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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↗

The effects of thermal mismatch and fabrication procedures on the deflection of layered all-ceramic discs.

OBJECTIVES: Residual thermal stress caused by thermal incompatibility of ceramic core and veneering porcelain in all-ceramic restorations might induce fracture or distortion of the restoration. The aim of this study was to evaluate the thermal compatibility between a ceramic core and veneering porcelain by measuring the bending of layered discs and to compare the result with the thermal mismatch values. METHODS: Thirty-five heat-pressed ceramic core discs were made and divided into seven groups (n=5). One group of discs was used as control and subjected only to firing cycles, while the other groups of discs were veneered with porcelains. The mismatch of thermal contraction coefficient values of the Empress 2 Core and veneer porcelains used ranged from -3.7 to 3.8 ppm/ degrees C. RESULTS: The Empress 2 Core disc without a veneer (control) was not significantly deflected by the fabrication procedures. The deflection of layered discs was strongly influenced by the degree of thermal mismatch during fabrication procedures. The greatest deflection occurred during the 2nd dentin firing and with the largest mismatch either positive or negative. SIGNIFICANCE: The deflection test proved to be a reliable test method for the evaluation of thermal compatibility of porcelains in all-ceramic systems.

Dental Porcelain↗

Strength and reliability of four-unit all-ceramic posterior bridges.

OBJECTIVES: The purpose of this study was to determine the in vitro load bearing capacity of four-unit posterior frameworks made of glass ceramic with lithium-disilicate crystals (E2), of zirconia-reinforced glass-infiltrated alumina (ICZ) and of zirconia stabilized with 3 mol% yttria (CEZ). METHODS: All frameworks mimicked a four-unit posterior situation with 7.3 mm2 interdental cross-sections and possessed exactly the same dimensions. The load bearing capacity was measured on a special bridge test setup with 15 specimens for each of the materials. The data were analyzed with Weibull statistics giving the characteristic load bearing capacity F0 at 63% failure probability and the Weibull modulus m as indicator for the reliability and reproducibility. RESULTS: For the E2 frameworks the average load bearing capacity and the SD was 260 (+/-53) N, the characteristic load F0 282 N and the reliability m = 5.7. For the ICZ frameworks the average load bearing capacity was 470 (+/-101) N, F0 518 N and m = 4.5. CEZ frameworks revealed the highest average load bearing capacity of 706 (+/-123) N, the highest characteristic load bearing capacity F0 = 755 N and the best reliability m = 7.0. SIGNIFICANCE: CEZ frameworks showed the best mechanical properties as demonstrated by the high values of average load bearing capacity, reliability and characteristic load bearing capacity with respect to the other ceramics studied. However, for four-unit posterior CEZ frameworks the connector size of 7.3 mm2 is insufficient to withstand occlusal forces reported in the literature. Four-unit posterior frameworks require a connector size larger than 7.3 mm2.

Aluminum Oxide↗

Fractographic analyses of three ceramic whole crown restoration failures.

OBJECTIVES: Develop fractographic techniques to perform failure analyses of three ceramic whole-crown clinical failures. METHODS: Three clinical whole-crown failures of different ceramic material systems were studied. The systems included appropriate veneers applied to core materials of cold isostatically pressed alumina, injection molded alumina/alumina-magnesia spinel, and hot pressed lithium disilicate. The surface topography was examined for classical fractographic features, utilizing both optical and scanning electron microscopes independently as well as group examination by four fractographers. RESULTS: All three restorations displayed many common fractographic features, the most important of which was wake hackle. Wake hackle occurs when an approaching crack front sweeps by a small bubble or discontinuity in a brittle material, leaving a trail. The resulting trails can be used to trace back crack progression to an initial starting area. Wake hackle was found to be common in the veneer portions of the crowns, and the strategy of creating a wake hackle map enabled crack paths to be traced from a core area outward in all three restorations. The fracture origin areas were located where hoop stresses are high. Another helpful fracture feature was compression curl, an indication of flexural stress, most visible under low incident optical lighting. SIGNIFICANCE: This study indicates that fractographic analyses can be productively performed on ceramic whole-crown failures. Optical examination under low incident lighting and wake hackle mapping were developed as promising techniques. Hoop stress was implicated as a concern in the three studied specimens, and should be considered when analyzing other whole-crown failures.

Aluminum Oxide↗

The influence of calcium fluoride (CaF2) on biaxial flexural strength of apatite-mullite glass-ceramic materials.

OBJECTIVE: The aim of this study was to evaluate the effect of varying the molar percentage of calcium fluoride (CaF2) on the biaxial flexural strength (BFS) of apatite-mullite glass-ceramics. METHODS: Three apatite-mullite glass-ceramic materials were produced based on a formula of 4.5SiO(2)-3Al2O(3)-1.5P2O(5)-3CaO-XCaF2, where X=0.5, 1 and 3 and called HG 1-3, respectively. These materials were used to produce discs of 2 mm thickness and 12 mm diameter using the lost-wax casting process. 30 discs per material were produced, 10 discs per material were cast and then left to bench cool (glass state), 10 discs per material were given a heat treatment at 765, 679 and 629 degrees C for 1h and then heat treated at 890, 860 and 824 degrees C for the HG 1-3, respectively, for another hour to form apatite. Ten discs per material were heat treated as previously described (765, 679 and 629 degrees C) then heat treated for 1h at 1022, 987 and 892 degrees C for the HG 1-3, respectively, to form apatite-mullite. The heat treatment temperatures were obtained from differential thermal analysis data. A lithium disilicate glass-ceramic was used as a control. Biaxial flexural strength (BFS) was determined using a LIoyd 2000R tester. RESULTS: Data showed that the BFS increased as the fluoride content increased, and the apatite-mullite samples had significantly higher BFS values than the as cast glass or apatite samples (p<0.05), with the control having significantly higher BFS values than all the HG glass-ceramic materials for every condition (p<0.05). The fictive glass transition temperature (Tg) was observed to drop with increasing fluoride content. SIGNIFICANCE: Increasing the CaF2 content increased the BFS and decreased the Tg of the glass-ceramic materials tested.

Aluminum Silicates↗

Strength and fracture pattern of monolithic CAD/CAM-generated posterior crowns.

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.

Aluminum Silicates↗

Influence of stress simulation parameters on the fracture strength of all-ceramic fixed-partial dentures.

OBJECTIVES: This in vitro study tested the influence of diverse stress simulation parameters on the fracture strength of all-ceramic three-unit fixed partial dentures (FPDs). METHODS: All-ceramic FPDs made of Empress 2 (Ivoclar-Vivadent, FL) were exposed to thermal cycling and mechanical loading (TCML) with varying loading parameters such as chewing force (amount, frequency), thermal loading, lateral jaw motion, abutment material, artificial periodontium or antagonistic denture. To investigate the influence of the abutment material, human teeth, polymer abutments and alloy abutments were used. Two different TCML devices with pneumatic or weight loading were compared. FPDs without aging were used as a control. RESULTS AND SIGNIFICANCE: Combined thermal and mechanical loading significantly reduced the FPD fracture resistance from 1832N to 410N. Duplication of chewing frequency, phase load increase or additional lateral movement did not effect the results. Increasing chewing force, artificial periodontium, and antagonist or abutment material reduced the fracture resistance of the tested FPDs. Different devices with weight or pneumatic loading had no significant influence on the loading capacity of the FPDs. Artificial aging should be performed combining thermal cycling with mechanical loading. Simulation of the artificial periodontium, human antagonists and abutments should be included to achieve a significant aging.

Bite Force↗

Two-year clinical evaluation of lithia-disilicate-based all-ceramic crowns and fixed partial dentures.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of crowns and fixed partial dentures (FPDs) made with the Empress 2 system over a 2-year period. METHODS: Twenty anterior or posterior all-ceramic (Empress 2) crowns and 20 anterior or posterior, three-unit fixed partial dentures were fabricated for 15 patients. Evaluations of the restorations were performed at baseline and once a year during the 2-year follow-up period. U.S. Public Health Service criteria were used to examine the marginal adaptation, color match, secondary caries and visible fractures in the restorations. Survival rate of the restorations were determined using Kaplan-Meier statistical analysis. RESULTS: U.S. Public Health Service criteria showed 100% Alpha scores concerning recurrent caries for both crowns and FPDs. No crown fractures were observed during the 2-year follow-up, however, 10 (50%) catastrophic failures of FPDs occurred. Five (25%) failures occurred within the 1-year clinical period and the others (25%) within the second year. SIGNIFICANCE: Single unit Empress 2 all-ceramic crowns exhibited a satisfactory clinical performance over 2-year period. Furthermore, the high fracture rate of Empress 2 FPDs limits the usage of Empress 2 for the fabrication of all-ceramic FPD.

Adult↗

Mechanical and fracture behavior of veneer-framework composites for all-ceramic dental bridges.

OBJECTIVES: High-strength ceramics are required in dental posterior restorations in order to withstand the excessive tensile stresses that occur during mastication. The aim of this study was to investigate the fracture behavior and the fast-fracture mechanical strength of three veneer-framework composites (Empress 2/IPS Eris, TZP/Cercon S and Inceram-Zirconia/Vita VM7) for all-ceramic dental bridges. METHODS: The load bearing capacity of the veneer-framework composites were evaluated using a bending mechanical apparatus. The stress distribution through the rectangular-shaped layered samples was assessed using simple beam calculations and used to estimate the fracture strength of the veneer layer. Optical microscopy of fractured specimens was employed to determine the origin of cracks and the fracture mode. RESULTS: Under fast fracture conditions, cracks were observed to initiate on, or close to, the veneer outer surface and propagate towards the inner framework material. Crack deflection occurred at the veneer-framework interface of composites containing a tough framework material (TZP/Cercon S and Inceram-Zirconia/Vita VM7), as opposed to the straight propagation observed in the case of weaker frameworks (Empress 2/IPS Eris). SIGNIFICANCE: The mechanical strength of dental composites containing a weak framework (K(IC)<3 MPam(1/2)) is ultimately determined by the low fracture strength of the veneer layer, since no crack arresting occurs at the veneer-framework interface. Therefore, high-toughness ceramics (K(IC)>5 MPam(1/2)) should be used as framework materials of posterior all-ceramic bridges, so that cracks propagating from the veneer layer do not lead to a premature failure of the prosthesis.

Aluminum Oxide↗

Cyclic fatigue in water of veneer-framework composites for all-ceramic dental bridges.

OBJECTIVES: Ceramic materials applied in dentistry may exhibit significant subcritical crack growth due to the severe cyclic loading in the aqueous environment encountered in the mouth during mastication. The authors report on the subcritical crack growth behavior of three dental restoration systems (Empress 2/IPS Eris, TZP/Cercon S and Inceram-Zirconia/Vita VM7) under cyclic loading in water, in order to establish guidelines for the use and design of long-lifetime all-ceramic posterior bridges. METHODS: Inert strength and lifetime tests under cyclic loading in an aqueous environment were performed in a mechanical bending apparatus and evaluated with Weibull statistics. RESULTS: Subcritical crack growth occurred predominantly in the outer veneer layer of the veneer-framework composites. The apatite-based veneer (IPS Eris) was more susceptible to subcritical crack propagation compared to the feldspathic glass veneers (Cercon S and Vita VM7). SIGNIFICANCE: Dental restoration systems containing apatite-based veneers and weak frameworks (Empress 2/IPS Eris) are not recommended for the fabrication of all-ceramic bridges in the molar region. Conversely, veneer-framework systems consisting of feldspathic glass veneers and tough zirconia-based frameworks (TZP/Cercon S and Inceram-Zirconia/Vita VM7) may exhibit lifetimes longer than 20 years if the bridge connector is properly designed.

Aluminum Oxide↗

Comparison of two bond strength testing methodologies for bilayered all-ceramics.

OBJECTIVES: This study compared the shear bond strength (SBS) and microtensile (MTBS) testing methodologies for core and veneering ceramics in four types of all-ceramic systems. METHODS: Four different ceramic veneer/core combinations, three of which were feldspathic and the other a fluor-apatite to their respectively corresponding cores, namely leucite-reinforced ceramic ((IPS)Empress, Ivoclar), low leucite-reinforced ceramic (Finesse, Ceramco), glass-infiltrated alumina (In-Ceram Alumina, Vita) and lithium disilicate ((IPS)Empress 2, Ivoclar) were used for SBS and MTBS tests. Ceramic cores (N=40, n=10/group for SBS test method, N=5 blocks/group for MTBS test method) were fabricated according to the manufacturers' instructions (for SBS: thickness, 3mm; diameter, 5mm and for MTBS: 10 mm x 10 mm x 2 mm) and ultrasonically cleaned. The veneering ceramics (thickness: 2mm) were vibrated and condensed in stainless steel moulds and fired onto the core ceramic materials. After trying the specimens in the mould for minor adjustments, they were again ultrasonically cleaned and embedded in PMMA. The specimens were stored in distilled water at 37 degrees C for 1 week and bond strength tests were performed in universal testing machines (cross-head speed: 1mm/min). The bond strengths (MPa+/-S.D.) and modes of failures were recorded. RESULTS: Significant difference between the two test methods and all-ceramic types were observed (P<0.05) (2-way ANOVA, Tukey's test and Bonferroni). The mean SBS values for veneering ceramic to lithium disilicate was significantly higher (41+/-8 MPa) than those to low leucite (28+/-4 MPa), glass-infiltrated (26+/-4 MPa) and leucite-reinforced (23+/-3 MPa) ceramics, while the mean MTBS for low leucite ceramic was significantly higher (15+/-2 MPa) than those of leucite (12+/-2 MPa), glass-infiltrated (9+/-1 MPa) and lithium disilicate ceramic (9+/-1 MPa) (ANOVA, P<0.05). SIGNIFICANCE: Both the testing methodology and the differences in chemical compositions of the core and veneering ceramics influenced the bond strength between the core and veneering ceramic in bilayered all-ceramic systems.

Aluminum Silicates↗

Material characteristics of a novel shrinkage-free ZrSiO(4) ceramic for the fabrication of posterior crowns.

OBJECTIVE: To confirm the clinical applicability of a novel ZrSiO(4) (zircon) based shrinkage-free ceramic material, the flexural strength, fracture toughness and chemical solubility were tested. In addition, the fracture load of full crowns made from this material was tested after cyclic thermomechanical loading. METHODS: Flexural strength of 12 specimens was measured using a biaxial bending test. Fracture toughness was measured using 10 slotted box shaped specimens. The specimens were fractured using a universal testing machine; fracture loads were recorded. A chemical solubility test was performed in accordance with ISO norm 6872. Additionally, 32 ZrSiO(4) all-ceramic crowns were fabricated on extracted caries-free human molars. Sixteen Empress 2 and 16 PFM crowns served as a reference control. After artificial aging of 1.2 million cycles in the chewing simulator, the survival rate of the crowns was determined. The fracture load of all surviving specimens was obtained by loading the crowns until fracture in a universal testing machine. RESULTS: A flexural strength of 328MPa was found. The fracture toughness of the ZrSiO(4) ceramic was 5.16MPam(0.5). The chemical solubility amounted to 7.2microg/cm(2). All specimens survived the chewing simulation (survival rate: 100%); no crowns had to be re-cemented. A mean fracture strength of 1790N was found for Everest HPC for Empress 2 crowns, 1715N for Empress 2 crowns and 2416N for PFM crowns. Fracture loads of PFM crowns were significantly higher than for Empress 2 crowns (P=0.032) as well as ZrSiO(4)-crowns (P=0.007). There was no significant difference between ZrSiO(4)-crowns and Empress 2 crowns (P=0.743). SIGNIFICANCE: At the present stage, Everest HPC can be recommended for the fabrication of single crowns as an alternative to conventional PFM and other all-ceramic crowns, because its fracture strength exceeds average masticatory forces in the posterior region.

Bite Force↗

Effect of milnacipran on extracellular monoamine concentrations in the medial prefrontal cortex of rats pre-treated with lithium.

Antidepressants are effective in most patients with depression, but sometimes have sub-optimal effects. Thus, there is a need to use more powerful antidepressants when dealing with treatment-resistant cases. Lithium carbonate is widely used for this purpose. We investigated the acute effects of milnacipran, a serotonin-noradrenaline reuptake inhibitor, on extracellular serotonin, dopamine and noradrenaline concentrations, in the rat medial prefrontal cortex. The effects of milnacipran were examined in rats following 7 days of treatment with lithium, and in untreated controls. The lithium group had significantly greater basal levels of extracellular serotonin than the control group. Milnacipran (3 mg/kg) combined with lithium treatment caused a greater increase in extracellular noradrenaline and dopamine levels than milnacipran alone. Milnacipran (3 and 30 mg/kg) combined with lithium treatment also caused a greater increase in extracellular serotonin levels than milnacipran alone. Thus, lithium might augment the antidepressant effects of serotonin-noradrenaline reuptake inhibitors by augmenting serotonin release.

Animals↗

Cytoprotection by lithium and valproate varies between cell types and cellular stresses.

Despite much evidence that lithium and valproate, two commonly used mood stabilizers, exhibit neuroprotective properties against an array of insults, the pharmacological relevance of such effects is not clear because most of these studies examined the acute effect of these drugs in supratherapeutic doses against insults which were of limited disease relevance to bipolar disorder. In the present study, we investigated whether lithium and valproate, at clinically relevant doses, protects human neuroblastoma (SH-SY5Y) and glioma (SVG and U87) cells against oxidative stress and endoplasmic reticulum stress in a time-dependent manner. Pretreatment of SH-SY5Y cells for 7 days, but not 1 day, with 1 mM of lithium or 0.6 mM of valproate significantly reduced rotenone and H2O2-induced cytotoxicity, cytochrome c release and caspase-3 activation, and increased Bcl-2 levels. Conversely, neither acute nor chronic treatment of SH-SY5Y cells with lithium or valproate elicited cytoprotective responses against thapsigargin-evoked cell death and caspase-3 activation. Moreover, inhibitors of glycogen synthase kinase-3 (GSK-3), kenpaullone and SB216763, abrogated rotenone-induced, but not H2O2-induced, cytotoxicity. Thus the cytoprotective effects of lithium and valproate against H2O2-induced cell death is likely independent of GSK-3 inhibition. On the other hand, chronic lithium or valproate treatment did not ameliorate cytotoxicity induced by rotenone, H2O2, and thapsigargin in SVG astroglial and U87 MG glioma cell lines. Our results suggest that lithium and valproate may decrease vulnerability of human neural, but not glial, cells to cellular injury evoked by oxidative stress possibly arising from putative mitochondrial disturbances implicated in bipolar disorder.

Antimanic Agents↗

Lithium augmentation in venlafaxine non-responders: an open study.

Thirteen major depressive patients not responding to a 4-week venlafaxine 300 mg treatment were eligible for a 4-week open trial of lithium addition. Two patients had to stop lithium for a possible moderate serotonin syndrome and five patients became responders, including one dramatic response and two semi-rapid responses.

Adult↗

Binding energies of water to lithiated valine: formation of solution-phase structure in vacuo.

Dissociation kinetics for loss of a water molecule from hydrated ions of lithiated valine, alanine ethyl ester and betaine are determined using blackbody infrared radiative dissociation at temperatures between -60 and 110 degrees C. From master equation modeling of these data, values of the threshold dissociation energy are obtained for clusters containing one through three water molecules. By comparing the values for valine with its two isomers, one a model for the nonzwitterion structure, the other a model for the zwitterion structure, information about the structure of valine in these hydrated clusters is inferred. Structures, relative energies, and water binding energies for these ions are also calculated at the B3LYP/6-31++G** level of theory. With one water molecule, both experiment and theory indicate that valine is not a zwitterion and that the lithium ion coordinates with the amino nitrogen and the carbonyl oxygen (NO coordinated) and the water molecule interacts directly with the lithium ion. With two water molecules, the zwitterion and nonzwitterion structures are nearly isoenergetic, but the experiment clearly indicates a NO-coordinated nonzwitterion structure. With three water molecules, both the experimental data and theory indicate that the lithium ion binds to the carboxylate group of valine, i.e., valine is zwitterionic with three water molecules. The agreement between the experimentally determined and calculated binding energies is good for all the clusters, with deviations of <== 0.12 eV.

Alanine↗