restorative dentistry

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(Sirona Dental Systems). The stylus design had a convex surface and was produced specifically for this study. The wear surface of the styli was designed by ...

Q U I N T E S S E N C E I N T E R N AT I O N A L

RESTORATIVE DENTISTRY Enamel wear opposing different surface conditions of different CAD/CAM ceramics Sheila Pestana Passos, DDS, MSc, PhD1/Anderson P. de Freitas, DDS, MSc, PhD2/Gabriel Iorgovan3/Amin Sami Rizkalla, MSc, PhD4/ Maria Jacinta Coelho Santos, DDS, MSc, PhD5/Gildo Coelho Santos Júnior, DDS, MSc, PhD6

Objective: The aim of this study was to evaluate bovine enamel wear opposed to four different ceramic substrates (CEREC) in the glazed and polished conditions. Method and Materials: Sixty-three ceramic (IPS Empress CAD, Paradigm C, Vitablocs Mark II) and fourteen composite resin (MZ100) styli were prepared. Ceramics were subdivided into three surface conditions (n = 7), unpolished, polished, and glazed, and the composite resin (n = 7) into unpolished and polished. All styli were used as wear antagonists opposing bovine enamel blocks (8 mm × 9 mm) in an oral wear simulator. Wear tests were conducted at 30 N abrasion and 70 N attrition forces applied at 1.7 Hz for 5,000 simulated mastication cycles. Abrasion and attrition wear were evaluated using an automatic profilometer. Statistical analyses were conducted using Tukey’s B rank order test, P = .05. Results: For bovine enamel opposing glazed Vitablocs, abrasion and attrition wear showed a volume loss significantly higher than bovine enamel opposing polished Vitablocs (P < .05). For attrition wear, bovine enamel opposing glazed Vitablocs and untreated Paradigm C showed a volume loss higher than bovine enamel opposing the other ceramic conditions. Conclusion: Abrasion and attrition wear of bovine enamel opposing antagonist ceramic was affected according to the ceramic surface condition and the ceramic material. Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel. In addition, the glaze layer presented as a protection, exhibiting fewer cracks and less loss of material on the ceramic surface. (Quintessence Int 2013;10:743–751; doi: 10.3290/j.qi.a29750)

Key words: abrasion wear, attrition wear, bovine enamel, ceramic antagonist, composite resin antagonist

Gradual wear of teeth is a normal mecha-

sion, abrasion, corrosion, and surface

nism in the human dentition,1 and wear

fatigue, since all of these processes result

occurs when two materials slide against

in degradation of the surface and disparity

each other. Wear can be attributed to adhe-

of opposing occlusal surface materials.2 Several factors are involved in clinical wear,

1

Postdoctoral Fellow, University of Alberta, Edmonton, AB,

such as the abrasive nature of food, chew-

Canada.

ing patterns, parafunctional habits, neuro-

Adjunct Professor, Federal University of Bahia, Salvador, Bahia,

muscular force, and antagonist restorative

Brazil.

material.3,4

2

Undergraduate Student, Schulich School of Medicine and Den-

Restorative materials with different abra-

tistry, The University of Western Ontario, London, ON, Canada.

sive behavior opposing teeth may acceler-

Associate Professor, Schulich School of Medicine & Dentistry,

ate the wear process in comparison with

The University of Western Ontario, London, ON, Canada.

natural dentition.5 It was reported by Oh et

Assistant Professor, Schulich School of Medicine & Dentistry,

al6 that the wear mechanism of enamel

3

4

5

The University of Western Ontario, London, ON, Canada. 6

Associate Professor and Chair, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.

Correspondence: Professor Gildo Coelho Santos Júnior, UWO

opposing ceramic might be more closely related to the ceramic microstructure, the roughness of contacting surfaces, and oral environmental influences. Therefore, there

Schulich School of Medicine & Dentistry, DSB 0147 London, ON,

are difficulties in correlating data from in

Canada. Email: [email protected]

vitro and in vivo studies.7-9

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Abrasion and attrition are two main wear

Modified ceramic systems such as cast-

mechanisms in dental materials.10 Abrasion

able glass-ceramics, CAD/CAM machin-

takes place in normal function in the pres-

able ceramics, and pressable ceramics

ence of a third body, such as food bolus

have been reported to be less abrasive

during mastication, and may occur due to

than conventional porcelains.15,23 There was

tooth brushing as well.

11,12

Attrition results

no agreement with regard to the influence

from the direct contact of opposing teeth

of polishing versus glazing on wear. There-

with increased load level which produces

fore, the purpose of this study was to evalu-

abrasion. During function, in the presence

ate bovine enamel wear when opposed by

of saliva, the action of these two mecha-

three different CAD/CAM ceramic sub-

nisms together promotes changes on the

strates and a composite resin. The specific

antagonist surfaces as a result of the wear

aim was to evaluate in vitro enamel wear of

process.

three

different

surface

conditions

The ideal restorative material possesses

(untreated, polished, and glazed) for each

wear resistance close to the enamel2 and

of the three ceramic substrates, and two

minimum abrasiveness. There are several in

different surface conditions (untreated and

vivo and in vitro studies of durability, wear

polished) for the composite resin substrate.

resistance, and the abrasive property of

The hypotheses were that (1) the enamel

porcelain when opposing human enamel or

wear would show no difference between

other dental restorative materials.13-23 These

different surface conditions of the compos-

investigations reported that dental porcelain

ite resin antagonist, (2) the enamel wear

has been described to be wear resistant

would show difference among different sur-

against opposing restorative materials and

face conditions of the ceramic antagonist,

enamel. Improvements in adhesive den-

and (3) the enamel wear would show differ-

tistry have driven the development of new

ence among different ceramic antagonists.

materials designed to be used in anterior and posterior crowns, including blocks to be used with computer-aided design/com-

METHOD AND MATERIALS

puter-assisted manufacture (CAD/CAM) technology. These ceramic materials have

Seventy-seven all-ceramic and composite

been improved in recent years; however,

resin styli were prepared by milling from a

when in contact with natural teeth they may

single design with the CEREC 3D system

cause wear. When porcelain surfaces

(Sirona Dental Systems). The stylus design

oppose enamel, wear resistance and abra-

had a convex surface and was produced

siveness of the porcelain are clinical con-

specifically for this study. The wear surface

cerns once the occlusal patterns should be

of the styli was designed by replication of a

maintained. Surface finishing of ceramic

hemispherical

restorations has been studied to minimize

Twenty-one styli were milled from each of

antagonist enamel wear.17,24

three ceramic materials: IPS Empress CAD

shape

(r = 3.28 mm).

According to Preis et al, 22 porcelain

(Ivoclar Vivadent), Paradigm C (3M ESPE),

showed comparable or lower wear than

and Vitablocs Mark II (Vident). Fourteen

enamel. On the other hand, several investi-

styli were milled from Paradigm MZ100 (3M

gators have demonstrated that, in general,

ESPE) composite resin material. A summary

ceramic substrates cause destructive abra-

of product specifications is shown in

sive wear of enamel.16-18,20,21,23,24 In addition,

Table 1.

the wear of the antagonist depends on the

The ceramic styli were subdivided into

ceramic material as reported by some in

three equal subgroups (n = 7) according to

vivo studies.25-27 Therefore, material charac-

different surface finishing: no treatment,

teristics may contribute to the accelerated

polished, and glazed. Composite resin styli

loss of opposing enamel, such as fracture

were subdivided into only two subgroups

toughness, internal porosities, and surface

(n = 7): no treatment and polished. Polish-

defects.6 Monasky and Taylor5 reported that

ing of the specimen surfaces was per-

rough-ground porcelain surfaces promoted

formed by a single operator, using an

excessive antagonist tooth wear.

OptraFine ceramic polishing system (Ivo-

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Table 1

Description of restorative materials tested

Materials

Material type

ID

Manufacturer

Shade, block size

Paradigm C

Leucite-reinforced glass ceramic

PC

3M ESPE

A3.5, I14

VITA Vitablocs Mark II

Fine-particle feldspar ceramic

V2

Vident

A3C, I14

IPS Empress CAD Multi

Leucite-reinforced glass ceramic

EC

Ivoclar Vivadent

A3.5, C14L

Paradigm MZ100

Composite resin

PM

3M ESPE

A3.5, I14

clar Vivadent), following the manufacturer’s

track. The abrasion and attrition forces put

recommendations: OptraFine F finishers

out by each of the four solenoids were cali-

(light blue) were used with water to smooth

brated with a digital readout force trans-

the ceramic surface. OptraFine P polishers

ducer (Interface). Wear testing was con-

(dark blue) were used with water to polish

ducted

the ceramic surface. Finally the OptraFine

attrition forces applied at 1.7 Hz (1.7

HP high polishing brushes and paste were

Hz = 102 cycles per minute) for 5,000 simu-

used without water to obtain a high luster

lating mastication cycles. Before each test,

gloss on the ceramic surface. Glazing was

3 ml of deionized water were added per

performed by a single operator, following

chamber to help clearing of debris away

the manufacturer’s instructions. All speci-

from the wear interface.

with

30 N

abrasion

and

70 N

mens were placed on the steel styli with

Enamel abrasion and attrition wear

LePage Epoxy Gel Syringe Glue (Henkel

depth measurements were determined

Corp) and fitted into the oral simulator as

using an Automated Profilometer (Proto-

the wear antagonists.

tech). The measurement of each enamel

Seventy-seven enamel specimens were

bovine sample was performed from the

prepared using bovine incisors extracted

noncontact area crossing the contact area

from 18-month-old animals. The extracted

to the noncontact area on the opposite

teeth were cleaned with curettes and stored

side.

in a 0.1% thymol solution at 5°C. Enamel

Data were analyzed statistically using

fragments approximately 8 mm × 9 mm

one-way ANOVA and a Tukey’s B rank

were obtained from the flattest portion of

order test at P = .05.

the facial surface of each incisor and cut

The ceramic samples were cleaned in

with a diamond disk (Isomet 1000, Buehler).

an ultrasonic bath with distilled water for 10

Enamel specimens were mounted with

minutes and then dried with compressed

Triad TruTray light-setting acrylic (Dentsply)

air. The specimens were fixed on an alumi-

into cylindrical polymethyl methacrylate

num stub and sputter coated with a thin

(PMMA) holders designed to fit the oral sim-

Pd-Au layer (80 Å), performed with a spe-

ulator. The enamel surface of the blocks

cific machine (K550X Sputter Coater, Emi-

was then ground flat with water-cooled car-

tech) (time: 1.5 minutes, 15 mA) for scan-

borundum disks (320, 600, and 1200

ning electron microscopy (SEM; S-2600N,

grades of Al2O3 papers; Buehler), and pol-

Hitachi) examination. The ceramic and

ished with felt papers with diamond spray

composite resin surfaces were analyzed

(1 mm; Buehler).

using SEM at contact and noncontact areas

Wear tests were conducted using a fourchamber Oral Wear Simulator (Proto-tech).

and

photomicrographs

recorded

at

1,000× magnification.

This dual-axis chewing simulator combines horizontal and vertical movements to slide an antagonist held by a steel stylus against

RESULTS

a flat specimen along a 5 mm track. The machine uses precision solenoids to pro-

The mean volume loss of the specimens

duce an abrasion force initially, followed by

after abrasion and attrition cycles and the

an attrition force at the endpoint of the

results of comparisons of means are sum-

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marized in Fig 1. After 5,000 loading cycles,

and Figs 3c and 3d), cracks were observed,

bovine enamel opposing all ceramic groups

and the surface topography strongly sug-

showed a volume loss higher than bovine

gests that there has been loss of material.

enamel opposing both composite resins

The surface presented more texture when

untreated and polished. There was no dif-

compared to the areas that were not tested,

ference on abrasion and attrition wear on

mainly for the glazed specimens (Fig 2c)

the

and for the polished composite resin

bovine

enamel

surface

between

untreated and polished composite resins

(Fig 3b). All ceramics showed superficial cracks

(P > .05). Regarding the ceramic materials, the

after testing, similar to those observed in

abrasion wear of bovine enamel opposing

the dental enamel. Loss of material and

Empress CAD and Paradigm C showed no

some cracks were found in some areas,

statistical difference among the different

although these effects were lower than

surface

ceramic.

those found on the untreated specimens.

Regarding the Empress CAD, the attrition

The ceramic materials were not quantita-

wear of bovine enamel showed no statisti-

tively evaluated.

conditions

for

each

cal difference among the different surface conditions. The attrition wear of bovine enamel opposing polished Paradigm C

DISCUSSION

showed statistical difference compared to the untreated condition. The abrasion and

The first hypothesis, that the abrasion and

attrition wear of bovine enamel against

attrition enamel wear would show no differ-

glazed Vitablocs showed a volume loss sig-

ence between the different surface condi-

nificantly higher than bovine enamel oppos-

tions of the composite resin antagonist, was

ing polished Vitablocs (P < .05) and no dif-

validated. The second and third hypothe-

ference was observed comparing glazed

ses, that the abrasion and attrition enamel

Vitablocs to untreated Vitablocs.

wear would show difference among different

Figures 2 and 3 show the SEM images

ceramic surface conditions and different

of a ceramic material and composite resin,

ceramic antagonists were partially accepted,

respectively. After testing (Figs 2d to 2f,

depending on the ceramic material.

MZ100 Untreated

MZ100 Untreated

MZ100 Polished

MZ100 Polished

Paradigm C Polished

Vitablocs Polished

Empress CAD Glazed

Empress CAD Polished

Empress CAD Polished

Empress CAD Glazed

Vitablocs Polished

Paradigm C Polished

Empress CAD Untreated

Empress CAD Untreated

Paradigm C Glazed

Paradigm C Glazed

Paradigm C Untreated

Vitablocs Untreated

Vitablocs Untreated

Vitablocs Glazed

Vitablocs Glazed

Paradigm C Untreated

0

10 20 30 40 50 60 70 80 90 100 110 120 0

Abrasion Wear (μm ± SD)

10 20 30 40 50 60 70 80 90 100 110 120

Attrition Wear (μm ± SD)

Fig 1 Rate of abrasion and attrition for the bovine enamel antagonist against the composite and ceramic materials. Vertical lines indicate insignificant differences.

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Two-body

wear 28,29

three-body

used as a result of direct contact between

wear30,31 are accepted models for in vitro

and

the test material and its antagonist, involv-

wear testing, and both have been reported

ing mixed wear of adhesion, attrition, and

in the literature. The difference between

fatigue.34 Wear of bovine enamel against

them is that three-body wear simulators use

three different ceramics and a composite

some abrasive slurry between the test

resin was tested.

specimen and the antagonist specimen.32,33

There was a large variation among stud-

In the present study, two-body wear was

ies regarding applied force, the used force

a

b

c

d

e

f

Fig 2 Representative SEM images of (a) untreated Vitablocs, (b) polished Vitablocs (polishing marks are visible), and (c) glazed Vitablocs. Representative SEM images of wear area of (d) untreated Vitablocs, (e) polished Vitablocs, (f) and glazed Vitablocs, opposing bovine enamel after 5,000 loading cycles.

a

b

c

Fig 3 Representative SEM images of (a) untreated MZ100, and (b) polished MZ100. Representative SEM images of wear area of (c) untreated MZ100, and (d) polished MZ100, opposing bovine enamel after 5,000 loading cycles.

d

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actuator, the number of cycles, the fre-

porcelain. However, several studies have

quency of cycles, the number of speci-

reported that porcelain against enamel

mens,24 and the simulator settings.35 Differ-

causes more antagonistic wear than zirco-

ences in study designs make it difficult to

nia,37,39,40 which has much higher fracture

compare the data of the present study with

toughness than porcelain. Low wear on the

others on a quantitative level according to

antagonist seems to be correlated with low

the wear of enamel opposing restorative

wear on high-strength substructure ceram-

materials.

ics.

According to the in vivo studies, the

In the present study, the teeth were

enamel wear rate (enamel/enamel and

loaded with 5,000 mastication cycles.

enamel/ceramic) was between 18 and

According to the results, glazed Vitablocs

261 μm.1,19,27,36 The minimum wear rate was

ceramic

attributed to enamel/enamel, which ranged

higher abrasion and attrition wear of bovine

from 18 to 38 μm.1 In the present study, the

enamel antagonist compared to polished

ceramics studied presented low abrasive

Vitablocs ceramic surfaces (Fig 1). Krejci et

wear

approximately

al23 and Heintze et al24 reported that the pol-

100 μm) when opposing bovine enamel.

ished surface of a glass ceramic promoted

This finding could be explained based on

significantly less antagonist wear than the

the fact that several other factors influence

glazed surface. Polishing has been sug-

the complex wear interaction between the

gested as a viable alternative to glazing by

antagonists and opposing substrates in the

several investigators.8,17,21,24,41-43 Further-

(maximum

mean

surfaces

caused

significantly

oral environment. These factors are the

more, reglazing or repeated firing of the

abrasive nature of food, chewing behavior,

surface requires additional time and may

parafunctional habits and neuromuscular

also lead to devitrification, resulting in

forces, and the antagonistic material (thick-

esthetic problems.44 It has also been sug-

ness, roughness, and hardness).

3,32,37

gested that the treatment of the ceramic

According to the results of the present

surface, whether it is glazed or polished,

study, different ceramic material with the

may influence only the early stages of the

same surface condition caused different

wear process.24 According to the present

opposing enamel abrasion wear. The three

study, the wear rate of enamel depends on

ceramic materials significantly differed in all

the texture and surface finish of the oppos-

of the physical and mechanical proper-

ing restoration. Aggressive wear of the

ties.38 However, such differences only could

opposing enamel by a glazed surface

be observed for the glazed specimens

(especially

except between both glazed leucite-re-

observed. This is likely to be attributable to

inforced glass ceramics (Paradigm C and

the fact that after removing the glaze layer

Empress CAD). This is likely to be attribut-

from

able to the fact that the glaze is removed

ceramic surface exhibits a rough surface

during the wear process, which exposes

once it is usually not polished. This phe-

the ceramic surface under the glaze layer.

nomenon accelerates the enamel wear.

Different ceramic materials affect the wear

Otherwise, no difference was observed on

mechanism, which could be observed

the bovine enamel surface for different

according to the findings of this investiga-

opposing Empress CAD surface conditions.

tion. The abrasion and attrition wear of

Kunzelmann et al45 could not find a sig-

bovine enamel opposing glazed Vitablocs

nificant difference in the wear of the human

the

in

wear

glazed

Vitablocs)

process,

the

was

exposed

were significantly higher compared to

enamel antagonists opposing similar CAD/

glazed Empress CAD. Additionally, glazed

CAM and laboratory-processed ceramic

Vitablocs caused higher antagonist abra-

materials. In the present study, no differ-

sion wear than glazed Paradigm C. This

ence among bovine samples opposing

can be explained based on the fact that

Empress CAD ceramic was observed. How-

Vitablocs is the hardest of the three ceramic

ever, Rosentritt et al 46 reported that the

materials evaluated, and has the lowest

abrasive rate is material-dependent.

fracture toughness.38 For example, more

On the other hand, Schuh et al47 com-

wear was expected from zirconia than from

pared SEM images of glazed and polished

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ceramics after in vitro wear testing, and the glazed surfaces demonstrated fewer cracks and less loss of material than the polished ceramics, indicating that the glazing process provided some surface protection during the time of testing.48 These findings are in accordance with the present study (Figs 2d to 2f), which demonstrated more cracks and more loss of material for untreated and polished ceramics. The images of untreated, polished, and glazed specimens suggest that one of the wear processes involved fatigue as a result of the repeated cycles. The wear processes were characterized by the propagation of the

Fig 4 Anterior view of ceramic crowns on the maxillary arch and natural dentition on the mandibular arch. Note the abrasion caused by the ceramic restorations on the mandibular anterior teeth.

microcracks on the surface and the loss of material (Fig 4). Imai et al25 also claim that after 50,000 cycles the glaze layer on their samples had not yet worn off.18 Thus, it is essential to evaluate the wear

and attrition wear on the bovine enamel surface, for the composite resins studied.

behavior of ceramic restorations opposing

Abrasion and attrition wear of ceramic

natural teeth. The wear process is complex

antagonist influenced the wear of bovine

and is influenced by the surface character-

enamel depending on the ceramic surface

istics of ceramic restorations. Taking the

condition and the ceramic material: the

results of the present study into account

abrasion wear of bovine enamel opposing

and from a clinical point of view, the ade-

Empress CAD and Paradigm C showed no

quate finishing procedure of the ceramic

difference between different surface condi-

restoration surface contributes to minimize

tions for each ceramic. In addition, the

the wear of the tooth antagonist. Addition-

abrasion and attrition wear of bovine

ally, occlusal intraoral restoration adjust-

enamel opposing glazed Vitablocs showed

ments affect the abrasiveness of a ceramic

a volume loss significantly higher than

restoration, which results in high wear of the

bovine enamel opposing polished Vita-

enamel antagonist. For that reason, the

blocs.

repolishing procedure49 is strongly recommended. Nevertheless, clinical studies are still required to test the performance of different

Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel.

ceramic materials in the oral environment

According to the qualitative analysis of

over time. Since ceramic materials undergo

the restorative materials, the glaze layer

constant improvements, new studies are

presented as a protection, exhibiting fewer

needed to evaluate the features of the new

cracks and less loss of material on the

systems.

ceramic surface.

CONCLUSION

REFERENCES

Within the limitations of this in vitro study, the following conclusions were drawn. Abrasion and attrition wear of ceramic antagonist affected the wear of bovine enamel more than composite resin antagonist. The surface conditions (untreated and polished) did not influence the abrasion

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