Objectives To measure the marginal and internal fit of three-unit fixed partial dentures (FPDs) using the micro-CT technique, testing the null hypothesis that there is no difference in the adaptation between the ceramic systems studied. Methods Stainless steel models of prepared abutments were fabricated to design the FPDs. Ten FPDs were produced from each framework ceramic (YZ - Vita In-Ceram YZ and IZ - Vita In-Ceram Zirconia) using CEREC inLab according to the manufacturer instructions. All FPDs were veneered using the recommended porcelain. Each FPD was seated on the original model and scanned using micro-CT. Files were processed using NRecon and CTAn software. Adobe Photoshop and Image J software were used to analyze the cross-sections images. Five measuring locations were used as follows: MG – marginal gap; CA - chamfer area; AW - axial wall; AOT - axio-occlusal transition area; OA - occlusal area. The horizontal marginal discrepancy (HMD) was evaluated in another set of images. Results were statistically analyzed using ANOVA and Tukey tests (α=0.05). Results The mean values for MG, CA, AW, OA and HMD were significantly different for all tested groups (p<0.05). IZ exhibited greater mean values than YZ for all measuring locations except for AW and AOT. OA showed the greatest mean gap values for both ceramic systems. MG and AW mean gap values were low for both systems. Significance The ceramic systems evaluated showed different levels of marginal and internal fit, rejecting the study hypothesis. Yet, both ceramic systems showed clinically acceptable marginal and internal fit.

Objective to evaluate the effect of the specimen design on the flexural strength (σf) and failure mode of ceramic structures, testing the hypothesis that the ceramic material under tension controls the mechanical performance of the structure. Methods Three ceramics used as framework materials for fixed partial dentures (YZ - Vita In-Ceram YZ; IZ - Vita In-Ceram Zirconia; AL - Vita In-Ceram AL) and two veneering porcelains (VM7 and VM9) were studied. Bar-shaped specimens were produced in three different designs (n=10): monolithic, two layers (porcelain-framework) and three layers (TRI) (porcelain-framework-porcelain). Specimens were tested for three-point flexural strength at 1 MPa/s in 37°C artificial saliva. For bi-layered design, the specimens were tested in both conditions: with porcelain (PT) or framework ceramic (FT) layer under tension. Fracture surfaces were analyzed using stereomicroscope and scanning electron microscopy (SEM). Young’s modulus (E) and Poisson’s ratio (ν) were determined using ultrasonic pulse-echo method. Results were statistically analyzed by Kruskal-Wallis and Student-Newman-Keuls tests. Results Except for VM7 and VM9, significant differences were observed for E values among the materials. YZ showed the highest ν value followed by IZ and AL. YZ presented the highest σf. There was no statistical difference in the σf value between IZ and IZ-FT and between AL and AL-FT. σf values for YZ-PT, IZ-PT, IZ-TRI, AL-PT, AL-TRI were similar to the results obtained for VM7 and VM9. Two types of fracture mode were identified: total and partial failure. Significance The mechanical performance of the specimens was determined by the material under tension during testing, confirming the study hypothesis.

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Objective The use of a 30 µm alumina–silica coated particle sand (CoJet™ Sand, 3M Espe), has shown to enhance the adhesion of resin cements to Y-TZP. The question is whether or not sandblasting 30 µm particles does negatively affect the fatigue limit (S–N curves) and the cumulative survival of Y-TZP ceramics. Method Four zirconia materials tested were: Zeno (ZW) (Wieland), Everest ZS (KV) (KaVo), Lava white (LV) and Lava colored (LVB) (3M Espe). Fatigue testing (S–N) was performed on 66 bar of 3 mm × 5 mm × 40 mm with beveled edges for each zirconia material provided by the manufacturers. One half of the specimens were CoJet sandblasted in the middle of the tensile side on a surface of 5 mm × 6 mm. Cyclic fatigue (N = 30/group) (sinusoidal loading/unloading at 10 Hz between 10% and 100% load) was performed in 3-point-bending in a water tank. Stress levels were lowered from the initial static value (average of N = 3) until surviving 1 million cycles. Fatigue limits were determined from trend lines. Kaplan–Meier survival analysis was performed to determine the failure stress at the median percentile survival level for 1 million of cycles before and after sandblasting. The statistical analyses used the log-rank test. Characterization of the critical flaw was performed by SEM for the majority of the failed specimens. Results The fatigue limits “as received” (ctr) were: LV = 720 MPa, LVB = 600 MPa, KV = 560 MPa, ZW = 470 MPa. The fatigue limits “after CoJet sandblasting” were: LV = 840 MPa, LVB = 788 MPa, KV = 645 MPa, ZW = 540 MPa. The increase in fatigue limit after sandblasting was 15% for Zeno (ZW) and Everest (KV), 17% for Lava (LV) and 31% for Lava colored (LVB). The KM median survival stresses in MPa were: ZW(ctr) = 549 (543–555), ZW(s) = 587 (545–629), KV(ctr) = 593 (579–607), KV(s) = 676 (655–697), LVB(ctr) = 635 (578–692), LVB(s) = 809 (787–831), LV(ctr) = 743 (729–757), LV(s) = 908 (840–976). Log-rank tests were significantly different (p < 0.001) for all sandblasted groups vs. the “as received” except for Zeno (Wieland) (p = 0.295). Failures started from both intrinsic and machined flaws. Significance 30 µm particle sandblasting did significantly improve the fatigue behavior of three out of four Y-TZP ceramic materials and can therefore be recommended for adhesive cementation procedures. This study was supported in part by grants from the Swiss Society for Reconstructive Dentistry (SSRD) and 3M Espe.

The past 3 years of research on materials for all-ceramic veneers, inlays, onlays, single-unit crowns, and multi-unit restorations are reviewed in this article. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, and a trend toward more clinically relevant in vitro test methods. This article includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data, and a summary of clinical longevity for prostheses constructed of various materials.

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Multiple host and treatment factors affected the healing time and outcome of root canal treatment. Follow-up protocols should consider these factors before concluding the treatment outcome: patient's age, immune condition, as well as roots with overextended fillings, root canal systems with smaller apical preparations (size <35) or roots with complex canal systems. Intervention may be recommended if the treatment quality was inadequate or if patients became symptomatic.