Blatz, Markus B.
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Publication Deep Margin Elevation: A Literature Review(2022-03-01) Samartzi, Theodora Kalliopi; Papalexopoulos, Dimokritos; Ntovas, Panagiotis; Rahiotis, Christos; Blatz, MarkusA conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Publication Marginal Adaptation of CAD/CAM Hybrid Ceramic Crowns Made on Preparations With and Without Surface Finishing(2021-04-29) Al-Hussainy, Faisal; Conejo, Julian; Anadioti, Eva; Mante, Francis K.; Blatz, Markus B.Statement of problem: Studies on previous generations of chair-side Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) systems concluded that preparation quality has an impact on marginal fit of milled restorations. However, as chair-side CAD/CAM technology improves, and newer systems and materials are released, it remains unclear if preparation quality still impacts marginal adaptation of milled restoration. Purpose: This in vitro study evaluated the marginal adaptation of ceramic crowns fabricated with a chair-side CAD/CAM system on preparations completed with and without surface finishing to identify if finishing preparation protocols affect the marginal fit. The null hypothesis was that there was no difference in the mean marginal adaptation of ceramic restorations between the two finishing protocols. Materials and Methods: A total of 10 maxillary right central incisor acrylic teeth were screwed into precision restorative typodont with soft gum and attached to a portable bench mount. Teeth were divided into two groups (Control group CG, Finished group FG) and prepared for all ceramic crowns with medium only/and fine grit burs under dental loupes with 4.5x magnification. The CG was prepared using the medium grit bur only, while the FG was prepared using the medium grit bur and then refined with the fine grit bur for two minutes. Preparations were scanned with an intraoral scanner and hybrid ceramic crowns were designed, milled and hand polished following the manufacturer’s recommendations. The hybrid ceramic crowns were cemented on the prepared teeth using a dual cure resin cement system. Design, milling and cementation were made by the same operator. To measure the vertical marginal gap between the margin of the crown and the finish line of the acrylic tooth, scanning electron microscope (SEM) images were made (Singh Center for Nanotechnology, University of Pennsylvania) with magnification of ×100. A total of 50 measurements were made per tooth: 25 mid-facial margin area and 25 mid-palatal margin area. The data were analyzed with Mann-Whitney Rank Sum Test to determine differences between the groups. A statistical software program was used for the analysis. Results: The FG resulted in a significant decrease in the overall mean marginal gap of CAD/CAM all ceramic crowns compared to the CG (p<0.001). Conclusion: Crown preparation finishing with fine grit bur has a significant impact on the marginal gap of all ceramic restorations.Publication Bond Strength of Different Self-Adhesive Resin Cements to Zirconia(2021-06-30) Patel, Nupur; Anadioti, Eva; Conejo, Julial; Ozer, Fusun; Mante, Francis; Blatz, MarkusObjectives: The purpose of the study was to compare the shear bond strength of five self-adhesive resin cements used to bond zirconia. Methods: Seventy-two KATANA Zirconia STML (n=12) specimens were sectioned and sintered in an induction furnace (CEREC SpeedFire, Dentsply Sirona, Germany). Specimen surfaces were ground finished with 800 grit silicon carbide abrasive with cooling water and cleaned with ultrasonication in alcohol. Specimens were air-particle abraded with 50 μm aluminum oxide at 2.8 bar pressure. Cylindrical composite resin specimens (2.1 mm in diameter, 3 mm in height) were bonded to the zirconia samples with self-adhesive resin cements Panavia SA Universal (PSA), TheraCem (TCM), SpeedCem 2.0 (SCM), RelyX Unicem 2 (RCM), PermaCem 2.0 (PCM) and dual-cure multi-step composite resin cement Panavia V5 (control, PV5, after application of ceramic primer) following manufacturers’ instructions. A load of 1000 g was applied to the composite cylinders during bonding in an alignment apparatus, then light cured for 80 s. Samples were stored in distilled water at 37° C for 24 h, then subjected to 10,000 thermal cycles. Shear bond strength was determined using a universal testing machine at a crosshead speed of 0.5 mm/min expressed in MPa. The fractured surfaces of specimens were inspected with a stereo microscope and classified as 8 adhesive, cohesive, or mixed failures. One-way ANOVA test and Tukey test were applied for statistical analysis. Results: Shear bond strength values [MPa] were for PSA 8.64 (1.78 SD), TCM 9.05 (2.64 SD), SCM 8.54 (1.92 SD), RCM 7.60 (1.26 SD), PMC 7.59 (1.10 SD) and PV5 9.59 (1.55 SD). One-way ANOVA test revealed no statistically significant differences in shear bond strength between the resin cements tested (p>0.05). Pair wise comparison using Tukey test revealed that the shear bond strength using RCM was statistically lower than that using PV5 (p<0.05). Conclusions: According to the results of this in vitro study, self-adhesive resin cements can achieve shear bond strengths to zirconia that are comparable multi-step resin cements. In routine clinical application, self-adhesive resin cements can be a user- friendly, less technique sensitive alternative for bonding Zirconia restorations following the APC concept.