Apresentacao GBRPI 2015

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

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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)

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