[Tension analysis of filled teeth by the finite element method].
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The treatment of this patient involved the coordination of periodontal, orthodontic, restorative, and aesthetic considerations. It was unique because it involved only resin as the primary restorative material, which allowed for conservative preparations and restorations. In the posterior, the use of direct and indirect resins resulted in the removal of little or no healthy tooth structure. In the anterior, the use of direct resin veneers required minimal removal of enamel, while still achieving proper function and aesthetics. Resin restorations in this particular case allowed for an acceptable clinical result and a highly satisfied patient.
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The aim of the present in vitro study was to compare the marginal adaptation and integrity of heat-pressed glass-ceramic veneers to adjacent class 3 composite restorations and to enamel using four dual-curing composite resin cements of different viscosity with their corresponding dentin bonding agents. Thirty-six caries-free human maxillary incisors were first restored with mesial and distal class 3 composite restorations and then prepared for facial ceramic veneers. The cavity margins of the veneers were located either in the class 3 composite restorations or in the residual enamel. Heat-pressed glass-ceramic veneers (IPS Empress) were inserted adhesively using one of the following four luting systems in nine teeth: SonoCem (SC) with EBS; Variolink Ultra (VU), Variolink High-Viscosity (VHV), and Variolink Low-Viscosity (VLV) with Syntac. The veneer margins in the region of the composite restoration and in the region apical to the composite restoration (ceramic/composite resin cement interfaces, composite resin cement/composite restoration interface, and composite resin cement/enamel interface) were evaluated before and after thermo-cycling and mechanical loading (TCML) by quantitative margin analysis under a scanning electron microscope (SEM) using an image analysis system. Furthermore, microleakage was assessed in each tooth by dye penetration after TCML. For all luting systems, SEM analysis revealed excellent marginal adaptation of the ceramic veneers to the composite restorations as well as to enamel. The median percentages of marginal gap formation were 1.1% and less before TCML and 5.1% and less after TCML. The error-rates method revealed no statistical influence of the interface or of the viscosity of the luting material. Maximal values of dye penetration showed a significantly higher microleakage at veneers cemented with VU (median: 86.4%) compared to SC (median: 13.3%). In conclusion, the present data demonstrated that existing clinically acceptable class 3 composite restorations have no negative influence on the marginal adaptation of ceramic veneers. This was valid independent of the viscosity of the dual-curing composite resin cement when SC, VHV, or VLV was used.
The aims of this study were to measure cuspal deflection of premolars restored with bonded amalgam and to investigate bond resistance to thermo-cycling and cyclic loading. Strain gauges were used to measure cuspal deflection of maxillary premolars restored with MOD bonded amalgam restorations. A nondestructive method was used in which teeth were loaded repeatedly to record cuspal deflection following different restorative procedures. Ten extracted premolars with similar dimensions were selected and their roots mounted in resin bases 2 mm below the CEJ. Two single-element strain gauges were bonded to the buccal and lingual surfaces of the cusps of each tooth at a level that corresponded to the pulpal floor of MOD cavities. These were connected to a strain indicator with a built-in wheat-stone bridge. An Instron machine was used to apply a 100 N compressive load. Micro-strain readings were recorded with each loading at the following stages: (1) sound unprepared teeth (baseline reading), (2) following preparation of a medium-size MOD cavity, (3) 24 hours following restoration with amalgam, (4) following amalgam removal, (5) 24 hours following restoration with bonded amalgam. Durability of the bond was further tested by cyclic loading of 2000, 4000, 6000, and 8000 load cycles. Mean micro-strain values recorded at the buccal cusp were: 48.0 (21.6), 126.8(57.2), 121.4(53.3), 120.8(56.1), and 65.2(36.5) for test stages 1, 2, 3, 4, and 5 respectively. Cuspal deflections following cyclic loading recorded at the buccal cusp were: 60.0(41.0), 63.6(51.9), 59.6(36.3), and 61.6(36.8) at the above four cyclic loading stages respectively. A similar trend was also observed for measurements of the lingual cusp. It was concluded that bonding amalgam restorations decreases cuspal deflection and consequently may assist in restoring tooth strength under conditions of the oral environment.
UNLABELLED: This in vitro study compared the ability of horizontal pins and a dental adhesive to reinforce the facial cusps of endodontically treated mandibular molars. Seventy-two mandibular molars were divided into six groups and mounted in acrylic blocks (n = 12). In Groups 1-5 standardized endodontic access and instrumentation in the coronal one-third of each root canal were completed. In Groups 1-4 the lingual cusps were reduced, leaving the buccal cusps intact. The facial cusps of the teeth in each group received one of the following modes of reinforcement: Group 1--no reinforcement; Group 2--dentin adhesive (Amalgambond Plus); Group 3--two horizontal TMS Minim pins; Group 4--two horizontal TMS Minim pins and Amalgambond Plus. Teeth in Group 5 were prepared for and restored with a complete cuspal coverage amalgam restoration using four vertical TMS Minim pins. Group 6 consisted of intact natural teeth. Using an Instron Universal Testing Machine, the lingual slope of the facial cusp of each specimen was loaded to failure using a compressive force applied at an angle 60 degrees to the long axis of the tooth. The mean fracture strengths for all groups were analyzed using a one-way ANOVA and Student-Newman-Keuls multiple range test (alpha = 0.05). Fracture patterns and modes of failure were also evaluated. RESULTS: The intact teeth (Group 6) were significantly more fracture resistant than all other groups, with the exception of Group 4 (combination of pins and adhesive). Group 1 (non-reinforced teeth) was significantly weaker than all other groups. Groups 2-4 (specimens with reinforced cusps) were not significantly different from each other. The use of horizontal pins or a combination of horizontal pins plus dentin adhesive for cuspal reinforcement resulted in significantly more teeth demonstrating favorable fracture patterns than did the use of adhesives alone. CONCLUSION: The buccal cusps of endodontically treated mandibular molars reinforced with a combination of horizontal pins and dentin adhesive were not significantly weaker than intact teeth. Of the restored teeth, those which had buccal cusps reinforced with horizontal pins and those treated with complete cuspal coverage amalgam restorations exhibited the most favorable restorative prognosis following cusp fracture.
The tensile strength of the bond formed between etched bovine enamel and selected resin systems was evaluated; also, the need for a resin pulpal barrier was examined. Results indicate that the BIS-GMA unfilled primer is unnecessary for strength or as a pulpal protectant. The large scatter of results substantiates the clinical hypothesis that the effectiveness of the acid etch is highly variable.
Overall, any of these systems can provide well-fitting, natural looking restorations as long as care is taken during the preparation and fabrication procedures. A key to successful use of all-ceramic materials is proper selection based on the clinical conditions involved in specific restorative procedures (see table). All systems have limitations on their use and when we try to stretch those limits, success rates may fall drastically. High stress areas should shift selection to high strength, clinically documented materials. Low stress areas requiring high translucency may be restored successfully using the lower strength castable glasses. Intermediate areas may shift selection to higher strength yet still translucent materials such as In-Ceram Spinell or Empress 2. Posterior regions might best be addressed with the use of In-Ceram Alumina or Procera. The case of posterior bridges would lock the selection into In-Ceram Zirconia. Finally, it is important for each of us to continually educate ourselves and to examine the evidence in order to make an informed decision and maximize clinical success.
Periodontal plastic surgical procedures provide a wide range of techniques to improve the esthetics of the mucogingival complex. Often these procedures are prerequisites for successful restorative therapy. This article presents a simple means of enhancing a patient's smile that can be provided by simple internal gingivectomies. The technique can be provided as a stand-alone procedure or in conjunction with restorative care. The surgery is simple and predictable with virtually no postsurgical sequellae.
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PURPOSE: This study was conducted to optimize the interdental design (wraparound) of porcelain laminates bonded to teeth in the presence of preexisting composite fillings. MATERIALS AND METHODS: A finite element model (2-dimensional mesh generated from a horizontal cross section of a maxillary incisor) was used to evaluate the effects of luting composite shrinkage and thermal changes on the stress distribution within the ceramic. The mesh included 3 restorative designs (3 degrees of interdental wrapping) and a Class III composite filling. Curing contraction of the luting composite was simulated at baseline temperature (37 degrees C). Thermal loads from 37 to 60 degrees C and from 37 to 5 degrees C were assessed with and without preexisting composite shrinkage. Surface tangential stresses were calculated at the ceramic surface and interface. RESULTS: Curing contraction alone generated mostly compressive stresses (peaks at 15 MPa) at both the ceramic surface and interface. Stresses remained compressive (peaks at 20 MPa) when thermal changes were added, except for the conservative veneer with minimum wraparound, the margins of which showed potentially harmful tensile stress peaks (approximately 7 MPa). Deformation of the tooth-restoration complex tended to be more uniform for veneers with maximum wraparound. In the presence of thermal loads alone, opposite effects were observed on the restoration surface and the interface, with compressive stresses on one side (up to 13 MPa) and tensile stresses on the other (up to 9 MPa). This effect of proximal bending (explained by the nearby expansion/contraction of the composite filling) was attenuated by the significant reduction of the bulk of the preexisting interdental composite by the overlapping veneer. CONCLUSION: In the finite element environment, the negative effect of the nearby expanding/contracting composite fillings can be minimized by extending the veneer over the preexisting interdental restoration. Because of the precompressed state resulting from composite shrinkage, ceramics showed lower temperature-induced tensile stresses.
The purpose of this study was to determine the effect of restoration size on the fracture strength of amalgam restorations bonded with Amalgambond Plus (with HPA). Research has shown that this adhesive is dispersed throughout the unset amalgam during condensation and that a decrease in diametral tensile strength, proportional to the amount of adhesive incorporated into the unset amalgam, has resulted. Smaller cavity preparations have a higher ratio of surface area to volume than do larger preparations, and it was anticipated that a proportionately greater amount of adhesive would be incorporated into smaller amalgam restorations. Sixty extracted human molars were divided into four groups of 15 teeth and mounted in tray acrylic-filled PVC cylinders. Shallow approximo-occlusal channels were prepared in two groups. One group was restored with Amalgambond Plus and Tytin amalgam, the other with just Tytin amalgam. Larger proximo-occlusal preparations were made in the remaining two groups, then restored in the same fashion. Samples were stored in 37 degrees C for at least 24 hours, then thermocycled from 5-55 degrees C 1000 times with a one-minute dwell time. Specimens were mounted in a Universal Testing Machine, and a chisel was applied to the restorations in compression mode at a crosshead speed of 5.0 mm/minute until bulk fracture of the amalgam occurred. The results indicated no difference in bulk fracture strengths between large amalgam restorations restored with and without Amalgambond Plus. However, small amalgam restorations restored with Amalgambond Plus exhibited significantly greater (p < 0.025) bulk fracture strengths than small amalgam restorations restored without use of the adhesive.
Edge strength is defined in this study as the resistance to fracture of the beveled extension normally located at the cavosurface margin of a dental restoration. The edge strength of direct-filling alloy restorations plays an important role in maintaining the integrity of margins at tooth-alloy interfaces during functional loading. The purpose of this study was to determine the relative strength of an experimental consolidated silver material in comparison to other direct filling materials. The method used was designed as a simulation for relative edge-strength clinical properties. Stainless steel dies were formed from disks 5 mm thick, each with a centered hole tapered (1/48) toward the bottom side of the disk. A 41 degrees bevel, 0.5 mm wide as viewed from above, was placed on the top-side of the disk. Dispersalloy (D) or Unison (U) amalgam, Z-100 composite (C), hand-consolidated silver powder (HAg), or pneumatically consolidated silver powder (PAg) was used to fill the die opening. Excess was polished from both sides of the disk with 600-grit abrasive paper. The sample was loaded from the beveled side with a 3 mm-in-diameter flat-ended plunger at a rate of 1.0 mm/minute until failure. Failure load and total energy to failure were recorded and compared. Tukey's multiple comparison test (p < 0.05) ranked the materials (U) > (HAg) > (D) > (PAg) > (C) for fracture strength and (HAg) > (D) > (U) > (PAg) > (C) for fracture energy.
This study investigates the effects of food-simulating liquids on composite and polyacid-modified composite restoratives. Three composite (Z100, Spectrum TPH, and Tetric Ceram) and three polyacid-modified composite (F2000, Dyract AP, and Compoglass) restoratives from the same manufacturers were selected for the study. Flexural strength specimens (25 x 2 x 2 mm) based on ISO 4049 specifications were fabricated according to the manufacturers recommendations. After light polymerization, the specimens were removed from their molds and conditioned for one week at 37 degrees C in the following mediums: (1) deionized water, (2) 0.02 M citric acid, (3) heptane, and (4) 50% ethanol-water solution. Specimens stored in air were used as controls. The sample size was five for each material-medium combination. After conditioning, the specimens were blotted dry, measured, and subjected to flexural strength testing using an Instron Universal Testing Machine with a crosshead speed of 0.05 mm/minute. With the exception of Compoglass, flexural strength of all restoratives after conditioning in heptane was significantly greater than that after conditioning in all other mediums and the control. Although no significant difference in flexural strength values was observed between the different restoratives when the materials were conditioned in heptane or air (control), significant differences were observed between the different restoratives after conditioning in aqueous solutions (water, citric acid, and ethanol-water solution). The flexural strengths of the composites were generally significantly higher than their polyacid-modified counterparts after conditioning in the various aqueous solutions. The detrimental effects of aqueous solutions on flexural strength appeared to be greater with polyacid-modified composite resins than with composite restoratives.
This study evaluated the effect of an intracoronal resin composite pin on Class IV resin composite restorations. A control group of 16 bovine teeth was prepared with standardized conventional Class IV preparations. For an experimental group, 16 similar Class IV preparations were made, with the addition of an intracoronal pin channel prepared with a #330 bur into the dentin. All specimens were restored with Herculite XRV and OptiBond according to the manufacturer's recommendations. After one week, specimens were placed in an Instron Universal Testing Machine and loaded at 90 degrees to the long axis until the restorations failed. Results indicated that the mean fracture load of the Class IV restoration group, with the resin composite pin, was 36% higher than the conventional Class IV group (p = 0.02). An intracoronal resin composite pin may aid the retention and resistance form of complex resin composite restorations.
Core build-ups should provide satisfactory strength and resistance to fracture both before and after crown preparation. This paper examines the resistance to fracture of core build-ups in different materials and the fracture resistance of core build-ups when these have been reduced for full crown preparation. Standardized core build-ups were made on groups of extracted molar teeth of similar size, with 10 teeth per group. Three resin-composite (prisma APH: Dentsply, Weybridge, UK; Ti-Core, Essential Dental Systems, NJ, US and Coradent, Vivadent, Liechtenstein), one cermet (Ketac-Silver, ESPE GmbH, Seefeld, Germany) and one amalgam material (Duralloy, Degussa Ltd, Cheshire, UK). These specimens were subjected to compressive force on a universal testing machine and the force at fracture noted. Standardized full crown preparations were made on a further five groups of core build-up specimens using the same materials as above. These prepared specimens were subjected to compressive force on a universal testing machine and the force to fracture noted. The results indicated that amalgam core build-ups demonstrated higher fracture resistance than the other materials examined. There was a general decrease in the fracture strength of the specimens following crown preparation, with the teeth restored with the amalgam core build-ups showing a greater percentage reduction in fracture strength than the other materials tested. Prepared core build-ups in a hybrid composite material provided the highest fracture resistance. The cermet material used provided the lowest resistance to fracture in both the core build-up and crown preparation specimens. In terms of fracture resistance, no advantage was apparent in using the two composite materials designated as being specifically appropriate for core build-ups.