RESUMEN
OBJECTIVE: This article aims to demonstrate the clinical application of a comprehensive workflow that integrates digital tools for accurate color matching, and its immediate implementation in the restoration of anterior teeth. CLINICAL CONSIDERATIONS: Two patients demonstrating dissatisfaction regarding a maxillary central incisor had an old restoration replaced resorting to a digital workflow to enhance the predictability of the new direct restoration. OptiShade allowed the precise assessment of tooth color and the CompoShade application provided precise color and material selection, as well as the determination of a layering strategy. Precision and accuracy of the colorimeter and the composite layering application were demonstrated clinically in vivo. CONCLUSIONS: Implementing a digital workflow with the integration of OptiShade measurements and the CompoShade layering recipe calculation, as well as the respective realistic try-in, enables the achievement of precise color matching for anterior composite restorations. CLINICAL SIGNIFICANCE: The employment of a digital colorimeter and layering recipes simplify shade matching, and optimizes composite resin clinical use and success. The implementation of a realistic try-in, previous to the definitive restoration, allows the clinician to perform any adjustments if needed.
RESUMEN
Multilayer monolithic zirconia, which incorporates polychromatic layers that mimic natural tooth gradients, offers enhanced aesthetics and functionality while reducing debonding risks and improving fabrication efficiency. However, uncertainties remain regarding the fracture characteristics of multilayer monolithic zirconia crowns under occlusal loading, whether composed of uniform or combined yttria levels. The current study investigated how variations in yttria levels and thicknesses affected the optical properties and fracture loads of multilayer monolithic zirconia. Samples of multilayer monolithic zirconia in the Vita A1 shade were used, while employing 3Y (SZ) and 4Y + 5Y (AZ) yttria levels. The optical properties, including the color difference (ΔEWS) and translucency parameters (TP00), were measured using a digital colorimeter. The fracture loads were analyzed using a universal testing machine, and fractured surfaces were examined under a stereomicroscope. Statistical analyses assessed the impacts of the yttria levels and sample thicknesses on the optical properties. The ΔEWS values of SZ ranged 3.6 to 4.0, while for AZ, ΔEWS at 0.5 mm was 3.9 and <2.6 for other thicknesses. The TP00 values decreased with an increased thickness, with AZ generally exhibiting greater translucency than SZ. In the fracture load investigations, SZ (>1600 N) generally exceeded AZ (>1260 N), with fracture loads notably increasing with thickness, particularly for premolars (SZ > 3270 N, AZ > 2257 N). SZ predominantly exhibited partial and complete fractures, whereas AZ showed fewer non-fracture categorizations. Complete fractures began with dense, irregular cracks that extended outward to reveal smooth surfaces, while premolars subjected to higher loads exhibited concentric ripple-like structures. Partial fractures revealed radial textures indicative of areas of stress concentration. In summary, higher yttria levels were correlated with increased translucency, while variations in the fracture loads primarily stemmed from differences in the tooth position or thickness. Overall, multilayer monolithic zirconia incorporating combined yttria levels of 4Y + 5Y (AZ) offered high translucency, precise color matching, and substantial fracture resistance, rendering it highly suitable for aesthetic and functional dental applications.
RESUMEN
OBJECTIVES: Multilayer monolithic zirconia (M-Zr) crowns can be engineered to achieve gradational translucency and color intensity. However, this modification may compromise the mechanical strength, raising concerns regarding the ability of M-Zr crowns to withstand occlusal stresses. The effects of M-Zr crown thickness on translucency and ability to endure occlusal forces were investigated at different tooth positions (incisors, premolars, and molars). The objective was to determine the minimal thickness of M-Zr crowns used in tooth preparation to meet aesthetic and functional demands. METHODS: M-Zr samples (Vita A1) with four thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were prepared and subjected to translucency testing using a digital colorimeter by 3-third and 9-square division methods. Crown-shaped M-Zr samples with three thicknesses (1.0, 1.5, and 2.0 mm) and three tooth positions (incisor, premolar, and molar) were digitally designed, and 2.0 mm metal abutments were fabricated. The samples were bonded to the abutments; their fracture characteristics were evaluated using a universal testing machine, and their fracture surfaces examined using an optical microscope. Statistical analyses included the Shapiro-Wilk test, Pearson correlation, and one-way and two-way ANOVA with a post hoc Tukey HSD test (α = 0.05). RESULTS: Color analysis results revealed a significant negative correlation between thickness and translucency (r < -0.96, P < 0.01), with the highest values in the incisal region. Cross-sectional profiles confirmed the uniform thickness and morphology of the digitally designed M-Zr crowns. The results of fracture strength analysis showed position-dependent variability, a strong positive correlation with thickness (r > 0.96, P < 0.01), and fracture strengths consistently exceeding 1200 N across all tooth positions. Fracture patterns indicated that thinner crowns at the incisors and molars were more prone to cracking, whereas those at the premolars demonstrated significantly higher strength (4872.51 N, P < 0.05), only with crack or even no fracture occurring at 2.0 mm. CONCLUSIONS: Thickness significantly influenced both the translucency and fracture strength of M-Zr, with the tooth position playing an additional role, albeit to a lesser extent. Although thinner crowns exhibited lower strength at each tooth position, even at a thickness of 1.0 mm, fracture strength exceeding 1200 N was maintained, surpassing the typical occlusal forces. Thus, it can be asserted that M-Zr crowns with a minimum thickness of 1.0 mm can meet both aesthetic and functional requirements.