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Retrospective clinical investigation and survival analysis on ceramic inlays and partial ceramic crowns: results up to 7 years.

This study retrospectively evaluated the clinical performance of 287 all-ceramic restorations placed during routine patient care in the University setting in the past 7 years. All patients (n = 106) with ceramic inlays or partial ceramic crowns (PCC), placed during 1988-1994 (n = 327) by five experienced dentists were asked to take part in a clinical investigation, and 92 patients with 287 restorations (232 inlays, 55 PCC) agreed to do so. The following ceramics were used: 44 (15.3%) Dicor (Dentsply), 126 (43.9%) IPS-Empress (Ivoclar), 82 (28.7%) Mirage II, 33 (11.5%) Cerec-Vita-Mark 1 (Vita), and 2 (0.7%) Duceram LFC (Ducera) restorations. The restorations were placed using the following luting composites: 73 (25.4%) Dual Cure Luting Cement (Optec), 81 (28.3%) Variolink high viscosity (Ivoclar), 32 (11.1%) Microfill Pontic C (Kulzer), 51 (17.8%) Dual Zement (Ivoclar), 40 (13.9%) Dicor Light Activated Cement (Dentsply), and 10 (3.5%) Vita Cerec Duo Cement (Vita). Restorations were evaluated according to the modified USPHS criteria. Kaplan-Meier analysis was used to calculate the probability of survival. Of the 287 restorations 270 (94.2%) were still in function without any need of intervention. Fourteen restorations (4.8%) had failed before starting the clinical investigation, and in three a fracture was found during the investigation. These 17 failed restorations consisted of 14 PCC and 3 ceramic inlays. The results of the clinical investigation revealed 59.2% Alpha-ratings for marginal adaptation. Only one restored tooth showed recurrent caries. The probability of survival (95% confidence interval) for 7 years was 98% (97.99-98.01%) for ceramic inlays and 56% (46-66%) for PCC. Our findings show that ceramic inlays can be regarded as an acceptable alternative to cast gold restorations within the methodological limitations of the present study. For PCC further experience with more recent ceramics is warranted.

Adolescent↗

Repair strength of etched vs silica-coated metal-ceramic and all-ceramic restorations.

The purpose of this in vitro study was to examine shear bond strengths of composite resin to metal-exposed porcelain-fused-to-metal (PFM) and all-ceramic restorations after silica coating or etching with 5% hydrofluoric acid (HF). Specimens were fabricated for each of the following groups: two all-ceramic materials [a feldspathic porcelain (Vita Mark II) and a leucite-reinforced glass-ceramic (IPS Empress)], and one noble metal-ceramic (Orplid Keramik I alloy; Vita VMK 68 N felspathic veneer ceramic). These groups were repaired with resin composites after different pretreatment methods. In one metal-ceramic subgroup the surface exhibited a 50% metal and 50% ceramic exposure. In the silica-coating groups, the specimen surfaces were air abraded with silica acid-modified Al2O3 (CoJet Sand) and treated corresponding to the porcelain repair with resin composite. For control groups, the surfaces were etched with 5% HF for 60 seconds and treated in the same way as the silica-coated groups. After 24 hours of storage (distilled water, 37 degrees C) and an additional 24 hours of thermocycling (1150 x 5 degrees C/55 degrees C) the specimens were debonded using a shear bond strength test (n = 15). In all groups the silica coat repair achieved equal or significantly higher bond strengths than did the etching technique (p < 0.05, Mann-Whitney U test). In the metal-exposed group, the mean bond strength increased from 7.3 MPa to 16.3 MPa following the silica-coat repair. Results indicated that silica coating represents a suitable treatment for the intraoral repair of the materials tested in the present study.

Acid Etching, Dental↗

Low wear rate of UHMWPE against zirconia ceramic (Y-PSZ) in comparison to alumina ceramic and SUS 316L alloy.

Partially stabilized zirconia ceramic is being recognized among ceramics for its high strength and toughness. With this ceramic, is possible to manufacture a 22-mm-size femoral head for low friction arthroplasty of the hip joint in association with an ultra-high-molecular-weight polyethylene socket. Wear-resistant properties of zirconia ceramic were screened on two principally different wear devices. Sterile calf bovine serum, physiological saline, and distilled water were chosen as the lubricant fluid media. Depending on the lubricant medium, the wear factor of polyethylene against zirconia ceramic counterfaces was 40 to 60% less than that against alumina ceramic counterfaces, and 5 to 10 times lower than with the SUS316L metal counterfaces. Polyethylene wear against metal was more susceptible in saline in which it had 2 to 3 times higher wear rate than with serum. On the other hand, different fluid media had little effect on polyethylene wear against ceramic counterfaces. In each set of tests, the wear factor obtained on an unidirectional wear device showed 10 to 15 times higher values, in comparison to the wear factor estimated on a reciprocating wear device.

Alloys↗

Effects of interconnecting porous structure of hydroxyapatite ceramics on interface between grafted tendon and ceramics.

The purpose of this study was to evaluate histologically and biomechanically the interface between porous hydroxyapatite ceramics and a tendon grafted into ceramics, and to compare the interface in two ceramics with different porous structures: interconnected porous calcium hydroxyapatite ceramics (IP-CHA) with an effective porosity index (interpore diameter > 20 microm) of 63.6%, and porous calcium hydroxyapatite ceramics with less interconnection (HA-L) with an effective porosity index of 5.5%. The tendon-IP-CHA complex and the tendon-HA-L complex were implanted into the bone defects made in both knees of rabbits. With IP-CHA, abundant fibrous tissue, including vessels and collagen fiber continuity, was observed inside interface-region pores. The amount of osseous tissue in interface-region pores increased over time, and at 24 weeks after operation, the tendon was in direct contact with the osseous tissue in IP-CHA. With HA-L, the amount of fibrous tissue in interface-region pores was low and did not increase. The results of biomechanical analysis revealed that the maximum tendon pull-out load from IP-CHA was significantly higher than that from HA-L. With the porous hydroxyapatite ceramics having highly interconnecting porous structure, a bioactive interface was achieved between ceramics and grafted tendon. On the basis of these results, we conclude that bone defects, including tendon insertion, can be reconstructed using IP-CHA.

Animals↗

The in vitro failure of all-ceramic crowns and the connector area of fixed partial dentures using bilayered ceramic specimens: the influence of core to dentin thickness ratio.

AIMS: To assess the effect of core to dentine thickness ratio on the bi-axial flexure strength and fracture mode and failure origin using bilayered ceramic specimens as an in vitro assessment for all-ceramic crowns and the connector area of fixed partial dentures (FPDs). METHODS: Sets of 30 bilayered composite discs, with a core layer thickness of 1mm and with core to dentine thickness ratios of 2:1, 1:1 and 1:2, were tested in bi-axial flexure with both the reinforcing core and veneering dentine loaded in tension. Mean flexure strengths, standard deviations and associated Weibull moduli (m) were determined. Optical microscopy was employed for identification of the fracture mode and failure origin for the failure all-ceramic crowns and the connector area of FPDs. RESULTS: For a core thickness of 1mm the core to dentine thickness ratio failed to influence the bi-axial flexure strength data when both the reinforcing core and veneering dentine porcelain were tested in tension. The number of fracture fragments, frequency of occurrence of specimen delaminations, Hertzian cone formations and sub-critical radial cracking in the bilayered dental ceramic composite disc-shaped specimens were dependent on the core to dentine thickness ratio and the surface loaded in tension. SIGNIFICANCE: The fracture mode and failure origin in bilayered ceramics tested to represent the failure mode of all-ceramic crowns and FPDs was dependent upon the core to dentine thickness ratio employed. However, the conventional wisdom regarding bilayered ceramic specimens with core thicknesses greater than 1mm are not followed when the core thickness was reduced to 1mm since the fracture resistance was not dependent on the core to dentine thickness ratio.

Aluminum↗

The effect of ceramic surface treatment on bonding to densely sintered alumina ceramic.

STATEMENT OF PROBLEM: Ceramic surface treatment is crucial for bonding to resin. High crystalline ceramics are poorly conditioned using traditional procedures. PURPOSE: The purpose of this study was to evaluate the effect of silica coating on a densely sintered alumina ceramic relative to its bond strength to composite, using a resin luting agent. Material and methods Blocks (6 x 6 x 5 mm) of ceramic and composite were made. The ceramic (Procera AllCeram) surfaces were polished, and the blocks were divided into 3 groups (n = 5): SB, airborne-particle abrasion with 110-microm Al 2 O 3 ; RS, silica coating using Rocatec System; and CS, silica coating using CoJet System. The treated ceramic blocks were luted to the composite (W3D Master) blocks using a resin luting agent (Panavia F). Specimens were stored in distilled water at 37 degrees C for 7 days and then cut in 2 axes, x and y, to obtain specimens with a bonding area of approximately 0.6 mm 2 (n = 30). The specimens were loaded to failure in tension in a universal testing machine, and data were statistically analyzed using a randomized complete block design analysis of variance and Tukey's test (alpha=.05). Fractured surfaces were examined using light microscopy and scanning electron microscopy to determine the type of failure. Energy-dispersive spectroscopy was used for surface compositional analysis. RESULTS: Mean bond strength values (MPa) of Groups RS (17.1 +/- 3.9) ( P =.00015) and CS (18.5 +/- 4.7) ( P =.00012) were significantly higher than the values of Group SB (12.7 +/- 2.6). There was no statistical difference between Groups RS and CS. All failures occurred at the adhesive zone. CONCLUSION: Tribochemical silica coating systems increased the tensile bond strength values between Panavia F and Procera AllCeram ceramic.

Air Abrasion, Dental↗

Effect of ceramic surface treatments on the bond of four resin luting agents to a ceramic material.

PURPOSE: This study evaluated the effect of various ceramic surface treatments on the shear bond strengths of four resin luting agents to Cerec 2 ceramic material. MATERIAL AND METHODS: Four ceramic surface treatments were performed. All groups were subjected to the control treatment, which was abrasion with No. 600 silicon carbide paper. The other three group treatments were etching with phosphoric acid gel, application of bonding agent containing silane coupler, and application of silane coupling agent after etching with phosphoric acid gel. Cerec 2 ceramic specimens were treated with one of the four methods and then cemented together with each of the four resin luting agents (Super-Bond C&B, Panavia 21, Clapearl, and Vita Cerec Duo Cement). Half of the specimens were stored in water and the other half were thermal cycled before shear bond strength testing. RESULTS: Treatment with the silane coupler improved the shear bond strength compared only with the abrasion with carbide paper (control). When the ceramic material was treated with the silane coupler or the silane coupling agent after etching with phosphoric acid gel, no significant differences in bond strength were noted between water storage and 20,000 thermal cycles for any of the four resin luting agents. After 20,000 thermal cycles, all specimens treated with the silane coupling agent with phosphoric acid gel except those cemented with Super-Bond C&B resin luting agent after etching showed cohesive failures within the ceramic. CONCLUSION: Combined surface treatment of etching with phosphoric acid and application of silane coupling agent provides the highest bond strengths of resin luting agents to Cerec 2 ceramic material after thermal cycling.

Acid Etching, Dental↗

Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement.

After total hip replacement an insufficient range of motion (ROM) can lead to contact between femoral neck and rim of the cup (= impingement) causing dislocation and consecutive material failure. The purpose of this study was to analyse the influence of different wear couples on the ROM and stability against dislocation. By means of a special testing device the ROM until impingement, the ROM until dislocation as well as the resisting moment against levering the head out of the cup were experimentally determined. Various total hip systems with cup inserts made of ceramic and polyethylene were comparatively examined in different implant positions. Maximum resisting moment as well as the ROM until impingement and dislocation were clearly influenced by the implant position. Furthermore, the stability against dislocation was affected by design parameters, whereas in the case of appropriate implant position differing wear couples (metal-on-polyethylene vs. ceramic-on-ceramic) had a minor impact. However, as shown by tests under lubricant conditions, ceramic-on-ceramic couples provided less dislocation stability in unfavourable implant position in comparison to metal-on-polyethylene. Therefore, ceramic-on-ceramic couples should only be applied in the case of optimised implant orientation preventing impingement and dislocation with subsequent material failure like chipping off or breakage.

Ceramics↗

Influence of incisal length of ceramic and loading orientation on stress distribution in ceramic crowns.

For ceramic crowns, the recommended depth of tooth reduction from the incisal edge of anterior teeth is 1.5 mm to 2.0 mm. Although some prosthodontists have suggested that incisal heights of ceramic which exceed 2 mm are associated with dangerously high intra-oral stresses, this theory has not been verified. The objective of this study was to test the hypothesis that the stress distribution in ceramic crowns designed for a prepared maxillary central incisor which are subjected to applied loading is relatively insensitive to the incisal length of ceramic. Finite element stress analyses were performed on three crown designs loaded with a horizontal or vertical force of 200 N along the lingual surface near the incisal edge. Ceramic crowns for maxillary central incisors were modeled with incisal lengths of 1.0 mm (Case I), 1.9 mm (Case II), and 4.0 mm (Case III). Zinc phosphate cement with a film thickness of 30 micron was included for each case. Plane-stress finite element analyses indicated that tensile and compressive stresses which were induced in cement and ceramic due to a vertically applied load of 200 N were comparable in magnitude for all three cases within the gingival third of the crowns. For Cases I, II, and III, tensile stresses at the facial region were 6.7, 5.4, and 6.5 MPa, respectively, in cement and 46.2, 48.6, and 49.2 MPa, respectively, in the ceramic. The results of this study tend to support the hypothesis that the amount of tooth reduction (1 to 4 mm) in an incisogingival direction does not significantly influence the stress distribution in the crown or cement layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Bite Force↗

Analysis of contact mechanics in ceramic-on-ceramic hip joint replacements.

The contact mechanics in ceramic-on-ceramic hip implants has been analysed in this study using the finite element method. Only the ideal conditions where the contact occurs within the acetabular cup were considered. It has been shown that the contact pressure distribution and the contact area at the main articulating bearing surfaces depend largely on design parameters such as the radial clearance between the femoral head and the acetabular cup, as well as the thickness of the ceramic insert. For the ceramic-on-ceramic hip implants used in clinics today, with a minimum 5-mm-thick ceramic insert, it has been shown that the radius of the contact area between the femoral head and the acetabular cup is relatively small compared with that of the femoral head and the ceramic insert thickness. Consequently, Hertz contact theory can be used to estimate the contact parameters such as the maximum contact pressure and the contact area.

Ceramics↗

[Factors analysis on ceramic crack of metal-ceramic restorations].

This article enumerated many possible causes of ceramic crack of metal-ceramic restorations and analysed the possible causes of ceramic crack of metal-ceramic restorations. And authors also discussed the effective ways to eliminate the improper factors to keep the good bond strength of ceramics to metal alloy and to avoid ceramic crack of metal-ceramic restorations.

Dental Restoration Failure↗

Ceramic acetabular liner fracture in total hip arthroplasty with a ceramic sandwich cup.

In total hip arthroplasty, a modular acetabular component with a sandwich insertion (alumina ceramics/polyethylene/titanium) was proposed. The polyethylene layer might reduce the rigidity of the ceramics and prevent an impingement between the ceramic liner rim and the femoral neck. A case of an acetabular liner fracture of the ceramic sandwich cup was presented. The fracture occurred 1.4 years after the operation without trauma. Because the ceramic liner rim was hit by the head following the impingement between the neck and the polyethylene, the cause of the fracture might be the stress concentration at the rim of the ceramic liner, of which the thickness was only 4 mm. At revision surgery, the fractured ceramic liner was replaced with a polyethylene liner without inner ceramic liner.

Aluminum Oxide↗

A comparison of fracture strength of yttrium-oxide- partially-stabilized zirconia ceramic crowns with varying core thickness, shapes and veneer ceramics.

The fracture strengths of stylized all-ceramic crowns manufactured using an yttrium-oxide-partially-stabilized (Y-TZP) zirconia ceramic core (Denzir) veneered with lithium disilicate glass-ceramics (IPS Empress 2 or IPS Eris) were evaluated. The Denzir cores were manufactured in two ways: either with different thickness in different parts of the restoration, called an 'adapted Denzir core'; or with a uniform core thickness of 0.5 mm. IPS Empress 2 all-ceramic crowns served as reference. There was no significant difference between the crowns with an 'adapted Denzir core' veneered with the two brands of glass-ceramics. No significant difference was seen between the crowns with a 0.5 mm Denzir core veneered with the two brands of glass-ceramics. The crowns with an 'adapted Denzir core' exhibited significantly higher values than those with a 0.5 mm Denzir core and than the IPS Empress 2 crowns used as reference. No significant differences were seen among the IPS Empress 2 crowns used as reference and the crowns with a 0.5 mm Denzir core. The mode of failure varied among the Empress 2 crowns and the crowns with a core of a Y-TZP zirconia ceramic. Long-term studies are necessary to assess the clinical performance of this restorative system.

Computer-Aided Design↗

Effect of ceramic surface treatment on the microtensile bond strength between a resin cement and an alumina-based ceramic.

PURPOSE: The objective of this study was to test the following hypothesis: the silica coating on ceramic surface increases the bond strength of resin cement to a ceramic. MATERIALS AND METHODS: In-Ceram Alumina blocks were made and the ceramic surface was treated: G1--sand-blasting with 110-microm aluminum oxide particles; G2--Rocatec System: tribochemical silica coating (Rocatec-Pre powder + Rocatec-Plus powder + Rocatec-Sil); G3--CoJet System: silica coating (CoJet-Sand) + ESPE-Sil. The ceramic blocks were cemented to composite blocks with Panavia F resin cement (under a load of 750 g/1 min). The cemented blocks were stored in distilled water at 37 degrees C for 7 days and sectioned along the x and y axes with a diamond disk. Samples with an adhesive area of ca 0.8 mm2 (n = 45) were obtained. The samples were attached to an adapted device for the microtensile test, which was performed in a universal testing machine (EMIC) at a crosshead speed of 1 mm/min. RESULTS: The obtained results were submitted to ANOVA and Tukey's test. Mean values of tensile strength (MPa) and standard deviation values were: (G1) 16.8+/-3.2; (G2) 30.6+/-4.5; (G3) 33.0+/-5.0. G2 and G3 presented greater tensile strength than G1. There was no significant difference between G2 and G3. All the failures took place at the ceramic/resin cement interface. CONCLUSION: The silica coating (Rocatec or CoJet systems) of the ceramic surface increased the bond strength between the Panavia F resin cement and alumina-based ceramic.

Analysis of Variance↗

The influence of multiple firing on thermal contraction of ceramic materials used for the fabrication of layered all-ceramic dental restorations.

OBJECTIVES: During the production of layered all-ceramic restorations transient and/or residual thermal stresses may be formed which may affect a restoration's longevity. The aim of this study was to evaluate the influence of multiple firings on the thermal behavior of veneering porcelains and a ceramic core. METHODS: The materials tested were: Empress 2 Core, Empress 2 Veneer and Eris glass-ceramics, Carrara Vincent and an experimental leucite-based veneering porcelain, Vitadur-Alpha aluminous porcelain, and two porcelains designed for titanium (i.e. Duceratin Dentine and Enamel). The thermal contraction coefficient of the materials was measured by means of dilatometery. The thermal contraction coefficient was measured during cooling and calculated over the temperature range of 450-20 degrees C by linear regression. One and two-way analysis of variance together with Tukey post-hoc tests were used as statistical analysis. RESULTS: Repeated firing affects the thermal contraction coefficients of Empress 2 Veneer, Carrara Vincent porcelain and the experimental porcelain. The thermal contraction coefficients of Empress 2 Core were significantly different from Vitadur-Alpha, Carrara Vincent, experimental porcelain, and Duceratin porcelains. The contraction coefficients of Empress 2 Veneer and Eris were closest to that of Empress 2 Core. SIGNIFICANCE: The Empress 2 Core and Eris glass-ceramics, the aluminous porcelain and Duceratin porcelains showed better thermal stability after repeated firing than leucite porcelains. It can be concluded that due to the thermal stability of glass-ceramic materials, layered all-ceramic restorations of these materials may perform better.

Aluminum Silicates↗

Vertical marginal discrepancy of ceramic copings with different ceramic materials, finish lines, and luting agents: an in vitro evaluation.

STATEMENT OF PROBLEM: Prosthetic restorations that fit poorly may affect periodontal health and occlusion. Studies that have evaluated the accuracy of fit of ceramic restorations before and after cementation assessed primarily intracoronal restorations. PURPOSE: This in vitro study evaluated the effect of different finish lines, ceramic manufacturing techniques, and luting agents on the vertical discrepancy of ceramic copings. MATERIAL AND METHODS: Two stainless steel molars were prepared for complete crowns with 2 different finish lines (heavy chamfer and rounded shoulder); each molar was duplicated to fabricate 90 copings. A total of 180 copings generated 18 groups (n=10 for each finish line-coping material-luting agent combination). Luting agents tested included zinc phosphate, resin-modified glass ionomer (Fuji Plus), and resin composite cements (Panavia F). A metal frame was developed on which to screw the stainless steel model and a ceramic coping; the distance (microm) between 2 predetermined points was measured before and after cementation by a profile projector under a torquing force. A 4-way ANOVA with repeated measurements was performed to assess the influence of each factor in the vertical marginal discrepancy: 3 between-coping factors (finish line-coping material-luting agent) and 1 within-coping factor (before and after cementation) (alpha=.05). RESULTS: Procera copings presented the lowest mean values ( P <.05) of vertical marginal discrepancy before and after cementation (25/44 microm) when compared to Empress 2 (68/110 microm) and InCeram Alumina copings (57/117 microm), regardless of any combinations among all finish lines and luting agents tested. CONCLUSION: Considering each factor separately, the ceramic manufacturing technique appeared to be the most important factor tested for the definitive vertical discrepancy of all-ceramic copings, with lower mean values for Procera copings.

Aluminum Oxide↗

Enhancement of bone regeneration using resorbable ceramics and a polymer-ceramic composite material.

The aim of this experimental study was to evaluate the use of resorbable implants for the repair of nonloaded skeletal defects. Porous ceramic implants of alpha-TCP, of glass-ceramic, and of solid composite implants of glass-ceramic/polylactic acid 8 mm in diameter and 2 mm in thickness were fabricated and implanted pressfit into biparietal, full-thickness defects of the calvaria of 60 adult rats. Twenty rats received unfilled defects and served as controls. Fluorochrome labeling of bone formation was performed during the observation period. Five animals from each group were evaluated after 6, 13, 26, and 52 weeks. The control defects showed incomplete regeneration, with bone formation extending 1.66 mm, on average, into the defect after 52 weeks. In the group of alpha-TCP implants, histologic evaluation indicated that the bone formed during initial stages had undergone resorption later on, so that bone repair after 52 weeks was not significantly enhanced, with an average depth of 1.83 mm of bone ingrowth. The glass-ceramic implants exhibited extensive bone formation and nearly complete repair of the calvarial defect, with 3.90 mm of bone ingrowth into the implant pores. Degradation of the ceramic was nearly complete, with a few remaining particles surrounded by soft tissue. The composite implants showed a negligible bone ingrowth of 0.63 mm, on average. Soft tissue had invaded the polylactic acid implant body, but no bone formation had taken place at the surface of the embedded ceramic particles. Degradation of the polymer was not complete after 52 weeks. It is concluded that the balance between degradation and bone formation is delicate and that chemical events and cellular reaction during degradation may counteract complementary bone ingrowth.

Absorbable Implants↗

[Comparative experimental investigations with bioglass (L. L. Hench), Al2O3-ceramic and Al2O3-ceramic coated with a mod. Bioglass. I. Results of experiments under non-loaded conditions (author's transl)].

This report deals with comparative results obtained with unloaded intra-osseous implants of bioglass (L. L. Hench), Al2O3-ceramic and Al2O3-ceramic coated with a mod. bioglass. Al2O3-ceramic and bone form a direct bony interface without fibrous tissue interposition, this resulting in a pure mechanic fixation of the implant through frictional forces of the surface roughed ceramic. Pure bioglass (45S5) and bone form a unique persisting direct interface by means of physico-chemical or biochemical phaenomena stabilizing the implant. Interface stability seams to be higher than the fatique strenth of the glass itself. This interface is developed as a consequence of solubility of some of the glass constituents within a surface layer of up to 200 microns, running parallel with a reduction of strength of this surface glass layer. The boronoxide containing bioglass, flame-sprayed onto Al2O3-ceramic samples seams to be less soluble and therefore seams to have lesser bonding capability to bone. The stability of the interface bioglass coating-Al2O3-ceramic was low.

Aluminum↗