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Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns.
J Dent. 2018 01; 68:41-50.JD

Abstract

OBJECTIVES

To explore fatigue limits of ceramic endocrowns for premolars.

METHODS

Forty-eight devitalized premolars were cut at the CEJ. They were restored with standardized CAD-CAM lithium disilicate reinforced ceramic restorations (IPS e.max CAD, Ivoclar-Vivadent) and divided into four Groups (n=12): overlays (Group A, no endo-core, negative control), endocrowns with an endo-core of 2mm (Group B), 4mm (GroupC) and crowns with post and core (Group D, positive control). All specimens were first submitted to thermo-mechanical cyclic loading (TCML)(1.7Hz, 49N, 600000 cycles, 1500 thermo-cycles). Margins were analysed before and after the loading. Survived specimens were then submitted to cyclic isometric stepwise loading (5Hz, 200N to 1200N) until completion of 105000 cycles or failure. In case of fracture, fragments were analysed using SEM and failure mode was determined. Results of stepwise loading were statistically analysed by Kaplan-Meier life survival analysis and log rank test (p=0.05).

RESULTS

All the specimens survived the TCML test except four specimens of Group A (early restorations' debonding). No difference in percentages of closed margins was found between endocrowns (Groups B, C) and crowns (Group D). After the stepwise test, differences in survival within the groups were not statistically significant. Most of restorations experienced non-reparable fracture.

CONCLUSIONS

Endocrowns with both 2-mm and 4-mm long endo-cores displayed outcomes after fatigue equivalent to classical crowns. Results of this study discourage the use of flat overlays with only adhesive retention.

CLINICAL SIGNIFICANCE

When restoring extremely destroyed devitalized premolars, adhesive strategies should be coupled to a macro-mechanical retention in the root.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Rocca GT
Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland. Electronic address: giovanni.rocca@unige.ch.
Daher R
Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland.
Saratti CM
Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland.
Sedlacek R
Laboratory of Biomechanics, Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University of Prague, Prague, Czech Republic.
Suchy T
Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Academy of Sciences of the Czech Republic, Prague, Czech Republic.
Feilzer AJ
Department of Dental Materials Science, ACTA, Amsterdam, The Netherlands.
Krejci I
Division of Cariology and Endodontology, School of Dentistry, University of Geneva, Geneva, Switzerland.

MeSH

BicuspidCementationCeramicsCompressive StrengthComputer-Aided DesignCrownsDental Marginal AdaptationDental MaterialsDental PorcelainDental Prosthesis DesignDental Restoration FailureDental Restoration, PermanentDental Stress AnalysisHumansMaterials TestingStress, MechanicalSurvival AnalysisTooth CervixTooth, NonvitalTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29107134

Citation

Rocca, G T., et al. "Restoration of Severely Damaged Endodontically Treated Premolars: the Influence of the Endo-core Length On Marginal Integrity and Fatigue Resistance of Lithium Disilicate CAD-CAM Ceramic Endocrowns." Journal of Dentistry, vol. 68, 2018, pp. 41-50.
Rocca GT, Daher R, Saratti CM, et al. Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. J Dent. 2018;68:41-50.
Rocca, G. T., Daher, R., Saratti, C. M., Sedlacek, R., Suchy, T., Feilzer, A. J., & Krejci, I. (2018). Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. Journal of Dentistry, 68, 41-50. https://doi.org/10.1016/j.jdent.2017.10.011
Rocca GT, et al. Restoration of Severely Damaged Endodontically Treated Premolars: the Influence of the Endo-core Length On Marginal Integrity and Fatigue Resistance of Lithium Disilicate CAD-CAM Ceramic Endocrowns. J Dent. 2018;68:41-50. PubMed PMID: 29107134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restoration of severely damaged endodontically treated premolars: The influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. AU - Rocca,G T, AU - Daher,R, AU - Saratti,C M, AU - Sedlacek,R, AU - Suchy,T, AU - Feilzer,A J, AU - Krejci,I, Y1 - 2017/10/26/ PY - 2017/02/22/received PY - 2017/10/11/revised PY - 2017/10/25/accepted PY - 2017/11/7/pubmed PY - 2019/4/23/medline PY - 2017/11/7/entrez KW - CAD-CAM KW - Endo-core KW - Endocrown KW - Endodontically treated KW - Fatigue KW - Lithium disilicate KW - Marginal integrity SP - 41 EP - 50 JF - Journal of dentistry JO - J Dent VL - 68 N2 - OBJECTIVES: To explore fatigue limits of ceramic endocrowns for premolars. METHODS: Forty-eight devitalized premolars were cut at the CEJ. They were restored with standardized CAD-CAM lithium disilicate reinforced ceramic restorations (IPS e.max CAD, Ivoclar-Vivadent) and divided into four Groups (n=12): overlays (Group A, no endo-core, negative control), endocrowns with an endo-core of 2mm (Group B), 4mm (GroupC) and crowns with post and core (Group D, positive control). All specimens were first submitted to thermo-mechanical cyclic loading (TCML)(1.7Hz, 49N, 600000 cycles, 1500 thermo-cycles). Margins were analysed before and after the loading. Survived specimens were then submitted to cyclic isometric stepwise loading (5Hz, 200N to 1200N) until completion of 105000 cycles or failure. In case of fracture, fragments were analysed using SEM and failure mode was determined. Results of stepwise loading were statistically analysed by Kaplan-Meier life survival analysis and log rank test (p=0.05). RESULTS: All the specimens survived the TCML test except four specimens of Group A (early restorations' debonding). No difference in percentages of closed margins was found between endocrowns (Groups B, C) and crowns (Group D). After the stepwise test, differences in survival within the groups were not statistically significant. Most of restorations experienced non-reparable fracture. CONCLUSIONS: Endocrowns with both 2-mm and 4-mm long endo-cores displayed outcomes after fatigue equivalent to classical crowns. Results of this study discourage the use of flat overlays with only adhesive retention. CLINICAL SIGNIFICANCE: When restoring extremely destroyed devitalized premolars, adhesive strategies should be coupled to a macro-mechanical retention in the root. SN - 1879-176X UR - https://www.unboundmedicine.com/medline/citation/29107134/Restoration_of_severely_damaged_endodontically_treated_premolars:_The_influence_of_the_endo_core_length_on_marginal_integrity_and_fatigue_resistance_of_lithium_disilicate_CAD_CAM_ceramic_endocrowns_ DB - PRIME DP - Unbound Medicine ER -