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Objectives: To investigate dimensional accuracy of polyether (PE) and vinylpolysiloxane (VPS) impressions taken with manually fabricated and 3D-printed trays., Materials and Methods: To evaluate impression accuracy, highly precise digital data of a metallic lower jaw model with prepared teeth (regions 34 and 36), an implant (region 47) and three precision balls placed occlusally along the dental arch served as reference. PE (Impregum, 3M Oral Care) and VPS (Aquasil, Dentsply Sirona) impressions (n = 10/group) were taken with trays fabricated using different materials and manufacturing techniques (FDM: filament deposition modeling, material: Arfona Tray, Arfona; printer: Pro2, Raise3D; DLP: digital light processing, material: V-Print Tray, VOCO, printer: Max, Asiga; MPR: manual processing with light-curing plates, material: LC Tray, Müller-Omicron) including an open implant impression. Scans of resulting stone models were compared with the reference situation. Global distance and angular deviations as well as local trueness and precision for abutment teeth and scan abutment were computed. Possible statistical effects were analyzed using ANOVA., Results: Clinically acceptable global accuracy was found (all mean absolute distance changes < 100 μm) and local accuracy for single abutments was excellent. All factors (abutment type, impression material, tray material) affected global accuracy (p < 0.05). In particular with PE impressions, MPR trays led to the best accuracies, both in horizontal and vertical direction., Conclusions: Within the limitations of this in vitro study, impression accuracy was high in use of both polyether and vinylpolysiloxane combined with different 3D-printed and customized trays making them recommendable for at least impressions for smaller fixed dental prostheses. Manually fabricated trays were overall still the best choice if utmost precision is required., Clinical Relevance: Based on the results of this study, use of innovative CAD-CAM fabrication of individual impression trays fulfills the perquisites to be a viable option for impression making. In the sense of translational research, performance should be proved in a clinical setting., (© 2024. The Author(s).)

Objectives: To compare the strength and reliability of 3D-printed 3Y-TZP zirconia manufactured with various printing orientations and staining., Materials and Methods: A total of one-hundred cylindrical zirconia specimens were designed and fabricated using 3D printing and processed according to ISO 6872 standards. Of these specimens, 80 were 3D printed using the new ZIPRO-D (ZD) 3D ceramic printer. In this ZD group, 60 specimens were printed in a vertical orientation and were either stained after debinding (ZD1, x-orientation, n = 20) or not stained (ZD2, x-orientation, n = 20; ZD3, y-orientation, n = 20) and the remaining 20 specimens out of n = 80 were printed in a horizontal orientation (ZD4). Further 20 specimens out of the entire sample N = 100 were printed vertically with the CeraFab7500 3D ceramic printer (LC). All completed specimens were loaded until fracture using a universal testing machine. Biaxial flexural strengths and Weibull parameters were computed for the ZD groups and for the LC group. Group and sub-group effects were evaluated using Welch ANOVA (alpha = 0.05)., Results: The mean (standard deviation, SD) biaxial flexural strengths of vertically oriented ZD samples with (ZD1) and without (ZD2/ZD3) staining were 811 (197) and 850 (152) MPa, respectively (p > 0.05). The ZD4 (horizontally printed), 1107 (144) MPa, and LC (1238 (327)) MPa samples had higher mean (SD) flexural strengths than the ZD1-3 specimens. No difference was observed between the ZD4 and LC group (p > 0.05). Weibull moduli were between m = 4.6 (ZD1) and 9.1 (ZD4) in the ZD group and m = 3.5 in the LC group., Conclusions: All tested 3D-printed zirconia specimens exceeded the flexural strengths required for class 5 restorations according to ISO 6872 standards. While the flexural strengths of zirconia printed using the novel ZD device in the vertical orientation are lower than those of zirconia printed using the LC printer, the ZD printer shows at least comparable reliability., Clinical Relevance: 3D-printing of zirconia is a new technology in dental application. Based on the presented strengths values, clinical application of 3D-printed zirconia for fixed dental protheses can be recommended., (© 2024. The Author(s).)

Objectives: The aim of this study was to compare failure load and initial damage in monolithic, partially veneered, and completely veneered (translucent) zirconia cantilevered fixed partial dentures (CFPDs), as well as completely veneered metal-ceramic CFPDs under different support and loading configurations., Materials and Methods: Eight test groups with anatomically congruent CFPDs (n = 8/group) were fabricated, differing in CFPD material/support structure/loading direction (load applied via steel ball (Ø 6 mm) 3 mm from the distal end of the pontic for axial loading with a 2-point contact on the inner cusp ridges of the buccal and oral cusps and 1.3 mm below the oral cusp tip for 30° oblique loading): (1) monolithic zirconia/CoCr abutment teeth/axial, (2) monolithic zirconia/CoCr abutment teeth/oblique, (3) partially veneered zirconia/CoCr abutment teeth/axial, (4) partially veneered zirconia/CoCr abutment teeth/oblique, (5) completely veneered zirconia/CoCr abutment teeth/axial, (6) completely veneered CoCr/CoCr abutment teeth/axial (control group), (7) partially veneered zirconia/implants/axial, and (8) partially veneered zirconia/natural teeth/axial. Restorations were artificially aged before failure testing. Statistical analysis was conducted using one-way ANOVA and Tukey post hoc tests., Results: Mean failure loads ranged from 392 N (group 8) to 1181 N (group 1). Axially loaded monolithic zirconia CFPDs (group 1) and controls (group 6) showed significantly higher failure loads. Oblique loading significantly reduced failure loads for monolithic zirconia CFPDs (group 2). Initial damage was observed in all groups except monolithic zirconia groups, and fractography revealed design flaws (sharp edges at the occlusal boundary of the veneering window) in partially veneered zirconia CFPDs., Conclusions: Monolithic zirconia CFPDs might be a viable alternative to completely veneered CoCr CFPDs in terms of fracture load. However, oblique loading of monolithic zirconia CFPDs should be avoided in clinical scenarios. Design improvements are required for partially veneered zirconia CFPDs to enhance their load-bearing capacity., Clinical Relevance: Monolithic zirconia may represent a viable all-ceramic alternative to the established metal-ceramic option for CFPD fabrication. However, in daily clinical practice, careful occlusal adjustment and regular monitoring should ensure that oblique loading of the cantilever is avoided., (© 2024. The Author(s).)

Objectives: To validate a new tooth mobility simulating in vitro model for biomechanical tests of dental appliances and restorations., Material and Methods: Load-deflection curves for teeth in CAD/CAM models (n = 10/group, 6 teeth/model) of the anterior segment of a lower jaw with either low tooth mobility (LM) or high tooth mobility (HM) were recorded with a universal testing device and a Periotest device. All teeth were tested before and after different ageing protocols. Finally, vertical load capacity (F max ) was tested in all teeth., Results: At F = 100 N load, vertical/horizontal tooth deflections before ageing were 80 ± 10 µm/400 ± 40 µm for LM models and 130 ± 20 µm/610 ± 100 µm for HM models. Periotest values were 1.6 ± 1.4 for LM models and 5.5 ± 1.5 for HM models. These values were within the range of physiological tooth mobility. No visible damage occurred during ageing and simulated ageing had no significant effect on tooth mobility. F max values were 494 ± 67 N (LM) and 388 ± 95 N (HM)., Conclusion: The model is practical, easy to manufacture and can reliably simulate tooth mobility. The model was also validated for long-term testing, so is suitable for investigating various dental appliances and restorations such as retainers, brackets, dental bridges or trauma splints., Clinical Relevance: Using this in-vitro model for high standardised investigations of various dental appliances and restorations can protect patients from unnecessary burdens in trials and practice., (© 2023. The Author(s).)

Objectives: To investigate whether artificial CAD/CAM processed (computer-aided design/manufacturing) teeth could be a feasible option for the production of dental in vitro models for biomechanical testing., Material and Methods: Disks (n = 10 per group) made from two different CAD/CAM-materials, one fiber-reinforced composite (FRC; Trinia, Bicon) and one polymethylmethacrylate-based resin (PMMA; Telio CAD, Ivoclar Vivadent), as well as bovine teeth (n = 10), were tested for their shear bond strength (SBS) and scored according to the adhesive remnant index (ARI). In addition, CAD/CAM-manufactured lower incisor teeth were tested for their ultimate load (F u )., Results: With regard to SBS, both PMMA (17.4 ± 2.2 MPa) and FRC (18.0 ± 2.4 MPa) disks showed no significant difference (p = 0.968) compared to bovine disks (18.0 ± 5.4 MPa). However, the samples differed with regard to their failure mode (PMMA: ARI 4, delamination failure; FRC: ARI 0 and bovine: ARI 1.6, both adhesive failure). With regard to F u , FRC-based teeth could withstand significantly higher loads (708 ± 126 N) than PMMA-based teeth (345 ± 109 N) (p < 0.01)., Conclusion: Unlike PMMA-based teeth, teeth made from FRC showed sufficiently high fracture resistance and comparable SBS. Thus, FRC teeth could be a promising alternative for the production of dental in vitro models for orthodontic testing., Clinical Relevance: CAD/CAM-processed teeth made from FRC enable the use of standardized geometry and constant material properties. Using FRC teeth in dental in vitro studies has therefore the potential to identify differences between various treatment options with rather small sample sizes, while remaining close to the clinical situation., (© 2022. The Author(s).)

Objectives: This in vitro study compared the dimensional accuracy of conventional impressions (CI) with that of digital impressions (DI) in a partially edentulous maxilla. DIs were made by two intraoral scanners, Omnicam (OC) and Primescan (PS)., Materials and Methods: CI and both intraoral scanners were used to take 30 impressions of two identical reference models. CIs were poured with type 4 gypsum and the saw-cut models were digitized. The reference models simulated a maxilla with six prepared teeth that accommodated a cross-arch fixed partial denture. Center points of five precision balls and center points at the margin level of each prepared tooth were used to detect changes in dimensions and tooth axis between the reference model and the scans., Results: For DI, the largest deviations (176 µm for OC and 122 µm for PS) occurred over the cross-arch. For CI, the largest deviation (118 µm) occurred over the anterior segment. For shorter distances up to a quadrant, DI was superior to CI. For longer scan distances, DI was comparable (2 sextant and anterior segment) or inferior (cross-arch) to CI. Vertical and tooth axis deviations were significantly smaller for CI than for DI (p < 0.001)., Conclusions: The impression method affected the impression accuracy of a partially edentulous maxilla with prepared teeth. DI is recommended for scans up to a quadrant. Larger scan volumes are not yet suitable for fabricating a fixed partial denture because of the high scatter of accuracy values., Clinical Relevance: In contrast to conventional impressions, digital impressions lead to comparable or better results concerning scans up to a quadrant. Consequently, for larger scan volumes, several smaller scans should be performed or, if restoration-related not possible, it is recommended to take conventional impressions., (© 2022. The Author(s).)

Objectives: To evaluate the dimensional accuracy of impressions taken by use of disposable stock plastic trays and to compare performance with that of metal trays., Materials and Methods: From a metallic model incorporating three precision balls and three abutment teeth, one-step dual-phase polyether (PE) and vinyl polysiloxane (VPS) impressions were taken using either metal or disposable plastic trays (n = 10 for each of the resulting four test groups). Respective plaster cast scans were aligned with the reference dataset to evaluate global (distance and angle deviations) and local (trueness and precision) accuracy. Analyses of variance (ANOVA) were conducted to determine group differences., Results: For all impression tray and material combinations, global accuracy was good (mean distance changes < 100 μm) with greatest deviations being observed for distances exceeding one quadrant of the dental arch. In general, distances measured in the plaster casts were too short. Only VPS impressions with plastic trays showed a different behavior with a large percentage of cross-arch distances exceeding the reference value. Mean local accuracy ranged between 6 and 14 μm (trueness), and 6 and 16 μm (precision). On abutment tooth level, metal trays were associated with a significantly better precision (p = 0.015)., Conclusions: The observed distortions of the studied impression trays and materials are small and should enable satisfying clinical impression-taking., Clinical Relevance: Cleaning and processing of metal trays before re-use are time-consuming. Especially for patients' management with single crowns and small fixed dental prostheses, disposable plastic trays can be a viable and cost-effective alternative.

Objectives: Conventional dental implants inserted in the molar region of the maxilla will reach into the sinus maxillaris when alveolar ridge height is limited. When surgery is performed without prior augmentation of the sinus floor, primary stability of the implant is important for successful osseointegration. This study aimed at identifying the impact of bone quality and quantity at the implantation site on primary implant stability of a simulated bicortical placement., Materials and Methods: In our in vitro measurements, bone mineral density, total bone thickness and overall cortical bone thickness were assessed by micro-computed tomography (μCT) of pig scapulae, which resembled well the bicortical situation found in human patients. Dental implants were inserted, and micromotion between bone and implant was measured while loading the implant with an axial torque., Results: The main findings were that primary implant stability did not depend on total bone thickness but tended to increase with either increasing bone mineral density or overall cortical bone thickness., Clinical Relevance: Limited bone height in the maxilla is a major problem when planning dental implants. To overcome this problem, several approaches, e.g. external or internal sinus floor elevation, have been established. When planning the insertion of a dental implant an important aspect is the primary stability which can be expected. With other factors, the dimensions of the cortical bone might be relevant in this context. It would, therefore, be helpful to define the minimum thickness of cortical bone required to achieve sufficient primary stability, thus avoiding additional surgical intervention.

Objectives: The aim of this in vitro study was to compare the tooth structure removal required for currently available ceramic crown materials., Material and Methods: Ninety typodont teeth (60 incisors, 30 molars) were assigned to nine study groups. The teeth were digitized, weighed with a high-precision balance, and fixed in carriers in identical alignment. Full-crown restorations were prepared according to material-specific guidelines for monolithic zirconia (MZ), polymer-infiltrated ceramics (PIC), buccally veneered zirconia (BVZ), feldspathic ceramics (FC), fully veneered zirconia (FVZ), and lithium disilicate (LD). Tooth structure removal was assessed by weighing the teeth before and after preparation. Coronal volume loss was analyzed statistically by use of one-way ANOVA and post-hoc Tukey HSD tests with α = 0.05., Results: Mean tooth structure removal for incisors was 42% (SD 2%) for MZ, 46% (SD 1%) for PIC, 50% (SD 2%) for BVZ, 57% (SD 1%) for FC, 57% (SD 2%) for FVZ, and 59% (SD 2%) for LD. Mean tooth structure removal for molars was 21% (SD 2%) for MZ, 31% (SD 1%) for PIC, and 35% (SD 1%) for LD. Inter-group differences were statistically significant, except for between FC and FVZ., Conclusions: Preparation of full ceramic crowns for restoration-free teeth is an invasive procedure. Selecting the ceramic material can, however, reduce loss of tooth structure substantially., Clinical Relevance: Monolithic zirconia is the least invasive material for the preparation of incisor and molar ceramic single crowns. Prescribing buccally veneered instead of fully veneered zirconia reduces preparation invasiveness significantly.

Objective: Optical coherence tomography (OCT) is a clinical standard in ophthalmology. Currently, its application in dentistry is gaining increasing interest. In this study, we tested the possibility to use a modified commercially available spectral domain OCT (SD-OCT) to assess the layer thickness of orthodontic surface sealants., Materials and Methods: Reference samples of surface sealants for calibration and repeatability testing were measured using a micrometer screw. SD-OCT measurements were compared with micro-CT and light microscopic analyses. After validating the calibration of the SD-OCT, surface sealant layer thickness after aging (thermo cycling) and simulation of professional tooth cleaning (PTC) was assessed using the SD-OCT on 45 extracted teeth assigned to three test groups (n = 15 each): Light Bond™ Sealant, Pro Seal®, and Opal® Seal., Results: SD-OCT showed excellent repeatability and accuracy for measurements of surface sealant layer thickness. Compared with micro-CT, SD-OCT showed better accordance with the reference measurements. The analysis of surface sealants after thermo cycling and PTC revealed poor resistance of Light Bond after only aging and demonstrated substantial wear of all sealants after aging and PTC., Conclusion: Imaging using commercially available ophthalmic SD-OCT might represent a suitable non-invasive methodology for longitudinal assessments of surface sealant layer thickness in vitro and in vivo., Clinical Relevance: SD-OCT might be a suitable non-invasive method for longitudinal assessments of surface sealant durability in clinical trials.

Objectives: In vitro investigation of the effects of fixed dental prosthesis (FDP) support and loading conditions on the fracture behavior of all-ceramic, zirconia-based FDP veneered with computer-aided design/computer-aided manufacturing (CAD/CAM)-manufactured lithium disilicate ceramic., Materials and Methods: Based on a model for a 3-unit FDP in the molar region (tooth in region 15, implant in region 17), 16 identical zirconia frameworks were fabricated and veneered with milled lithium disilicate ceramic. Another 16 FDPs were manufactured similarly, using a model in which the tooth was replaced by an implant. The specimens underwent 10,000 thermal cycles between 6.5 and 60 °C and 1,200,000 chewing cycles with a force magnitude of 100 N. All were then subsequently loaded until fracture in a universal testing device. Half of the FDPs were subjected to centric and axial loading on the pontic, the others to eccentric and oblique loading on one cusp of the pontic., Results: No failures were observed after artificial aging. Fracture loads of tooth-implant-supported restorations were 1636 ± 158 and 1086 ± 156 N for axial and oblique loading, respectively; implant-supported FDPs fractured at 1789 ± 202 and 1200 ± 68 N, respectively. Differences were significant for load application (P < 0.001) and support type (P = 0.020). For the two types of load application, fracture mode differed substantially: complete fracture was observed for centric and axial loading whereas mixed cohesive/adhesive failure was observed for many FDPs loaded eccentrically and obliquely., Conclusions: The high incidence of chipping of manually veneered implant-supported all-ceramics restorations might be reduced by use of CAD/CAM-manufactured lithium disilicate veneers., Clinical Relevance: FDPs veneered with lithium disilicate resist occlusal forces of 500 N, irrespective of load application and support type. The fracture resistance of implant-supported FDPs was, however, higher than that of combined tooth-implant-supported FDPs. Their clinical use seems to be justified.

Objectives: The objective of this in vitro study was to assess the effect of wall thickness on the fracture loads of monolithic lithium disilicate molar crowns., Material and Methods: Forty-eight extracted molars were prepared by use of a standardized preparation design. Lithium disilicate crowns (e.max CAD, Ivoclar/Vivadent, Schaan, Liechtenstein) of different wall thicknesses (d = 0.5, 1.0, and 1.5 mm; n = 16 for each series) were then constructed and milled (Cerec MC-XL, Sirona, Bensheim, Germany). After placement of the teeth in acrylic blocks (Technovit, Heraeus Kulzer, Hanau, Germany), the crowns were adhesively luted (Multilink, Ivoclar Vivadent). In each series, eight crowns were loaded without artificial aging whereas another eight crowns underwent thermocycling (10,000 cycles, THE-1100, SD Mechatronik) and chewing simulation (1.2 million cycles, Willytec CS3, SD Mechatronik, F max = 108 N). All specimens were loaded until fracture on one cusp with a tilt of 30° to the tooth axis in a universal testing machine (Z005, Zwick/Roell). Statistical assessment was performed by use of SPSS 19.0., Results: Crowns with d = 1.0 and 1.5 mm wall thickness did not crack during artificial aging whereas two of the crowns with d = 0.5 mm wall thickness did. The loads to failure (F u) of the crowns without aging (with aging) were 470.2 ± 80.3 N (369.2 ± 117.8 N) for d = 0.5 mm, 801.4 ± 123.1 N (889.1 ± 154.6 N) for d = 1.0 mm, and 1107.6 ± 131.3 N (980.8 ± 115.3 N) for d = 1.5 mm. For aged crowns with d = 0.5 mm wall thickness, load to failure was significantly lower than for the others. However, differences between crowns with d = 1.0 mm and d = 1.5 mm wall thickness were not significant., Conclusions: Fracture loads for posterior lithium disilicate crowns with 0.5 mm wall thickness were too low (F u < 500 N) to guarantee a low complication rate in vivo, whereas all crowns with 1.0 and 1.5 mm wall thicknesses showed appropriate fracture resistances F u > 600 N., Clinical Relevance: The wall thickness of posterior lithium disilicate crowns might be reduced to 1 mm, thus reducing the invasiveness of the preparation, which is essential for young patients.

The objectives of this study were to measure the occlusal wear of composite resin denture teeth in patients wearing a complete denture and to evaluate factors affecting wear. Fifty participants provided with complete dentures in at least one jaw were included. Gypsum casts were made from preliminary vinyl polysiloxane impressions 4 weeks after insertion, then after 6 (t(1)), 12 (t(2)), and 24 months (t(3)). Three-hundred and three posterior denture teeth were evaluated after 24 months. Wear was measured indirectly, from the casts, by means of a three-dimensional laser scanner device. Sequential images of the occlusal surfaces were digitized and superimposed (occlusal matching). Statistical analysis was performed by the use of mixed regression models, with the patient being a random effect. Mean wear (median, interquartile range; micrometer) of the entire occlusal surface was 8 (19) at t(1), 18 (34) at t(2), and 40 (61) at t(3). Maximum vertical loss (median, interquartile range; micrometer) was 92 (112) at t(1), 146 (148) at t(2), and 226 (184) at t(3). The dental status of the opposing jaw and the nature of the opposing material significantly affected the wear of denture teeth at t (3). Gender, daily wearing time, jaw, and type of tooth had no significant effects on the extent of wear. Clinically relevant vertical loss of composite resin denture teeth occurs after 24 months. Considering the limitations of this study, wear of denture teeth was affected by dental status and opposing material. The results suggest that wear of composite resin denture teeth exceeds that of enamel.

It is well established that subjects without molars have reduced ability to comminute foods. However, epidemiological studies have indicated that the masticatory system is able to functionally adapt to the absence of posterior teeth. This supports the shortened dental arch concept which, as a prosthetic option, recommends no replacement of missing molars. Biomechanical modeling, however, indicates that using more anterior teeth will result in a larger temporomandibular joint load per unit of bite force. In contrast, changing bite from incisor to molar position increases the maximum possible bite force and reduces joint loads. There have been few attempts, however, to determine realistic joint loads and corresponding muscular effort during generation of occlusal forces similar to those used during chewing with intact or shortened dental arches. Therefore, joint and cumulative muscle loads generated by vertical bite forces of submaximum magnitude moving from canine to molar region, were calculated. Calculations were based on intraoral measurement of the feedback-controlled resultant bite force, simultaneous electromyograms, individual geometrical data of the skull, lines of action, and physiological cross-sectional areas of all jaw muscles. Compared to premolar and canine biting, bilateral and unilateral molar bites reduced cumulative muscle and joint loads in a range from 14% to 33% and 25% to 53%, respectively. During unilateral molar bites, the ipsilateral joints and contralateral muscles were about 20% less loaded than the opposing ones. In conclusion, unilateral or bilateral molar biting at chewing-like force ranges caused the least muscle and joint loading.