prof. paulo cesar's lecture at nova southeastern in jan 2015

8/9/2019 Prof. Paulo Cesar's Lecture at Nova Southeastern in Jan 2015

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University of So Paulo

School of Dentistry

Department of Biomaterials and Oral Biology

Associate Prof. Paulo Francisco Cesar

Dental biomaterials science: building long la

aesthetic restorations

Collaborators:

Prof. Lucas Hian da Silva

Prof. Susana Salazar-Marocho


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Universidade de So Paulo

Faculdade de Odontologia

Departamento de Biomateriais e Biologia Oral


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1.1. What are the options?

1.Ceramics


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1. Ceramics

Porcelains

Glass-ceramics

Glass-infiltrated composites

Polycrystalline ceramics


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Porcelains

Porcelains


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Porcelains

1 2 3

45 6


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Glass-ceramics (leucite or lithium disilicate)

1 2

3 4 5

Gonzaga, 2007


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Glass-infiltrated composite


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Polycrystalline

Y-TZP

Alumina

1 2 3


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1 2 3

4 5 6
http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663


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a) Leque de opes

b) O material de escolha

c) Novas perspectivas

1.2. Material of choice

1.Ceramic
http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663


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1. Ceramics

Veneers

Inlays /Onlays

Crowns

Fixed partial dentures

Abutments

Large infra-structures for implants
http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663http://www.google.com/url?sa=i&rct=j&q=choosing&source=images&cd=&cad=rja&docid=Vr6FWwSy_nkoLM&tbnid=ZIABKMj1sbgd5M:&ved=0CAUQjRw&url=http://www.realizzazione-sito-internet.biz/index/software-ecommerce-cms/grafica-personalizzata.html&ei=HHISUp6mCNLh4APIjoHoDg&psig=AFQjCNE8d9-bgBA_4wkJwl2fhHjvs4o8uw&ust=1377026969294663


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Porcelains or Glass-cer Veneers

D


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Inlay/OnlayPorcelains or Glass-c

1 2 3 4

5 6

Porcelains


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Crowns

Glass-ceramics coping+veneering ceramic or monolithic)

High translucency:

1 2 3 4

5 6

coping+ven

eeringceramic


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Glass-ceramics monolithic)

1 2 3

4 5

D


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Glass-ceramic monolithic)


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Glass-ceramic monolithic)

D


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Fixed partial denturesY-TZP


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Abutments Y-TZP

Dr. Susanne Scherrer (Univ of Geneva)

1 2


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D

3 4


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Large infra-structures over implants

Lohb


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Loh


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Failed from a stress concen

tip of the zirconia framework

Crack moved in a downward

A secondary edge chip on th

zirconia framework was inci

related to the final failure.

Lohbauer et al., 2010


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Dr. Susanne Scherrer (Un



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Dr.

1 2

3 4



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Secondary caries/marginal discoloration/

wear of cement line/ minor edge chippings

Debonding

Fractures

Veneers/Inlay/Onlay/Crowns

Fixed partial dentures FPDs)

1.2.1. Clinical failures

Dr. Susan

Secondary caries/marginal discoloration/wear of cement line/minor


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Secondary caries/marginal discoloration/wear of cement line/ minor


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Due to the posterior location of the restorations, these time-

dependent degradation processes were not of concern clinically

and were only observed by the examiners.


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Debonding

Evaluation of Tensile Retention of Y-TZP Crowns Cemented on Resin Compo

of the Cement and Y-TZP Surface Conditioning.

Rippe M, Amaral R, Oliveira F, Cesar PF, Scotti R, Valandro L, Bottino M.

Oper Dent. 2015 Jan-Feb;40(1):E1-E10.

Evaluation of tensile retention of Y-TZP crowns after long-term aging: effect o

substrate and crown surface conditioning.

Amaral R, Rippe M, Oliveira BG, Cesar PF, Bottino MA, Valandro LF.

Oper Dent. 2014 Nov-Dec;39(6):619-26.

1

2

1


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1

2


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2


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After 42 months one debonding

occurred in each group;

No effect of resin cement: Panavia 21

versus Multilink.

1.2.1. Clinical Failures


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Zhang et al., 201

Fractures

Inlay/Onlay/Crowns


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Zhan

Inlay/Onlay/Crown


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Defects on the cementation surface

Thompson eDicor crown in a premolar


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Inlay/Onlay/Crowns


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Marginal defects

Procera crowns (alumina coping + veneering porcelain)


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Fractographic Analy

premolars and 11 mo

All fractures initiated

the crowns and usu

area close to the

curvature of the marg


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Zhan


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Inlay/Onlay/Crown


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Cone cracks (NO attrition)

Inlay/Onlay/Crown


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Cone crakcs (NO attrition)

Inlay/Onlay/Crown


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Cone crakcs (NO attrition)

Fard

Inlay/Onlay/Crown


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Cone cracks (NO attrition)


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Zhang

Inlay/Onlay/Crowns


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Partial cone cracks (WITH attrition)

Optical (a) surfa(bottomY-TZP ssphere under noKim et al., 2008 Kim et al., 2010

Inlay/Onlay/Crown


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Partial cone cracks (WITH attrition)


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In vitroIn vivo


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Zhan

h

Inlay/Onlay/Crown


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Chipping Fracture of the porcelain layer (Procera Alumina after 4 years.

Sche


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Sch

Chipping

Inlay/Onlay/Crown


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Porcelain fused to metal fractured after 2 months. Cour


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compression curl

Court

Compression


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Compression

curl

2 blunt contacts

Courtesy


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Courtesy


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In the chipping area a small b

veneering material (size 1 x 0.

The chipping occurred 7 mont


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K


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Chipping/incisal edge Ch

Fracture Mu


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Critical crack initiated at the incisal c

propagated gingivally;


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propagated gingivally;

The estimated stresses were lower t

strength of the veneer materials;

Contact damage, fatigue, and proce

veneer lead to chipping of veneering

lithium disilicate and glass-infiltrated


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Fractography: Y-TZP coping veneered with glass-ceramic.Authors: Rodrigo Souza, Susana Salalar-Marocho and Paulo Cesar


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Age: 22 years;

Gender: female;

No parafunctional habits;

Metal post;

Luting cement: U100 (3M)

Lifetime: 1 year;

Slow cooling;

Y-TZP Coping: Lava (3M); Veneering ceram: Emax Ce


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Origin is here (occlusal).


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Arrest lines indicate direction of crack propagation.


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Roughness of occlusal s


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Multiple damage.

Wear of the

Area without loss of glazelayer (but a bit porous)


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Multiple hack


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Origin


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Conclusion

Origin on occlusal surface;

Relationship with cumulative damage on

Delamination was observed;

Problem with coping design.


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Cour


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Cour


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Cour


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Fracture rates (%) of the venering porcelain applied over Y-TZP in clinica

Study Year %Fracture

Larsson 2013 88.9

Beuer 2010 7

Tinschert 2008

Continued...


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Koenig et al., 2007

Larsson 2013 88.9

Rinke 2013 28.8

Zembic 2012 0

Ortorp 2012 3Vigolo 2012 7.7

Lops 2013 10.8

Burke 2013 24.2

Sailer 2007 15

Schmitter 2012 26.7

Schmitt 2012 28Molin 2008 0

Sagirkaya 2012 0.9

Pelaez 2012 10

Salido 2012 29.1

Rinke 2013 5

Sailer 2009 33

Edelhoff 2008 9Beuer 2009

Schmitt 2010 5

Papaspyridakos 2012 31

Raigrodski 2006 2

Pospiech 2003 2

Esquivel-Upshaw 2013 16

Tsumita 2010 14Cehreli 2009

Ohlmann 2012 2

Bornemann 2003 3

Ohlmann 2008 1

Larsson 2006 5


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grade 1 = small chip that does not demand any action, except polishing.

grade 2 = moderate chip that can be repaired.

grade 3 = large chip that leads to replacement of the prosthesis.


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Heintz

Technologies to overcome the problem of c


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Pressing the veneering ceramic over Y-TZP

CAD-on system

Rapid layer technique

Pressing the veneering ceramic over Y-TZP


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http://sayakaattitude.blogspot.com/2011/07/ema


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A


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A


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A


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Sintered

Sintered

+Fibers

Hot-pressed

Ho

Flexural strength(MPa)

51.3 4.9c 65.2 4.4b 67.1 7.9b 76

A

Sintered Sintered + Fibers


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Hot-Pressed Hot-Pressed + Fibers

A


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CAD-on system


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Source: w


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http://www.v

1 2


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3 4

http://www.vita-zahnfa


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1.2.1. Clinical failures

Fractures

FPDs


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Zhang et al., 20

FPDs

Zhang et al., 2014

Fractures

FPDs


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Borba et al., 2015, a


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FRACTURE ORIGIN AT THE INTERFACE(ALUMINA + VM7)


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Borb

Dent Mater. 2008 Aug;24(8):1077-82


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Primary fractures in clinically fa

FPDs initiated from the veneer su


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Interfacial delamination in glascore bilayer dental ceramic stru

the secondary fracture initiation

stresses in Y-TZP-based fixed par


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Proper treatment planning is needed to ensure an adequate con

height of 4 mm or more on allceramic prostheses made with a

disilicatebased core ceramic.


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1.3. The future

1. Ceramics
http://www.google.com/url?sa=i&rct=j&q=future%20holds&source=images&cd=&cad=rja&docid=e6UDqxli78iPpM&tbnid=MRsH7jgHtrO5QM:&ved=0CAUQjRw&url=http://smpsboston.wordpress.com/2011/06/07/what-the-future-holds-for-the-industry/&ei=TG4SUo3uBtPh4AOp14CYDw&psig=AFQjCNFPXRACyd2DHkB_bQT2hdLbhk4VlQ&ust=1377025954849791http://www.google.com/url?sa=i&rct=j&q=future%20holds&source=images&cd=&cad=rja&docid=e6UDqxli78iPpM&tbnid=MRsH7jgHtrO5QM:&ved=0CAUQjRw&url=http://smpsboston.wordpress.com/2011/06/07/what-the-future-holds-for-the-industry/&ei=TG4SUo3uBtPh4AOp14CYDw&psig=AFQjCNFPXRACyd2DHkB_bQT2hdLbhk4VlQ&ust=1377025954849791


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Monolithic zirconia

Lithium silicate with zirconia particles

Interpenetrating ceramic-resin composite network

Monolithic zirconia (Lava Plus, 3M)


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Edmara Berga

Advisor: Altair


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Edmara Berga

Advisor: Altair

O

N

T

R

O

L


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G

D

Edmara Berga

Advisor: Altair


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Edmara Berga

Advisor: Altair

Lithium silicate with zirconia particles (Suprinity, Vita)


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Nathlia Carvalho, Master Thesis, 2014

Advisor: Renata Melo (UNESP/Brazil)

Interpenetrating ceramic-resin composite network (Enamic, Vita)


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Nathlia Carvalho, Master Thesis, 2014

Advisor: Renata Melo (UNESP/Brazil)


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Denry

Monolithic Y-TZ Lithium silicate (Suprinity)


2. Surface treatments


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Acid etching

Silanes

Sandblasting with aluminaparticles

Sandblasting with aluminaparticlescovered with silica (Tribo-ch Ceramic primers

Acid etching Hidrofluoric acid HF)

Micromechanical bonding between ceramic and adhesive/resin cemen


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1 2

Silane

Bi-functional molecule(bondsto silicaand resin composites)

It isused in association with HForTribo-chemical treatment

Brands: Monobond-s (IvoclarVivadent), Prosil (FGM),Silane (Ultradent).


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Sandblasting with alumina particles

Parameters:


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Particle size:50to 150m

Pressure:2.8bar

Time:10s

Distance:10mm

Que

Bond strength between resin cement and Y-TZP



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Am

Creation of critical flawsv sus compressive layer Y-TZP)



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Zha

3M ESPE

Compression layer

Sandblasting with alumina particles covered wit


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Impacton thesurfaceat high v

Formationof silica layer.

Chemical bondsbetween silica

3M ESPE

Brands:

Rocatec Plus (particlesof 110m)



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Cojet orRocatec Soft (particlesof 30m)

Bond strength between resin cement and Y-TZP



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0

5

10

15

20

25

30

controle envelhecido controle envelhecido

Jateamento Silicatizao

Bondstrength(MPa)

Aged

Sandblasting Alumina+ silica

Control ControlAged

Primers for ceramic materials

Phosphate-based monomers(MDP,VBATDT)

Chemical bondsbetween metallicoxides (e.g.,ZrO2) and resin cement.


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Brands:

Metal/ZirconiaPrimer (Ivoclar Vivadent),Porcelain Primer (Bisco),

Clearfil Ceramic Primer (Kuraray).

Bond strength between resin cement and Y-TZP after therm


6

Koizumi et al., 2012


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0

1

2

3

4

5

6

Sem TC Com TC

MZ Primer + Multilink

Bondstrength(MPa

)

Control Aged

Best results were seen when primers are associated to other surfac

Y-TZP-after Cojet



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Tanaka et al., 2008

35

51

35

48

SILANO SILANO+MDP SILANO SILANO+MDP

CONTROLE ENVELHECIDO

Bon

dstrength

(MPa

)

Control Aged

Silane SilaneSilane + MDP Silane+ MDP


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Porcelains and Glass-ceramics

HF + S

Ceramic group Time

HF concentration: 8 to 10%


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Glass-ceramics

(lithium disilicate)20 to 30 s

Porcelains 1 to 2 min

Glass-ceramics

(leucite)1 min


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2.3. The future

2. Surface treaments


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Glaze layer on the internal surface of Y-TZP crowns

Internal glaze layer

Application of glaze layer on theinternal surfaceof Y-TZP crowns.

Makesthesurfacesusceptibleto HF


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Vanderlei et al.,

glazespray glazepowder/liquid H

Internal glaze layer


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Glaze

Vanderlei et al., 2013


3. Cements


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Resin modified GICs

Resin cements:

Conventional

Conventional + self-etching primer

Self-adhesives

Zinc phosphate Conventional glass-ionomer cements (GIC)

Resin modified GICs

Fluoride release and control of setting time

Brands: RelyX Luting 2 ou Plus Automix (3M ESPE)


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Resin cements

Conventional +

Self etching primer

onventional

Self-adhes


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Photo-activated

Dual Dual Dual

Chemically

activated

Chemically

activated

Resin Cements

Conventional +

Self etching primer

onventional

Self-adhes


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acid + primer + bond

cement cement

Self-etching primer

cement

Conventional resin cement

Photo-cured

Less quantity of amines (chemical activators) = better color stability

Brands: RelyXVeneer (3M ESPE) e VariolinkVeneer (Ivoclar)


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Conventional resin cement

Dual

Stable bond strength to dental tissues: interaction with the best adhesive s

Brands: RelyXARC (3M ESPE), Variolink II (Ivoclar) and EnForce (Dentsply)


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Resin Cements

Conventional +

Self etching primer

onventional

Self-adhes


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cement cement

Self-etching primer

cement

Conventional resin cement+ Self-etching primer

Dual

Brands: PanaviaF 2.0 (Kuraray) e Multilink (Ivoclar)


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MDP:

10-methacryloxydecyl dihydrogen

MDP


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Resin

composite

Resin Cements

Conventional +

Self etching primer

onventional

Self-adhes


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cement cement

Self-etching primer

cement

Self-adhesive cements

Dual

One step, less technique sensitive.

Brands: U200 (3M ESPE), SmartCem 2 (Dentsply) and Panavia SA (Kuraray)


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De Muncket al., 2004

Unicem 3M ESPE)

U200 3M ESP


3. Cements

A di h b


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According to the substrate:

Metal cores

Resin composites (fiber posts)

Tooth substrate

3.2. O material de escolha

3. Cimentos


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Resin composites Metal Tooth

Glass-ceramic crowns

Polycrystalline crowns

Thin Veneers, Inlays, Onlaysof porcelain or g

Thick Crowns, Inlays e Onlaysof porcelain or


Metal cores

Conventional resin ce

Self-etching primer M

Self-adhesive

Glass-ceramic crown


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Conventional resin cement+

Self-etching primer (MDP)

Chemical bond to metallic oxides of the post

Good hybrid layer on remaining dentin tissue

Self-adhesive

Easy to use

Less technique sensitive


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Substrate resin composite or tooth

Thin Veneers, Inlays, Onlaysof

porcelain or glass-ceramic

Conventional re

activated only.

11


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0

1

2

3

Rely X ARC Variolink II Rely X Veneer Variolink Veneer Filtek Flow

DUAL S FOTO FLOW

Colorchange(DeltaE,

Lab)

Color change as a function of the cement

Archegasetal.,2011

Photo-cured only.

Thick Crowns, Inlays e Onlays of

porcelain or glass-ceramic

Conentional resin ceme

Self-adhesive small area



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Luhrs et al., 2010


Synergic effect of Coje



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Conventional resin cement +

Self-etchng primer MDP)

*Additional acid etching of enamel with

phosphoric acid is necessary

Y-TZ

Silane

Synergic effect of Cojet + silane + MDP

1 Cojet


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Y-TZ

Y-T

1.Cojet

2.Silaneapplication

3.Ceramicprimer

3.3. The future

3. Cements


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Universal adhesives

3

Universal adhesives

Dual resin cement+ Universal adhesive

Indicated for all materials


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Cojet Scotchbond Universal

RelyX Ult1

23

acid/primer/adhesive + silane + MDP)

500

600

700

800

Lava Zirconia Crown Retention to Human Tooth

Detachment Load (N) after Thermocycling and Fatigue


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3M 2011. All Rights Reserved.

0

100

200

300

400

Multilink Automix Panavia F2.0 RelyX Ultimate

Burgess et al, Retention of zirconia crowns bonded with adhesive resin cements, AADR 2012, Abstract

App:QR Code Reader

App Store


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Google Play Store

[email protected]

prof. paulo cesar's lecture at nova southeastern in jan 2015

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