Objective: To carry out a morphometric analysis of small oval root canals prepared with different instruments (part 1) and filled with different sealers (part 2). Method and materials: Ninety extracted mandibular incisors with small oval root canals were instrumented with Self-Adjusting File (n = 45), XP-endo Finisher (n = 15), GentleFile (n = 15), or Reciproc (n = 15). All groups of part 1 were filled with AH Plus (n = 15 each). For part 2 (including group Self-Adjusting File/AH Plus) teeth instrumented with Self-Adjusting File were additionally filled with GuttaFlow Bioseal (n = 15) or Total Fill BC sealer (n = 15). All sealers were placed with a lentulo and filled with master point and additional points. Serial cuts were made at 1-mm intervals up to 10 mm. Total root canal area, percentage of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software. Results: Preparation with Reciproc caused significantly wider canals than with Self-Adjusting File, GentleFile, or XP-endo Finisher, but also resulted in the greatest PGFA and lowest percentage of sealer (P ≤ .05). Following XP-endo Finisher, the significantly greatest percentage of debris (30%) was found 1 mm from the apex (P ≤ .05). Regarding different sealers, only minor differences were found (GuttaFlow Bioseal: less percentage of sealer at 2 and 3 mm levels [P ≤ .05]). Conclusion: Within the limits of this study Reciproc caused the greatest substance loss, but also the most favorable PGFA. The apical debris accumulation with XP-endo Finisher needs further investigation. The sealers under investigation performed equally well. Schlagwörter: GentleFile, GuttaFlow Bioseal, Self-Adjusting File, small oval root canal, Total Fill BC sealer, XP Endo Finisher

Purpose: The present study investigated the influence of simulated intraoral conditions (increased temperature and humidity) on two different surface pretreatment methods to repair a lithium-disilicate glass-ceramic (LDS). Materials and Methods: A total of 540 rectangular lithium-disilicate glass-ceramic bars were manufactured (3 x 7 x 9 mm; IPS e.max CAD, Ivoclar Vivadent). Further specimen preparation was performed in an incubator with controlled relative humidity (RH) and temperature to simulate three different environmental settings: laboratory conditions (LC, n = 180, 23°C, 50% RH), rubber-dam conditions (RC, n = 180, 30°C, 50% RH) or oral conditions (OC, n = 180, 32°C, 95 ± 5% RH). One-third of the bars under each condition (n = 60) were grit blasted (GBL) with alumina (35 µm at 1 bar pressure for 10 s and a working distance of 4 ± 1 cm) and primed (60 s, Monobond Plus, Ivoclar Vivadent). Another third (n = 60) were pretreated with a self-etching glass-ceramic primer (MEP, Monobond Etch & Prime, Ivoclar Vivadent). One group without surface pretreatment (n = 60, NoPT) served as a control. All pretreated surfaces were coated with Heliobond (Ivoclar Vivadent). Two bars from the same pretreatment method were luted perpendicular to each other with a resin composite to form a square adhesion area of 9 mm2 (TetricEvo Ceram, Ivoclar Vivadent), and light cured for 20 s on each side (1200 mW/cm2, Bluephase 20i, Ivoclar Vivadent). All specimens were stored for 24 h in distilled water at 37°C. Half of the specimens from each environmental setting and pretreatment method (n = 15) were thermocycled (TC, 5000 cycles, 5/55°C, 30-s dwell time), and tensile bond strength (TBS) testing was performed for all groups using an x-bar rope-assisted set-up. Data were statistically analyzed using two-way ANOVA (α = 0.05) with Bonferroni adjustment. Results: Regardless of the environmental and storage conditions (24 h or TC), MEP showed a significantly higher mean TBS than GBL. A decrease in TBS was recorded in specimens under OC compared to RC and LC for both pretreatment methods independent of the storage condition. No significant difference in mean TBS was found between RC and LC within the MEP pretreatment group for the 24 h stored and thermocycled specimens. For all MEPs and GBLs, TC reduced the mean TBS in all environmental conditions. The NoPT groups showed no adhesion regardless of environmental or storage conditions. Conclusions: Increased temperature and high humidity significantly reduced TBS. However, MEP was less sensitive to environmental influences than GBL, which makes it a promising candidate for intraoral ceramic repair. These findings suggest that clinical intraoral repair of lithium-disilicate glass-ceramics should be performed using a rubber-dam, primarily when using GBL. Schlagwörter: self-etching glass-ceramic primer, grit blasting, silanization, lithium-disilicate ceramic, tensile bond strength, thermocycling

Adhäsive Teilkronen sind eine optimale Restauration für Kavitäten, die nicht direkt mit Komposit restauriert werden können. Sie sind ästhetisch und vergleichsweise substanzschonend. Noch nie standen so viele unterschiedliche Materialien für eine solche Restauration zur Verfügung. 
Der folgende Beitrag ordnet die Materialien anhand ihrer mechanischen Eigenschaften und Mikrostruktur ein und leitet daraus ab, in welcher klinischen Situation welches Material die beste Option ist und welche Materialien und Möglichkeiten für die klinische Anwendung zur Verfügung stehen. Schlagwörter: Lithiumdisilikatkeramik, Lithiumsilikatkeramik, CAD/CAM-Komposit, Hybridkeramik, Zirkonoxid, adhäsive Teilkrone

Die manuelle Bearbeitung (Schleifen, Sandstrahlen, Polieren) beeinflusst die Konstruktion von Restaurationen. Der Beitrag beschreibt die wichtigsten Problemstellen bei der Bearbeitung gesinterter und ungesinterter Konstruktionen. Dabei sollten Eigenschaften, wie zum Beispiel die Festigkeit, nicht negativ beeinflusst, bestenfalls sogar optimiert werden. Die Bearbeitung von gesinterten Restaurationen mit Schleifwerkzeugen sollte vermieden oder auf ein Minimum reduziert werden, um dadurch Oberflächendefekte zu reduzieren und die Fehlerpopulation gering zu halten. Schlagwörter: Zirkonoxid, Nachbearbeitung, Biegefestigkeit, Rauheit, Bruchzähigkeit

Objectives: The aim of this study was to carry out a morphometric analysis of small oval root canals filled with GuttaFlow 2 sealer (Coltène/Whaledent) using different methods of sealer placement and different root canal filling techniques. Method and materials: Eighty extracted mandibular incisors with small oval root canals were instrumented with the Self-Adjusting File (Redent Nova). GuttaFlow 2 was placed using a lentulo spiral, paper point, master point, or sonically activated CanalBrush (Coltène/Whaledent), followed by the placement of a master point and accessory points (M?P+) (part 1). GuttaFlow 2 was placed using a lentulo spiral without a gutta-percha point, together with a single point, with a chloroform-dipped master point, or the latter with accessory points (ChMP+) (part 2). Serial cuts were made at 1-mm intervals up to 10 mm. The percentages of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software. Results: For part 1 of the study (sealer placement), significant differences regarding PGFA at 2 and 5 mm from the apex were found, whereas for part 2 (filling technique), significant differences were found at all levels besides 2 and 4 mm (Kruskal-Wallis test, P = .05). ChMP+ reached 85% PGFA at 3 mm from the apex, but only 30% near the apex. The MP+ groups showed a relatively equal distribution of PGFA by 60% to 80% at different levels. GuttaFlow 2 without a gutta-percha point exhibited significantly more voids and debris than the other groups (Kruskal-Wallis test, P = .05). Conclusion: Within the limits of this study, MP+ could be recommended for clinical use. The presence of voids and debris for the group without a gutta-percha point needs further investigation. Schlagwörter: CanalBrush, chloroform-softened master point, GuttaFlow, oval root canal, percentage of gutta-percha filled area, Self-Adjusting File

Indirekte CAD/CAM-Komposite entwickeln sich zu einer immer beliebteren Alternative für metallische und auch keramische Restaurationsmaterialien. Leider ist die klinische Datenlage zu dieser Materialklasse äußerst schlecht. Diese Studie setzte sich zum Ziel, die hydrolytischen und die mechanischen Eigenschaften marktüblicher CAD/CAM-Komposite zu erfassen und zu bewerten. Schlagwörter: CAD/CAM, Werkstoffe, Biegefestigkeit, Hydrolyse, Degradation, Weibull-Statistik

Für die Anwendung in der Zahnmedizin wurde die Methode der Fraktografie erweitert und den spezifischen klinischen Belangen angepasst. Ziel dieses Beitrags ist es, die Anwendung und den Nutzen der Fraktografie in der Zahnmedizin am Beispiel einer systematischen, retrospektiven Analyse von annähernd 900 frakturierten Restaurationen aus einem großen deutschen CAD/CAM-Fräszentrum zu verdeutlichen. Schlagwörter: Werkstoffe, CAD/CAM, Keramik, Fraktur, Befestigung, klinische Fraktografie

Purpose: The development of a novel material requires a comprehensive pre-clinical assessment of clinical longevity before any market release. This study aimed to investigate the mechanical performance of a novel self-adhesive restorative material (ASAR MP4). Materials and Methods: Fracture strength (FS), flexural fatigue strength (FFS) and fracture toughness (KIc) were measured for the experimental material ASAR MP4 in self-cure (SC) and light-cure (LC) mode. ASAR MP4 was processed in capsules. Three direct resin composites (CeramX mono+, DentsplySirona; Heliomolar, IvoclarVivadent; Filtek Supreme XTE, 3M) and two glass-ionomer-cement (GIC) based materials (Equia Forte, GC; Fuji II LC, GC) were selected for comparison with ASAR MP4. FS specimens (n = 15) were tested in a 4-point bending configuration according to ISO 4049 and 9917. FFS specimens (n = 25) were additionally stressed for 104 loading cycles using the staircase approach. The single-edge-notch beam (SENB) configuration was selected for determining KIc according to ISO 13586. All specimens were stored for 14 days at 37°C. Data were analyzed using Weibull statistics (FS), ANOVA (FS, KIc), and the non-parametric Mann-Whitney U-test (FFS). Results: The FS, FFS and KIc data of the ASAR MP4 material reveal a mechanical performance in the range of the successful permanent direct resin composites CeramX mono+ and Heliomolar. The results for ASAR MP4 in SC mode were superior to the LC mode. A fine-grained and pore-free microstructure was observed. Conclusion: Within the limitations of this study we conclude that the novel self-adhesive restorative material ASAR MP4 exhibits mechanical performance close to that of the resin composites Heliomolar and CeramX mono+, both indicated for permanent use in the load-bearing posterior region. Processing the material in either self-cure or light-cure mode led to superior performance over glass-ionomer cements. Schlagwörter: flexural strength, cyclic fatigue, fracture toughness, self-adhesion, resin composite, glass-ionomer cement

Purpose: To investigate the tensile bond strength of silane-containing universal adhesives and self-etch glass-ceramic primer to lithium disilicate glass ceramics (LS2). Materials and Methods: 960 rectangular LS2 bars (7 mm x 3 mm x 9 mm, IPS e.max CAD, Ivoclar Vivadent) were manufactured and divided into 4 groups (n = 240). Group 1 was etched with ~5% hydrofluoric acid (HF) for 20 s (VITA Ceramics Etch, Vita Zahnfabrik), group 2 was etched with ~5% HF for 20 s and silanized (ESPE Sil, 3M Oral Care), group 3 was pre-treated with a self-etching glass-ceramic primer (Monobond Etch & Prime, Ivoclar Vivadent, and group 4 received no pre-treatment. Three universal adhesives (iBOND Universal, Heraeus Kulzer; Scotchbond Universal Adhesive, 3M Oral Care; Futurabond U, Voco) were applied to the differently pre-treated surfaces, with Heliobond (Ivoclar Vivadent) serving as control. The bars from each group were paired and luted perpendicularly, forming a square bonded area of 9 mm2, using Variolink II (Ivoclar Vivadent) with a constant pressure of 10 N, followed by light curing (40 s at 800 mW/cm2, Elipar Trilight, 3M Oral Care). The resulting specimens were stored for 24 h at 37°C in distilled water. Half of the specimens of each group were submitted to tensile bond strength testing, the other half were thermocycled ([TC] 5000 cycles, 5°C/55°C, 30-s dwell time) before testing. Data were analyzed using three-way ANOVA (α = 0.05). Results: Group 2 (HF etched and silanized) and group 3 (self-etching glass-ceramic primer) reached significantly higher mean bond strengths than did groups 1 (only HF etched) and 4 (no pre-treatment). Conclusion: Additional silanization of HF-etched LS2 statistically signficantly improved the tensile bond strength of the silane-containing universal adhesive (Scotchbond Universal). The self-etching glass-ceramic primer Monobond Etch & Prime achieved mean bond strengths that did not differ significantly from HF-etched and silanized specimens. Schlagwörter: silanization, universal adhesive, lithium disilicate ceramic, tensile bond strength, self-etch glass ceramic primer