apresentacao gbrpi 2015
DESCRIPTION
Apresentacao GBRPI 2015TRANSCRIPT
Universidade de São PauloFaculdade de OdontologiaDepartmento de Biomateriais e Biologia Oral
Prof. Paulo Francisco Cesar
Análise de falha e previsão de tempo de vida de próteses totalmente cerâmicas
1. What are the options?
2. Material of choice
3. Clinical failures
4. The future
Outline:
1. What are the options?
1. What are the options?
Porcelains
Glass-ceramics
Glass-infiltrated composites
Polycrystalline ceramics
Brands
VM7, VM9, VM13 (Vita), d.Sign (Ivoclar), Super-PorcelainEX-3/Cerabien (Noritake), Duceram Kiss (Degudent).
E.Max Sistem: leucite or lithium disilicate (Ivoclar).
In-Ceram Sistem from Vita (Al, Zr, Spinell).
In-Ceram2000 (Vita), Lava (3M), Cercon (DeguDent), Everest (Kavo), Zeno (Wiedland).
1. What are the options?
Porcelains
Glass-ceramics
Glass-infiltrated composites
Polycrystalline ceramics
Porcelains
Borba, 2010
Porcelains
1 2 3
4 5 6
Alberto Calazans
Glass-ceramics (leucite or lithium disilicate)
1 2
3 4 5
Gonzaga, 2007
Glass-infiltrated composite
Polycrystalline
Y-TZP
Alumina
Borba, 2010
1 2 3
4 5 6
a) Leque de opções
b) O material de escolha
c) Novas perspectivas
2. Material of choice
2. Material of choice
Veneers
Inlays /Onlays
Crowns
Fixed partial dentures
Abutments
Large infra-structures for implants
Porcelains or Glass-ceramics Veneers
Dr. Alexandre Cesar
Inlay/Onlay Porcelains or Glass-ceramics
1 2 3 4
5 6
Po
rce
lain
s
1 2 3
4 5
Gla
ss-c
era
mic
s
Crowns
Glass-ceramics (coping+veneering ceramic or monolithic)
High translucency:
1 2 3 4
5 6
Dr. Walter Miranda
cop
ing+
ven
ee
rin
g ce
ram
ic
Glass-ceramics (monolithic)
1 2 3
4 5
Dr. Jamil Shibli
Glass-ceramic (monolithic)
Dr. Jamil Shibli
Glass-ceramic (monolithic)
Dr. Jamil Shibli
Crowns
Low translucency
Y-TZP
Dr.
Ale
xan
dre
Ce
sar
1 2 3
4 5 6
Fixed partial dentures Y-TZP
Cercon/Dentstply
Abutments Y-TZP
Dr. Susanne Scherrer (Univ of Geneva)
Dr. Jamil Shibli
1 2
3 4
Large infra-structures over implants
Lohbauer et al., 2010
Lohbauer et al., 2010
Failed from a stress concentrating zone at the
tip of the zirconia framework (origin);
Crack moved in a downward direction;
A secondary edge chip on the palatal exposed
zirconia framework was incidental and not
related to the final failure.
Lohbauer et al., 2010
Dr. Susanne Scherrer (Univ. of Geneva)
Large infra-structures over implants
Metal
Dr. Alexandre Cesar
1 2
3 4
Large infra-structures over implants
3. Clinical Failures
Dr. Susanne Scherrer
Secondary caries/marginal discoloration/
wear of cement line/ minor edge chippings
Debonding
Fractures
Veneers/Inlay/Onlay/Crowns
Fixed partial dentures (FPDs)
3. Clinical failures
Dr. Susanne Scherrer
Secondary caries/marginal discoloration/wear of cement line/minor edge chippings
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.
Secondary caries/marginal discoloration/wear of cement line/ minor edge chippings
Debonding
Evaluation of Tensile Retention of Y-TZP Crowns Cemented on Resin Composite Cores: Effect
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 of the core
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
2
After 42 months one debonding
occurred in each group;
No effect of resin cement: Panavia 21
versus Multilink.
Zhang et al., 2014
3. Clinical Failures
Fractures
Inlay/Onlay/Crowns
Zhang et al., 2014
Defects on the cementation surface
Thompson et al., 1994Dicor crown in a premolar
Inlay/Onlay/Crown
Zhang et al., 2014
Marginal defects
Quinn et al., 2005Procera crowns (alumina coping + veneering porcelain)
Inlay/Onlay/Crowns
Fractographic Analysis of 13 incisors, 3
premolars and 11 molars;
All fractures initiated in the cervical margin of
the crowns and usually from the proximal
area close to the most coronally placed
curvature of the margin.
Oilo et al., 2014
Cesar, 2012
Cesar, 2012
Zhang et al., 2014
Cone cracks (NO attrition)
Kim et al., 1999
Post-indentation half-surface (top) and section view
(bottom), monolith porcelain specimen (Vita Mark II,
Vita Zahnfabrik) loaded axially in cyclic fatigue. Note
deep-penetrating cone cracks from inner contact zone.
Inlay/Onlay/Crown
Zhang et al., 2009
Cone cracks (NO attrition)
Fardim, 2013
Inlay/Onlay/Crown
Cone crakcs (NO attrition)
Fardim, 2013
Inlay/Onlay/Crown
Cone crakcs (NO attrition)
Fardim, 2013
Inlay/Onlay/Crown
Cone cracks (NO attrition)
Fardim, 2013
Inlay/Onlay/Crown
Zhang et al., 2014
Partial cone cracks (WITH attrition)
Optical micrographs showing(a) surface (top) and side view(bottom) sliding wear track onY-TZP surface caused by WCsphere of radius r=1.5 mmunder normal load of 1000 N.Kim et al., 2008 Kim et al., 2010
Inlay/Onlay/Crowns
Dr.
Ja
mil
Sh
ibli
Inlay/Onlay/Crown
Partial cone cracks (WITH attrition)
In vitroIn vivo
Zhang et al., 2014
Chipping Fracture of the porcelain layer (AllCeram) over
Procera Alumina after 4 years.
Scherrer et al., 2007
Inlay/Onlay/Crown
Scherrer et al., 2007
Porcelain fused to metal fractured after 2 months.
Chipping
Inlay/Onlay/Crown
Courtesy Susanne Scherrer
compression curl
Courtesy Susanne Scherrer
Compression curl
2 blunt contacts
Courtesy Susanne Scherrer
Courtesy Susanne Scherrer
Belli et al., 2014
In the chipping area a small bubble within the
veneering material (size 1 x 0.2 mm) is visible;
The chipping occurred 7 months after insertion
2009 Jun;5(5):1668-77
Koenig et al., 2007
Chipping/incisal edge Chipping/cervical area
Fracture Multiple cracks
Quintessence Int 2014;45:369–376
InCeram Alumina + Veneering porcelain
Critical crack initiated at the incisal contact area and
propagated gingivally;
The estimated stresses were lower than the measured
strength of the veneer materials;
Contact damage, fatigue, and processing flaws within the
veneer lead to chipping of veneering porcelain in anterior
lithium disilicate and glass-infiltrated alumina crowns.
Qian et al., 2014
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 Ceram;
Fractography: Y-TZP coping veneered with glass-ceramic.Authors: Rodrigo Souza, Susana Salalar-Marocho and Paulo Cesar
L
Adhesive fracture (delamination)exposing the Y-TZP coping
B
(Mesial)
Cohesive fracture veneering ceramic
“Arrest lines”
Arrest lines indicate direction of crack propagation.
Origin is here (occlusal).
Roughness of occlusal surface (buccal cusp).
Multiple areas of occlusaldamage.
Wear of the glaze layer.
Area without loss of glaze layer (but a bit porous)
Multiple hackle lines.
Origin
Conclusion
Origin on occlusal surface;
Relationship with cumulative damage on glaze layer;
Delamination was observed;
Problem with coping design.
Courtesy Rodrigo Souza
Courtesy Rodrigo Souza
Courtesy Rodrigo Souza
Koenig et al., 2007
Fracture rates (%) of the venering porcelain applied over Y-TZP in clinical trials
Study Year %Fracture
Larsson 2013 88.9
Rinke 2013 28.8
Zembic 2012 0
Ortorp 2012 3
Vigolo 2012 7.7
Lops 2013 10.8
Burke 2013 24.2
Sailer 2007 15
Schmitter 2012 26.7
Schmitt 2012 28
Molin 2008 0
Sagirkaya 2012 0.9
Pela´ez 2012 10
Salido 2012 29.1
Beuer 2010 7.4
Tinschert 2008 6
Rinke 2013 5.8
Sailer 2009 33.4
Edelhoff 2008 9.5
Beuer 2009 0
Schmitt 2010 5.9
Papaspyridakos 2012 31.3
Raigrodski 2006 25
Pospiech 2003 2.6
Esquivel-Upshaw 2013 16.7
Tsumita 2010 14.3
Cehreli 2009 0
Ohlmann 2012 20
Bornemann 2003 3.3
Ohlmann 2008 13
Larsson 2006 54
Continued...
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.
Heintze & Rousson 2010
Technologies to overcome the problem of chipping
Pressing the veneering ceramic over Y-TZP
CAD-on system
Rapid layer technique
http://sayakaattitude.blogspot.com/2011/07/emax-zirpress-2.html
Pressing the veneering ceramic over Y-TZP
Araújo et al., 2015
Araújo et al., 2015
Araújo et al., 2015
SinteredSintered
+Fibers
Hot-pressed Hot-pressed
+ Fibers
Flexural strength (MPa)
51.3 ± 4.9c 65.2 ± 4.4b 67.1 ± 7.9b 76.5 ± 11.0a
Araújo et al., 2015
Sintered Sintered + Fibers
Hot-Pressed Hot-Pressed + Fibers
Araújo et al., 2015
Sintered: 4.0 ± 1.1b Sintered + Fibers: 10.4 ± 4.5a
Hot-Pressed : 0.3 ± 0.2c Hot-Pressed + Fibers: 2.6 ± 2.4b,c
POROSITY (%)
Araújo et al., 2015
CAD-on system
Source: www.ivoclar.com
Rapid layer techique
http://www.vita-zahnfabrik.com/
http://www.vita-zahnfabrik.com/
1 2
3 4
http://www.vita-zahnfabrik.com/
Zhang et al., 2014
3. Clinical failures
Fractures
FPDs
Zhang et al., 2014
Borba et al., 2015, accepted in Dent Mater
Fractures
FPDs
CC
HL
Fractures
FPDs
Borba et al., 2015, accepted in Dent Mater
FRACTURE ORIGIN AT THE INTERFACE
(ALUMINA + VM7)
Borba, 2010
Dent Mater. 2008 Aug;24(8):1077-82
Primary fractures in clinically failed Y-TZP-based
FPDs initiated from the veneer surfaces.
Interfacial delamination in glass veneer/zirconia
core bilayer dental ceramic structures controlled
the secondary fracture initiation sites and failure
stresses in Y-TZP-based fixed partial dentures.
Taskonak et al., 2008
Proper treatment planning is needed to ensure an adequate connector
height of 4 mm or more on allceramic prostheses made with a lithia
disilicate–based core ceramic.
4. The future
4. The future
Monolithic zirconia
Lithium silicate with zirconia particles
Interpenetrating ceramic-resin composite network
Monolithic zirconia (Lava Plus, 3M)
Edmara Bergamo, Master Thesis, 2015
Advisor: Altair Cury (Unicamp/Brazil)
Edmara Bergamo, Master Thesis, 2015
Advisor: Altair Cury (Unicamp/Brazil)
CO
NT
RO
LA
GE
D
Edmara Bergamo, Master Thesis, 2015
Advisor: Altair Cury (Unicamp/Brazil)
Edmara Bergamo, Master Thesis, 2015
Advisor: Altair Cury (Unicamp/Brazil)
Lithium silicate with zirconia particles (Suprinity, Vita)
Nathália Carvalho, Master Thesis, 2014
Advisor: Renata Melo (UNESP/Brazil)
Source: Vita
Interpenetrating ceramic-resin composite network (Enamic, Vita)
Nathália Carvalho, Master Thesis, 2014
Advisor: Renata Melo (UNESP/Brazil)Source: Vita
Denry & Kelly, 2014
Monolithic Y-TZP Lithium silicate (Suprinity)
