Microcomputed Tomography Evaluation of Cement Shrinkage Under Zirconia.

Microcomputed tomography evaluation
of cement shrinkage under zirconia

versus lithium disilicate veneers
Intoduction
Intoduction
• Computer-aided design and computer-aided
manufacturing (CAD-CAM) technology and the improved
translucency of recently developed high-strength
monolithic zirconia could make them clinically
acceptable for veneers if bonding to zirconia was as
predictable as to glass-ceramics.
• Few studies have compared the behavior of resin

cements between glass-ceramic and zirconia veneers
before and after polymerization.
Free volumetric shrinkage
• Free volumetric shrinkage is defined as the deformation of the material
that occurs with unbonded surfaces.
• Historically, free shrinkage has been measured with standard tests such
as physical dilatometers and cross-sectional imaging.
• Microfocus X-ray computed tomography (μCT) provides nondestructive
assessment of the internal structures of biomaterials.
• This technique provides high resolution 3D images that compare the
volumetric changes before and after polymerization with image
analysis software.
Purpose
• The purpose of this in vitro study was to
evaluate the volumetric polymerization
shrinkage of resin cement, marginal
discrepancy, and cement thickness before and
after polymerization for glass-ceramic and
zirconia veneers with light-polymerizing resin
cement.
Null Hypothesis
• The null hypothesis was that no significant

difference would be found in the volumetric
polymerization shrinkage of light-polymerizing
resin cement, cement thickness, and marginal
discrepancy between glass-ceramic veneers
and zirconia veneers.
Materials and Methods
20 Teeth
8×7 mm intact
labial enamel
10 Maxillary 3 Maxillary
4 Maxillary 3 Mandibular
central lateral
canines canines
incisors incisors
• The enamel surfaces were treated with airborne-particle abrasion (50µmAl2O3

at 0.1 MPa air pressure for 10 seconds at a10-mm distance and at 90 degrees)
• Leveling of incisal edge.
• Figure 1. Demonstration of veneer
design on each tooth.
• A, Uniform sticker attached to enamel
surface.
• B, Die spacer marked edge of veneer.
• C, Sticker removed revealing outline

and position of veneer.
• D, Veneer designed on scanned 3D
image following outline on tooth
surface.
• E, Veneer designed based on its
anatomy with cement space set at 100
μm.
• F, CAD-CAM lithium disilicate veneer.
(20)
Ceramic Veneers
(10) Lithium Disilicate (10) Zirconia

(IPSe.max CAD LT; Ivoclar (Katana UTML; Kuraray
Vivadent AG) Noritake Dental Inc)
Material Lot No:
Monobond Plus LOT# X12846; Ivoclar Vivadent AG
PS Ceramic Etching Gel LOT#U12483; Ivoclar Vivadent AG
Total Etch Gel LOT# V42176; IvoclarVivadent AG
Adhese Universal LOT#V30333; Ivoclar Vivadent AG
Elipar S10 (1200 mW/cm2) LOT# W94432; 3M ESPE
Variolink Esthetic LC LOT# V30333; Ivoclar VivadentAG
Liquid Strip LOT# X37900; Ivoclar Vivadent AG
Devices &soft-ware
• µCT machine (X5000; North Star Imaging)

• Multifunctional Chewing Simulator CS-4.8;SD Mechatronik
• Amira soft-ware 6.7
• low-speed diamond saw (Preciso CL40;Top Tech)
• (SEM) (JSM-7000; JEOL)
Tests
Volumetric Cement Marginal

shrinkage thickness discrepancy
Before After Before After

polymerization polymerization polymerization polymerization
• Figure 2. μCT 3D image analysis for extraction of cement in representative lithium
disilicate specimen.
• A, Reconstructed 3D cement layer is distinctly observed with different radiopacity level
from the veneer and tooth structure (arrow).
• B, Cement layer digitally extracted for volume calculations.
Results
Results
Results
Discussion
• The null hypothesis that no significant difference
would be found in cement volumetric shrinkage,
marginal discrepancy, and cement thickness was
partially rejected.
178 ±41
158 ±37
115 ±33
107 ±32
157 ±27 162± 53
147±27 147 ±52
• Figure 3. μCT sagittal cross-section representing cement deformation after
polymerization shrinkage in lithium disilicate veneer.
• A, Before polymerization.
• B, After polymerization.
• Figure 4. μCT oblique cross-section at incisal area showing
• void deformation (black arrow),
• crack propagation (white arrow),
• debonding (red arrow)
of resin cement with zirconia veneer. A, Before polymerization. B, After polymerization.
• Figure 5. μCT sagittal images after mastication simulator testing with no apparent
debonding between veneer, resin cement, and enamel surface.
• A, Lithium disilicate veneer.
• B, Zirconia veneer.
• Figure 6.
• SEM images
examining
integrity of
resin cement
(C)
• and its
adaptation to
enamel (E) and
veneer (V)
• after 400 000
loading cycles.
• A& B, Lithium
disilicate
veneer.
• C& D, Zirconia
veneer.
Conclusion
Conclusion
• The volumetric polymerization shrinkage of the resin cement did not
differ between the lithium disilicate and the zirconia veneers (P=.139).
• After polymerization, a smaller marginal discrepancy and cement
thickness was observed (P<.05), regardless of the veneer materials.
• A smaller marginal discrepancy was found for the zirconia compared with
the lithium disilicate (P=.004), whereas the cement thicknesses did not
differ (P=.144).
• Considering bonding and cementation, adhesively cemented high
translucency monolithic zirconia seems to be a suitable option for
veneers.
Strength points
• Excellent technique;
• Non destructive.
• High resolution 3D images.
Weakness points
• Non standardization of the teeth selected.

• Non standardization of veneer thickness.
• Only two teeth from each group was subjected to cyclic loading.
• The image analysis process in the µCT image analysis software is
extremely critical.
Thank you

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Microcomputed tomography evaluation

of cement shrinkage under zirconia

• Few studies have compared the behavior of resin

• The null hypothesis was that no significant

• The enamel surfaces were treated with airborne-particle abrasion (50µmAl2O3

• C, Sticker removed revealing outline

(10) Lithium Disilicate (10) Zirconia

• µCT machine (X5000; North Star Imaging)

Volumetric Cement Marginal

Before After Before After

• Non standardization of the teeth selected.

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