Division of Aesthetic and Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Switzerland.
Bindl A, Mörmann WH. Survival rate of mono-ceramic and ceramic-core CAD/CAM-generated anterior crowns over 2-5 years. Eur J Oral Sci 2004; 112: 197-204.Copyright Eur J Oral Sci, 2004Anterior mono-ceramic (Mk II, n = 18) and ceramic core (In-Ceram Spinell, n = 18) crowns were CAD/CAM-fabricated using Vitablocs with the Cerec 2 CAD/CAM system and bonded in 24 patients. All crowns were rated using modified United States Public Health Services (USPHS) criteria at baseline and after a service time of 2-5 years. Survival of the crowns, regarding fracture, was analysed (Kaplan-Meier) after 44.7 +/- 10.3 months. Gingival health at crowns was assessed using plaque and bleeding scores. One core crown and one mono-ceramic crown had fractured after 42.5 months and 12 months, respectively, with survival rates of 91.7% for In-Ceram Spinell and 94.4% for Mk II; the difference was not statistically significant. Between baseline and follow-up examinations, non-significant shifts from A- to B-ratings occurred, particularly for marginal adaptation, for both crown types. Plaque and bleeding scores did not differ between the ceramic crown types but showed significantly less plaque and less bleeding at ceramic crowns than at control teeth at follow-up. The clinical performance of mono-ceramic crowns was judged to be similar to that of ceramic core crowns.
Cariology, Restorative Sciences,and Endodontics, School of Dentistry, University of Michigan, 1011 N. University, Ann Arbor, MI 48109-1078, USA. firstname.lastname@example.org
Department of Prosthodontics, Ludwig-Maximilians University, Goethestr. 70, Munich, Germany. email@example.com
The aim of this study was to determine the values of retentive forces of double crowns. The effect of the abutment height, the material of the inner crown, and the taper were evaluated. Sixty inner crowns each were fabricated from zirconia and a gold alloy having three different abutment heights (5, 7, and 9 mm) and two different tapers (0 degrees and 2 degrees ). All outer crowns were made with an electroforming system. The removal test was performed by a standardized setup using a universal testing machine at a crosshead speed of 1,000 mm min(-1). Ten separation cycles were performed of each specimen, and the mean was imported into a statistical program. The retention forces were in the range of 0.37 and 2.65 N. The abutment height (p < 0.001), the material of the inner crown (p = 0.035), and the taper (p < 0.001) showed statistical influence on the retention force in the two-way ANOVA. Zirconia primary crowns performed better than gold alloy in the 0 degrees group, especially with short abutments. However, a taper of 0 degrees and short abutments have clinical drawbacks that were not evaluated in this study. In situations with long abutment teeth and a 2 degrees taper zirconia is an alternative to gold alloy primary crowns.
Department of Prosthodontics, University Hospital Freiburg, School of Dentistry, Freiburg, Germany. firstname.lastname@example.org
OBJECTIVE: This study aimed at evaluating the integration of zirconia implants in a rat femur model. MATERIAL AND METHODS: Zirconia implants with two distinct surface topographies were compared with titanium implants with similar topographies. Titanium and zirconia implants were placed into the femurs of 42 male Sprague-Dawley rats. Four groups of implants were utilized: machined zirconia implants, zirconia implants with a rough surface, machined titanium implants, and titanium implants with an electrochemically roughened surface. After a healing period of 28 days, the load-bearing capacity between the bone and the implant surface was evaluated by a push-in test. Additionally, after a healing period of 14 and 28 days, respectively, bone tissue specimens containing the implants were processed and histologically analyzed. RESULTS: The mean mineralized bone-to-implant contact showed the highest values after 14 and 28 days for the rough surfaces (titanium: 36%/45%; zirconia: 45%/59%). Also, the push-in test showed higher values for the textured implant surfaces, with no statistical significance between titanium (34 N) and zirconia (45.8 N). CONCLUSIONS: Within the limits of the animal investigation presented, it was concluded that all tested zirconia and titanium implant surfaces were biocompatible and osseoconductive. The presented surface modification of zirconia implants showed no difference regarding the histological and biomechanical results compared with an established electrochemically modified titanium implant surface.
Research and Development, Ivoclar Vivadent AG, Bendererstr. 2, FL-9494 Schaan, Liechtenstein. email@example.com , Head of Ceramic Development, Ivoclar Vivadent AG, Bendererstrasse 2, FL-9494 Schaan, Liechtenstein. firstname.lastname@example.org , Dentist, Dental Clinic, Research and Development, Ivoclar Vivadent AG, Bendererstr. 2, FL-9494 Schaan, Liechtenstein. email@example.com , Head of Dental Clinic, Research and Development, Ivoclar Vivadent AG, Bendererstr. 2, FL-9494 Schaan, Liechtenstein. firstname.lastname@example.org , Research and Development, Ivoclar Vivadent AG, Bendererstr. 2, FL-9494 Schaan, Liechtenstein. email@example.com.
Sintered ceramics and glass-ceramics are widely used as biomaterials for dental restoration, especially as dental inlays, onlays, veneers, crowns or bridges. Biomaterials were developed either to veneer metal frameworks or to produce metal-free dental restorations. Different types of glass-ceramics and ceramics are available and necessary today to fulfill customers' needs (patients, dentists and dental technicians) regarding the properties of the biomaterials and the processing of the products. All of these different types of biomaterials already cover the entire range of indications of dental restorations. Today, patients are increasingly interested in metal-free restoration. Glass-ceramics are particularly suitable for fabricating inlays, crowns and small bridges, as these materials achieve very strong, esthetic results. High-strength ceramics are preferred in situations where the material is exposed to high masticatory forces.
Department of Prosthodontics, Ludwig-Maximilians University, Munich, Germany. firstname.lastname@example.org
The marginal fit of 14-unit fixed dental prosthesis retainers and single-crown copings fabricated by the same computer-aided design (CAD)/computer-aided manufacturing (CAM) system were evaluated in vitro hypothesizing that the marginal opening might be independent of the type of restoration. Eight ivorine maxillary teeth (FDI locations 27, 25, 23, 21, 11, 13, 15 and 17) were prepared to accommodate a 14-unit prosthesis. Ten fixed dental prosthesis retainers and 40 single-crown-copings were fabricated using Zeno CAD/CAM on 20 master dies. Four cross-sections were made from each tooth and the marginal gap dimensions were measured. One-way anova was used to test the difference between the experimental groups and two-way anova and a post hoc test (Student-Newman-Keuls) were carried out to determine the influence of the location of the abutment tooth and the measurement location within the abutment tooth in the experimental groups (P < 0.05). Mean marginal gap dimensions and standard deviations for fixed dental prosthesis retainers and single-crown copings were 25 +/- 29 and 13 +/- 12 microm, respectively. The type of restoration showed a significant influence (P < 0.001) on the marginal gap. The location of the abutment tooth (P < 0.001) and the measurement location (P < 0.001) exhibited significant influence on marginal gaps of fixed dental prosthesis retainers while no influence on single-crown copings could be detected. The highest marginal gaps were found at the palatal surface of the incisor and canine of the 14-unit fixed dental prosthesis retainers. Fourteen-unit fixed dental prosthesis showed significantly higher marginal openings than single crowns fabricated under the same conditions. However, both restorations showed clinically acceptable marginal openings.
Department of Prosthodontics, Ludwig-Maximilians University, Munich, Germany. email@example.com
The purpose of this in vitro study was to compare the precision of fit of substructures milled from semi-sintered zirconia blocks fabricated with two different computer-assisted design (CAD)/computer-assisted manufacturing (CAM) systems. Three-unit posterior fixed dental prostheses (FDP) were fabricated for standardized dies (n = 10) with the Lava CAD/CAM system (Lava) and the Procera-bridge-zirconia CAD/CAM system (Procera). After cementation to the dies, the FDP were embedded and sectioned. Four cross-sections were made of each abutment tooth, and marginal and internal fit were evaluated under an optical microscope. A one-way analysis of variance was used to compare data (alpha = 0.05). Mean gap dimensions at the marginal opening for Lava and Procera were 15 (+/-7) microm and 9 (+/-5) microm, respectively. Mean marginal openings (P = 0.012) and internal adaptation at two out of three measurement locations were significantly different. Within the limitations of this study, the results suggest that the accuracy of both investigated systems is satisfactory for clinical use.
Dental School, University of Passo Fundo, Passo Fundo, Brazil. firstname.lastname@example.org
BACKGROUND The authors conducted a comprehensive literature review to compile and compare clinical evidence for the treatment of teeth using all-ceramic restorations. TYPES OF STUDIES REVIEWED The authors searched the English-language peer-reviewed literature using MEDLINE and PubMed with a focus on research published between 1993 and 2008. They also conducted a hand search of relevant dental journals. They reviewed randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies and longitudinal retrospective studies. RESULTS Evidence suggests that for veneers, intracoronal restorations and complete-coverage restorations for single-rooted anterior teeth, clinicians may choose from any all-ceramic system on the basis of esthetic needs (many systems have had greater than 90 percent success at six years). Well-studied molar restorations include those made of alumina and, increasingly, zirconia and bonded lithium disilicate. Reasonable evidence has shown the effectiveness of anterior three-unit fixed partial dentures made of lithium disilicate, alumina and zirconia. For three-unit restorations involving a molar, expert consensus suggests that only zirconia-based systems are indicated. CLINICAL IMPLICATIONS Available evidence indicates the effectiveness of many all-ceramic systems for numerous clinical applications. Bonding has been shown to increase clinical success. Studies of zirconia prostheses indicate problems with porcelain cracking.
High-strength CAD/CAM-fabricated veneering material sintered to zirconia copings--a new fabrication mode for all-ceramic restorations.
Florian Beuer, Josef Schweiger, Marlis Eichberger, Heinrich F Kappert, Wolfgang Gernet, Daniel Edelhoff
Department of Prosthodontics, Ludwig-Maximilians-University, Munich, Germany. email@example.com
OBJECTIVES With this in vitro study the fracture strength of zirconia-based crown copings being veneered with a CAD/CAM generated high-strength ceramic cap by sintering is compared with anatomically identical zirconia-based crowns, which were either overpressed or veneered by the layering technique for completion. METHODS A 1.2mm, 360 degrees chamfer preparation was performed on a second maxillary molar and was dublicated 15 times in a cobalt-chromium-alloy. A sample of 45 zirconia copings was produced and divided into three groups. In the first group (VT) zirconia copings received conventional veneering in layering technique, in the second group the veneering porcelain was pressed over the zirconia coping (PT), and for the third group (ST) a CAD/CAM-fabricated high-strength anatomically shaped veneering cap was sintered onto the zirconia coping. All crowns were cemented conventionally onto their dies and tested in the universal testing machine until clinical failure. The fracture load data were compared by a one-way analysis of variance and a multiple comparison posthoc test (alpha<0.05). RESULTS Specimens from group VT showed a mean (S.D.) fracture load of 3700.39 (1238.72) N, group OT 3523.73 (1181.11) N and group ST 6262.67 (2257.42) N. The difference between groups VT/OT and ST were statistically significant (P<0.001). SIGNIFICANCE The new CAD/CAM-fabricated bilayered restorations (ST) were superior to the present techniques (VT and OT) in terms of fracture load and offer the possibility to produce cost-effective crowns and fixed partial dentures with a potential lower risk of chippings.
Implant replacement of the maxillary central incisor utilizing a modified ceramic abutment (Thommen SPI ART) and ceramic restoration.
University of Iowa Hospitals and Clinics, Hospital Dentistry Institute, Division of Maxillofacial Prosthodontics, 200 Hawkins Drive, Iowa City, IA 52242-1049, USA. firstname.lastname@example.org
The prosthetic restoration of a missing anterior tooth with a dental implant is a challenge. Treatment coordination with a multidisciplinary team is critical in the successful outcome of this type of patient treatment. Newer surgical treatment modalities in the management of hard and soft tissues are becoming common, with very good predictability and long-term stability. Additionally, the use of advanced dental technology and materials such as sintered zirconium allows the restorative practitioner the opportunity to fabricate an esthetic, precise-fitting, biocompatible, and strong definitive prosthesis for the patient, with good longevity. CLINICAL SIGNIFICANCE: The use of an all-ceramic abutment and restoration is described, along with the "soft tissue sculpting" procedure through the use of a custom provisional restoration. The relative ease and convenience of the procedure is also illustrated.
Division of Prosthodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE, Minneapolis, MN 55455, USA. email@example.com
STATEMENT OF PROBLEM Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated. PURPOSE This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use. MATERIAL AND METHODS A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought. RESULTS The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation. CONCLUSIONS Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.
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Division of Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Zurich, Switzerland.
PURPOSE: One-visit in-office CAD/CAM fabrication of esthetic ceramic crowns as a superstructure for posterior implants is quite new. The aim of the study was to evaluate the strength of esthetic ceramic CAD/CAM crowns with varied occlusal thickness and seated with adhesive and nonadhesive cements on titanium and zirconia abutments. MATERIALS AND METHODS: Esthetic ceramic CAD/CAM-generated molar crowns (n = 15 per group) with occlusal thicknesses of 0.5 mm and 1.5 mm were seated on titanium (1) and zirconia (2) abutments: noncemented (a) and with nonadhesive cement (b) or 2 adhesive resin-based cements (c) and (d). In addition, 15 molar crowns with 5.5-mm occlusal thickness were seated on short zirconia abutments (3) using cements (c) and (d). All crowns had the identical occlusal morphology and were loaded with a crosshead speed of 0.5 mm/min until fracture. Load data were analyzed using 2-way ANOVA, the Scheffé test, and Weibull probability of failure analysis. RESULTS: Fracture loads of 1.5-mm occlusal thickness crowns (a, b, c, d) were higher (P <.001) than those of 0.5-mm crowns (except for group ld). Occlusal 5.5-mm crowns on short zirconia abutments had similar (2c) or less (2d) strength than the respective 1.5-mm crowns. Nonadhesive crowns (1b, 2b) were weaker (P <.001) than adhesive crowns (1c, 1d, 2c, 2d). Fracture loads of 0.5- and 1.5-mm crowns were significantly higher on titanium than on zirconia abutments with both cements. Adhesive cement d generally showed higher fracture loads than c on both titanium and zirconia. CONCLUSION: Esthetic ceramic CAD/CAM molar implant crowns gained high strength with adhesive cements on both titanium and zirconia implant abutments compared to nonadhesive cementation.
The objective of this study was to evaluate, by scanning electron microscopy, the marginal and internal fit of all-ceramic three-unit fixed partial denture (FPD) frames fabricated by computer-assisted design/computer-aided machining (CAD/CAM) and CAM techniques using blocks of infiltration ceramic, high-strength yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) zirconia sinter ceramic, high-strength dense sintered Y-TZP zirconia ceramic, and glass ceramic. Slip-cast infiltration ceramic was used as a traditional control. The cementation interface widths of the FPD frame copings on butt (A) shoulders of Cerec In-Ceram zirconia (A1, 53 +/- 17 microm) were smaller than those of slip-cast In-Ceram zirconia (A6, 113 +/- 25 microm). Cerec Y-TZP zirconia (A2, 53 +/- 9 pm) and DCS Y-TZP zirconia (A4, 32 +/- 6 microm) interfaces were both significantly smaller than those of Cercon Y-TZP zirconia (A5, 120 +/- 6 microm). Internally, A2 (103 +/- 14) interfaces were smaller than A4 interfaces (144 +/- 15 microm). On chamfer shoulders (B), Cerec Y-TZP zirconia (B1, 71 +/- 5 microm) interfaces were smaller than Cercon interfaces (B2, 129 +/- 38 microm); internally, B1 (80 +/- 11 microm) interfaces were smaller than B2 interfaces (130 +/- 12 microm). CAD/CAM produced better marginal and internal accuracy of fit compared to slip casting and CAM techniques.
Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Plattenstrasse 11, Zurich, CH-8032, Switzerland. firstname.lastname@example.org
PURPOSE: To assess the accuracy of preparation surface area measurements (mm2) using the Cerec digital mouth camera in vitro and to analyze a collection of 514 Cerec camera in vivo optical impressions of preparations from 274 patients according to the size of preparation/bonding area (mm2) METHODS: The surface area (mm2) of model preparations with known dimensions namely of one occlusal (1) and one mesio-occluso-distal (2) cavity as well as of one central incisor (3) and one molar (4) crown preparation was calculated from linear (a) design dimensions,(b) slide-gauge and (c) coordinate-measuring-machine data as benchmark measurements and from repeated (n=10)(d) laser-scan (control),(e) Cerec-camera mounted on a support,(f) handheld Cerec-camera measurements. Data of (d),(e) and (f) was statistically analyzed. From a collection of data sets clinically recorded with the Cerec camera, the surface areas of 514 preparations from 274 patients were analyzed according to the type of tooth and type of preparation. RESULTS: Occlusal cavity mm2 data 1(d) 48 +/- 0.4, 1(e) 48 +/- 0.2, 1(f) 48 +/- 0.6 and mod cavity mm2 data 2(d) 137 +/- 2, 2(e) 138 +/- 1, 2(f) 138 +/- 4 did not differ between (d),(e) and (f)(P> 0.05) confirming the hypothesis for inlay cavities. Incisor crown preparation mm2 data 3(d) 82+0.4 differed (P< 0.001) from 3(e) 85 +/- 0.2 and 3(f) 85 +/- 0.6 as well as molar crown preparation mm2 data 4(d) 133 +/- 0.6 differed by 3.5%(P< 0.001) from 4(e) 137 +/- 0.4 and 4f) 138 +/- 1. Clinical cavity and crown preparation area data obtained from in vivo Cerec camera recordings differentiated between type of tooth and type of cavity. 2D data of "classic","reduced" and "endo" type crown preparations did not differentiate clearly.
OBJECTIVES: This study evaluated the strength and fracture pattern of monolithic posterior CAD/CAM crowns hypothesizing that zinc-phosphate cemented lithium disilicate crowns might show the same fracture strength as adhesively cemented crowns. METHODS: Two sets of monolithic posterior crowns each with uniform occlusal and lateral wall thickness of 1.5mm were fabricated from three types of block ceramic (1) lithium disilicate glass,(2) leucite glass and (3) feldspathic ceramic using CEREC 3 CAD/CAM. Crowns (n=15) of ceramics (1),(2) and (3) each were (A) zinc-phosphate cemented,(B) adhesively cemented on resin-based composite dies and loaded until fracture. Load data was analyzed using ANOVA and Scheffé tests. Crack pattern was evaluated on an additional three sample cross-sections for each group at start of fracture. RESULTS: Radial cracks originated early at the cementation interfaces and cone cracks were observed finally at the loading sites. Mean load values (SD) of A-crowns at fracture start/end (1) 807 (91) N/2082 (192) N;(2) 915 (193) N/1130 (166) N;(3) 985 (199) N/1270 (301) N were all significantly (P<0.001) lower when compared to their B-crown analogs (1) 1456 (205) N/2389 (84) N;(2) 1684 (395) N/2469 (171) N;(3) 1548 (304) N/2392 (75) N, rejecting the authors hypothesis. A-1 crowns had significantly (P<0.001) higher fracture load than A-2 and A-3 crowns. The A-1 crown fracture load data, even if significantly (P<0.001) lower, came close to the B-1 values. SIGNIFICANCE: Adhesive cementation balanced the strength of weak ceramics with that of strong ceramic and recommended itself for leucite glass ceramic and feldspathic ceramic crowns. Zinc-phosphate cementation appeared feasible for lithium disilicate crowns.
Survival of ceramic computer-aided design/manufacturing crowns bonded to preparations with reduced macroretention geometry.
Clinic of the Division of Aesthetic and Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Switzerland. email@example.com
PURPOSE: Adhesive cementation reduces the need for macroretentive preparation for crowns. This study investigated the survival and clinical rating of monolithic computer-aided design/manufacturing (CAD/CAM) ceramic crowns bonded to preparations with reduced macroretention, hypothesizing that adhesion would compensate for reduced retention geometry. MATERIALS AND METHODS: Two-hundred eight posterior CAD/CAM-generated crowns from feldspar block ceramic were adhesively bonded in 136 patients in three preparation groups: classic (100% stump height, n = 70); reduced (reduced stump height or irregular stump, n = 52); and endo (absent stump but pulp chamber retention cavity, n = 86). Crowns were examined at baseline and after 55 +/- 15 months using modified USPHS criteria. Plaque and bleeding of gingiva around the crowns were assessed. RESULTS: Cumulative Kaplan-Meier survival of crowns on premolars/molars was: classic = 97.0%/94.6%; reduced = 92.9%/92.1%; and endo = 68.8%/87.1%, confirming the hypothesis for classic, reduced, and endo molars as well as for classic and reduced premolars. A significant difference was found between classic and endo premolar crowns, rejecting the hypothesis for endo preparation on premolars. Plaque and bleeding indices were significantly lower for crowned teeth than for controls. CONCLUSION: The survival of classic and reduced crowns was rated adequate for premolars and molars. Endo preparation appeared acceptable for molar crowns but inadequate for premolar crowns.
Clinic of the Division of Aesthetics and Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Switzerland.
PURPOSE: This study investigated fracture load of computer-aided design/manufacturing (CAD/CAM)-generated slot-inlay fixed partial dentures (FPD) machined from ceramic and composite. MATERIALS AND METHODS: Ninety slot-inlay FPDs were machined in groups of 15 specimens each using the same design on a Cerec 3 unit. Materials were assigned to groups:(1) Mk II feldspathic ceramic,(2) ProCAD glass-ceramic,(3) glass-ceramic 1,(4) glass-ceramic 2,(5) composite 1, and (6) composite 2. The slot-inlay FPDs were placed on models with two abutment teeth without cementation and loaded to fracture. For control, test bars (n = 15) were machined from each of the materials, and flexural strength was examined using three-point bending. Data were statistically analyzed using ANOVA and Scheffé tests. RESULTS: Fracture load of groups 4 (1,557 N, SD 236), 5 (1,048 N, SD 77), and 6 (1,512 N, SD 106) was significantly higher than that of groups 1 (652 N, SD 53) and 2 (773 N, SD 65). Flexural strength of group 4 (256 MPa, SD 20) was significantly higher than that of groups 1 (103 MPa, SD 6), 2 (127 MPa, SD 15), 3 (162 MPa, SD 32), 5 (178 MPa, SD 18), and 6 (170 MPa, SD 20). CONCLUSION: Fracture loads of glass-ceramic 2 and composite 2 appear adequate for CAD/CAM slot-inlay FPDs.
Division of Aesthetic and Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Switzerland. firstname.lastname@example.org
The effect of hardware and software on the quality of Cerec all-ceramic partial crowns was investigated in this cross-sectional study. Partial crowns (n = 818) had been adhesively placed in 496 patients between 1993 and 1997 using Cerec 1 and Cerec 2 units (groups 1 and 2) as well as Cerec 2 with wall-spacing software (group 3). From each group, 25 randomly selected partial crowns were evaluated using modified United States Public Health Service (USPHS) criteria. Of these, 12 were randomly selected in each group, replicas taken and examined in a scanning electron microscope for marginal interfacial width and for continuous margin adaptation. Interfacial width of group 1 (308 +/- 95 micro m) was significantly larger than those of groups 2 (243 +/- 48 micro m) and 3 (207 +/- 63 micro m). Continuous margin adaptation at the tooth-luting composite and luting composite-restoration interfaces showed only minor differences in groups 1 (94.5 +/- 8% and 95.5 +/- 2%), 2 (98.1 +/- 1% and 97.5 +/- 1.4%) and 3 (96.8 +/- 3% and 96.8 +/- 2%). Pooled clinical rating was excellent or good at 97% for all groups, indicating acceptable restoration quality except for one breakage in group 1.
Clinic of the Division of Aesthetics and Computer Restorations, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Switzerland. email@example.com
PURPOSE: This study evaluated the clinical performance of posterior CAD/CAM-generated In-Ceram Alumina and In-Ceram Spinell core crowns. MATERIALS AND METHODS: Nineteen In-Ceram Spinell core crowns (four premolars and 15 molars) and 24 In-Ceram Alumina core crowns (two premolars and 22 molars) in 21 patients were examined using modified USPHS criteria at baseline and after a mean service time of 39 +/- 11 months. The crown copings were machined from Vitablocs In-Ceram Alumina and Vitablocs In-Ceram Spinell using the Cerec 2 CAD/CAM system. RESULTS: Two molar In-Ceram Alumina core crowns fractured after respective service times of 14 and 17 months in the same patient. The Kaplan-Meier survival rate regarding fracture of the ceramic was 92% for In-Ceram Alumina and 100% for In-Ceram Spinell. At the follow-up examination, 80% alpha ratings and 18% beta ratings for In-Ceram Alumina core crowns and 84% alpha ratings and 15% beta ratings for In-Ceram Spinell core crowns were recorded. CONCLUSION: Despite the two fractures, the clinical quality of CAD/CAM-generated In-Ceram Alumina and In-Ceram Spinell posterior crowns was excellent. Within the limitations of this study, both types of crowns appeared to be feasible.
Center of Dental and Oral Medicine, Clinic for Preventive Dentistry, Periodontics, and Cariology, Section for Tooth-Colored and Computer Restorations, University of Zurich, Plattenstrasse 11, CH-8028 Zurich, Switzerland. firstname.lastname@example.org
An update is given on the research and development of chair-side all-ceramic CAD/CAM restorations. The Cerec CAD/CAM technology now has close to 8000 users worldwide. Recent improvements provide a sufficiently user-friendly handling of all components to accommodate the user with ordinary technical skills. CAD/CAM technology using non-metallic esthetic materials is increasingly gaining importance in restorative dentistry.
Int J Comput Dent. 2012 ;15 (1):3-5 22930943
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Int J Prosthodont. ;25 (5):480-3 22930770
The aim of this retrospective study was to evaluate the clinical performance of cobalt-chromium (Co-Cr) single crowns. Ninety restorations were placed in 55 patients, and follow-up examinations were performed annually for 5 years. Six patients (8 crowns) were regarded as dropouts. During the follow-up period, 15 (17%) crowns/abutment teeth experienced some type of complication; 8 (9%) of these were regarded as failures. The cumulative survival rate was estimated at 90.3% over 5 years, though only 3 (3%) crowns had complications that could be related to the crown material. The results suggest that Co-Cr single crowns are a promising alternative to other alloys used in fixed prosthodontics.
Department of Prosthodontics, Christian-Albrechts University, Kiel, Germany. email@example.com
PURPOSE To evaluate the long-term outcome of all-ceramic resin-bonded fixed dental prostheses (RBFDPs) made with a two-retainer design or a cantilever single-retainer design. MATERIALS AND METHODS Overall, 38 anterior RBFDPs were made from a glass-infiltrated alumina ceramic (In-Ceram). Sixteen RBFDPs had a two-retainer design, while 22 RBFDPs had a cantilever single-retainer design. Phosphate monomer containing luting agents were used either after silica coating and silanation or after air-abrasion only. The mean observation time in the two-retainer group was 120.2 months and in the single-retainer group 111.1 months. RESULTS No restoration debonded. In the two-retainer group unilateral and bilateral fractures of the connectors occurred. In the case of unilateral fracture, the pontic remained in situ as a cantilever RBFDP for several years. In the single-retainer group, only one FDP fractured and was lost 48 months after insertion. The 10-year survival rate was 73.9% in the two-retainer group and 94.4% in the single-retainer group. When unilateral fracture of a FDP was taken as a criterion for failure, the 10-year survival rate decreased to 67.3% in the two-retainer group. CONCLUSION Cantilever all-ceramic RBFDPs are an adequate alternative to two-retainer RBFDPs.
Department of Prosthodontics, Martin-Luther-University Halle-Wittenberg, Center for Dentistry and Oral Medicine, Halle, Germany. firstname.lastname@example.org
There is lack of knowledge about the clinical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) titanium-ceramic-fixed partial dentures (FPDs). The purpose of this study was to evaluate CAD/CAM titanium-ceramic FPDs after 3 years in function. Thirty-one FPDs were fabricated for 23 patients. The Ti frameworks were completely fabricated using CAD/CAM technology, and the low-fusing porcelain was veneered. After confirming there were no mechanical or biological complications, the FPDs were cemented using zinc phosphate cement. The patients were recalled at 12, 24, and 36 months after cementation to examine for the presence of any mechanical complications, such as fractures of the veneering porcelain or the supportive framework, or biological complications, including caries, gingivitis, or periodontitis. The periodontal condition was measured using probing depth (PD), bleeding on probing (BOP), and plaque index (PI). Success and survival rates were estimated using the Kaplan-Meier analysis. There were four cohesive and three adhesive porcelain fractures, but no framework fractured. The Kaplan-Meier cumulative success rate of the CAD/CAM titanium-ceramic crown with regard to mechanical complications was 76.4%, and the cumulative survival rate was 96.8% after 3 years of use. One patient developed caries, but the condition was not associated with marginal discrepancy. No other biological complications were reported. The periodontal parameters demonstrated a tendency that slightly increased up to 24 months and was maintained by 36 months. At the end of the follow-up, PD was 2.86 mm, percentile of surface with BOP was 23.5, and PI was 0.45. The CAD/CAM titanium-ceramic FPDs survived in the mouths of patients without major complications for 3 years, although the risk of porcelain fracture appeared to be relatively high.
Am J Dent. 2010 Jun ;23 (3):161-7 20718214
Controlled, prospective clinical split-mouth study of cast gold vs. ceramic partial crowns: 5.5 year results.
Department of Operative Dentistry and Periodontology, Dental School, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. email@example.com
Cerec3D endocrowns--two-year clinical examination of CAD/CAM crowns for restoring endodontically treated molars.
Department of Dental Prosthetics, University Clinic for Dental Oral and Craniomandibular Sciences, Clinic of the Albert Ludwigs University Freiburg, Germany. firstname.lastname@example.org
The present clinical study evaluates the clinical prognosis of Cerec3D endocrowns over an observation period of two years. Twenty Cerec endocrowns (VITABLOCS Mark II, Vita Zahnfabirk, Bad Säckingen, Germany) were placed with PanaviaTM F 2.0, a dual-curing bonding composite. The control examinations took place semi-annually and the restorations were evaluated based on modified US Public Health Service criteria (USPHS). The two-year survival rate of the Cerec endocrowns was 90%. Two out of 20 endocrowns were assessed as failure because of fractures. The first fracture was observed after 12 months and the second fracture after 18 months. No recurrent caries was diagnosed during the entire examination period. Slight percussion symptoms were found on three restorations in the first weeks after placement. The results of the present study show that good esthetic and functional results similar to those of other restoration types can be achieved with endocrowns and that CAD/CAM-fabricated crowns represent a very promising treatment alternative for endodontically treated molars.
Int J Prosthodont. ;23 (3):214-6 20552085
A preliminary study on the short-term efficacy of chairside computer-aided design/computer-assisted manufacturing- generated posterior lithium disilicate crowns.
The purpose of this preliminary study was to evaluate the clinical performance of chairside-generated crowns over a preliminary time period of 24 months. Forty-one posterior crowns made of a machinable lithium disilicate ceramic for full-contour crowns were inserted in 34 patients using a chairside computer-aided design/computer-assisted manufacturing technique. The crowns were evaluated at baseline and after 6, 12, and 24 months according to modified United States Public Health Service criteria. After 2 years, all reexamined crowns (n = 39) were in situ; one abutment exhibited secondary caries and two abutments received root canal treatment. Within the limited observation period, the crowns revealed clinically satisfying results. Int J Prosthodont 2010;23:214-216.
Department of Fixed Prosthodontics, Tsurumi University, School of Dental Medicine, Yokohama, Japan.
PURPOSE: This study prospectively evaluated the clinical performance of posterior zirconium-oxide-based all-ceramic fixed partial dentures (FPDs). METHODS: Forty-two abutments of 21 Cercon FPDs were fitted in 20 patients at the Tsurumi University Dental Hospital from August 2005 to August 2006. The performance of these FPDs was evaluated using the California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. RESULTS: All FPDs were examined after a mean observation period of 28.1 (+/-3.4) months. During the observation period, no fracturing of FPDs was seen. All of the FPDs examined were rated as satisfactory with regard to all factors at the follow-up examinations based on the CDA quality assessment criteria. CONCLUSION: Within the limitations of this short-term clinical study, no core framework fractures were seen. According to the CDA criteria, 100% of the FPDs were rated as satisfactory during this observation period.
All-ceramic partial coverage restorations--midterm results of a 5-year prospective clinical splitmouth study.
Department of Prosthodontics, Albert-Ludwigs-University, Freiburg, Germany. email@example.com
OBJECTIVES Midterm-evaluation of a 5-year prospective clinical splitmouth-investigation on survival rate and long-term behavior of all-ceramic partial coverage restorations (PCRs) on molars. Pressed ceramic and CAD/CAM fabricated PCRs were compared. METHODS 80 vital molars of 25 patients were restored with all-ceramic PCRs (40 IPS e.max Press*[IP] and 40 ProCAD*[PC]). IP-PCRs were heat pressed following the lost-wax method. PC-PCRs were fabricated with Cerec 3** and Cerec InLab** CAD/CAM system (**Sirona Dental Systems, Bensheim, Germany). All PCRs were adhesively luted with a light-polymerizing composite (Syntac*/Tetric*)(*Ivoclar Vivadent, Schaan, Liechtenstein). Clinical reevaluations were performed at baseline and 13, 25, and 36 months after insertion of the PCRs according to the modified United States Public Health Services (USPHS) criteria. Absolute failures were demonstrated by Kaplan-Meier survival rate. RESULTS After an observation time up to 3 years, survival rate of IP-PCRs was 100% and 97% for PC-PCRs due to one severe fracture. The PC-PCR had to be replaced after 9 months. Secondary caries and endodontic complications did not occur. Increased clinical service time resulted in significant decrease of marginal adaptation (p=0.031) and enhanced marginal discoloration (p<0.0001). Both PCR ceramic materials demonstrated significant deteriorations in color match (p<0.0001) and surface roughness (p<0.0001), IP-PCRs were significantly more affected (p< or =0.005). Regarding anatomic form IP-PCRs performed significantly better (p=0.0012). CONCLUSION Pressed ceramic and CAD/CAM fabricated partial coverage restorations exhibited a reliable treatment option to restore larger defects in posterior teeth. Marginal degradation of the resin cement and deterioration of the all-ceramic materials during clinical function determine the clinical long-term performance of partial coverage restorations.
Department of Prosthodontics, University Medical Center Freiburg, Germany. firstname.lastname@example.org
The aim of this randomized controlled clinical trial was to evaluate over a 5-year period, the clinical outcome of shrinkage-free ZrSiO(4)-ceramic (KaVo Everest HPC) full coverage crowns on posterior teeth in comparison with conventional gold crowns that served as the control. This study reports results of a 5-year study protocol up to 24 months. Patients totalling 224 were randomly divided into two treatment groups. Of these, 123 patients were restored with 123 Everest HPC crowns, fabricated by the Kavo Everest computer-aided manufacturing (CAM) procedure and 101 patients received 101 gold crowns, but two were excluded from analysis. All crowns were conventionally cemented with glass-ionomer cement. After an observation period of 6, 12 and 24 months, the prospective survival rates (Kaplan-Meier) for the KaVo Everest HPC crowns were 97.9%, 95.1% and 89.8% and for the gold crowns 100%, 94.8% and 92.7%, respectively. There were no significant differences between the two groups (P = 0.2). The 1-year failure rates were 4.9% for the KaVo Everest HPC crowns and 5.2% for the gold crowns. The 1-year cumulative risks for loss of vitality, secondary caries, fractures, loss of crown and extraction of abutment of the analyzed abutments (88) were 8.9%, 0%, 0%, 1.1% and 1.1%, respectively, for the gold crowns and 2.8%, 0%, 4.7%, 0% and 0.9%, respectively, for the ceramic crowns (107 analyzed abutments). No perfect marginal fit was shown by 49.5% of the evaluated ceramic crowns and 26.1% of the gold crowns. Only 1.9% of the KaVo Everest HPC crowns had a marginal crevice. In conclusion, Everest HPC crowns with an adequate occlusal tooth reduction of >1.5 mm are suitable for posterior restorations, but the marginal fit shows a potential for improvement.
J Dent Child (Chic). ;75 (1):44-7 18505647
University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas, USA.
PURPOSE The purpose of this study was to determine if crimping the lingual aspect of commercially available, preveneered, anterior stainless steel primary crowns affects the fracture resistance of the veneer facings. METHODS Twenty-six anterior NuSmile crowns (size A1) were divided into 2 groups: group 1 served as the control, and group 2 was manually crimped evenly on the lingual cervical portion. All crowns were cemented onto a screw-mounted resin core duplicated from a manually prepared Kilgore tooth and tested under compression. Recorded were fracture resistance, percent of veneer facing loss, and fracture to the gingival margin. Differences between the control and experimental groups were analyzed by independent t test and chi-square (alpha=0.05). RESULTS The mean shear force required to fracture the veneers of the noncrimped crowns was 510.11 N (+/-79.66 SD), and 511.02 N (+/-62.37) for the crimped crowns. The mean percentage of veneer facing removed in the noncrimped crowns was 33%(+/-12.18), and 43%(+/-14.30) in the crimped crowns. No significant difference in shear strengths (P=.970) and in percentage of veneer loss (P=.063) was shown between crimped and noncrimped crowns. A mean of 8% of the noncrimped crowns and 23% of the crimped crowns had veneers fracturing to the gingival margin. The chi-square test showed no significant difference (P=.297). CONCLUSIONS The veneer resistance to fracture for the crimped crowns was comparable to noncrimped crowns. The crimped crowns, however, were associated with greater veneer surface area loss.