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9 protocols using celtra duo

1

Ceramic Material Effects on Endocrown Designs

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Teeth were divided randomly into two groups according to the ceramic materials used: Group CD; Celtra Duo (Dentsply, Sirona, Dental Systems Gmbh FabrikstraBe, Bensheim, Germany) and Group VE; Vita Enamic (Vita, Vita Zahnfabrik, Bad Säckingen, Germany) (Table 1).
Each group was further sub-divided into two subgroups (n = 10) according to the endocrown preparation design: Subgroup W; with 3 mm intraradicular extension, and subgroup WO; without intraradicular extension.
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2

Biogeneric Copy Restoration Design

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Before cavity preparation, all teeth were scanned with an intraoral scanner in the Biogeneric Copy mode (CEREC Primescan, Dentsply Sirona, Bensheim, Germany). After cavity preparation, the samples were scanned again, and then restorations were designed with Computer-Aided Design (CAD) software (CEREC SW 5.2, Dentsply Sirona, Bensheim, Germany), using the biogeneric copy from the initial scan to recreate the natural features of the original, unprepared tooth in the restorations. All overlay restorations were created from zirconia-reinforced lithium disilicate ceramic shade A2 (Celtra Duo®, Dentsply Sirona, Bensheim, Germany) in a milling unit (Primemill, Dentsply Sirona, Bensheim, Germany). After the milling process, heat treatment was performed using a sintering furnace (CEREC SpeedFire, Dentsply Sirona, Bensheim, Germany) at a temperature of 820 °C for 10 min and 45 s. The tooth preparation and the overlay restoration design for each experiment group are shown in Fig. 2.

The tooth preparation and the overlay restoration design for each experiment group.

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3

Color Stability of CAD/CAM Ceramic Discs

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Four ceramic materials were used to prepare 120 disc-shaped specimens: (1) polymer-infiltrated ceramic (ENAMIC) (Vita Zahnfabrik, Bad Saeckingen, Germany), (2) lithium disilicate crystals embedded in a glassy matrix (IPS E.Max CAD) (Ivoclar Vivadent, Schaan, Liechtenstein), (3) Celtra Duo (Dentsply, PA, US), and (4) Suprinity (VITA Zahnfabrik, Bad Sackingen, Germany). Each group consisted of 30 specimens, which were further distributed into three subgroups (n = 10) according to thickness (0.5, 1.0, and 1.5 mm), yielding a total of 12 groups.
The specimens were tested over five substrates: A3.5 shade composite resin (A3.5), A1 shade zirconia (ZR), nickel–chromium alloy (NC), black (B), and white (W). A spectrophotometer (Ultrascan XE, HunterLab, Reston, VA, USA) was used for color measurement at wavelengths from 360 to 750 nm and a view-area size of 9.53 mm.
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4

Adhesive Overlay vs. Crown Restorations on Endodontically Treated Molars

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This study was designed in four study groups (n = 12 each), where the specimens were randomly allocated considering:

“Preparation design” in two levels: extracted molars, once endodontically treated, were prepared for a cuspal coverage restoration with two different designs: a low‐retentive adhesive overlay preparation and a high‐retentive full crown preparation with margin located 1 mm above cementum‐enamel junction (CEJ).

“Restorative material” in two levels: Cuspal coverage adhesive restorations were performed using two different cad‐cam monolithic materials: a HTZ designed for posterior teeth (Katana STML, Kuraray Noritake) and a ZLS (Celtra Duo, Dentsply).

The materials employed in the present study are detailed in Table 1.
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5

Evaluation of Core Build-up and CAD/CAM Restorations

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The general description of the main materials used in the present study, their manufacturers and composition are listed in Table 1.
This study was designed in 6 study groups (n= 8), where the specimens were randomly allocated (www.randomizer.org) considering:

“Core build-up” in 2 levels, being one condition where the build-up core was done only using a bulk-fill composite resin (Grandioso X-tra, Voco, Cuxhaven, Germany); or another condition where it was done associating composite resin and a fiber post (Rebilda Post #15, Voco, Cuxhaven, Germany);

“CAD/CAM blocks” in 3 levels: after core build-up, 3 different CAD/CAM restorative materials were tested: a nanohybrid composite resin (GB, GrandioBlocks, Voco, Cuxhaven, Germany), a flexible hybrid ceramic (CS, Cerasmart 270, GC, Tokyo, Japan), or a zirconia reinforced lithium silicate (CD, Celtra Duo, Dentsply, Konstanz, Germany).

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6

Fabrication of Ceramic Dental Discs

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The samples in this study were prepared by using two different materials: zirconia-reinforced lithium-silicate glass (LS-10) ceramics (Celtra Duo, DentsplySirona, Bensheim, Germany) and lithium disilicate (LS-20) ceramics (IPS e.max CAD, Ivoclar, Vivadent, Schaan, Liechtenstein). These materials are different in their composition; however, their exact composition is not provided by the manufacturer(s). The samples were prepared as discs (10 mm in diameter and 1 mm in thickness). The shaping process was conducted by using a dental milling unit (Cerec, MCXL, DentsplySirona, Bensheim, Germany). The utilization discs dimension enabled us to conduct all analyses in this study without the modification of the as-prepared discs.
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7

Comparative Evaluation of Dental Materials

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Fifteen dental materials were tested and included the following: feldspar ceramic (VITABLOCS® Mark II, VITA Zahnfabrik, Bad Säckingen, Germany), lithium disilicate glass-ceramic (IPS e. max® CAD, Ivoclar Vivadent, Schaan, Liechtenstein) pre-sintered and post-sintered, zirconia-reinforced lithium silicate (ZLS) ceramic (Celtra Duo, Dentsply Sirona, York, PA, USA) pre-sintered and post-sintered, hybrid ceramic (VITA ENAMIC®, VITA Zahnfabrik, Bad Säckingen, Germany), zirconia 3Y-TZP (3D pro-Zir®, Aidite technology, Qinhuangdoo, China), polymethyl methacrylate (PMMA) (Ceramill® temp, Amann Girrbach North America, Charlotte, NC, USA), bis-acrylic composite (Protemp™ 4, 3 M, Saint Paul, MN, USA), packable composite resin (Grandio, VOCO Gmbh, Cuxhaven, Germany), and flowable composite resin (Grandio Flow, VOCO Gmbh, Cuxhaven, Germany), gutta-percha (Obtura Flow 150®, Obtura Spartan Endodontics, Algonquin, Il, USA), glass ionomer composite liner (Ionoseal®, VOCO America, Indian Land, SC, USA), resin-modified glass ionomer restorative (Fuji II LC®, GC America, Alsip, IL, USA), amalgam (Permite, SDI Limited, Victoria, Australia). Each material was configured into 2 × 2x2 mm cubes (Fig. 1, Fig. 2).

Complete workflow of the testing process.

Fig. 1

A simplified version of the testing process.

Fig. 2
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8

Fabrication of Zirconia-Reinforced Lithium Silicate Endocrowns

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Endocrowns were made using the CEREC AC system (Dentsply Sirona). Teeth were scanned with omnicam (Dentsply Sirona), and CEREC 3D software (version 4.4) was used for designing the endocrowns. To ensure that all fabricated endocrowns were identical, using the biogeneric mode design, the original anatomy produced by the software was used. For all restorations, at least 2 mm occlusal thickness at the reduced walls were considered (Zhang et al., 2022 (link)) along with a 60 mm cementing space (Zheng et al., 2022 (link)). Each wall's thickness was measured using the cursor detail tool, and subtle modifications were made to preserve the anatomy while maintaining a minimum thickness of 2 mm for each wall. Zircona‐reinforced lithium silicate ceramic blocks (Celtra Duo, Dentsply Sirona) were used for milling with the help of CEREC MCXL milling machine using 12 s step and cylinder‐pointed burs. After every four milling a new pair of bur replaced the old one (Ceylan et al., 2022 (link)). Finally, a total number of 36 fabricated endocrowns were crystallized in furnace (CEREC speed fire, Dentsply Sirona) at 820°C.
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9

Fabrication and Cementation of Zirconia-Reinforced Restorations

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After virtual designing the restorations in the CAD software (CEREC, Software version 5.1.3, DentsplySirona, Bensheim, Germany) the digital file was sent to an in-house milling machine (CEREC MCXL, Den-tsplySirona, Bensheim, Germany). The restorations were milled out of a zirconia-reinforced lithium silicate glass-ceramic block (Celtra Duo, DentsplySirona, Bensheim, Germany). After machining, the fixation of the sprue from all the restorations was removed. Subsequently, the restorations were tried in and selective chairside adjustments were performed. When a correct fit was achieved, the restorations were cemented by using a 3-step etch-and-rinse adhesive system and dualcuring resin cement. After removal of excess cement and polishing the restorations were delivered in the same appointment.
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