PURPOSE. The purpose of this study was to evaluate the effect of the zirconia surface architecturing technique (ZSAT) on the bond strength between veneering porcelain and zirconia ceramic. MATERIALS AND METHODS. 20 sintered zirconia ceramic specimens were used to determine the optimal surface treatment time, and were randomly divided into 4 groups based on treatment times of 0, 1, 2, and 3 hours. After etching with a special solution, the surface was observed under scanning electron microscope, and then the porcelain was veneered for scratch testing. Sixty 3 mol% yttria-stabilized tetragonal zirconia polycrystal ceramic blocks were used for tensile strength testing; 30 of these blocks were surface treated and the rest were not. Statistical analysis was performed using ANOVA, the Tukey post-hoc test, and independent t-test, and the level of significance was set at ${\alpha}=.05$. RESULTS. The surface treatment of the zirconia using ZSAT increased the surface roughness, and tensile strength test results showed that the ZSAT group significantly increased the bond strength between zirconia and veneering porcelain compared to the untreated group (36 MPa vs. 30 MPa). Optimal etching time was determined to be 2 hours based on the scratch test results. CONCLUSION. ZSAT increases the surface roughness of zirconia, and this might contribute to the increased interfacial bond strength between zirconia and veneering porcelain.

PURPOSE. The purpose of this in vitro study was to evaluate the accuracy of a new implant impression technique using bite impression coping and a dual arch tray. MATERIALS AND METHODS. Two implant fixtures were placed on maxillary left second premolar and first molar area in dentoform model. The model with two fixtures was used as the reference. The impression was divided into 2 groups, n=10 each. In group 1, heavy/light body silicone impression was made with pick up impression copings and open tray. In group 2, putty/light body silicone impression was made with bite impression copings and dual arch tray. The reference model and the master casts with implant scan bodies were scanned by a laboratory scanner. Surface tessellation language (STL) datasets from test groups was superimposed with STL dataset of reference model using inspection software. The three-dimensional deviation between the reference model and impression models was calculated and illustrated as a color-map. Data was analyzed by independent samples T-test of variance at ${\alpha}=.05$. RESULTS. The mean 3D implant deviations of pick up impression group (group 1) and dual arch impression group (group 2) were 0.029 mm and 0.034 mm, respectively. The difference in 3D deviations between groups 1 and 2 was not statistically significant (P=.075). CONCLUSION. Within limitations of this study, the accuracy of implant impression using a bite impression coping and dual arch tray is comparable to that of conventional pick-up impression.

PURPOSE. The purpose of this in vitro study was to evaluate the effect of abrasive toothbrushing on the surface properties of monolithic computer-assisted design and computer-assisted manufacturing (CAD/CAM) materials stored in food-simulating liquids (FSLs). MATERIALS AND METHODS. Fourty-eight disk-shaped test specimens of each material (Paradigm MZ100/PMZ, Lava Ultimate/LU, Vita Enamic/VE, and Vita Mark II/VMII) with a diameter of 10.0 mm and a thickness of $3.0{\pm}0.05mm$ were prepared. Specimens were divided into 4 subgroups (n=12) and stored in air, distilled water, 0.02 M citric acid, or 75% ethanol/water solution for 7 days at $36.5^{\circ}C$. Then, the specimens were brushed in a multi-station brushing machine under a vertical load of 2.0 N for 3 hours. Surface gloss (GU), roughness (Ra), and hardness (Vickers [VHN]) were measured after storage and brushing simulation. The data sets were statistically analyzed with 2 and 3-way ANOVAs followed by the Tukey's post-hoc comparisons (${\alpha}=.05$). RESULTS. Statistically significant difference was found among the materials concerning the results of surface properties. VMII showed the highest VHN, while PMZ produced the lowest. Storage in FSLs significantly affected the VHN of PMZ and LU. VMII showed the lowest Ra and highest GU irrespective of FSLs and of abrasive toothbrushing. VE, LU, and PMZ produced significant decrease in GU and increase in Ra after toothbrushing. CONCLUSION. Surface properties of monolithic CAD/CAM restorative materials were differently affected by the storage media and abrasive toothbrushing.

PURPOSE. The aim of this clinical study was to assess the accuracy of the implants placed using a universal digital surgical guide. MATERIALS AND METHODS. Among 17 patients, 28 posterior implants were included in this study. The digital image of the soft tissue acquired from cast scan and hard tissue from CBCT have been superimposed and planned the location, length, diameter of the implant fixture. Then digital surgical guides were created using 3D printer. Each of angle deviations, coronal, apical, depth deviations of planned and actually placed implants were calculated using CBCT scans and casts. To compare implant positioning errors by CBCT scans and plaster casts, data were analyzed with independent samples t-test. RESULTS. The results of the implant positioning errors calculated by CBCT and casts were as follows. The means for CBCT analyses were: angle deviation: $4.74{\pm}2.06^{\circ}$, coronal deviation: $1.37{\pm}0.80mm$, and apical deviation: $1.77{\pm}0.86mm$. The means for cast analyses were: angle deviation: $2.43{\pm}1.13^{\circ}$, coronal deviation: $0.82{\pm}0.44mm$, apical deviation: $1.19{\pm}0.46mm$, and depth deviation: $0.03{\pm}0.65mm$. There were statistically significant differences between the deviations of CBCT scans and cast. CONCLUSION. The model analysis showed lower deviation value comparing the CBCT analysis. The angle and length deviation value of the universal digital guide stent were accepted clinically.

PURPOSE. Conventional resin-bonded fixed partial dentures (RBFPDs) are usually made with a two-retainer design. Unlike conventional RBFPDs, cantilever resin-bonded fixed partial dentures (Cantilever RBFPDs) are, for their part, made with a single-retainer design. The aim of this study was to compare the effect of tooth surface preparation on the bond strength of zirconia cantilever single-retainer RBFPDs. The objective is to evaluate the shear bond strength of these single-retainer RBFPDs bonded on 3 different amount of tooth surface preparation. MATERIALS AND METHODS. Thirty extracted bovine incisors were categorized to 3 groups (n=10), with different amounts of tooth surface preparations. Teeth were restored with single-retainer RBFPDs with different retainer surfaces: large retainer of $32mm^2$; medium retainer of $22mm^2$; no retainer and only a proximal connecting box of $12mm^2$. All RBFPDs were made of zirconia and were bonded using an adhesive system without adhesive capacity. Shear forces were applied to these restorations until debonding. RESULTS. Mean shear bond strength values for the groups I, II, and II were $2.39{\pm}0.53MPa$, $3.13{\pm}0.69MPa$, and $5.40{\pm}0.96MPa$, respectively. Statistical analyses were performed using a one-way ANOVA test with Bonferroni post-hoc test, at a significance level of 0.001. Failure modes were observed and showed a 100% adhesive fracture. CONCLUSION. It can be concluded that the preparation of large tooth surface preparation might be irrelevant. For zirconia single-retainer RBFPD, only the preparation of a proximal connecting box seems to be a reliable and minimally invasive approach. The differences are statistically significant.

PURPOSE. To assess the degree of conversion (DC) and light irradiance delivered to light-cured and dual-cured cements by application of different light sources through various types of monolithic computer-aided design and computer-aided manufacturing (CAD/CAM) materials. MATERIALS AND METHODS. RelyX Ultimate Clicker light-cured and dual-cured resin cement specimens with 1.5-mm thicknesses (n=300, 10/group), were placed under four types of crystalline core structure (Vita Enamic, Vita Suprinity, GC Ceresmart, Degudent Prettau Anterior). The specimens were irradiated for 40 seconds with an LED Soft-Start or pulse-delay unit or 20 seconds with a QTH unit. DC ratios were determined by using Fourier transform infrared spectroscopy (FTIR) after curing the specimen at 1 day and 1 month. The data were analyzed using the Mann-Whitney U test (for paired comparison) and the Kruskal-Wallis H test (for multiple comparison), with a significance level of P<.05. RESULTS. DC values were the highest for RelyX Ultimate Clicker light-cure specimens polymerized with the LED Soft-Start unit. The combination of the Vita Suprinity disc and RelyX Ultimate Clicker dual-cure resin cement yielded significantly higher values at both timepoints with all light units (all, P<.05). CONCLUSION. Within the limitations of this study, we conclude that the DC of RelyX Ultimate Clicker dual-cure resin cement was improved significantly by the use of Vita Suprinity and the LED Soft-Start light unit. We strongly recommend the combined use of an LED light unit and dual-cure luting cement for monolithic ceramic restorations.

PURPOSE. To investigate the fatigue and fracture resistance of computer-aided design and computer-aided manufacturing (CAD/CAM) ceramic molar crowns on dental implants and human teeth. MATERIALS AND METHODS. Molar crowns (n=48; n=8/group) were fabricated of a lithium-disilicate-strengthened lithium aluminosilicate glass ceramic (N). Surfaces were polished (P) or glazed (G). Crowns were tested on human teeth (T) and implant-abutment analogues (I) simulating a chairside (C, crown bonded to abutment) or labside (L, screw channel) procedure for implant groups. Polished/glazed lithium disilicate (E) crowns (n=16) served as reference. Combined thermal cycling and mechanical loading (TC: $3000{\times}5^{\circ}C/3000{\times}55^{\circ}C$; ML: $1.2{\time}10^6$ cycles, 50 N) with antagonistic human molars (groups T) and steatite spheres (groups I) was performed under a chewing simulator. TCML crowns were then analyzed for failures (optical microscopy, SEM) and fracture force was determined. Data were statistically analyzed (Kolmogorow-Smirnov, one-way-ANOVA, post-hoc Bonferroni, ${\alpha}=.05$). RESULTS. All crowns survived TCML and showed small traces of wear. In human teeth groups, fracture forces of N crowns varied between $1214{\pm}293N$ (NPT) and $1324{\pm}498N$ (NGT), differing significantly ($P{\leq}.003$) from the polished reference EPT ($2044{\pm}302N$). Fracture forces in implant groups varied between $934{\pm}154N$ (NGI_L) and $1782{\pm}153N$ (NPI_C), providing higher values for the respective chairside crowns. Differences between polishing and glazing were not significant ($P{\geq}.066$) between crowns of identical materials and abutment support. CONCLUSION. Fracture resistance was influenced by the ceramic material, and partly by the tooth or implant situation and the clinical procedure (chairside/labside). Type of surface finish (polishing/glazing) had no significant influence. Clinical survival of the new glass ceramic may be comparable to lithium disilicate.

PURPOSE. Plasma activation of hydrophobic zirconia surfaces might be suitable to improve the bond strength of luting materials. The aim of this study was to analyze the influence of nonthermal argon-plasma on the shear bond strength (SBS) between zirconia and different combinations of 10-MDP adhesive systems and luting composites after artificial aging. MATERIALS AND METHODS. Two hundred forty Y-TZP specimens were ground automatically with $165{\mu}m$ grit and water cooling. Half of the specimens received surface activation with nonthermal argon-plasma. The specimens were evenly distributed into three groups according to the adhesive systems ([Futurabond U, Futurabond M, Futurabond M + DCA], VOCO GmbH, Germany, Cuxhaven) and into further two subgroups according to the luting materials ([Bifix SE, Bifix QM], VOCO GmbH). Each specimen underwent artificial aging by thermocycling and water storage. SBS was measured in a universal testing machine. Statistical analysis was performed using ANOVA and $Scheff{\grave{e}}$ procedure with the level of significance set to 0.05. RESULTS. Surface activation with nonthermal plasma did not improve the bond strength between zirconia and the tested combinations of adhesive systems and luting materials. The plasma-activation trended to reveal higher bond strength if the self-etch luting material (Bifix SE) was used, irrespective of the adhesive system. CONCLUSION. Plasma-activation seems to be suitable to improve bond strength between zirconia and self-etch resin materials. However, further research is necessary to identify the influence of varying plasma-parameters.

PURPOSE. Fractures, occlusal adjustments, or marginal corrections after removing excess composite cements result in rough surfaces of all-ceramic FPDs. These have to be polished to prevent damage of the surrounding tissues. The aim of this study was to evaluate the roughness of zirconia, silicate-ceramic, and composite after polish with different systems for intraoral use. MATERIALS AND METHODS. Each set of 50 plates was made of zirconia, silicate-ceramic, and composite. All plates were ground automatically and were divided into 15 groups according to the treatment. Groups Zgrit, Sgrit, and Cgrit received no further treatment. Groups Zlab and Slab received glaze-baking, and group Clab was polished with a polishing device. In the experimental groups Zv, Sv, Cv, Zk, Sk, Ck, Zb, Sb, and Cb, the specimens were polished with ceramic-polishing systems "v", "k", and "b" for intraoral use. Roughness was measured using profilometry. Statistical analysis was performed with ANOVA and $Scheff{\acute{e}}$-procedure with the level of significance set at P=.05. RESULTS. All systems reduced the roughness of zirconia, but the differences from the controls Zgrit and Zlab were not statistically significant (P>.907). Roughness of silicate ceramic was reduced only in group Sv, but it did not differ significantly from both controls (P>.580). Groups Cv, Ck, and Cb had a significantly rougher surface than that of group Clab (P<.003). CONCLUSION. Ceramic materials can be polished with the tested systems. Polishing of interface areas between ceramic and composite material should be performed with polishing systems for zirconia first, followed by systems for veneering materials and for composite materials.

PURPOSE. The purpose of this study was to compare the cutting method and the lamination method to investigate whether the CAD data of the proposed inlay shape are machined correctly. MATERIALS AND METHODS. The Mesial-Occlusal shape of the inlay was modeled by changing the stereolithography (STL). Each group used SLS (metal powder) or SLA (photocurable resin) in the additive method, and wax or zirconia in the subtractive method (n=10 per group, total n=40). Three-dimensional (3D) analysis program (Geomagic Control X inspection software; 3D systems) was used for the alignment and analysis. The root mean square (RMS) in the 2D plane state was measured within $50{\mu}m$ radius of eight comparison measuring points (CMP). Differences were analyzed using one-way analysis of variance and post-hoc Tukey's test were used (${\alpha}=.05$). RESULTS. There was a significant difference in RMS only in SLA and SLS of 2D section (P<.05). In CMP mean, CMP 4 ($-5.3{\pm}46.7{\mu}m$) had a value closest to 0, while CMP 6 ($20.1{\pm}42.4{\mu}m$) and CMP 1 ($-89.2{\pm}61.4{\mu}m$) had the greatest positive value and the greatest negative value, respectively. CONCLUSION. Since the errors obtained from the study do not exceed the clinically acceptable values, the lamination method and the cutting method can be used clinically.

PURPOSE. To evaluate the reproducibility of scan-based abutments using a blue light model scanner. MATERIALS AND METHODS. A wax cast abutment die was fabricated, and a silicone impression was prepared using a silicone material. Nine study dies were constructed using the prepared duplicable silicone, and the first was used as a reference. These dies were classified into three groups and scanned using a blue light model scanner. The first three-dimensional (3D) data set was obtained by scanning eight dies separately in the first group. The second 3D data set was acquired when four dies were placed together in the scanner and scanned twice in the second group. Finally, the third 3D data set was obtained when eight dies were placed together in the scanner and scanned once. These data were then used to define the data value using third-dimension software. All the data were then analyzed using the non-parametric Kruskal-Wallis H test (${\alpha}=.05$) and the post-hoc Mann-Whitney U-test with Bonferroni's correction (${\alpha}=.017$). RESULTS. The means and standard deviations of the eight dies together were larger than those of the four dies together and of the individual die. Moreover, significant differences were observed among the three groups (P<.05). CONCLUSION. With larger numbers of abutments scanned together, the scan becomes more inaccurate and loses reproducibility. Therefore, scans of smaller numbers of abutments are recommended to ensure better results.