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      Influence of thickness and incisal extension of indirect veneers on the biomechanical behavior of maxillary canine teeth

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          Abstract

          Objectives

          To analyze the influence of thickness and incisal extension of indirect veneers on the stress and strain generated in maxillary canine teeth.

          Materials and Methods

          A 3-dimensional maxillary canine model was validated with an in vitro strain gauge and exported to computer-assisted engineering software. Materials were considered homogeneous, isotropic, and elastic. Each canine tooth was then subjected to a 0.3 and 0.8 mm reduction on the facial surface, in preparations with and without incisal covering, and restored with a lithium disilicate veneer. A 50 N load was applied at 45° to the long axis of the tooth, on the incisal third of the palatal surface of the crown.

          Results

          The results showed a mean of 218.16 µstrain of stress in the in vitro experiment, and 210.63 µstrain in finite element analysis (FEA). The stress concentration on prepared teeth was higher at the palatal root surface, with a mean value of 11.02 MPa and varying less than 3% between the preparation designs. The veneers concentrated higher stresses at the incisal third of the facial surface, with a mean of 3.88 MPa and a 40% increase in less-thick veneers. The incisal cover generated a new stress concentration area, with values over 48.18 MPa.

          Conclusions

          The mathematical model for a maxillary canine tooth was validated using FEA. The thickness (0.3 or 0.8 mm) and the incisal covering showed no difference for the tooth structure. However, the incisal covering was harmful for the veneer, of which the greatest thickness was beneficial.

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          Most cited references38

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          Clinically relevant approach to failure testing of all-ceramic restorations.

          One common test of single-unit restorations involves applying loads to clinically realistic specimens through spherical indenters, or equivalently, loading curved incisal edges against flat compression platens. As knowledge has become available regarding clinical failure mechanisms and the behavior of in vitro tests, it is possible to constructively question the clinical validity of such failure testing and to move toward developing more relevant test methods. This article reviewed characteristics of the traditional load-to-failure test, contrasted these with characteristics of clinical failure for all-ceramic restorations, and sought to explain the discrepancies. Literature regarding intraoral conditions was reviewed to develop an understanding of how laboratory testing could be revised. Variables considered to be important in simulating clinical conditions were described, along with their recent laboratory evaluation. Traditional fracture tests of single unit all-ceramic prostheses are inappropriate, because they do not create failure mechanisms seen in retrieved clinical specimens. Validated tests are needed to elucidate the role(s) that cement systems, bonding, occlusion, and even metal copings play in the success of fixed prostheses and to make meaningful comparisons possible among novel ceramic and metal substructures. Research over the past 6 years has shown that crack systems mimicking clinical failure can be produced in all-ceramic restorations under appropriate conditions.
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            CAD/CAM Ceramic Restorative Materials for Natural Teeth

            Advances in computer-aided design (CAD) / computer-aided manufacturing (CAM) technologies and their ease of application enabled the development of novel treatment concepts for modern prosthodontics. This recent paradigm shift in fixed prosthodontics from traditional to minimally invasive treatment approaches is evidenced by the clinical long-term success of bonded CAD/CAM glass-ceramic restorations. Today, defect-oriented restorations, such as inlays, onlays, and posterior crowns, are predominately fabricated from glass-ceramics in monolithic application. The variety of CAD/CAM ceramic restorative systems is constantly evolving to meet the increased demands for highly aesthetic, biocompatible, and long-lasting restorations. Recently introduced polymer-infiltrated ceramic network CAD/CAM blocks add innovative treatment options in CAD/CAM chairside 1-visit restorations. The material-specific high-edge stability enables the CAD/CAM machinability of thin restoration margins. Full-contour zirconia restorations are constantly gaining market share at the expense of bilayered systems. Advancements in material science and bonding protocols foster the development of novel material combinations or fabrication techniques of proven high-strength zirconia ceramics. CAD/CAM applications offer a standardized manufacturing process resulting in a reliable, predictable, and economic workflow for individual and complex teeth-supported restorations. More evidence from long-term clinical studies is needed to verify the clinical performance of monolithic polymer-infiltrated ceramic network and zirconia teeth-supported minimally invasive and extensive restorations.
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              Tooth structure removal associated with various preparation designs for anterior teeth.

              The conservation of sound tooth structure helps preserve tooth vitality and reduce postoperative sensitivity. Innovative preparation designs, like those for porcelain laminate veneers, are much less invasive than conventional complete-coverage crown preparations. However, no study has quantified the amount of tooth structure removed during these preparations. The purpose of this study was to quantify and compare the amount of tooth structure removed when various innovative and conventional tooth preparation designs were completed on different teeth. . A new comprehensive tooth preparation design classification system was introduced. Typodont resin teeth representing the maxillary left central incisor, maxillary left canine, and mandibular left central incisor were prepared with the following designs: partial (V1), traditional (V2), extended (V3), and complete (V4) porcelain laminate veneer preparations; resin-bonded retainer preparation with grooves (A1) and with wing/grooves (A2); all-ceramic crown preparation with 0.8 mm axial reduction and tapering chamfer finish line (F1), all-ceramic crown preparation with 1.0 mm axial reduction and rounded shoulder finish line (F2), and metal-ceramic crown with 1.4 mm axial reduction and facial shoulder finish line (F3). After tooth preparations (10 per group), the crown was separated from the root at the CEJ. The removed coronal tooth structure was measured with gravimetric analysis. Means and standard deviations for tooth structure removal with different preparation designs were calculated and analyzed with analysis of variance at a significance level of P<.05. Significant differences in the amount of tooth structure removal were noted between preparation designs. Ceramic veneers and resin-bonded prosthesis retainers were the least invasive preparation designs, removing approximately 3% to 30% of the coronal tooth structure by weight. Approximately 63% to 72% of the coronal tooth structure was removed when teeth were prepared for all-ceramic and metal-ceramic crowns. For a single crown restoration, the tooth structure removal required for an F3 preparation (metal-ceramic crown) was 4.3 times greater than for a V2 preparation (porcelain laminate veneer, facial surface only) and 2.4 times greater than for a V4 preparation (more extensive porcelain laminate veneer). Within the limitations of this study, tooth preparations for porcelain laminate veneers and resin-bonded prostheses required approximately one-quarter to one-half the amount of tooth reduction of conventional complete-coverage crowns.
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                Author and article information

                Journal
                Restor Dent Endod
                Restor Dent Endod
                RDE
                Restorative Dentistry & Endodontics
                The Korean Academy of Conservative Dentistry
                2234-7658
                2234-7666
                November 2018
                12 November 2018
                : 43
                : 4
                : e48
                Affiliations
                Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Institute of Science and Technology, São José dos Campos, SP, Brazil.
                Author notes
                Correspondence to João Paulo Mendes Tribst, DDS. PhD Student, Departament of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Av. Eng. Francisco José Longo, 777 Jardim São Dimas, São José dos Campos, SP, Brazil. joao.tribst@ 123456ict.unesp.br
                Author information
                https://orcid.org/0000-0003-2627-8628
                https://orcid.org/0000-0002-5707-7565
                Article
                10.5395/rde.2018.43.e48
                6237725
                6cab945e-b9f9-44f8-adf2-a4a9e0c06def
                Copyright © 2018. The Korean Academy of Conservative Dentistry

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 July 2018
                : 27 October 2018
                Funding
                Funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo, CrossRef https://doi.org/10.13039/501100001807;
                Award ID: 16/20021-0
                Categories
                Research Article

                dental veneer,finite element analysis,prosthesis design

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