the highest results (42 ± 20 MPa), followed by the LUA group (38 ± 18 MPa). EMAX had a mean of 34 ± 16 MPa, and VE was the lowest in this study (30 ± 17 MPa). In all groups, the central beams performed better than the perimeter beams. Both EMAX and VE had the most adhesive fractures, while LUA and LUS had a predominance of cohesive fractures. Conclusions: Lava Ultimate^® nanoceramic resin with the silica coating protocol obtains the best bond strength values. Full article

Self-adhesive resin cements (SARCs) are used because of their mechanical properties, ease of cementation protocols, and lack of requirements for acid conditioning or adhesive systems. SARCs are generally dual-cured, photoactivated, and self-cured, with a slight increase in acidic pH, allowing self-adhesiveness and increasing resistance to hydrolysis. This systematic review assessed the adhesive strength of SARC systems luted to different substrates and computer-aided design and manufacturing (CAD/CAM) ceramic blocks. The PubMed/MedLine and Science Direct databases were searched using the Boolean formula [((dental or tooth) AND (self-adhesive) AND (luting or cement) AND CAD-CAM) NOT (endodontics or implants)]. Of the 199 articles obtained, 31 were selected for the quality assessment. Lava Ultimate (resin matrix filled with nanoceramic) and Vita Enamic (polymer-infiltrated ceramic) blocks were the most tested. Rely X Unicem 2 was the most tested resin cement, followed by Rely X Unicem > Ultimate > U200, and μTBS was the test most used. The meta-analysis confirmed the substrate-dependent adhesive strength of SARCs, with significant differences between them and between SARCs and conventional resin-based adhesive cement (α < 0.05). SARCs are promising. However, one must be aware of the differences in the adhesive strengths. An appropriate combination of materials must be considered to improve the durability and stability of restorations. Full article

This in vitro study compared the color change (∆E) and biaxial flexural strength (BFS) of two resin nanoceramics (LU and CS) and two polymer-infiltrated ceramic networks (VE and CU) after different surface finishing protocols. A total of 192 discs (12 × 1.2 mm²) were prepared from the materials (n = 48) and then polished with 1200-grit silicon carbide paper, followed by roughening with a 30 µm grit diamond bur. According to the surface finishing applied, the discs from each material category were categorized into four groups: control group (no finishing), polishing (MP), glazing (OG), or a combination of MP and additional polishing (MP+PP). Following surface finishing, all the discs were immersed in a coffee beverage to simulate one year of clinical use. A spectrophotometer and universal testing machine were used to measure the ∆E and BFS, respectively. Fractographic analysis was performed using scanning electron microscopy images. Multivariate analysis of variance was used for the statistical analysis, followed by one-way ANOVA and post hoc Dunnett’s test (a = 0.05). The ∆E and BFS were significantly impacted by material type and surface finishing (p ≤ 0.05). Irrespective of the materials and finishing, untreated LU and OG-treated VE specimens demonstrated the highest (2.98 ± 0.36) and lowest (1.21 ± 0.33) color changes. Regarding BFS, untreated CU and OG-treated CS specimens demonstrated the lowest (121.88 ± 2.08 MPa) and highest (174.17 ± 3.83 MPa) values. Surface finishing using glazing resulted in the highest BFS and lowest ∆E compared to other surface finishing protocols for the tested materials. VE demonstrated the least color changes, and CS showed the highest BFS following surface finishing of the materials tested. Surface finishing is material dependent; thus, it is critical to use the best surface finishing protocol in a clinical setting. Full article

Background: This systematic review aims to evaluate the color stability of resin composite CAD/CAM blocks (CCB) when submitted to staining solutions. Methods: A systematic search was performed on different databases (Embase, Medline, Scopus, Web of Science). Search terms were: ‘polymer infiltrated’, ‘polymer-based’, ‘resin nanoceramic’, ‘resin ceramic’, ‘hybrid composite’, ‘hybrid ceramic’, ‘composite ceramic’, ‘resin infiltrated’, ‘CAD-CAM’, ‘CAD/CAM’, ‘color stability’, ‘staining’, ‘staining susceptibility’, ‘color change’, ‘color difference’. Inclusion criteria: in vitro articles published in the English language until 18 September 2022 without initial time restriction evaluating the color stability of CCB when submitted to staining solutions. Exclusion criteria: studies investigating color change induced by smoke or whitening treatments; studies not including a clinical evaluation of the results using the thresholds for color perceptibility and acceptability. Risk of bias assessment using the QUIN tool. Findings: Out of the 378 initially retrieved articles, 19 were included in this review. They investigated 17 different CCBs and different artificial staining by liquid protocols, including coffee, red wine, tea, and cola. CCBs exceeded clinical acceptability thresholds for color shift in 18 out of 19 studies, with a significantly higher color stability than conventional hybrid resin-based composites (RBCs), and a significantly lower color stability than ceramic materials. The identified differences in CCBs in color stability can be attributed to the material’s composition, but also to the heterogeneity of staining procedures. Interpretation and clinical implication: Clinicians should be aware that, although to a lower degree when compared to RBCs used in direct or indirect procedures, CCBs undergo color changes to a higher degree in comparison to ceramic materials. Full article