Survival rate and fracture strength of maxillary incisors, restored with different kinds of full veneers [Elektronische Ressource] : an in-vitro study / vorgelegt von Nektaria Stathopoulou

Aus der Universitätsklinik für Zahn-, Mund-, und Kieferheilkunde der
Albert-Ludwigs-Universität Freiburg
Abteilung für Zahnärztliche Prothetik
(Ärztl. Direktor: Prof. Dr. J. R. Strub)


Survival rate and fracture strength of maxillary incisors,
restored with different kinds of full veneers.
An in-vitro study


INAUGURAL-DISSERTATION
zur Erlangung des
Zahnmedizinischen Doktorgrades
Der Medizinischen Fakultät der Albert-Ludwigs-Universität
Freiburg


Vorgelegt 2003
Von
Nektaria Stathopoulou
Geboren in Athen, Griechenland















Dekan: Prof. Dr. med. J. Zentner
1. Gutachter: Prof. Dr. J. R. Strub
2. Gutachter: PD. Dr. P. Hahn
Jahr der Promotion: 2003


























To my parents and my brother
Table of contents:

1. Introduction...................................................................................................... 1
2. Literature review ............................................................................................. 2
2.1 Historic perspective .................................................................................... 2
2.2 Indications and contraindications of porcelain veneers........................ 3
2.3 Classification of currently available all-ceramic systems for porcelain
veneers................................................................................................................ 5
2.3.1. Sintered ceramics.................................................................................................... 5
2.3.2. Infiltrated ceramics................................................................................................. 7
2.3.3. Castable ceramics 8
2.3.4. Pressable ceramics ................................................................................................ 10
2.3.5. Machining techniques .......................................................................................... 11
2.3.5.1. Copy-milling technique.............................................................. 11
2.3.5.2. CAD/CAM Systems ................................................................... 12
2.4. Preparation design................................................................................... 14
2.5. Luting procedure ..................................................................................... 18
2.5.1. Conditioning of the ceramic surface .................................................................. 18
2.5.2. Conditioning of the tooth surface....................................................................... 19
2.5.3. Luting composite .................................................................................................. 21
2.5.4. The adhesion complex: tooth/luting composite/porcelain ........................... 22
2.6. Survival rate and fracture strength of porcelain veneers................... 22
2.6.1. Biting forces and range of temperature on anterior dentition ....................... 22
2.6.2. Survival rate of porcelain veneers...................................................................... 23
2.6.3. Fracture strength of porcelain veneers .............................................................. 24
3. Aim of the study ............................................................................................ 27
4. Materials and Methods ................................................................................ 28
4.1. Materials.................................................................................................... 28
4.1.1. Abutment teeth ..................................................................................................... 28
4.1.2. Ceramic system 28
4.1.3. Luting agent........................................................................................................... 29
4.1.4. Impression materials ............................................................................................ 31
4.1.5. Die materials.......................................................................................................... 31
4.1.6. Additional materials used ................................................................................... 32
4.2. Methods..................................................................................................... 32
4.2.1. Teeth ....................................................................................................................... 32
4.2.1.1. Selection of the abutment teeth ................................................. 32
4.2.1.2. Diagnostic Wax-up...................................................................... 33
4.2.1.3. Tooth preparation........................................................................ 33
4.2.2. Fabrication of the master models ....................................................................... 36
4.2.2.1. Impression .................................................................................... 36
4.2.2.2. Fabrication of the master dies.................................................... 36
4.2.3. Fabrication of the veneers 36
4.2.3.1. Wax-up.......................................................................................... 36
4.2.3.2. Investment 37
4.2.3.3. Preheat and Pressing................................................................... 37
4.2.3.4. Divestment ................................................................................... 38
4.2.3.5. Glazing 38
4.2.4. Cementation of the veneers................................................................................. 39
4.2.4.1. Pre-treatment of the veneers (Fig. 4.5) ..................................... 39
4.2.4.2. Pre-treatment of the abutments (Fig. 4.6) ................................ 39
4.2.4.3. Bonding procedure (Fig. 4.7) ..................................................... 40
4.2.5. Preparing the test specimens for the artificial-mouth ..................................... 41
4.2.5.1. Artificial periodontal membrane .............................................. 41
4.2.5.2. Fabrication of the master models for the artificial mouth..... 41
4.2.6. Dynamic loading in the artificial mouth ........................................................... 42
4.7. Examination of post-bonding cracks..................................................... 46
4.8. Fracture strength test (Fig. 4.12)............................................................. 46
4.9. Statistic analysis of data .......................................................................... 47
5. Results ............................................................................................................. 47
5.1. Dynamic loading in the artificial oral environment............................ 47
5.1.1. Survival rate .......................................................................................................... 47
5.1.2. Crack development .............................................................................................. 50
5.1.2.1. Crack formation rate (Fig. 5.3)................................................... 50
5.1.2.2. Crack pattern of porcelain veneers (Table 5.1)........................ 52
5.2. Fracture strength test............................................................................... 54
5.2.1. Fracture strength of individual samples ........................................................... 54
5.2.2. Statistical evaluation of data 57
5.2.3.1. Component of the restoration that failed................................. 60
5.2.3.2. Position of the restoration where fracture occurred .............. 62
6. Discussion....................................................................................................... 64
6.1. Discussion of the materials..................................................................... 64
6.1.1. Extracted human teeth as abutments................................................................. 64
6.1.2. The storage solution ............................................................................................. 65
6.1.3. EPC as a material for the fabrication of full veneers ....................................... 65
6.2. Discussion of the methods...................................................................... 66
6.2.1. Preparation of the specimens for the artificial mouth..................................... 66
6.2.1.1. Preparation................................................................................... 66
6.2.1.2. Cementation ................................................................................. 68
6.2.1.3. Artificial membrane .................................................................... 69
6.2.2. Dynamic loading in the artificial mouth ........................................................... 70
6.2.2.1. Angulation in the artificial mouth ............................................ 70
6.2.2.2. Contact point of the applied force in the artificial mouth ..... 71
6.2.2.3. Artificial ageing an