Abstract To treat a patient with anterior crossbite, the clinician should first assess if it is a genuine class III or a pseudo‐class III malocclusion. Cephalometric analysis is important; however, registering a patient's centric relation (CR) is simple, quick, and costless and can play a decisive role in a differential diagnosis for this type of patient profile. This clinical report depicts a patient clinically diagnosed as class III. After mandible manipulation in CR, it was noted that the patient in question was a pseudo‐class III. The treatment was based on the pseudo‐class III diagnosis. Therefore, the patient was rehabilitated by occlusal adjustments and conventional and implant‐supported prostheses and without the need for invasive orthognathic surgery.
The aim of the present study was to assess the shock absorbing capacity of implant-supported restorations (CAD/CAM composite resin or zirconia abutment with composite resin or porcelain crown/onlay) and a simulated natural tooth complex using the Periometer(®) .One hundred and twenty Morse taper implants (Titamax CM 11 mm) were mounted on bone-simulating acrylic resin base and restored with CAD/CAM zirconia (60) and metal composite resin Paradigm MZ100 (60) abutments. Using CEREC3, standardized onlays (60) and crowns (60) were designed and milled in ceramic (Paradigm C) or composite resin (Paradigm MZ100) to simulate a maxillary premolar. All restorations were luted with a preheated light curing composite resin (Filtek Z100). Fifteen extracted human upper premolars were mounted with a simulated PDL and used as control group. The Periometer(®) , a new handheld percussion probe that measures the energy loss coefficient (LC) for both natural teeth and implant-supported structures, was positioned perpendicularly to the buccal surface of each restoration. Three measurements of the LC were collected for each specimen. The effect of each variable (abutment material, restoration material, and restoration design) on the LC was explored using multiple regression analysis.Differences in LC between the abutment material (zirconia/Paradigm MZ100), the restoration material (Paradigm C/Paradigm MZ100) and the restoration design (onlay/crown) were recorded. The average LC of zirconia and metal composite resin abutments ranged from 0.040 to 0.053 and 0.059 to 0.068, respectively. Zirconia abutments restored with composite resin restorations (LC 0.051-0.053) had the closest LC value when compared with teeth with simulated PDL (0.049).Composite resin onlays/crowns bonded to zirconia implant abutments presented similar dynamic response to load (damping behavior) when compared to teeth with a simulated PDL.
Abstract Objectives This study assessed the fatigue resistance and failure mode of porcelain and composite resin crowns and onlays bonded to premolar custom zirconia implant abutments. Materials and methods Sixty standardized zirconia implant abutments were milled (NeoShape) according to two different restoration designs (onlay or crown). Using Cerec 3, the corresponding onlays and crowns were fabricated either in ceramic (Paradigm C) or composite resin (Paradigm MZ100), resulting in four experimental groups ( n = 15). The fitting surfaces of the abutments were airborne‐particle abraded and cleaned. The intaglio surfaces of the restorations were HF‐etched and silanated (Paradigm C) or airborne‐particle abraded and silanated (Paradigm MZ100). Following insertion of the abutments into a Morse taper implant (Titamax CM), all restorations were bonded with a zirconia primer (Z‐Prime Plus), adhesive resin (Optibond FL), and a preheated light curing composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz) was simulated, starting with a load of 50N (5000×), followed by stages of 200N, 400N, 600N, 800N, 1000N, 1200N, and 1400N (25,000× each). Samples were loaded until fracture or to a maximum of 180,000 cycles. The four groups were compared using the life table survival analysis (Logrank test at P = 0.05). Results All composite resin onlays and crowns survived (100% survival rate), while ceramic ones fractured at an average load of 1347N and 1280N, respectively, (survival rate of 46.7% and 20%) with a significant difference in survival probability ( P < 0.0001). Fractures consisted in partial or total failure of the restoration only (no abutment failure, no screw loosening). Conclusions Composite resin onlays and crowns bonded to custom zirconia implant abutments presented a significant higher survival rate when compared to ceramic onlays and crowns.
ABSTRACT Statement of Problem: Cracked teeth may traditionally require the use of complete coverage crowns. Alternative conservative treatments involve the use of adhesive inlays/onlays with the possibility of including a fiber patch to reinforce the cracked cusp. Purpose: The purpose of this study was to evaluate the fatigue strength of compromised molars restored with computer‐aided‐design/computer‐assisted‐manufactured (CAD/CAM) composite resin inlays/onlays with and without fiber‐reinforced immediate dentin sealing (IDS). Methods and Materials: Large mesio‐occluso‐distal preparations with cracked/undermined palatal cusps were simulated on 40 extracted maxillary molars. All teeth received IDS (Optibond FL, Kerr, Orange, CA, USA), and composite resin (Paradigm MZ100, 3M‐ESPE, St. Paul, MN, USA) inlays ( N = 20) and onlays ( N = 20). A fiber patch (Ribbond, Ribbond Inc., Seattle, WA, USA) was applied in half of the preparations. Restorations were adhesively luted with pre‐heated composite resin (Z100, 3‐M ESPE) and submitted to cyclic isometric loading at 5 Hz, starting with a load of 50 N (5,000 cycles), followed by stages of 150, 300, 450, 600, 750, 900, and 1,050 N at a maximum of 25,000 cycles each. Specimens were loaded until fracture or to a maximum of 180,000 cycles. Groups were compared using the life table survival analysis. Results: Differences in survival probability were found ( p = 0.04). The inlay group with fiber patch failed at an average load of 870 N, and none of the specimens withstood all 180,000 load cycles; survival rates of inlays and onlays without fibers, and onlays with fibers were 10, 30, and 50%, respectively. Conclusions: Onlays (with or without fibers) increased the fatigue resistance of compromised molars in this in vitro study. CLINICAL SIGNIFICANCE The results of this in vitro study suggest that molars with a compromised cusp may be best reinforced by a cusp‐protecting composite resin onlay. There was no benefit of using fiber reinforcement under those indirect restorations. (J Esthet Restor Dent 24:135–147, 2012)
To evaluate the fatigue resistance and failure mode of composite resin and porcelain onlays and crowns bonded to premolar custom metal-composite resin premolar implant abutments.Sixty composite resin mesostructures were fabricated with computer assistance with two preparation designs (crown vs onlay) and bonded to a metal implant abutment. Following insertion into an implant with a tapered abutment interface (Titamax CM), each metal-composite resin abutment was restored with either composite resin (Paradigm MZ100) or ceramic (Paradigm C) (n = 15) and attached with adhesive resin (Optibond FL) and a preheated light-curing composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz) was then simulated, starting with 5,000 cycles at a load of 50 N, followed by stages of 200, 400, 600, 800, 1,000, 1,200, and 1,400 N (25,000 cycles each). Samples were loaded until fracture or to a maximum of 180,000 cycles. The four groups were compared using life table survival analysis (log-rank test). Previously published data using zirconia abutments of the same design were included for comparison.Paradigm C and MZ100 specimens fractured at average loads of 1,133 N and 1,266 N, respectively. Survival rates ranged from 20% to 33.3% (ceramic crowns and onlays) to 60% (composite resin crowns and onlays) and were significantly different (pooled data for restorative material). There were no restoration failures, but there were adhesive failures at the connection between the abutment and the mesostructure. The survival of the metal-composite resin premolar abutments was inferior to that of identical zirconia abutments from a previous study (pooled data for abutment material).Composite resin onlays/crowns bonded to metal-composite resin premolar implant abutments presented higher survival rates than comparable ceramic onlays/crowns. Zirconia abutments outperformed the metal-composite resin premolar abutments.
Applying the biomimetic principles, maximum preservation of the sound tooth structure may be achieved by means of adhesive restorations. Due to bonding, it is possible to conduct minimally invasive esthetic procedures with laminate veneers assuring a high mechanical resistance of the tooth/restoration bond. A clinical case of adhesive restorations is presented using the bonding protocol respecting the diversity of each product's commercial brands and manufacturer's recommendations.
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