In the modern era of metal-free minimally-invasive dentistry, there is a growing tendency toward using metal-free restorative alternatives that provide not only excellent aesthetics but also enable superior durability. Fibre-reinforced composite (FRC) is one cost-effective alternative that fulfils the requirements of aesthetics and durability, and offers favourable physico-mechanical properties. Many FRC applications are well-documented in the literature, such as crowns and fixed partial dentures (FPD); however, their clinical implementation is still limited, owing to the lack of significant knowledge about their longevity, deterioration signs, optimum design and overall performance. This in-vitro research aimed to address these uncertainties by investigating the performance of FRC restorations, and the influence of fibre reinforcement on particular physcio-mechanical properties, including surface hardness, edge-strength, shear bond strength, fatigue and wear resistance. Basic testing models were used to investigate the effect of incorporating differently-oriented FRCs on the surface hardness, edge-strength and shear bond strength of particulate-reinforced composite (PRC). The results revealed that the incorporation of FRC significantly enhanced surface hardness (by 12 - 19 %) and edge-strength (by 27 -75 %). However, this incorporation significantly reduced the shear bond strength (SBS) between PRC and other restorative materials, including lithium disilicate ceramic (10.9±3.1 MPa) and Co-Cr metal alloy (12.8±2.3 MPa), compared to the control (15.2±3.6 MPa, 15.0±3.7 MPa). The orientation of FRC was also found to affect the efficiency of reinforcement as bidirectional FRCs exhibited significantly higher hardness (76.8±1.2 VHN), edge-strength (67.7±8.2 N) and SBS (14.1±3.9 MPa) values than unidirectional FRCs (72.4±1.2 VHN, 56.8±5.9 N, 9.8±2.3 MPa).Clinically-relevant testing models, employing accelerated aging techniques, were performed to investigate the fatigue and wear behaviours of anatomically-shaped FRC restorations in-vitro. Direct inlay-retained FRC-FPDs with two framework designs, were tested for their fatigue behaviour and load-bearing capacity. Type-I design (with an additional bidirectional FRC layer incorporated perpendicular to the loading direction) yielded significantly higher fatigue resistance (1144.0±270.9 N) and load-bearing capacity (1598.6±361.8) than Type-II design (with a woven FRC embedded around the pontic core) (716.6±72.1 N, 1125.8±278.2 N, respectively). However, Type-19II design exhibited fewer delamination failures. Both framework design and dynamic fatigue were found to have a significant influence (p < 0.05) on the load-bearing capacity of FRC-FPDs. Additionally, the in-vitro fatigue and wear behaviours of FRC crowns, fabricated conventionally from bidirectional FRC and indirect PRC (Sinfony), were compared with those made of two CAD/CAM alternatives, namely Lava Zirconia (LZ) and Lava Ultimate (LU). A chewing simulator was employed to induce some fatigue wear in crowns, while an intraoral 3D scanner was used to quantify the resultant morphological changes. The results showed that FRC crowns had significantly lower mean cumulative wear (233.9±100.4 μm) than LU crowns (348.2±52.0 μm), but higher than LZ crowns (16.4±1.5 μm). The mean load bearing-capacity after fatigue simulation was also the highest for LZ crowns (1997.8±260.2 N) compared with FRC (1386.5±258.4 N) and LU crowns (756.5±290.9 N).Accordingly, the incorporation of FRC in resin-composite restorations is advocated since it increases surface hardness and marginal integrity, improves fatigue and wear behaviours, and enhances load-bearing capacity and overall performance.

Syfte: Syftet med denna studie är att jämföra fraktur styrkan och frakturmönster hos tre-leds broar utförda i litiumdisilikat när broarna tillverkas genom pressteknik jämfört med frästa tre-leds broar genom CAD/CAM system.Hypotes: Pressteknik är bättre lämpad med avseende till fraktur resistens då fräsning av litiumdisilikat block kan resultera i defekter och spänning i materialet, detta gör materialet mer benäget till chipping/mikroabrasioner på ytan som skulle kunna propagera och på så sätt påverka fraktur resistensen. P-värde sattes till p ≤0.05.Material och metod: 40 3-leds broar tillverkades med pressteknik jämfört med fräst teknik med CAD/CAM system i grupper. Dessa delades in i undergrupper baserat på anatomin. Broarna genomgick en artificiell åldringsprocess som utgjordes av termocykling och förbelastning. Efter den artificiella åldringsprocessen utsattes broarna för belastning fram till fraktur. Den statistiska datan samlades in och analyserades. Även fraktur mönstret analyserades. Resultat: Där fanns ingen signifikant skillnad gällande fraktur styrkan mellan de full anatomiska grupperna. Där fanns inte heller någon signifikant skillnad gällande fraktur styrkan mellan underkonstruktion grupperna. Hypotesen falsifieras därför.Slutsats: Där fanns ingen signifikant skillnad gällande hur mycket belastning det krävs för att frakturera broarna som tillverkats genom pressteknik jämfört med broarna tillverkade med hjälp av CAD/CAM teknik. Där finns ett tydligt mönster gällande fraktur mönstret men en slutsats kan inte dras med tanke på antalet broar som använts. / Aim: The aim of this study was to compare fracture load and fracture mode of three-unit fixed partial dentures, made in lithium disilicate when the FDPs are made with pressing technique versus milled with a CAD/CAM system.Hypothesis: Pressing technique is better suited with regards to fracture load since milling of lithium disilicate blocks can result in defects and tension build up in the material, leaving the material more prone to chipping/micro-abrasions on the surface that could propagate and thus affecting the fracture load. P-value set to p ≤0.05.Material and methods: 40 FDPs where manufactured with pressing technique versus milled with a CAD/CAM system in each group. Furthermore, each group where subdivided depending on the anatomy. The FDPs thereafter underwent an artificial ageing process consisting of thermocycling and preloading. After the artificial aging process the FDPs were subjected to load to fracture, where the statistical data was collected and analyzed. Also, the fracture mode was observed and analyzed.Results: There was no significant difference regarding the fracture strength between the full anatomy groups. There was also no significant difference regarding the fracture strength between the core-design groups. The hypothesis was therefore rejected.Conclusion: There is no significant difference with regards to how much load is required to fracture FDPs made through pressing technique compared to FDPs made through the use of CAD/CAM technique. There is a clear pattern regarding the fracture patterns, however a conclusion can’t be drawn considering the sample size.

L’objectif de cette étude était d’évaluer et de comparer la force d’adhésion de deux résines de collage: le ClearfilTM Esthetic Cement & DC Bond Kit (C) et le RelyXTM Unicem (R), sur trois adhérents différents : une surface d’émail, un alliage de métaux non précieux (Np) et un alliage de métaux semi-précieux (Sp). La surface des échantillons des alliages métalliques a subi différents traitements de surface. Sur l’émail (n=15) ainsi que sur les plaquettes d’alliages Np et Sp (n=15), des cylindres de résine étaient appliqués et polymérisés. Suite au processus de collage, les échantillons ont été incubés à 37°C pendant 24 heures, puis ont subi 500 cycles de thermocyclage. Des tests de cisaillement ont été effectués, suivi par l’analyse de la surface des échantillons au microscope à balayage électronique. Une comparaison de type T-test et des comparaisons multiples post hoc, ont été effectuées pour l’analyse statistique (p 0,05). Sur l’émail, les résultats ont démontré que la résine C présentait une force d'adhésion moyenne statistiquement supérieure (33,97±17,18 MPa) à la résine R (10,48±11,23 MPa) (p 0,05). Le type d’alliage utilisé n’influençait pas la force d’adhésion, et ce, peu importe le type de résine de collage (p>0,05). Pour le groupe Sp, la résine C a démontré une adhésion statistiquement supérieure à la résine R, et ce, pour tous les traitements de surface (p 0,05). En conclusion, la résine C a démontré des résultats d’adhésion significativement supérieurs à la résine R sur l’émail ainsi que sur presque toutes les surfaces traitées des alliages de métaux. / The objective of this study was to assess and compare the shear bond strength of two types of resin cements: ClearfilTM Esthetic Cement & DC Bond Kit (C) and RelyXTM Unicem (R) when these resins cements were applied to three different surfaces: enamel, non precious metal alloy (Np) and semi-precious metal alloy (Sp). Both types of alloy surfaces were treated differently. On both enamel (n=15) and alloy plates Np and Sp (n=15) surfaces, cylinder shaped resin cements were bonded and lightpolymerized. After the adhesion process, all samples were placed into an incubator at 37°C for 24 hours and 500 thermal cycles were accomplished. Shear bond strength tests followed by electron microscopy analysis were performed. Statistical analysis was done using a T-test comparison followed by a post hoc multiple comparisons (p 0.05). The results on enamel showed that the C resin cement had a statistically significant higher bond strength (33.97±17.18 MPa) than the R resin cement (10.48±11.23 MPa) (p 0.05). The type of alloy did not influence the bond strength regardless the type of resin cement (p 0.05). For the Sp group, the bond strength was statistically higher for the C resin than for the R resin and those results are valuable for all treated surfaces (p 0.05). To conclude, the C resin cement showed a statistically significant higher bond strength than the R resin cement with enamel and most of the metal alloy treated.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Para reabilitar a ausência de um elemento dentário posterior, as próteses parciais fixas (PPF) com retentores intracoronários são uma alternativa aos implantes osseointegrados. O objetivo deste estudo foi avaliar a distribuição de tensões nessas próteses com três combinações de materiais: cerâmica de zircônia parcialmente estabilizada por ítria (ZPEI) revestida por cerâmica de fluorapatita (&#945;), cerâmica de dissilicato de lítio (&#946;) ou compósito fibrorreforçado (&#947;). Na composição &#945;, foram analisadas a presença ou ausência da cerâmica de revestimento na parede cervical das caixas proximais e três variações na área total da seção transversal dos conectores (4 mm de largura x 3,2, 4,2 ou 5,2 mm de altura). Em 8 modelos bidimensionais de elementos finitos, uma carga vertical de 500 N foi aplicada na fossa central do pôntico e as tensões principais máximas (tração) e mínimas (compressão) foram apontadas em MPa. Inicialmente foram avaliados os 6 modelos com PPF de ZPEI e suas variações. Os maiores valores das tensões de tração foram encontrados no terço cervical dos conectores. Quando presente nestas regiões, a cerâmica de revestimento recebeu tensões acima do limite de sua resistência à flexão. Na comparação entre os modelos sem cerâmica de revestimento na parede cervical das caixas proximais, mesmo aquele com conectores de 3,2 x 4 mm, cuja infraestrutura apresentava 2,5 x 3 mm, poderia ser recomendado para uso clínico. Altos valores de tensões de compressão foram registrados entre o terço oclusal e médio dos conectores, correspondente à união entre as cerâmicas, o que poderia ocasionar, devido à flexão, falhas adesivas. Posteriormente, o modelo de ZPEI com a cerâmica de fluorapatita ausente da parede cervical das caixas proximais e área total dos conectores de 4,2 x 4 mm foi comparado aos dois outros materiais com conectores de mesma área. Na PPF de dissilicato de lítio, os valores representaram uma provável violação do limite de sua resistência à flexão. A PPF de compósito fibrorreforçado apresentou tensões bem abaixo do limite de resistência à flexão de sua infraestrutura, mas, como no modelo de ZPEI, tensões compressivas se concentraram com alto valor entre o terço oclusal e médio dos conectores, local de união entre a resina composta e a infraestrutura de fibras. Os resultados mostraram que a cerâmica de dissilicato de lítio e a presença da cerâmica de fluorapatita na parede cervical das caixas proximais deveriam ser contraindicadas para a condição proposta. Parece viável uma área de conectores na infraestrutura de ZPEI com no mínimo 2,5 x 3 mm. A PPF de compósito fibrorreforçado apresenta resistência estrutural para a situação estudada, mas, como também aquelas compostas de ZPEI, aparenta ter como pontos fracos a adesão entre a infraestrutura e o material de cobertura e a própria resistência deste último. / Inlay-retained fixed partial dentures (IRFPD) are an alternative to osseointegrated implants to replace a single missing posterior tooth. The aim of this study was to evaluate the stress distribution within these prostheses with three material combinations: yttria-tetragonal zirconia polycrystal (Y-TZP) ceramic veneered with fluorapatite ceramic (&#945;), lithium-disilicate ceramic (&#946;) or fiber-reinforced composite (&#947;). In composition &#945;, an analysis was conducted on the presence or absence of the veneering ceramic on the cervical wall of the proximal boxes and three variations in the total area of the connectors cross-section (4 mm in width x 3.2, 4.2 or 5.2 mm in height). In 8 two-dimensional finite element models, a vertical load of 500 N was applied on the central fossa of the pontic. Maximum (tension) and minimum (compression) principal stresses were then shown in MPa. First, the 6 models with Y-TZP fixed partial dentures (FPD) and their variations were evaluated. The highest values of tensile stresses were found at the cervical third of the connectors. When present in these regions, the veneering ceramic received stresses beyond its flexural strength limit. In the comparison among models without veneering ceramic on the cervical wall of the proximal boxes, even the model with connectors of 3.2 x 4 mm, whose framework presented 2.5 x 3 mm, could be recommended for clinical use. High values of compressive stresses were recorded between the middle and occlusal thirds of the connectors, corresponding to the juncture of the ceramics. Owing to flexure, these stresses might lead to adhesive failures. Then, the Y-TZP model without fluorapatite ceramic on the cervical wall of the proximal boxes and total connector area of 4.2 x 4 mm was compared to the other two materials with connectors of the same area. For the lithium-disilicate FPD, the observed values would probably exceed its flexural strength limit. The fiber-reinforced composite FPD presented stresses far below the flexural strength limit of its framework, but, as observed in the Y-TZP model, high values of compressive stresses were concentrated between the middle and occlusal thirds of the connectors, where the juncture of the composite and the fiber framework is located. The results showed that the use of lithium-disilicate ceramics and the presence of fluorapatite ceramics on the cervical wall of the proximal boxes should be contraindicated for the condition proposed. A minimum of 2.5 x 3 mm for the connector area of the Y-TZP framework seems viable. The fiber-reinforced composite FPD presented structural resistance for the situation studied but, as was also the case of the Y-TZP fixed partial dentures, its weak points seem to be the adhesion between the framework and the veneering material, as well as the resistance of the veneering material itself.

L’objectif de cette étude était d’évaluer et de comparer la force d’adhésion de deux résines de collage: le ClearfilTM Esthetic Cement & DC Bond Kit (C) et le RelyXTM Unicem (R), sur trois adhérents différents : une surface d’émail, un alliage de métaux non précieux (Np) et un alliage de métaux semi-précieux (Sp). La surface des échantillons des alliages métalliques a subi différents traitements de surface. Sur l’émail (n=15) ainsi que sur les plaquettes d’alliages Np et Sp (n=15), des cylindres de résine étaient appliqués et polymérisés. Suite au processus de collage, les échantillons ont été incubés à 37°C pendant 24 heures, puis ont subi 500 cycles de thermocyclage. Des tests de cisaillement ont été effectués, suivi par l’analyse de la surface des échantillons au microscope à balayage électronique. Une comparaison de type T-test et des comparaisons multiples post hoc, ont été effectuées pour l’analyse statistique (p 0,05). Sur l’émail, les résultats ont démontré que la résine C présentait une force d'adhésion moyenne statistiquement supérieure (33,97±17,18 MPa) à la résine R (10,48±11,23 MPa) (p 0,05). Le type d’alliage utilisé n’influençait pas la force d’adhésion, et ce, peu importe le type de résine de collage (p>0,05). Pour le groupe Sp, la résine C a démontré une adhésion statistiquement supérieure à la résine R, et ce, pour tous les traitements de surface (p 0,05). En conclusion, la résine C a démontré des résultats d’adhésion significativement supérieurs à la résine R sur l’émail ainsi que sur presque toutes les surfaces traitées des alliages de métaux. / The objective of this study was to assess and compare the shear bond strength of two types of resin cements: ClearfilTM Esthetic Cement & DC Bond Kit (C) and RelyXTM Unicem (R) when these resins cements were applied to three different surfaces: enamel, non precious metal alloy (Np) and semi-precious metal alloy (Sp). Both types of alloy surfaces were treated differently. On both enamel (n=15) and alloy plates Np and Sp (n=15) surfaces, cylinder shaped resin cements were bonded and lightpolymerized. After the adhesion process, all samples were placed into an incubator at 37°C for 24 hours and 500 thermal cycles were accomplished. Shear bond strength tests followed by electron microscopy analysis were performed. Statistical analysis was done using a T-test comparison followed by a post hoc multiple comparisons (p 0.05). The results on enamel showed that the C resin cement had a statistically significant higher bond strength (33.97±17.18 MPa) than the R resin cement (10.48±11.23 MPa) (p 0.05). The type of alloy did not influence the bond strength regardless the type of resin cement (p 0.05). For the Sp group, the bond strength was statistically higher for the C resin than for the R resin and those results are valuable for all treated surfaces (p 0.05). To conclude, the C resin cement showed a statistically significant higher bond strength than the R resin cement with enamel and most of the metal alloy treated.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Para reabilitar a ausência de um elemento dentário posterior, as próteses parciais fixas (PPF) com retentores intracoronários são uma alternativa aos implantes osseointegrados. O objetivo deste estudo foi avaliar a distribuição de tensões nessas próteses com três combinações de materiais: cerâmica de zircônia parcialmente estabilizada por ítria (ZPEI) revestida por cerâmica de fluorapatita (&#945;), cerâmica de dissilicato de lítio (&#946;) ou compósito fibrorreforçado (&#947;). Na composição &#945;, foram analisadas a presença ou ausência da cerâmica de revestimento na parede cervical das caixas proximais e três variações na área total da seção transversal dos conectores (4 mm de largura x 3,2, 4,2 ou 5,2 mm de altura). Em 8 modelos bidimensionais de elementos finitos, uma carga vertical de 500 N foi aplicada na fossa central do pôntico e as tensões principais máximas (tração) e mínimas (compressão) foram apontadas em MPa. Inicialmente foram avaliados os 6 modelos com PPF de ZPEI e suas variações. Os maiores valores das tensões de tração foram encontrados no terço cervical dos conectores. Quando presente nestas regiões, a cerâmica de revestimento recebeu tensões acima do limite de sua resistência à flexão. Na comparação entre os modelos sem cerâmica de revestimento na parede cervical das caixas proximais, mesmo aquele com conectores de 3,2 x 4 mm, cuja infraestrutura apresentava 2,5 x 3 mm, poderia ser recomendado para uso clínico. Altos valores de tensões de compressão foram registrados entre o terço oclusal e médio dos conectores, correspondente à união entre as cerâmicas, o que poderia ocasionar, devido à flexão, falhas adesivas. Posteriormente, o modelo de ZPEI com a cerâmica de fluorapatita ausente da parede cervical das caixas proximais e área total dos conectores de 4,2 x 4 mm foi comparado aos dois outros materiais com conectores de mesma área. Na PPF de dissilicato de lítio, os valores representaram uma provável violação do limite de sua resistência à flexão. A PPF de compósito fibrorreforçado apresentou tensões bem abaixo do limite de resistência à flexão de sua infraestrutura, mas, como no modelo de ZPEI, tensões compressivas se concentraram com alto valor entre o terço oclusal e médio dos conectores, local de união entre a resina composta e a infraestrutura de fibras. Os resultados mostraram que a cerâmica de dissilicato de lítio e a presença da cerâmica de fluorapatita na parede cervical das caixas proximais deveriam ser contraindicadas para a condição proposta. Parece viável uma área de conectores na infraestrutura de ZPEI com no mínimo 2,5 x 3 mm. A PPF de compósito fibrorreforçado apresenta resistência estrutural para a situação estudada, mas, como também aquelas compostas de ZPEI, aparenta ter como pontos fracos a adesão entre a infraestrutura e o material de cobertura e a própria resistência deste último. / Inlay-retained fixed partial dentures (IRFPD) are an alternative to osseointegrated implants to replace a single missing posterior tooth. The aim of this study was to evaluate the stress distribution within these prostheses with three material combinations: yttria-tetragonal zirconia polycrystal (Y-TZP) ceramic veneered with fluorapatite ceramic (&#945;), lithium-disilicate ceramic (&#946;) or fiber-reinforced composite (&#947;). In composition &#945;, an analysis was conducted on the presence or absence of the veneering ceramic on the cervical wall of the proximal boxes and three variations in the total area of the connectors cross-section (4 mm in width x 3.2, 4.2 or 5.2 mm in height). In 8 two-dimensional finite element models, a vertical load of 500 N was applied on the central fossa of the pontic. Maximum (tension) and minimum (compression) principal stresses were then shown in MPa. First, the 6 models with Y-TZP fixed partial dentures (FPD) and their variations were evaluated. The highest values of tensile stresses were found at the cervical third of the connectors. When present in these regions, the veneering ceramic received stresses beyond its flexural strength limit. In the comparison among models without veneering ceramic on the cervical wall of the proximal boxes, even the model with connectors of 3.2 x 4 mm, whose framework presented 2.5 x 3 mm, could be recommended for clinical use. High values of compressive stresses were recorded between the middle and occlusal thirds of the connectors, corresponding to the juncture of the ceramics. Owing to flexure, these stresses might lead to adhesive failures. Then, the Y-TZP model without fluorapatite ceramic on the cervical wall of the proximal boxes and total connector area of 4.2 x 4 mm was compared to the other two materials with connectors of the same area. For the lithium-disilicate FPD, the observed values would probably exceed its flexural strength limit. The fiber-reinforced composite FPD presented stresses far below the flexural strength limit of its framework, but, as observed in the Y-TZP model, high values of compressive stresses were concentrated between the middle and occlusal thirds of the connectors, where the juncture of the composite and the fiber framework is located. The results showed that the use of lithium-disilicate ceramics and the presence of fluorapatite ceramics on the cervical wall of the proximal boxes should be contraindicated for the condition proposed. A minimum of 2.5 x 3 mm for the connector area of the Y-TZP framework seems viable. The fiber-reinforced composite FPD presented structural resistance for the situation studied but, as was also the case of the Y-TZP fixed partial dentures, its weak points seem to be the adhesion between the framework and the veneering material, as well as the resistance of the veneering material itself.