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To evaluate clinical performance of the new CAD/CAM resin-matrix ceramics and compare it with ceramic partial coverage restorations.An electronic search of 3 databases (The National Library of Medicine (MEDLINE/PubMed), Scopus, and the Cochrane Central Register of Controlled Trials) was conducted. English clinical studies published between 2005 and September 2020 that evaluated the clinical performance of CAD/CAM resin-matrix ceramics inlays, onlays, or overlays were selected. The primary clinical question was applied according to PICOS strategy (Population, Intervention, Comparison, Outcome, Study design). The included studies were individually evaluated for risk of bias according to the modified Cochrane Collaboration tool criteria.A total of 7 studies were included according to the established inclusion and exclusion criteria. From the included studies, 6 were randomized clinical trials while one study was longitudinal observational study without control group. According to the results of the included studies, the success rate of CAD/CAM resin-based composite ranged from 85.7 to 100% whereas the success rate reported for ceramic partial coverage restorations ranged from 93.3 to 100%. Fractures and debondings are found to be the most common cause of restorations failure.CAD/CAM resin-based composite can be considered a reliable material for partial coverage restorations with clinical performance similar to glass ceramic restorations. However, this result needs to be confirmed in long-term evaluations.CAD/CAM resin-based composites provide a potential alternative to ceramic indirect restorations. However, clinicians must be aware of the lake of knowledge regarding long-term outcome.

INTRODUCTION: The goal of this study was to investigate the influence of the ceramic translucency, restoration type and polymerization time on the relative degree of conversion of a dual-curing resin cement and a conventional microhybrid resin composite using a high-power light-curing device.METHODS AND MATERIALS: Two 4.0 mm thick onlay (O) and two 7.5 mm thick endocrown (E) lithium disilicate restorations in high and low translucency (HT/LT) were fabricated on a decapitated molar. The pulp chamber was prepared to accommodate a 2 mm layer of a microhybrid resin composite (MHC) or dual-curing resin cement (DCC). Composite specimens were light-cured (n = 15; 1200 mW/cm2) without or through an onlay or endocrown restoration. Fourier-transform infrared spectroscopy (FTIR) absorbance curves were collected for the same composite specimen after 3 × 20, 3 × 40, 3 × 60 and 3 × 90 s of light-curing. The relative degree of conversion (DC%) was calculated and results analyzed using Kruskal-Wallis test and Friedman's ANOVA. Alpha was set at 0.05.RESULTS: After 3 × 60 s, the DC of MHC was significantly lower (p = 0.03; r = 0.61) under LT/EC restorations (Mdn: 77.8%) than HT/EC restorations (Mdn: 95.2%). DC of the DCC was not significantly affected by the ceramic translucency or restoration type. MHC had a significant higher DC than DCC under the HT/O, LT/O and HT/E restorations. There were no significant differences between MHC and DCC cured through LT/E restorations.CONCLUSION: DC for DCC was not significantly affected by the ceramic translucency or restoration type. DC for MHC was significantly lower for LT/EC than HT/EC restorations after 3 × 60s polymerization, but not different for the high translucent restorations and low translucent onlays.CLINICAL RELEVANCE: the use of light-curing microhybrid composite for bonding high translucent onlays and endocrowns and low translucent onlays seems feasible.

Submitted by Guilherme Schmitt de Andrade (guisdandrade@hotmail.com) on 2021-10-22T18:39:54Z No. of bitstreams: 1 Tese_Guilherme Andrade.pdf: 2459854 bytes, checksum: 06305d31709342806b2c78d26a270e81 (MD5) Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2021-10-22T20:03:51Z (GMT) No. of bitstreams: 2 andrade_gs_dr_sjc_int.pdf: 2459854 bytes, checksum: 06305d31709342806b2c78d26a270e81 (MD5) andrade_gs_dr_sjc_par.pdf: 412455 bytes, checksum: 810bc14182b0c131f104aea99ff1aab9 (MD5) Made available in DSpace on 2021-10-22T20:03:51Z (GMT). No. of bitstreams: 2 andrade_gs_dr_sjc_int.pdf: 2459854 bytes, checksum: 06305d31709342806b2c78d26a270e81 (MD5) andrade_gs_dr_sjc_par.pdf: 412455 bytes, checksum: 810bc14182b0c131f104aea99ff1aab9 (MD5) Previous issue date: 2021-08-24 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Este estudo avaliou o efeito de 3 desenhos de preparos dentários para restaurações parciais indiretas de cobertura total na veracidade e precisão de modelos digitais obtidos por 3 escâneres intraorais; e na tensão de contração de polimerização residual por meio de análise de elementos finitos. Foram considerados os seguintes preparos: contendo redução de istmo (IST); sem redução de istmo (wIST) e preparo não retentivo (nRET). Para avaliação da veracidade e precisão, 10 varreduras foram realizadas em modelos referência de resina epóxi de contendo os dentes 45, 47 e com preparo no 46. Os modelos de referência digital foram obtidos usando um escâner industrial. Três escâneres intraorais foram comparados (n=10): Element 2 (ELE); Trios 3 (TRI); Primescan (PRI). A veracidade (μm) e a precisão (μm) foram analisadas em um software de sobreposição tridimensional. Os dados foram analisados utilizando os testes de Kruskal-Wallis e Dunn (α = 0,05). Para avaliar a tensão de contração, os preparos foram modelados em um dente 46 contendo: esmalte, dentina, cimento, restauração de cerâmica, polpa, ligamento periodontal, osso cortical e esponjoso. As interfaces foram consideradas coladas e os volumes considerados homogêneos, lineares e isotrópicos. A contração do cimento foi simulada e critério de Tensão Máxima Principal foi adotado para análise dos resultados. O preparo não retentivo obteve maior veracidade (3,8 μm) e precisão (2,7 μm) em comparação com os demais (veracidade = 6-7 μm, precisão = 4-5 μm). A veracidade foi menor no grupo ELE × IST (16), seguido por ELE × wIST (13 μm) e PRI × IST (7,8 μm). Não foi encontrada diferença entre os escâneres PRI e TRI (6 μm), com desempenho inferior para ELE (13 μm). As discrepâncias positivas foram maiores na proximal em IST e wIST. Os picos de tensão (MPa) de contração seguiram a seguinte sequência: restauração=IST (13,4) > wIST (9,3) > nRET (9); cimento=IST (16,9) > wIST (12,6) > nRET (10-7,5); dente=IST (10,7) > wIST (10,5) > (9). Conclui-se que o preparo nRET foi vantajoso para a redução da tensão de contração e para a obtenção de modelos com maior veracidade e precisão. This study evaluated the effect of 3 preparations designs for full-coverage onlay on the accuracy of digital models obtained by intraoral scanners; and in the polymerization residual shrinkage stress by means of finite element analysis. The following preparations were evaluated: with isthmus preparation (IST); without isthmus preparation (sIST) and non-retentive preparation (nRET). For the evaluation of accuracy, 10 digital impressions were performed in a reference epoxy resin model from a lower hemiarch (teeth 45, 46 and 47) with a preparation on the teeth 46. The digital reference models were obtained using an industrial scanner. Three intraoral scanners were compared (n=10): Element 2 (ELE); Trios 3 (TRI); Primescan (PRI). Trueness (μm) and precision (μm) were analyzed using a three-dimensional superimposition software. Data were analyzed using Kruskal-Wallis and Dunn tests (α = 0.05). To assess the shrinkage stress, the preparations were modeled on a tooth #46 containing: enamel, dentin, cement, ceramic restoration, pulp, periodontal ligament, cortical and cancellous bone. The interfaces were considered bonded and the volumes as homogeneous, linear and isotropic. The cement shrinkage was simulated, and the Maximum Principal Stress criterion was adopted to analyze the results. The non-retentive preparation had greater trueness (3.8 μm) and precision (2.7 μm) compared to the others (trueness = 6-7 μm, precision = 4-5 μm). The trueness was lower in the ELE × IST (16), followed by ELE × wIST (13 μm) and PRI × IST (7.8 μm). No difference was found between PRI and TRI scanners (6 μm), with lower performance for ELE (13 μm). Positive discrepancies were greater in the proximal in IST and wIST. The stress (MPa) of followed the sequence: restoration=IST (13.4) > wIST (9.3) > nRET (9); cement=IST (16.9) > wIST (12.6) > nRET (10-7.5); tooth=IST (10.7) > wIST (10.5) > (9). It can be concluded that the nRET preparation was advantageous for reducing the contraction stress and for obtaining models with greater accuracy and precision. Demanda Social - DS (2018-2020)

OBJECTIVE This study aimed to evaluate the influence of the presence of adjacent teeth on the accuracy of intraoral scanning (IOS) systems for class II inlay preparation. MATERIALS AND METHODS The mesio-occlusal inlay preparation was prepared in an anatomical model of the maxillary molar. The prepared tooth was secured to a typodont with the mesial adjacent tooth removed or in situ. Ten digital impressions of the inlay preparation were acquired using three IOS systems (CEREC Primescan, 3Shape TRIOS 3, and Medit i500). A laboratory scanner (3Shape E3) was used to obtain the reference scan data. The mean absolute deviation values were calculated to evaluate the accuracy of the digital models. RESULTS The group with the adjacent teeth present showed lower trueness and precision compared to that without the adjacent tooth (p

To compare the effect of the immediate dentin sealing (IDS) and resin cement type on fracture resistance of Class II mesio-occluso-distal (MOD) zirconia inlay restorations.90 Class II MOD cavities on freshly extracted human mandibular third molars, prepared with a high-speed handpiece, were divided into two groups: those with IDS (CR+) and without IDS (CR-). The CEREC system was used to prepare zirconia inlays from Katana super translucent multi-layered blocks. The inlays were cemented with one of three resin cements: RelyX Unicem 2 (RU), Multilink Automix (MA), or Super-Bond (SB). These specimens were stored in water at 37°C for 24 hours and exposed to 5,000 thermal cycles. A vertical load was applied with a metal sphere (Φ 6-mm) on a material testing system, with a crosshead speed of 0.5 mm/minute, until the specimen fractured. Fracture resistance was measured for each tooth, and the fractures were categorized according to Burke's classification. Statistical analyses were conducted using two-way ANOVA and Tukey's honest significant difference tests (P0.05).No significant differences in tooth fracture resistance were identified between the CR+ and CR- groups. The SB group had a significantly higher fracture resistance compared to that of the MA group. Fracture morphology showed many mode IV fractures in all groups. IDS did not affect tooth fracture resistance, although there was a significant difference in tooth fracture resistance for different resin cement types used with Class II MOD zirconia inlay restorations.Zirconia inlay restorations provide excellent mechanical performance, morphology, and esthetic appearance. In vitro, zirconia inlays cemented with any luting resin cement restored tooth fracture resistance to levels similar to that of intact teeth. Fracture resistance varied among the different resin cements.

Orientador: Mario Alexandre Coelho Sinhoreti Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: As restaurações estéticas indiretas têm sido a opção de escolha no caso de cavidades extensas. No entanto, este tipo de restauração demanda um desenho de preparo muito mais invasivo, podendo levar a sensibilidade pós-operatória, assim como também, certa incompatibilidade entre o cimento resinoso e o adesivo. Na tentativa de solucionar estas limitações tem sido sugerida uma técnica chamada de "Resin Coating Technique" ou Técnica de Selamento Dentinário (TSD), que consiste em proteger a superfície exposta após o preparo com um sistema adesivo e sobre este é aplicado ou nao um "liner" (monômero hidrófobo ou resina composta de baixa viscosidade). A utilização desta técnica vem oferecendo bons resultados, embora, pouco se sabe referente à combinação apropriada entre adesivo e "liner" e a interação desta técnica com os diferentes tipos de cimento resinoso. Portanto, este estudo teve como objetivos avaliar a influencia de diferentes combinações da TSD, na adaptação marginal, resistência de união, nanoinfiltração de restaurações indiretas, e após de ter identificado a combinação mais apropriada para a TSD, foi avaliada a interação desta com os cimentos resinosos através dos testes de adaptação marginal e resistência de união. Para estes estudos foram avaliados as combinações de sistemas adesivos que utilizam o condicionamento acido prévio de 2 e 3 passos e adesivos autocondicionantes de 1 e 2 passos seguido da aplicação ou não aplicaçao de uma camada de "liner" (monômero hidrófobo/resina composta de baixa viscosidade). Nas combinações avaliadas os grupos que obtiveram menores resultados tanto para adaptação marginal e resistência de união foram as combinações que não utilizaram liner. O grupo adesivo autocondicionante de 2 passos/resina composta de baixa viscosidade apresentou maior resistência de união e menor grau de nanoinfiltração. No entanto, todas as combinações avaliadas de TSD não conseguiram evitar a desadaptação marginal e nanoinfiltração das restaurações. Referente ao comportamento desta combinação com diferentes tipos de cimento, foi avaliada a adaptação marginal e resistência de união de diferentes cimentos resinosos (autocondicionante, autoadesivo e de ativação química) obtendo como resultados que o grupo que obteve melhores valores de resistência de união foi o grupo que utilizou cimento autocondicionante, embora não houve diferença entre os cimentos no que se refere à adaptação marginal. Por tanto, pelos achados destes estudos conclui-se que para obter melhor adaptação marginal utilizando a TSD é necessária a aplicação de um liner. A combinação de sistema autocondicionante 2 passos/resina de baixa viscosidade obteve maiores valores de resistência de união e menor padrão de nanoinfiltração. O cimento resinoso autocondicionante mostra-se ser o mais compatível com a TSD. Abstract: Indirect esthetic restorations have been considered an excellent restorative alternative for extensive cavities. However, this type of restoration demands a more invasive preparation, which may cause post-operative sensibility and incompatibility between resin cement and adhesive system. In attempt to minimize these limitations the Resin Coating Technique (RCT) has been proposed. This technique consists in protecting the exposed dentin after the cavity preparation with an adhesive, followed by the application or not application of a liner (hydrophobic monomer or low viscosity resin). The effectiveness of this technique was reported in several studies, however, little is known about the appropriate combination between adhesive and liner and the behavior of this RCT with different resin cements. Therefore, the aims of this study were: evaluate the influence of the combination of different materials used in the RCT on the marginal adaptation, bond strength and nanoleakage of indirect restorations and after identify the most appropriate combination for the RCT, was evaluated the behavior of this RCT with different resin cements using the marginal adaptation and bond strength tests. For these studies were evaluated etch and rise adhesive system (2 and 3 steps) and self-etch adhesives (2 and 1step) followed of the application of liner layer (hydrophobic monomer or low viscosity resin). In all evaluated combinations, the groups that showed low results in marginal adaptation and bond strength were the combinations that not used a liner. The group self etch 2 steps/flow composite resin, showed high bond strength and low nanoleakage. However, in all the restorations showed marginal disadaptation and nanoleakage, independent of the material combinations used for the resin coating. In the study about the interaction of the RCT with the type of resin cement (Self-etching, Self-Adhesive and Chemical Cure) evaluating marginal adaptation and bond strength, was obtained the highest bond strength for the Self-etch group, however, there is no difference between groups for marginal adaptation. So, within the limits of this study, it can be concluded that the use of a liner is necessary for a better marginal adaptation using the RCT. The combination of self etch 2steps/flow composite resin showed high bond strength and low nanoleakage. The self etch resin cement revealed high bond strength showing more compatibility with the RCT. Doutorado Materiais Dentários Doutor em Materiais Dentários

To evaluate the stress distribution of inlays fabricated with restorative materials of different elastic moduli under two functional loading conditions by using three-dimensional (3D) finite element analysis (FEA) models of a second maxillary premolar.A 3D model of a sound maxillary left second premolar and its supporting bone was generated in a previous study and reutilized under permission of the authors for the present study. Inlay models obtained from the sound tooth were then assigned according to the type and inherent elastic modulus of the restorative material used, as follows: microhybrid composite (Filtek Z250); indirect resin composite (Paradigm); lithium disilicate reinforced glass ceramic (IPS e.max Press); and type III gold alloy. The geometric models were then exported for 3D FEA. All materials were considered isotropic, homogeneous, and linear-elastic. A static load of 100 N was applied in two conditions: axially at both cusps (axial loading) and at the mesial marginal ridge (proximal loading). Maximum principal and von Mises stresses were used to analyze the stress distribution pattern in inlays and sound premolar models.Under axial loading condition, either resin composite, ceramic or type III gold alloy inlays generated a similar biomechanical behavior, especially in terms of stress distribution in the remaining tooth structure and cusp deflection. However, higher tensile stresses were observed along the proximal gingival margin of the preparation under proximal loading in the Z250 and Paradigm models, as well as a greater cusp deflection. In contrast, a deflection like the sound model was observed in the ceramic and gold inlay models.Restorative materials with higher elastic modulus, such as dental ceramics and type III gold alloys, seem to be the best choice for maxillary premolars restored with inlays in the presence of occlusal contact on the marginal ridge.

The aim of the present study was to compare inlay and onlay restorations fabricated from conventional impressions and two different digital impression systems in terms of clinical features and marginal fit.Participants were randomly assigned to three groups according to the type of impression system used. The impressions were taken with polyvinyl siloxane silicone material for the control group (CON). For the digital impressions, Trios Pod Scanner (3Shape) was used for the TRIOS group and Cerec AC Omnicam (Sirona) for the CEREC group. A total of 40 IPS e.max CAD and 20 IPS e.max Press (both Ivoclar Vivadent) inlay and onlay restorations were then placed in 24 participants. Clinical evaluations, Plaque Index, Gingival Index, and pocket probing depth measurements were taken at baseline, 6 months, and 12 months using FDI criteria. The continuous margin percentages were quantitatively examined by scanning electron microscopy at baseline and 12 months.All the restorations showed clinically acceptable measurements at baseline, 6 months, and 12 months. The continuous margin evaluations showed no statistically significant difference between the groups.Based on the 12-month follow-up results, inlay and onlay restorations fabricated with digital impressions were found to be a reliable alternative to conventional impressions.

Background Bony reconstruction and dental rehabilitation of patients with posttraumatic anterior maxillary alveolar defects is a very complicated procedure. The aim of this study is the assessment of vertical ridge augmentation using autogenous onlay vs inlay bone grafting techniques in the anterior maxilla. Materials and methods Sixteen patients (40 implants) with vertically deficient anterior maxillary alveolar ridges were equally allocated into two groups; Autogenous block bone graft was harvested from the chin with simultaneous implant placement was done either onlay (control) or inlay (study). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical height on cross sectional cuts of cone beam computed tomography (CBCT) using special software. Finally, the amount of vertical gain and marginal bone loss in each group was compared to that of the other. Results Wound healing was uneventful for all cases except three cases of the onlay group showed wound breakdown and graft loss. The mean vertical bone gain in the control group was -0.02 mm while in the study was 3.34 mm. While the mean of the crestal bone loss of the control group was 4.77 mm and that of the study group was 1.65 mm. Conclusion The final vertical bone gain was statistically significant in the study group, so the inlay bone grafting technique with immediate implant placement could be used successfully for vertical alveolar ridge augmentation in the esthetic zone.

Objective To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period. Clinical considerations A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years. Conclusion Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations. Clinical significance The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

The aim of this study was to evaluate the accuracy of two intraoral scanners used in the dental office. A molar fixed in a typodont was prepared for a ceramic onlay. The preparation was scanned using a high-resolution scanner (reference scanner) and saved as stereolithography (STL) format. The prepared resin molar was scanned again using the intraoral scanners, and all the scans were saved as well in STL format. All STL files were compared using metrology software (Geomagic Control X). Overlapping the meshes allowed the assessment of the scans in terms of trueness and precision. Based on the results of this study, the differences of trueness and precision between the intraoral scanners were minimal.

Objective The aim of this study was to evaluate the 2-year clinical performance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite inlay restorations in comparison with direct resin composite restorations. Materials and methods In 44 patients, 120 class II (mesio-occlusal/disto-occlusal) cavities were randomly assigned into two groups; CAD/CAM resin composite inlay group (Lava Ultimate), direct resin composite group (Clearfil Majesty Posterior). Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years according to the FDI criteria. The data were analyzed using Friedman's ANOVA and Mann-Whitney U tests (α = .05). Results In 41 patients, 114 restorations were evaluated at the second year (recall rate 93.2%). All restorations were ideal or clinically acceptable. At the first year, considering all criteria, there were no statistically significant differences between the groups. However, there was a significant difference in terms of surface luster at second year, in favor of inlay restorations (P = .015). The marginal staining of resin composites increased after 2 years (P = .046), but there was no significant difference between the groups. Conclusions Except the surface luster, 2-year clinical performance of CAD/CAM resin composite inlay restorations was found similar to direct resin composite restorations according to FDI criteria CLINICAL SIGNIFICANCE: The clinical performance of CAD/CAM resin composite inlays was acceptable in class II cavities subsequent to 2-year evaluation.

Dental education is incorporating computer-assisted design/computer-assisted manufacturing (CAD/CAM) into patient care delivery. The aim of this study was to determine if lean production methods applied to the preclinical phase of dental education would reduce the students' time (efficiency) to complete CAD/CAM indirect restorations (CAD/CAM IR) without compromising the desired quality of the CAD/CAM tooth preparations (effectiveness). In 2016, all third-year students at one U.S. dental school were randomly assigned to control and research groups (approximately 33 per group). The control group was taught using existing methods, while the course was redesigned to incorporate lean methods for the research group. Cycle times of the CAD/CAM IR process for both groups were collected and statistically analyzed to compare the effectiveness of the redesign. Standardized grading forms and tools were used to assess the quality of the CAD/CAM tooth preparations. The research group demonstrated significantly faster preparation times with both crowns and onlays (p0.05) than the control group. The research group also produced CAD/CAM crown and onlay designs at a significantly faster pace than the control group (p0.05). There was no significant difference between the control and research groups associated with the scanning process times (p0.05) nor in the quality of the CAD/CAM tooth preparations (p0.05). This study demonstrated that lean methods applied to pedagogy significantly decreased preparation and design times in a CAD/CAM restorative dentistry course without compromising the quality of the CAD/CAM tooth preparations.

Objectives This investigation was a longitudinal, randomized clinical trial to measure the clinical performance of a nano-ceramic material (Lava Ultimate/3M) for chairside Computer Assisted Design/Computer Assisted Machining (CAD/CAM) fabricated restorations. Materials and methods One hundred and twenty chairside CAD/CAM onlays were restored with a CEREC system randomly assigned to 60 leucite-reinforced ceramic (IPS EmpressCAD/Ivoclar Vivadent AGBendererstrasse 2FL-9494 SchaanLiechtenstein) onlays and 60 nano-ceramic (Lava Ultimate/3M) onlays. Equal groups of onlays were cemented using a self-etch and a total etch adhesive resin cement. The onlays were recalled for a period of 5 years. Results At 1 week postoperatively, 10% of the onlays cemented with both the self-etch and total etch adhesive resin cements were reported as slightly sensitive. However, all patients were asymptomatic by the 4th week without treatment. Four leucite-reinforced onlays and one nano-ceramic onlay fractured and required replacement. Conclusions Adhesive retention with a self-etch or total etch cementation technique resulted in a similar clinical outcome with no reported debonds. The nano-ceramic onlays had a lower incidence of fracture compared to the leucite-reinforced ceramic onlays with both having a very low risk of fracture. Nano-ceramic onlays performed equally as well as glass ceramic onlays over 5 years of clinical service. Clinical significance Ceramic materials have been a mainstay for chairside CAD/CAM restorations for the past 30 years and a new category of resilient ceramics with a resin matrix has been introduced reported to offer ceramic-like durability and esthetics with resin-like efficiency in handling. There are no long-term clinical studies on the performance of these materials. This is a 5-year randomized clinical trial on the performance of nano-ceramic onlays.

Treatment of gingival recessions associated with noncarious cervical lesions (NCCL) can be a challenging clinical situation for clinicians. Both periodontal and restorative treatment can be necessary for this kind of defect. By using both digitally precise computer-aided design/computer-assisted manufacture (CAD/CAM) procedures and natural inlay (NI) material for restoration of defects before the coronally advanced flap (CAF) surgery, attachment of soft tissues on the root surface can be achieved successfully. Seven nonsmoking patients with NCCL associated with gingival recessions in the maxillary esthetic zone were treated with NI restoration before CAF surgery. All of the included patients needed at least one tooth extraction, and extracted teeth were used for NI restoration for the CAD/CAM milling procedure. After application of the restorative material onto NCCL defects, CAF surgery was performed for root coverage. The primary outcome was increased mean root coverage percentage and clinical attachment gain after a 6-month follow-up period. Successfully restored NCCL defects were covered with CAF, and 91.67% mean root coverage was achieved with a 1.98-mm attachment gain. Additionally, 71.42% of the root surfaces covered completely. Application of NI restoration materials with CAD/CAM techniques can be a promising procedure for the restoration of NCCL defects before periodontal surgery. This method can achieve a better clinical attachment after root surface coverage.

SUMMARY Aims: To evaluate the effect of two composite restorative techniques (direct bulk fill vs indirect CAD/CAM) on the fracture resistance and mode of fracture of extended mesio-occlusal-distal (MOD) cavity preparations. Methods: Fifty-one sound human mandibular third molars were divided into three groups (n=17). Extended bucco-lingual MOD cavities were prepared. Teeth in group 1 were restored with a bulk-fill resin composite (Filtek Bulk-Fill Posterior Restorative), teeth in group 2 were restored with composite computer-aided design/computer-aided manufacturing (CAD/CAM) inlays (Lava Ultimate), and teeth in group 3 served as control and remained intact. All specimens were submitted to thermocycling, and a fracture resistance test was performed using a Universal testing machine (0.5 mm/min). Mode of fracture was classified into five types. One-way analysis of variance and the Duncan test were used to analyze the fracture load data at a significance level of α = 0.05. A chi-square test was used for the analysis of fracture mode between the restorative groups. Results: Statistical analysis showed significant differences in fracture resistance among the experimental groups. The teeth restored with the bulk-fill composite exhibited lower fracture resistance (1285.3±655.0 N) when compared to the teeth restored with the composite CAD/CAM inlays (1869.8±529.4 N) (p Conclusions: Although both types of restorations failed at loads larger than those found in the oral cavity, the CAD/CAM composite inlays increased the fracture resistance of teeth with large MOD cavities when compared to direct bulk-fill composite restorations. The majority of fracture types were intraorally repairable for both restorative techniques.

Ceramic fracture and debonding are the primary failures that follow ceramic inlay and can lead to stress and tooth fracture. In this study, we examined two designs-concave and flat-of the gingival cavity bottom for tooth cavities restored using ceramic inlays. We investigated the biomechanical behavior of ceramic inlay-restored teeth (concave and flat) through three-dimensional finite element analysis (FEA) and experimentally validated the results using an ultrahigh-speed camera. We conducted in vitro real-time recording of the deformation of a restored tooth during loading using an ultrahigh-speed camera. This technique enables further image registration to observe deformation variation and vector fields. The deformation vector fields revealed that the concave design moved the deformation toward the buccal side of the cavity bottom, whereas the flat design moved it toward the palatal side. These findings correlated with the FEA results, which indicated that the concave design constrained stress in the dentin cavity and relieved palatal stress. Our results suggest that incorporating a concave design in cavity preparation can improve the fracture resistance of ceramic inlay-restored teeth, preventing unrestorable fractures. The current study is the first to utilize an ultrahigh-speed camera in dental biomechanics, and such cameras are useful for nondestructive and dynamic analysis. STATEMENT OF SIGNIFICANCE: First utilize ultrahigh-speed cameras in dental biomechanics analysis. Tooth fracture videos captured by ultrahigh-speed camera helps us learn fracture mechanics in between tooth cavity design and ceramic inlay. Concave design leads to stress in safer areas that causes a less damaging fracture. Minimal invasive preparation by concave design strengthens tooth fracture resistance. Non-destructive data from ultrahigh-speed cameras combined with FEA can get more insight into how the stress and strain derived in biomaterials.

Definitive restorative management of young permanent molars affected with severe MIH is still elusive with a dearth of conservative restorative options. The present trial compared the 36 months clinical and radiographic performance of minimally invasive cast metal and indirect resin onlays for rehabilitation of permanent first molars affected with severe MIH. In this parallel group open label randomised trial, 42 vital molars affected with severe MIH in 30 children, aged 8–13 years were randomly allocated using stratified permuted block randomization to receive either a cast metal onlay or an indirect composite onlay (n = 21 each). Clinical and radiographic evaluations of these onlays were carried out at 9, 18 and 36 months using the USPHS criteria. Cumulative survival rate as well as the calculated clinical success rates of both types of onlays were also determined. The longevity of onlays was assessed using Kaplan–Meier survival analysis. At 36 months, overall retention rate was found to be 95% with complete elimination of any pre-existing sensitivity. Cumulative survival rates were found to be 95% vs. 100%, p = 0.67, while the calculated clinical success rates were 90% and 85.7% for metal and resin onlays, respectively, with no significant differences (p = 0.76). Mean survival rates based on Kaplan–Meier analysis were determined to be 85% vs. 100% for the metal and composite groups, respectively (p = 0.075). Irrespective of the type of material used, onlays offer a predictable and conservative restorative alternative for molars affected with severe MIH. The trial is registered under Clinical Trial Registry India (CTRI/2016/10/007379).

Objective In the past, discrepancies between laboratory results and clinical behavior have been observed for all-ceramic restorations. This analysis of fracture resistance of zirconia-based inlay-retained fixed partial dentures (IRFPDs) aimed at identifying correlations between an in-vitro test setup and the clinical situation. The effects of tooth material, tooth mobility, restoration design, load direction, and different cements were taken into account. Methods The in-vitro test model and IRFPD were reverse engineered (Geomagic DesignX) and meshed predominantly with hexahedral elements (approx. 230,000 elements). Homogenous, linear-elastic behavior was assumed for all materials. On the basis of the calculated stresses (ANSYS 18.2) and already known strength distributions for the restorative materials fracture resistance of the complete restoration and force at initial damage (fracture within the veneer) was estimated on the basis of the principal stress hypothesis. Differences depending on the assumed clinical situation and effects of different variables on fracture resistance were evaluated. Results All variables tested in the finite element analysis affected the calculated fracture resistance of the IRFPD. Use of resin teeth led to an underestimation of fracture resistance by up to −57%, whereas fracture resistance of IRFPDs on metal abutment teeth was close to the clinical reference (−6% to +15%). Good correlation between the clinical scenario and that using metal teeth could only be achieved when the natural resilience of the abutment teeth was simulated. Significance When testing fracture resistance of zirconia-based IRFPDs, metal abutment teeth in combination with simulated tooth resilience can reflect the clinical situation accurately.

SUMMARY The use of computer-aided design/computer-aided manufacturing (CAD/CAM) dentistry has triggered novel approaches to restoring teeth in ways that increase efficiency, improve esthetics, and conserve tooth structure. Endodontically treated mandibular incisors offer a challenging restorative opportunity due to the small amount of natural tooth structure and the required amount of reduction needed for restorative material. The case presented demonstrates how to leverage chairside CAD/CAM technology to restore a discolored and fractured endodontically treated mandibular incisor without the use of a post and core and completing the restoration in a single visit.

To compare the accuracy of computer monitor and smartphone screen for radiographic diagnosis of marginal gap. Forty teeth with mesial-occlusal-distal inlays (each tooth with a perfect fit and a 0.4-mm marginal gap restoration) were imaged with a phosphor plate system. Original digital radiographs were exported and analyzed with two different methods: computer monitor and smartphone screen; for the last method, images were shared with WhatsApp. Three examiners assessed all radiographs (n = 160) for the presence of marginal gap by using a dichotomous scale (yes/no). Diagnostic performance of each examiner and viewing method was evaluated by means of sensitivity (Se), specificity (Sp), and overall accuracy (Ac). Difference between the frequencies of gap detection of each method was analyzed using the McNemar test. Intra- and inter-examiner agreements were calculated using kappa statistics. Intra- and inter-examiner agreements were ≥ 0.80 for both methods. Similar diagnostic performance was found for computer monitor (Se = 0.87–1; Sp = 0.8–0.97; Ac = 0.84–0.99) and smartphone (Se = 0.77–1; Sp = 0.87–1; Ac = 0.88–0.95) viewing methods. No statistically significant differences in the frequency of gap detection were observed between the methods (P > 0.05). Diagnostic accuracy of smartphone screens was similar to that of computer monitor for marginal gap detection. Smartphones are becoming a common daily tool. In this sense, it might be an important new aid in Dentistry, including radiographic evaluation, which could benefit patients and dentists.

Well-balanced physical properties of computer-aided design and computer-aided manufacturing (CAD-CAM) materials are important to ensure the clinical success and longevity of restorations. Therefore, the capacity of a material to dissipate destructive fracture energy by means of elastic and plastic material deformation is of interest. However, little information is available on how to quantify the resilience and toughness of CAD-CAM materials.The purpose of this in vitro study was to investigate and compare the resilience and toughness of CAD-CAM restorative materials and assess their capability to dissipate destructive fracture energy in comparison with a high-gold-content alloy.Restorative materials for 3-unit fixed partial dentures (Alphador No. 1, IPS e.max CAD, Lava Plus, PEEK Optima), crowns and onlays (CERASMART, CEREC Blocs, Lava Ultimate, VITA ENAMIC), and interim prostheses (M-PM Disc, Telio CAD) were investigated. The strain energy density was determined with a 3-point bend test to calculate the modulus of toughness, the modulus of resilience, and the elastic recovery and thus characterize the material properties of resilience and toughness. Data were statistically analyzed with a generalized linear mixed model by using the Huber-White sandwich estimator (α=.05).Significant differences were found among the materials concerning the modulus of toughness, the modulus of resilience, the elastic recovery, and the difference between the elastic recovery and the modulus of resilience (P.001). Alphador produced the highest mean regarding the modulus of toughness followed by Telio CAD, Lava Plus, M-PM Disc, CERASMART, and Lava Ultimate; all showed significantly higher capacities to dissipate energy by elastic and plastic deformation when compared with the ceramic materials (IPS e.max CAD, VITA ENAMIC, CEREC Blocs). For the modulus of resilience and elastic recovery, Lava Plus and Alphador showed the highest mean values and therefore better able to only elastically absorb destructive fracture energy; the least able materials were VITA ENAMIC and CEREC Blocs. As PEEK Optima, M-PM Disc, and Lava Ultimate showed higher mean values for the modulus of resilience than IPS e.max CAD, they were better able to elastically dissipate energy.Alphador had the highest values for the modulus of toughness, the elastic recovery, and the difference between the elastic recovery and the modulus of resilience; this was equivalent to pronounced energy dissipation capacities. In comparison, Lava Plus showed the highest modulus of resilience but significantly lower results for all other parameters and therefore fewer energy-consuming capabilities. The new polymer-based CAD-CAM restorative materials in general had a higher modulus of toughness and elastic recovery than ceramics and thereby partially resemble Lava Plus, all with similar capacities to dissipate destructive energy.

Aim: To evaluate the occlusal and internal marginal adaptation of inlay restorations made of different materials, using CAD-CAM. Methods: Preparations were made for MOD inlays of one-third intercuspal width and 4 mm depth in 30 third human molars. The teeth were restored using CAD-CAM materials (n=10) of nanoceramic resin (Lava Ultimate), polymer-infiltrated ceramic network (VITA ENAMIC), or lithium disilicate glass-ceramic (IPS e.max CAD). The specimens were cemented with dual resin cement and sectioned at the center of the restoration, after which the two halves were evaluated, and photographed The occlusal and internal discrepancy (μm) was determined at five points: cavosurface angle of the occlusal-facial wall (CA-O); center of the facial wall (FW); faciopulpal angle (FPA); center of the pulpal wall (PW); and center of the lingual wall (LW). The data were submitted to the Kruskal-Wallis and the Dunn tests (α=0.05). Results: No difference was observed among the materials regarding the occlusal discrepancy at the CA-O, FPA, or PW internal points. The e.max CAD measurement at FW showed larger internal discrepancy than that of Lava (p=0.02). The internal discrepancy at LW was greater for e.max CAD than VITA ENAMIC (p=0.02). Conclusion: Lithium disilicate glass-ceramic presented greater internal discrepancy in relation to the surrounding walls of the inlay preparations.

A clinical and functional examination of the maxillofacial area was performed in 280 patients with the defects of the lateral teeth being replaced with ceramic crown inlays or light-cured composites three years ago. Computer methods were used to assess the articulation, occlusion and tone of the masticatory muscles on the T-Scan III and Bio EMG III devices. In a third of the lateral teeth, an unreasonable increase in indications to composite fillings has been established – when more than 50.0% of the occlusal surface is destroyed. Indicators of dental status are significantly better when using ceram- ic inlays compared with fillings made of composite material in the long term after treatment of multiple caries. Ceramic crown inlays prevent occlusal-articulatory disorders and dysfunction of the masticatory apparatus, characteristic in long-term periods for patients with multiple caries when replacement of lateral teeth defects with fillings made of composite.

For restoring extensive cavities in severely damaged or decayed posterior teeth, especially those with thin walls, indirect restorations are recommended rather than direct fillings. Regarding indirect restorations for inlays and onlays, composite resin-based CAD/CAM materials are considered to have several advantages over ceramics such as easy manufacturing, lower cost, and simpler repairability. A case is presented in this article in which the treatment plan and protocol combine multiple evidence-based clinical techniques such as immediate dentin sealing (IDS), cavity design optimization (CDO), and cervical margin relocation (CMR). For CDO and CMR, two different types of flowable composite resins with different viscosities were used. Restoring such extensively damaged teeth using a defect-oriented adhesive technique is considered a challenge both in terms of the preservation of healthy tooth structure and the proper isolation for adhesive luting. The IDS technique was used to enhance the bonding to the remaining dentin, while CDO was performed to avoid unnecessary removal of vital tooth structure, for example, undercuts. The deep subgingival margins were elevated using the CMR technique to facilitate the impression taking and a contamination-free luting of the final restoration. Combining the aforementioned techniques enabled a defect-oriented, minimally invasive restoration of a severely decayed tooth. The aim of this article is to present those techniques in a simplified way through a clinical case as a step-by-step guide for the practitioner.

This study aimed to assess the effects of a temporary sealing material and cleaning method of resin-coated dentin on the bond strength of computer-aided design/computer-aided manufacturing (CAD/CAM) inlay restorations. Resin-coated dentin surfaces were unsealed or temporarily sealed for 1 h or 1 week. For the temporarily sealed group, a hydraulic temporary sealing material was removed and further divided into four groups: without cleaning, cleaned with a rotational brush, a universal cleaner or an air-polishing device. Some specimens were investigated with energy dispersive X-ray spectroscopy and the others were used for microtensile bond strength (MTBS) test. A sealing material could not be removed with a rotational brush, which resulted in pretest failures in all specimens after 1 h and which resulted in low MTBS after 1 week. An air-polishing device can clean resin-coated dentin temporarily sealed with a hydraulic temporary sealing material and resulted in the similar MTBS as in the unsealed group.

Inlay-retained dental bridges can be a viable minimally invasive alternative when patients reject the idea of implant therapy or conventional retained full-coverage fixed dental prostheses, which require more tooth preparation. Inlay-retained dental bridges are indicated in patients with good oral hygiene, low susceptibility to caries, and a minimum coronal tooth height of 5 mm. The present study aims to evaluate, through the finite element method (FEM), the stability of these types of dental bridges and the stresses on the supporting teeth, under the action of masticatory forces. The analysis revealed the distribution of the load on the bridge elements and on the retainers, highlighting the areas of maximum pressure. The results of our study demonstrate that the stress determined by the loading force cannot cause damage to the prosthetic device or to abutment teeth. Thus, it can be considered an optimal economical solution for treating class III Kennedy edentation in young patients or as a provisional pre-implant rehabilitation option. However, special attention must be paid to its design, especially in the connection area between the bridge elements, because the connectors and the retainers represent the weakest parts.

To evaluate the marginal and internal adaptation of all-ceramic crowns and inlays fabricated by different scanners of the same CAD/CAM system.All-ceramic crown preparations were performed on typodont maxillary first premolars, and mandibular first molars were prepared for ceramic Class II mesio-occlusal inlays. Two intraoral scanners (CEREC Bluecam and Omnicam, Dentsply Sirona) and one model scanner (CEREC inEos X5, Dentsply Sirona) were used to scan the preparations. All restorations were fabricated by milling single-feldspathic ceramic blocks (CEREC Blocks). The marginal and internal discrepancies of restorations were evaluated via micro-CT analyses.For linear crown measurements, the marginal gaps were 63.75 μm, 88.24 μm, and 90.89 μm for Bluecam, Omnicam, and inEos X5, respectively. For crowns at central groove areas, the maximum values for Bluecam, Omnicam, and inEos X5 were found to be 144.78 μm, 165.19 μm, and 129.49 μm, respectively. For inlays, the highest range at the midpoint of the axiopulpal line angle for Bluecam, Omnicam, and inEos X5 were determined as 138.57 μm, 184.33 μm, and 179.71 μm, respectively. In volumetric measurements, inEos X5 showed lower gap for both crowns (11.47 mmWhen all-ceramic crowns were evaluated, there were generally no significant differences found between scanners for the regional linear measurements, but more gaps occurred in restorations obtained with intraoral scanners for volumetric measurements. On the other hand, when the inlay restorations were evaluated, significant differences were found between groups except for the midpoint of the axio-pulpal line angle and the midpoint of the mesio-gingival margin. However, marginal and internal gaps of both crowns and inlays presented mean values less than 150 μm in many surfaces, which could be considered clinically acceptable.

SUMMARY Background In the preparation of inlay cavities, a choice must be made between conventional standard and minimally invasive preparation designs; in the long run, this choice can affect the integrity of the bonded interface. Purpose To evaluate the effect of minimally invasive cavity preparation designs on the extent and contributing mechanisms of damage to ceramic inlay bonded interfaces. Methods and Materials Tooth blocks with 90°, 120° and 75° marginal angles were prepared, representing tooth cavities with conventional standard and minimally invasive preparations with large divergence and convergence angles and bonded to monolithic ceramic (IPS e.max CAD). Vickers indentations were placed at various distances from the bonded interface. The indentation morphology and crack length were observed. Reciprocating wear tests were performed on the bonded interface with a 20-newton (N) vertical load. The wear depth and wear-scar morphology were characterized after increments of cyclic sliding contact. Results The 120° group exhibited longer indentation cracks in the ceramic, whereas the 75° group showed larger indentations in the enamel when compared to the 90° group (p0.147) and morphology were found at the later wear stage among the three groups. Conclusion Within the limitations of this study, minimally invasive preparations with 120° and 75° marginal angles can result in early sever damage at the ceramic inlay bonded interface but show comparable wear behaviors to the conventional 90° group at the later stage.

A paradigm shift is taking place in contemporary restorative dentistry coupled with the constant evolution of digital technology. The adhesive partial restorations represent this new dentistry which wants to be economical in dental tissue, adhesive and biomimetic. This requires clinicians to change their practice, including forgetting the strict rules of preparations for traditional crown. The object of this thesis is therefore to describe the evolution of new concepts of preparation of partial bonded restorations in CAD/CAM. To do this, in the first part, the developments concerning CAD/CAM will be described. Then the second part will present the new concepts of preparations with the different strategies that the clincian can use. The third part will expose the architectural principles and examples of these new preparations.; Un changement de paradigme s’opère au sein de la dentisterie restauratrice contemporaine couplée à l’évolution constante du numérique. Les restaurations partielles collées représentent cette nouvelle dentisterie qui se veut économe en tissus dentaire, adhésive et biomimétique. Cela demande aux praticiens de changer leurs habitudes, notamment d’oublier les règles strictes des préparations pour prothèses conjointes. L’objet de cette thèse est donc de décrire l’évolution des nouveaux concepts de préparations des restaurations partielles collées en CAO et CFAO. Pour cela, dans une première partie, seront décrites les évolutions concernant la CFAO. Puis la seconde partie présentera les nouveaux concepts de préparations avec les différentes stratégies que le praticien peut utiliser. La troisième partie exposera les principes architecturaux et des exemples de ces nouvelles préparations.

Chairside CAD/CAM is a convenient approach for fabricating dental restorations. However, the effect of CAD/CAM restoration type on marginal fit accuracy has not been fully investigated. This study evaluated of the marginal fit accuracy of 3 chairside CAD/ CAM restoration types (crown, inlay and onlay) using CEREC Bluecam (BC) and CEREC Omnicam (OC) scanners. Three artificial maxillary first molars received crown, inlay and onlay preparations. A total of 10 CAD/CAM ceramic restorations were produced for each tooth by each intraoral scanner. The marginal gap was measured along the preparation margin. For the BC, all the restorations had similar marginal gaps (crowns = 113.9 μm; inlays = 120.9 μm; onlays = 132.5 μm) (p = 0.20), while for the OC, the crowns (72.2 μm) and the inlays (74.9 μm) exhibited better marginal fit than the onlays (96.4 μm) (p = 0.003). For every restoration type, the OC provided a superior outcome compared with the BC. Therefore, the restoration type influenced the marginal gap, where the crowns tended to have the least marginal gap while the onlays had the greatest marginal gap. The newer scanner (OC) of the same manufacturer was more accurate than the older scanner (BC).