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Carlo MONACO

Professore Associato
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2022 - Disinfection protocols during COVID-19 pandemic and their effects on prosthetic surfaces: a systematic review [Articolo su rivista]
Di Fiore, A.; Monaco, C.; Granata, S.; Stellini, E.
abstract

PURPOSE: To describe the possible adverse effects of sodium hypochlorite (NaOCl) solutions, high-concentration alcohol solutions, and povidone-iodine products, which are indicated for disinfection of inanimate surfaces against human coronavirus of the severe acute respiratory syndrome (SARS-CoV), on prosthesis materials, including zirconia, lithium disilicate, and acrylic resin. MATERIALS AND METHODS: A systematic literature research for articles published between January 2010 and February 2020 was conducted in Scopus, PubMed/Medline, Web of Science, Embase, and Science Direct using a combination of the following MeSH/Emtree terms and keywords: sodium hypochlorite, alcohol, ethanol, povidone-iodine, dental ceramic, zirconia, lithium disilicate, and acrylic resin. RESULTS: A total of 538 studies were identified in the search during initial screening, of which 44 were subject to full-text evaluation, and 24 fulfilled the inclusion criteria. Seven articles on zirconia and lithium disilicate investigated the effect of NaOCl (0.5% and 1%), 96% isopropanol, and 80% ethanol on bond strength after saliva contamination. The remaining articles evaluated color alteration, surface roughness modifications, decrease in flexural strength, and bonding strength of all cleaning agents on acrylic resin. CONCLUSION: NaOCl (1%) solution for 1 minute is recommended to reduce SARS-CoV infectivity and to minimize the risk of cross-contamination through prosthetic materials. The increase in surface roughness and color alteration were recorded using 1% NaOCl on acrylic resin, but this increase was not clinically significant. A decrease in bonding strength was determined after using 1% NaOCl, 96% isopropanol, and 80% ethanol solutions on lithium disilicate. Silanization before the try-in procedure and the application of the second layer of silane after cleaning methods are recommended to improve the bonding strength.

2022 - Effect of Toothpaste on the Surface Roughness of the Resin-Contained CAD/CAM Dental Materials: A Systematic Review [Articolo su rivista]
Di Fiore, A.; Stellini, E.; Basilicata, M.; Bollero, P.; Monaco, C.
abstract

Background: The purpose of this review is to describe the possible effect of toothbrushing on surface roughness of resin-contained CAD/CAM materials. Methods: Systematic literature search for articles published in peer-reviewed journals between January 2000 and February 2020 has been conducted, which evaluated the effect of brushing on surface roughness of resin-contained CAD/CAM dental materials. The research was conducted in Scopus, PubMed/Medline, Web of Science, Embase, and Science Direct using a combination of the following MeSH/Emtree terms: “brushing”, “resin-based”, “dental”, “CAD/CAM”, and “surface roughness”. Results: A total of 249 articles were found in the search during initial screening. Fifty-five articles were selected for the full-text evaluation after the steps of reading of abstract/title and remotion of duplicate. Only six articles fulfilled the inclusion criteria. The Cohen’s Kappa agreement test showed an index of 0.91 for full-text. Discussion: Four of five selected articles identified an increase of surface roughness on resin-contained CAD/CAM materials after toothbrushing. Although all the articles examined used different toothpastes with no homogeneous relative dentine abrasivity (RDA) and cycles of brushing, the findings are about the same. The possible reason is attributable to the compositions of the resin-contained CAD/CAM materials. Conclusions: The surface roughness of most resin-contained CAD/CAM materials was affected by artificial toothbrushing. Correct knowledge of the composition of the dental material and toothpastes is fundamental to avoid an increase of surface roughness on prosthetic rehabilitation.

2021 - Assessment of fit on ten screw-retained frameworksrealized through digital full-arch implant impression [Articolo su rivista]
De Francesco, M.; Stellini, E.; Granata, S.; Mazzoleni, S.; Ludovichetti, F. S.; Monaco, C.; Di Fiore, A.
abstract

Background: Discordant opinions have emerged among clinicians and researchers regard-ing a digital impression for full-arch implant-supported fixed dental prostheses (FDPs). The purpose of this study was to assess the fit of screw-retained milled frameworks on six implants realized from digital impressions through the Sheffield test. Methods: One patient received a maxillary full-arch implant-supported FDP. Six months after the surgical procedure, ten intraoral full-arch digital impressions were performed to mill ten frameworks. To clinically assess the fit, the Sheffield test was applied for all frameworks. The gaps among the frameworks and the implant analogs were measured using a microscope on the master model realized with a traditional impression. The Wilcoxon sum-rank test was used to compare the misfit value among the different implant positions. Results: The Sheffield test did not show gaps in the framework–implant interfaces when the screw was completely tightened on the more distal implant for all the milled frameworks. The mean misfit value calculated after microscope examination was 38 ± 5 µm. Differences that were statistically significant emerged when the misfit values of central positions were compared with other values. Conclusions: The use of full-arch implant digital impressions represents a viable alternative to traditional impressions for the fabrication of implant-supported FDPs.

2021 - Automatic Digital Design of the Occlusal Anatomy of Monolithic Zirconia Crowns Compared to Dental Technicians’ Digital Waxing: A Controlled Clinical Trial [Articolo su rivista]
Fiore, A. D.; Monaco, C.; Brunello, G.; Granata, S.; Stellini, E.; Yilmaz, B.
abstract

Purpose: Reconstructing the occlusal morphology of posterior teeth in definitive dental prosthesis can be challenging. The use of the correlation technique enables replication of the information and occlusal anatomy of interim dental prostheses to the definitive ones. The purpose of this controlled clinical trial was to compare the static and dynamic contacts (SDC) of monolithic zirconia crowns designed with correlation and library techniques. Material and Methods: Twenty-four patients were included in the study for a total of 28 molars. For each abutment tooth, an interim crown was fabricated and two digital scans, with and without the interim crown in place were made. Two single crowns were designed using correlation and library techniques. Fifty-six monolithic zirconia crowns were milled. The interim and definitive crowns were evaluated intraorally for SDC by using a 24-μm-thick blue articulating foil. After removing the interim and definite crowns, extraoral photographs were taken to calculate the SDC area using software (ImageJ) and analyzed by the Kruskal-Wallis test. Results: The average and ± standard deviation (SD) of area of the occlusal marks on interim crowns was 32.27 ± 3.45 mm2. Definitive crowns designed by using the correlation technique had an area of 31.01 ± 3.73 mm2; the area in the library technique was 36.85 ± 5.78 mm2. No statistically significant difference was found (p = 0.091) between the occlusal mark areas of the interim and definitive crowns designed by using the correlation technique. Whereas, there were significant differences between the areas of occlusal marks of the interim and definitive crowns designed by using the library technique, and between the areas of occlusal marks of definitive crowns designed by using the correlation and library techniques (p < 0.001). Conclusion: The average area of the SDC of monolithic zirconia crowns designed by using the correlation technique was similar to that of interim crowns. The library technique was less effective when replicating the SDC compared to the correlation technique.

2021 - Clinical performance of posterior monolithic zirconia implant-supported fixed dental prostheses with angulated screw channels: A 3-year prospective cohort study [Articolo su rivista]
Di Fiore, A.; Granata, S.; Monaco, C.; Stellini, E.; Yilmaz, B.
abstract

Statement of problem: The choice of retention type of an implant-supported fixed dental prosthesis (FDP) becomes critical when the dental implant is not placed in a prosthetically ideal location. In recent years, computer-aided design and computer-aided manufacturing (CAD-CAM) technology has enabled the correction of the location of screw access hole depending on the clinical needs of the patient. However, how FPDs with angulated screw channels (ASCs) perform clinically is unclear. Purpose: The purpose of this prospective clinical study was to evaluate the mechanical complications and crestal bone loss (CBL) when posterior monolithic zirconia implant-supported FDPs with an ASC are used. Material and methods: Participants (N=37) with a missing single posterior tooth or multiple teeth, sufficient bone height, and an implant site without infection were included. Each participant received parallel-walled implants (Nobel Parallel CC) of 7-, 8.5-, or 10-mm length by using a 1-stage approach. After 4 months of healing, a conventional impression was made, and a digital workflow was followed. Monolithic zirconia restorations (Katana ML) were milled, stained, and mechanically attached to a titanium base (NobelProcera ASC abutment). CBL was measured from radiographs at 6, 12, 24, and 36 months after the placement of the prosthesis. Implant and prosthetic characteristics including implant diameter, implant length, screw channel angle (angle≤15 degrees versus angle>16 degrees), prosthetic type (single crown versus multiple-unit FDP), and antagonist dentition (natural versus prosthesis) were also recorded. A generalized linear mixed model with a log link was estimated to assess the independent predictors of CBL among the angles of ASC-retained definitive restorations and the clinically relevant variables (α=.05). Results: Thirty-seven participants received 51 implants, and the median follow-up period was 30 months (interquartile range: 22-36). Two single-crown implants failed within the first 12 months of delivery. The implant and restoration survival rate was 96% at 36 months. Screw loosening was recorded in 2 study participants. After a follow-up of 36 months, the mean ±standard deviation CBL value was 0.15 ±0.14 mm with an increase over time (P<.001). The effect of the angle of ASC, implant diameter, implant length, prosthetic type, and antagonist on the CBL was not statistically significant (P>.05). Conclusions: CBL was not associated with the angle of ASC, implant diameter, implant length, prosthetic type, or antagonist when posterior monolithic zirconia implant-supported FDPs with ASCs were used. Screw loosening in 2 situations was the only mechanical complication during the first 3 years of service.

2021 - Digital Jaw Relation Record of Edentulous Patients in the CAD-CAM Workflow of the Implant-Supported Full-Arch Prosthesis [Articolo su rivista]
Ragazzini, Nicola; Baldissara, Paolo; Monaco, Carlo; Ciocca, Leonardo
abstract

No abstract is required for research letters.

2021 - Fatigue failure and success rate of lithium disilicate table-tops as a function of cement thickness [Articolo su rivista]
Baldissara, P.; Koci, B.; Monaco, C.; Scotti, N.; Breschi, L.; Ciocca, L.
abstract

Purpose: Under thin, partial coverage restoration the proper cement thickness to be clinically employed still remains an issue. The aim of this study was to determine the failure and success rates of simplified lithium disilicate occlusal veneers as a function of cement thickness. The null hypothesis was that cement thickness has no effect on the fatigue resistance. Methods: Sound human molars were severed in a plane parallel to the occlusal surface to create a flat dentin surface surrounded by enamel edges. Forty-five occlusal veneers 1.0 mm thick (IPS e.max CAD LT) were luted to the teeth with Multilink Automix resin cement, creating 3 experimental groups (n=15) with cement thicknesses of 50, 100, and 200 µm. The restorations were fatigue-cycled using a ball mill machine containing zirconia and stainless steel spheres. Twelve 60 min cycles were performed. Survival statistics were applied to “failure” and “success” events, comparing the three groups using a log-rank Mantel– Cox test and a log-rank test for trends (alpha = 0.05). Results: The failure and success rates were not significantly influenced by cement thickness (P = 0.137 and P = 0.872, respectively); thus, the null hypothesis was accepted. However, when log-rank test for trends was applied to failure events, the tendency to have less failures with increasing thicknesses was found statistically significant (P = 0.047). Conclusions: The cement thickness within the range adopted here did not have a significant effect on the failure or success rate of lithium disilicate occlusal veneers when exposed to randomized impact stresses generating fatigue phenomena.

2020 - 2D/3D accuracies of implant position after guided surgery using different surgical protocols: A retrospective study [Articolo su rivista]
Monaco, C.; Arena, A.; Corsaletti, L.; Santomauro, V.; Venezia, P.; Cavalcanti, R.; Di Fiore, A.; Zucchelli, G.
abstract

Purpose: To compare the 2D and 3D positional accuracy of four guided surgical protocols using an analysis of linear and angular deviations. Methods: DICOM and.STLs files obtained from a CBCT and a digital impression were superimposed with software to plan implant position. Fifty-six patients were subdivided into 4 groups: FGA group (template support [Ts]: teeth [T]; bed preparation [Bp]: fully guided [FG]; implant insertion [Ii]: 3D template [3Dt]; device [D]: manual adapter [MA], FGM group (Ts: T; Bp: FG; Ii: 3Dt; D: fully guided mounter [FGM]), PG group (Ts: T; Bp: FG; Ii: manual; D: none) and MS group (Ts: mucosa; Bp: FG; Ii: 3Dt; D: FGM). The position of 120 implants was assessed by superimposing the planned and final position recorded with a digital impression. Results: In FGA group, 3D deviations were 0.92 ± 0.52 mm at the implant head and 1.14 ± 0.54 mm at the apex, and the angular deviation (ang. dev.) was 2.45 ± 1.24°. In FGM group, were 0.911 ± 0.44 mm (head) and 1.11 ± 0.54 mm (apex), and the ang. dev. was 2.73 ± 1.96°. In PG group, were 0.95 ± 0.47 mm (head) and 1.17 ± 0.488 mm (apex), and the ang. dev. was 3.71 ± 1.67°. In MS group, were 1.15 ± 0.45 mm (head) and 1.42 ± 0.45 mm (apex), and the ang. dev. was 4.19 ± 2.62°. Ang. dev. of MS group was different from the other groups (P < 0.05). Conclusions: Guided surgery showed a sufficient accuracy.

2020 - Assessment of the different types of failure on anterior cantilever resin-bonded fixed dental prostheses fabricated with three different materials: An in vitro study [Articolo su rivista]
Di Fiore, A.; Stellini, E.; Savio, G.; Rosso, S.; Graiff, L.; Granata, S.; Monaco, C.; Meneghello, R.
abstract

background: resin-bonded fixed dental prosthesis (RBFDP) represents a highly aesthetic and conservative treatment option to replace a single tooth in a younger patient. The purpose of this in vitro study was to compare the fracture strength and the different types of failure on anterior cantilever RBFDPs fabricated using zirconia (ZR), lithium disilicate (LD), and PMMA-based material with ceramic fillers (PM) by the same standard tessellation language (STL) file. Methods: sixty extracted bovine mandibular incisives were embedded resin block; scanned to design one master model of RBFDP with a cantilevered single-retainer. Twenty cantilevered single-retainer RBFDPs were fabricated using ZR; LD; and PM. Static loading was performed using a universal testing machine. Results: the mean fracture strength for the RBFDPs was: 292.5 Newton (Standard Deviation (SD) 36.6) for ZR; 210 N (SD 37.6) for LD; and 133 N (SD 16.3) for PM. All the failures of RBFDPs in ZR were a fracture of the abutment tooth; instead; the 80% of failures of RBFDPs in LD and PM were a fracture of the connector. Conclusion: within the limitations of this in vitro study, we can conclude that the zirconia RBFDPs presented load resistance higher than the maximum anterior bite force reported in literature (270 N) and failure type analysis showed some trends among the groups.

2020 - In vitro 2D and 3D roughness and spectrophotometric and gloss analyses of ceramic materials after polishing with different prophylactic pastes [Articolo su rivista]
Monaco, C.; Arena, A.; Scheda, L.; Di Fiore, A.; Zucchelli, G.
abstract

Statement of problem: The effect of prophylactic polishing pastes on composite resin materials has been extensively investigated, but little is known about their effect on ceramic materials. Purpose: The purpose of this in vitro study was to evaluate the effect of prophylactic polishing pastes on the 2D and 3D roughness, translucency, and gloss of different ceramic materials. Material and methods: A total of 120 flat specimens (thickness: 2 mm) obtained from computer-aided design and computer-aided manufacturing (CAD-CAM) blocks of leucite glass-ceramic (Empress CAD), lithium disilicate glass-ceramic (e.max CAD), and zirconia (Zenostar MT) were glazed and sintered. Forty specimens from each material were then divided into 4 groups and polished with Cleanic fine, Nupro fine, or Proxyt fine pastes, leaving the control group untreated. The specimens were polished for 2 minutes with a prophylaxis cup mounted on a handpiece, applying a constant load of 3.9 N at 2000 rpm. Surface roughness was measured by using a contact profilometer and a 3D optical profilometer. The translucency parameter and gloss value were calculated by using a spectrophotometer and a glossmeter. One specimen per group was observed by scanning electron microscopy at ×200 magnification. Differences in means were compared by using 2-way ANOVA followed by the Tukey honestly significant difference (HSD) test (α=.05). Results: The 2D roughness of Empress was lower than that of e.max (P<.05) and was increased by using Cleanic fine and Nupro fine pastes (P<.05). The translucency parameter values of Empress and Zenostar decreased with the use of Nupro fine paste (P<.05). Zenostar showed the lowest translucency (P<.05). The effect of prophylactic polishing pastes on gloss was minimal (P>.05). The gloss of Empress was higher than that of Zenostar and e.max (P<.05). The Pearson correlation showed that gloss and surface roughness were correlated (P<.001). Conclusions: Polishing procedures can alter the surface of a ceramic restoration.

2020 - Influence of ceramic firing on marginal gap accuracy and metal-ceramic bond strength of 3D-printed Co-Cr frameworks [Articolo su rivista]
Di Fiore, A.; Savio, G.; Stellini, E.; Vigolo, P.; Monaco, C.; Meneghello, R.
abstract

Statement of problem: The marginal gap and ceramic bond strength of metal-ceramic restorations are important for success. However, studies evaluating the marginal gap and ceramic bond strength of fixed partial dentures (FPDs) produced with 3D printing technologies such as selective laser melting (SLM) are scarce. Purpose: The purpose of this in vitro study was to investigate the marginal gap of cobalt-chromium (Co-Cr) alloy frameworks produced by SLM technology before and after ceramic firing. Additionally, the metal-ceramic bond strength was evaluated with the Schwickerath crack-initiation test according to the International Standards Organization (ISO) 9693-1:2012. Material and methods: Conventional impressions were made, and the definitive cast of a patient requiring a 4-unit FPD was scanned. After designing the FPD, the files were sent to a service center for the fabrication of a metal master model, 80 Co-Cr frameworks, and 80 flat specimens (25×3×0.5 mm) with SLM technology. The marginal gap between frameworks and the abutment tooth of the metal master model was nondestructively measured by using an optical coordinate-measuring machine. A total of 80 sets, consisting of 1 framework and 1 flat specimen, were sent to 80 dental laboratory technicians for ceramic firing. Detailed instructions for correct manipulation of the framework and flat specimen were provided. The marginal gap was remeasured, and the 3-point bend test was used to evaluate metal-ceramic bond strength. Results: Only 28 of the 80 dental technicians returned the specimens within a prespecified time and/or in adequate condition. The mean ±standard deviation marginal gap of the framework before ceramic firing was 25 ±9 μm and 34 ±12 μm after firing. The difference was statistically significant (P=.001). The mean ±standard deviation 3-point bend strength was 33 ±9 MPa. Conclusions: Ceramic firing affected the marginal gap; however, all Co-Cr frameworks had a marginal gap lower than 120 μm, which is reported to be a clinically acceptable limit. Most of the specimens (80%) had a metal-ceramic bond strength value higher than the 25-MPa ISO 9693 requirement. Five of 28 dental laboratory technicians were not able to comply with ceramic firing instructions.

2019 - Comparison of accuracy of single crowns generated from digital and conventional impressions: An in vivo controlled trial [Articolo su rivista]
Di Fiore, A.; Francesco, M. D. E.; Monaco, C.; Stocco, E.; Vigolo, P.; Stellini, E.
abstract

Aim With the advances of digital technology, intraoral digital impression (DI) technique has become a major trend in prosthodontics with respect to traditional impression (TI) techniques; despite that, very few data are available concerning its accuracy. Thus, the purpose of this study was to compare the effectiveness of DI versus TI considering both marginal and internal gap (MG, IG, respectively) in cobalt-chromium (Co-Cr) single crowns manufactured by mean of computer-aided design and computer-aided manufacturing (CAD/CAM) technology. Material and methods Thirty posterior teeth were considered for this study. For each abutment tooth, sixty and thirty copings were produced with the aid of TI and DI, respectively. Thirty of the sixty copings of the TI-group were then randomly selected to be veneered and cemented onto existing abutments. The space existing between the internal surface of the coping and the abutment tooth was evaluated onto an in vitro replica; the MG and IG were measured by Scanning Electron Microscope. The data were analysed by the Wilcoxon test (1-tailed). Results The mean MG was 75.04 μm (SD = 13.12) and 55.01 μm (SD = 7.01) for the TI group and DI group, respectively. As regards the mean IGs, the values recorded were of 78.36 μm (SD = 19.66) for the TI-group and 59.20 μm (SD=3.33) for the DI-group. A statistically significant difference was found between the two groups (p-value = 0.001). Conclusions Copings manufactured from DI showed better MGs and IGs with respect to copings produced from TI. However, both approaches produced clinically acceptable results.

2019 - Digital bar prototype technique for full-arch rehabilitation on implants [Articolo su rivista]
Monaco, C.; Arena, A.; Pallotti, G.; di Fiore, A.; Scheda, L.
abstract

Background and Overview: The aim of the authors in this case report was to describe a new approach to using the digital bar prototype technique for complete digital full-arch implant rehabilitation. Two combinable structures were used during the same visit as prototypes to simultaneously test the implant locations and the prosthetic parameters. Then the structures were joined together to form the final prosthesis. Case Description: After the implant integration with the immediate provisional restoration, 3 sets of digital impressions were obtained to obtain a master digital model (MDM). A stereolithographic model with implant analogs was printed on the basis of the MDM. A titanium bar with implant connections and a functional resin structure were milled on the basis of the MDM and used as prototypes. To check the accuracy of the implant impression, the titanium prototype was tried in, and clinical and radiographic tests were performed. Then the resin prototype was slid into the positional prototype and fitted to the patient, and the esthetic and occlusal properties were evaluated and refined. Definitive restoration was obtained by luting the 2 prototypes together and finalizing the prosthesis with pink resin. Conclusions and Practical Implications: The prototypes allowed the clinician to simultaneously verify the accuracy of the digital impressions and test the prosthetic parameters in 1 visit. Moreover, they were used to create the final restoration. The digital bar prototype technique also allowed for the reduction of clinical and laboratory time in a full-arch rehabilitation on implants. Nevertheless, obtaining a full-arch impression in an edentulous arch can be challenging, and further studies are necessary to evaluate the long-term success of this technique.

2019 - Digital impression of teeth prepared with a subgingival vertical finish line: A new clinical approach to manage the interim crown [Articolo su rivista]
Di Fiore, A.; Vigolo, P.; Monaco, C.; Graiff, L.; Ferrari, M.; Stellini, E.
abstract

Aim Intraoral scanner can simplify the prosthodontic workflow with reduction of time, cost and several steps. However, clinical conditions can affect the quality of the digital impressions, especially if the tooth is prepared with subgingival vertical finish line. This report describes a technique to manage the interim crown by means of a case report. Case report A 63-year-old female patient needed to be treated with a single-unit fixed dental prosthesis in the posterior area. A new technique to manage the interim crown and to obtain accurate digital impression of an abutment tooth with subgingival vertical finish line without the use of retraction techniques is described. Conclusion This method allows the control of many problems associated to digital impressions such as localized bleeding, retraction technique and limits of scanners to acquire subgingival vertical finish line.

2019 - Fatigue resistance of monolithic lithium disilicate occlusal veneers: a pilot study [Articolo su rivista]
Baldissara, P.; Monaco, C.; Onofri, E.; Fonseca, R. G.; Ciocca, L.
abstract

The use of thin lithium disilicate (LD) occlusal veneers is an effective method to increase the vertical dimension of occlusion in cases of tooth wear. However, doubt remains regarding the threshold thickness to be used in this restoration class. This study aims to evaluate the effect of ceramic thickness on the survival rate and failure pattern of LD molar veneer restorations using a simplified fatigue testing machine. Sixty sound, freshly extracted human molars were used. Three groups (n = 20) were randomly created with different ceramic thicknesses (0.5, 0.8, and 1.2 mm), and 60 LD IPS e.max Press LT occlusal veneers were fabricated. The ceramic restorations were luted with a resin cement. The stainless-steel rotating drum of the ball mill contained 10 zirconia (Y-TZP) and 10 stainless steel spheres, in 500 mL of distilled water at 37 ± 1 °C. Crack growth in the LD restorations was evaluated under a stereomicroscope following each fatigue testing run (12 60-min runs). Progressive damage was observed as a function of cycling time. Survival was significantly influenced by the restoration thickness (p = 0.002, log-rank test), with thicker restorations exhibiting a higher survival rate. Thinner restorations (0.5 mm) showed significantly lower survival rate than 0.8- and 1.2-mm restorations (p < 0.016); no significant difference was observed between the 0.8- and 1.2-mm restorations. A threshold value of 0.8 mm may represent an acceptable compromise between fatigue resistance and tooth reduction.

2019 - Full arch digital scanning systems performances for implant-supported fixed dental prostheses: a comparative study of 8 intraoral scanners [Articolo su rivista]
Di Fiore, A.; Meneghello, R.; Graiff, L.; Savio, G.; Vigolo, P.; Monaco, C.; Stellini, E.
abstract

Purpose: Compare the accuracy of intraoral digital impression in full-arch implant-supported fixed dental prosthesis acquired with eight different intraoral scanner (Ios). Methods: A polymethyl methacrylate acrylic model of an edentulous mandible with six scan-abutment was used as a master model and its dimensions measured with a coordinate measuring machine. Eight different Ios were used to generate digital impression: True Definition, Trios, Cerec Omnicam, 3D progress, CS3500, CS3600, Planmeca Emelard and Dental Wings. Fifteen digital impressions were made. A software called “Scan-abut” was developed to analyse and compare the digital impression with the master model, obtaining the scanning accuracy. The three-dimensional (3D) position and distance analysis were performed. Results: Mean value of the 3D position analysis showed that the True Definition (31 μm ± 8 μm) and Trios (32 μm ± 5 μm) have the best performance of the group. The Cerec Omnicam (71 μm ± 55 μm), CS3600 (61 μm ± 14 μm) have an average performance. The CS3500 (107 μm ± 28 μm) and Planmeca Emelard (101 μm ± 38 μm) present a middle-low performance, while the 3D progress (344 μm ± 121 μm) and Dental Wings (148 μm ± 64 μm) show the low performance. The 3D distance analysis showed a good linear relationship between the errors and scan-abutment distance only with the True Definition and CS3600. Conclusions: Not all scanners are suitable for digital impression in full-arch implant-supported fixed dental prosthesis and the weight of the output files is independent from the accuracy of the Ios.

2019 - Implant Digital Impression in the Esthetic Area [Articolo su rivista]
Monaco, Carlo; Scheda, Lorenzo; Baldissara, Paolo; Zucchelli, Giovanni
abstract

The aim of this report is to describe two standardized protocols for digital impression when implant support rehabilitation is used in the esthetic area. The two techniques were used to transfer all provisional crown parameters to definitive restorations in different clinical scenarios. In the direct technique, an impression (STL1) is made of the provisional restorations attached to the implants, with surrounding gingival tissue. The second scan (STL2) captures the sulcular aspect of the peri-implant soft tissue immediately after removal of the provisional restoration. The last impression (STL3) of the complete arch is made with a standardized scanbody attached to the implant to capture the 3D location of the implant. The direct technique is indicated when the peri-implant soft tissues are stable upon removal of the provisional restoration. The indirect technique is used when the gingival tissue collapses rapidly after the removal of the provisional crown. The impressions of the provisional restoration and the position of the implant are similar to those obtained with the direct technique, and the shape of the peri-implant tissue is extrapolated from the negative shape obtained from making the digital impression when the provisional restoration is taken out of the mouth. Finally, in both techniques the 3 scans are superimposed to obtain a file, which contains the details of the peri-implant soft tissue. The direct and indirect digital techniques allowed realization of a predictable definitive restoration in the esthetic zone in different clinical scenarios, reducing the duration of clinical procedures.

2019 - In vitro 3D and gravimetric analysis of removed tooth structure for complete and partial preparations [Articolo su rivista]
Monaco, C.; Arena, A.; Stelemekaite, J.; Evangelisti, E.; Baldissara, P.
abstract

Purpose: To quantify and to compare a gravimetric and three-dimensional (3D) analysis of the removed tooth structure for different complete crown preparations. Methods: A total of 80 molar resin teeth and 8 preparation finishing lines were chosen: 1 for metal ceramic crowns (MCC); 3 for zirconia all-ceramic crowns: knife edge (ZirKnE), chamfer (ZirCha), and shoulder (ZirSho); 4 for lithium disilicate: light chamfer (LDLCha), chamfer (LDCha), shoulder (LDSho) and table top. Teeth were individually weighed to high precision and then prepared following the preparation guidelines. The teeth were reweighed after preparation, and the amount of structural reduction was calculated. In addition, all teeth were scanned before and after preparation, and the 3D volume of removed dental tissue was calculated, superimposing the two.stl files, as a difference of the volumes before and after the preparation. Kruskal–Wallis statistical analysis was carried out to determine significant differences among the groups with a significance level of p < 0.05. Results: Both analyses showed that LDLCha, ZirKnE and table-top preparations produced the smallest amount of removed structure, whereas the preparations for MCC, ZirSho and LDSho were more destructive. For MCC, 2.6 times more tooth structure must be removed than for table top. ZirKnE was 17.82% and LDLCha was 21.51% more conservative than MCC. The data obtained through the volumetric method were similar with those obtained by gravimetric analysis. Conclusions: ZirKnE, LDLCha, and table-top preparations produced the least amount of tooth tissue removal. Three-dimensional volumetric analysis can be a possible alternative to gravimetric analysis.

2019 - Influence of crown-to-implant ratio on long-term marginal bone loss around short implants [Articolo su rivista]
Di Fiore, A.; Vigolo, P.; Sivolella, S.; Cavallin, F.; Katsoulis, J.; Monaco, C.; Stellini, E.
abstract

Purpose: To evaluate the influence of the crown-to-implant ratio (CI) on marginal bone loss (MBL) around short dental implants placed in the posterior mandible. Materials and Methods: All patients treated with short implants (7-mm length) in the posterior mandible between 1994 and 2003 at the Dental Clinic of the Department of Neuroscience of the University of Padua (Italy) were retrospectively included in the analysis. MBL and clinical CI (cCI) were measured on the radiographs. Implant characteristics including implant diameter, prosthetic type, retention mode, antagonist type, veneering material, and implant surfaces were retrieved from local medical records. A generalized linear mixed model was estimated to identify the predictors of MBL. Results: A total of 108 dental implants placed in 51 patients were included in the analysis. Mean follow-up was 16 years (range: 11 to 20 years). Mean cCI was 2.21 (SD = 0.31) with a mean crown height of 10.86 mm (SD = 0.99). Mean MBL was 1.42 mm (SD = 0.38). At multivariable analysis, cCI ≥ 2 was associated with higher MBL (regression coefficient: 0.27; 95% CI: 0.15 to 0.40), while implant characteristics, follow-up, and site were not associated with MBL. The effect of a cCI ≥ 2 was estimated in an increase of 0.28 mm in MBL (95% CI: 0.14 to 0.43 mm). Conclusion: Higher cCI was associated with greater MBL of implant-supported fixed dental prostheses in short dental implants placed in the posterior mandible, while implant characteristics, follow-up, and site were not associated with MBL. However, the increase of 0.28 mm of MBL in patients with a cCI ≥ 2 may not be clinically relevant.

2019 - Influence of preparation design and spacing parameters on the risk of chipping of crowns made with Cerec Bluecam before cementation [Articolo su rivista]
Arena, A.; Baldissara, P.; Ciocca, L.; Scotti, R.; Monaco, C.
abstract

Purpose: To evaluate the influence of the preparation design and spacing parameters on the risk of chipping of crowns made by CEREC Bluecam before cementation. Methods: A knife-edge preparation and a chamfer preparation were made on upper premolars. The teeth were scanned and two Co–Cr alloy replicas were made. Fifteen full crowns were manufactured for four groups using CEREC. The groups differed in type of preparation (knife-edge (KE) or chamfer (CHA)) and spacing parameters: spacer (0 or 150 μm), marginal adhesive gap (10 or 50 or 150 μm) and margin thickness (0 or 300 μm). The four groups were: CHA 150 (spacer)- 50 (marginal adhesive gap)- 0 (margin thickness), KE 150-50-0, KE 150-50-300 and KE 150-150-300. The crowns were loaded before cementation by using an Instron machine to simulate the masticatory load applied during a trial. Differences in means were compared using two-way ANOVA and a post-hoc test (Tukey Test). The level of significance was set at P = 0.05. Results: The fracture values, ordered from least to most resistant, were: KE 150-50-300 group, CHA 150-50-0 group, KE 150-50-0 group and KE 150-150-300 group. Two-way ANOVA revealed statistically significant differences between pairs of means (p < 0.05). Tukey's test showed that restorations of the KE 150-150-300 group can withstand a load significantly higher than that of other groups (p < 0.01). In this group, the failures were mostly minor chippings, while the other groups had mostly major chippings and fractures. Conclusions: Marginal adhesive gap can affect the trial of a full crown.

2019 - Manufacturing of Metal Frameworks for Full-Arch Dental Restoration on Implants: A Comparison between Milling and a Novel Hybrid Technology [Articolo su rivista]
Ciocca, L.; Meneghello, R.; Savio, G.; Scheda, L.; Monaco, C.; Gatto, M. R.; Micarelli, C.; Baldissara, P.
abstract

Purpose: To determine the trueness and precision of frameworks manufactured with a selective laser melting/milling hybrid technique (SLM/m) and conventional milling by comparing the implant-platform/framework interface with those of the original computer-aided design (CAD). Materials and Methods: Using a virtual 6-implant-supported full-arch framework CAD drawing, 27 titanium replicas were manufactured by 3 independent manufacturing centers (n = 9/center) using a hybrid SLM/m technology (labs 1 and 2) or the conventional milling technique (lab 3). Using an opto-mechanical coordinate measuring machine, the frameworks’ misfit distribution and patterns were analyzed, and the position error between paired platform positions within each framework was evaluated to calculate the misfit tendency for each group. A multilevel analysis using a mixed-effects model was conducted (α = 0.05). The trueness was evaluated as the dimensional difference from the original, while the precision as the dimensional difference from a repeated scan. Results: The 3 dimensional misfits differed significantly among the 3 groups, with the milled group exhibiting the least accurate outcome (p = 0.005). The mean 3D positioning errors ranged from 8 to 16 µm and from 9 to 22 µm for the SLM/m technique (labs 1 and 2, respectively), and from 20 to 35 µm for conventional milling (lab 3). Regarding the misfit distribution pattern, the misfit increased with the distance between paired platform positions in all groups. Conclusions: All groups had 3D misfits well within the error limits reported in the literature. The 3D misfits of new hybrid (SLM/milling) and conventional (milling) procedures differed significantly among them, with the milling technique the less accurate and precise. The largest errors in all groups were found between the most distant implants, resulting in a correlation between the framework span and the inaccuracies.

2019 - Nanostructured zirconia-based ceramics and composites in dentistry: A state-of-the-art review [Articolo su rivista]
Arena, A.; Prete, F.; Rambaldi, E.; Bignozzi, M. C.; Monaco, C.; Di Fiore, A.; Chevalier, J.
abstract

The objective of this paper is to review the current knowledge on the development of nanostructured zirconia-based ceramics and composites suitable for application in dentistry. Isi Web of Science, Science Direct, Scientific.net databases, and Google were searched electronically for the period of 1980 to the present, matching the keywords “nano” with the keywords: “Zirconia, ZrO2, Y-TZP, and dental, dentistry”. A total of 74 papers were found, with the majority coming from Asia, indicating a more active scientific interest on the topic in this geographic area, followed by Europe, South America, and North America. The research shows, even though the scientific activity on nanostructured ceramics was intense in the last fifteen years, the development of fully dense zirconia-based nanoceramics is yet at an initial stage, most of all from the point of view of the clinical applications. It has been demonstrated that nanostructured ceramics can show improved properties because of the reduction of the grain size to the nanoscale. This is also true for zirconia-based nanoceramics, where some improvements in mechanical, optical, as well as resistance in low-temperature degradation have been observed. Potential applications of this class of material in the dental field are discussed, summarizing the results of the latest scientific research.

2019 - Survival rate and load to failure of premolars restored with inlays: An evaluation of different inlay fabrication methods [Articolo su rivista]
Pivetta Rippe, M.; Monaco, C.; Missau, T.; Wandscher, V. F.; Volpe, L.; Scotti, R.; Bottino, M. A.; Valandro, L. F.
abstract

Statement of problem: Studies that evaluate the survival rate and load to fracture of premolars restored with inlays produced using different methods are lacking. Purpose: The purpose of this in vitro study was to compare the survival rate and fracture load of premolars restored with inlays fabricated using different methods. Material and methods: Thirty maxillary premolars were selected, embedded, and prepared to receive inlays fabricated using different methods (n=10): LaCom-digital scanning with Lava C.O.S. scanner (3M ESPE), followed by milling of composite resin block (Lava Ultimate; 3M ESPE) in a milling unit; CeCom-digital scanning with Cerec 3D Bluecam scanner (Dentsply Sirona), followed by milling of a Lava Ultimate block in Cerec (Dentsply Sirona); PresDis-impression with polyvinyl siloxane, inlay made using the lost wax technique, and IPS e.max Press (Ivoclar Vivadent AG) pressed ceramic (lithium disilicate). A dual-polymerizing resin cement system was used to lute the inlays. Inlays were mechanically cycled (2 Hz, 106 mechanical pulses, 80 N) after 24 hours, and the specimens were stored in distilled water at 37°C for 11 months. Then, a fatigue test was conducted using a 10-Hz frequency and 400-N load on the inner inclines of the cusps. The test was complete when the specimen fractured or when the specimen reached 1.5×106 cycles. The specimens that survived fatigue testing were submitted to a single-load fracture test in a universal testing machine and analyzed using a stereoscope for failure classification. Survival rates were estimated using the Kaplan-Meier method and log-rank test (Mantel-Cox). Fracture load data were analyzed using 1-way ANOVA (α=.05). Results: No significant differences were detected among the groups for the survival rate (P=.87) or for the load to fracture (P=.78). Most failures were longitudinal, catastrophic fractures. Conclusions: Premolars restored with inlays fabricated using the tested methods had similar survival rates and loads to fracture.

2018 - 5-year outcomes after coverage of soft tissue dehiscence around single implants: A prospective cohort study [Articolo su rivista]
Zucchelli, Giovanni; Felice, Pietro; Mazzotti, Claudio; Marzadori, Matteo; Mounssif, Ilham; Monaco, Carlo; Stefanini, Martina
abstract

To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants.

2018 - A fully digital approach to replicate functional and aesthetic parameters in implant-supported full-arch rehabilitation [Articolo su rivista]
Monaco, C.; Ragazzini, N.; Scheda, L.; Evangelisti, E.
abstract

Purpose: The aim of this technical procedure was to use a fully digital technique (FDT) for full-arch implant support rehabilitation. The FDT was used to transfer the provisional restoration parameters to definitive restorations using intraoral scanners. Methods: Three sets of digital impressions were obtained. Through the first set, standard tessellation language 1 (STL1), provisional restorations screwed to implants and the surrounding gingival tissue was captured. STL2 consisted of intraoral scans of standardized scanbodies screwed to implants to collect 3D positioning data of implants. STL3 included the digital impression of provisional restoration out of the mouth in order to capture the gingival architecture and the peri-implant soft tissue that was not possible to transfer with the previous impressions. STL1, STL2, and STL3 were combined using computer-aided design (CAD) functions into a single file, STL4. Thus, STL4 contained information on the 3D implant positions, soft tissue architectures, occlusal relationships, correct occlusal vertical dimension and aesthetic features. Using STL4, the master models with implant analogues were 3D printed. Computer-aided design and computer-aided manufacturing milled (CAD/CAM-milled) aluminium bars and a resin prototype were produced to test the accuracy and the functional and aesthetic parameters. Titanium frameworks were digitally designed using STL4, milled using CAD/CAM, and finalized with pink resin and resin teeth. Conclusion: The FDT provided an effective fully digital protocol to capture all information for provisional full-arch implant restorations using an intraoral scanner and transfer that information to definitive restorations.

2018 - Bond Strength to Cubic Zirconia and Lithium-disilicate. A Preliminary Study [Relazione in Atti di Convegno]
Parisi, Candida; Greishberger, Tommaso; Monaco, Carlo; Ciocca, Leonardo; Baldissara, Paolo
abstract

Objectives: Bonding to polycrystalline ceramics is a concern in fixed prosthodontics. Aim of this study was to determine the micro-SBS of two MDP-based cements to cubic-zirconia (ZIR) and lithium-disilicate (L-DIS). The null hypothesis was that mean micro-SBS did not vary among tested groups. Methods: Twenty plates 12x12x2mm of Katana-UTML, (Kuraray-Noritake), and 20 of IPS e.max CAD LT, (Ivoclar-Vivadent) were used as substrates. They were assigned to 4 groups (n=40) according to the combination with two resin-cements: PanaviaV5 (PV5) + Clearfil-Ceramic-Primer-Plus, (groups PV5/ZIR and PV5/L-DIS); PanaviaSA (PSA) self-adhesive cement, (groups PSA/ZIR and PSA/L-DIS). The ceramics were pre-treated following the cements manufacturer instructions: ZIR-tablets were sandblusted (Al2O3 powder, 50mm); L-DIS-tablets were conditioned (35% H3PO4, K-Etchant Syringe). Four cylinders (1.7mm diameter, 2mm height) of resin-cement were applied on each plate with vertical load (1Kg) and light-cured (20sec). All samples were stored in water (37°C, 24h) and tested for micro-SBS (Instron-machine). Failed surfaces were analyzed under optical-microscope and failure pattern was determined (adhesive, cohesive or mixed). Percentage of actual-failed/total adhesive surface was calculated with dedicated software (Zeiss ZEN). Mean micro-SBS values were measured (MPa) and statistically analyzed (Kruskall-Wallis-test, Dunn’s test, a=0.05). Results: The null hypothesis that micro-SBS did not vary among the groups was rejected, (p&lt;0.05). Mean values varied from 7.7±1.9MPa (PSA/L-DIS) to 19.6±1.7MPa (PV5/ZIR). All groups were statistically different, except PSA/ZIR vs PV5/L-DIS, (p&gt;0.05). Both cements presented significantly higher bond strength to ZIR than L-DIS substrate. For each substrate, PV5 showed higher bond strength than PSA. Adhesive failures were mostly observed in all groups. Mean percentage of actual-failed adhesive surface varied from 69.5% (PSA/ZIR) to 85.1% (PV5/L-DIS). Conclusions: ZIR treatment with MDP-based primer helped obtaining improved adhesion. L-DIS treatment with H3PO4 should be further investigated and compared with the conventional HF treatment. Micro-SBS measurements after longer aging conditions are needed to evaluate the bonding stability.

2018 - Crown lengthening and restorative procedures in the esthetic zone [Articolo su rivista]
Marzadori, Matteo; Stefanini, Martina; Sangiorgi, Matteo; Mounssif, Ilham; Monaco, Carlo; Zucchelli, Giovanni
abstract

Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin?

2018 - In vitro assessment of the accuracy of digital impressions prepared using a single system for full-arch restorations on implants [Articolo su rivista]
Ciocca, Leonardo; Meneghello, Roberto; Monaco, Carlo; Savio, Gianpaolo; Scheda, Lorenzo; Gatto, Maria Rosaria; Baldissara, Paolo
abstract

Purpose: This study describes a method for measuring the accuracy of the virtual impression. Methods: In vitro measurements according to a metrological approach were based on (1) use of an opto-mechanical coordinate measuring machine to acquire 3D points from a master model, (2) the mathematical reconstruction of regular geometric features (planes, cylinders, points) from 3D points or an STL file, and (3) consistent definition and evaluation of position and distance errors describing scanning inaccuracies. Two expert and two inexpert operators each made five impressions. The 3D position error, with its relevant X, Y, and Z components, the mean 3D position error of each scanbody, and the intra-scanbody distance error were measured using the analysis of variance and the Sheffe’s test for multiple comparison. Results: Statistically significant differences in the accuracy of the impression were observed among the operators for each scanbody, despite the good reliability (Cronbach’s α = 0.897). The mean 3D position error of the digital impression was between 0.041 ± 0.023 mm and 0.082 ± 0.030 mm. Conclusions: Within the limitations of this in vitro study, which was performed using a single commercial system for preparing digital impressions and one test configuration, the data showed that the digital impressions had a level of accuracy comparable to that reported in other studies, and which was acceptable for clinical and technological applications. The distance between the individual positions (#36 to #46) of the scanbody influenced the magnitude of the error. The position error generated by the intraoral scanner was dependent on the length of the arch scanned. Operator skill and experience may influence the accuracy of the impression.

2018 - The prototype concept in a full digital implant workflow [Articolo su rivista]
Monaco, Carlo; Scheda, Lorenzo; Ciocca, Leonardo; Zucchelli, Giovanni
abstract

Background: The aim of this case report is to describe the innovative concept of a prototype use in a digital implant workflow. A prototype is required for simultaneous evaluation of the accuracy of a dental impression and esthetic and functional parameters before final framework realization. Case Description: Three digital impressions were obtained to create a master file, which contained information on the 3-dimensional (3D) position of the implant, the gingival architecture, and the esthetic and functional features of the provisional restoration. A stereolithographic master model (SMM) featuring implant analogs was 3D printed. Two prototypes were realized with the use of 2 different modalities. The first resin prototype (A), which lacked implant connections, was produced with the use of a certified digital workflow process. The titanium connections were luted onto the SMM. The second resin prototype (B), considered experimental, was a single piece with milled implant connections. Both prototypes were tested in the patient by means of visual inspection, finger pressure testing, screw resistance testing, and periapical radiography. In the case of accurate fit of prototype A or B on the SMM and misfit in the patient, the impression should be invalidated. For prototype B, in the case of proper fit in the patient and misfit on the SMM (because of the occurrence of an error during 3D printing, incorrect analog position, or both), the impression should be validated, but the model should be adapted. Conclusions and Practical Implications: The use of a prototype allows the clinician to simultaneously test implant position and esthetic and functional parameters. However, a single-structure prototype could be preferable for the identification of impression inaccuracy.

2018 - Translucency of IPS e.max and cubic zirconia monolithic crowns [Articolo su rivista]
Baldissara, Paolo; Wandscher, Vinícius Felipe; Marchionatti, Ana Maria Estivalete; Parisi, Candida; Monaco, Carlo; Ciocca, Leonardo
abstract

Statement of problem: Although several monolithic zirconia ceramics have recently been introduced, the need for improved optical properties remains. The newest cubic-zirconia has been claimed to have optimal translucency characteristics for esthetic restorations. Purpose: This in vitro study evaluated the optical properties of novel cubic ultratranslucent (UT) and supertranslucent (ST) zirconia by comparing them with lithium disilicate (L-DIS) glass-ceramic for the manufacture of monolithic computer-aided design and computer-aided manufacturing (CAD-CAM) molar crowns. Material and methods: The UT and ST multilayered zirconia and the low-translucency grade L-DIS were milled. Eighty monolithic crowns were made from 2 CAD files, corresponding to thicknesses of 1.0 and 1.5 mm, and subdivided (n=20) into 4 groups: UT1.0, UT1.5, ST1.0, and L-DIS1.5. All groups were shaded using A2 color standard. Translucency of the crowns was measured by total transmission, using a photoradiometer in a dark chamber; furthermore, the contrast ratio was analyzed using a dental spectrophotometer applied to the buccal surface of the crowns. Data were analyzed using the Kruskal-Wallis and post hoc multiple Mann-Whitney U tests with Bonferroni correction (α=.05 divided by the number of tests performed in each set). Results: When the ceramic types were analyzed, using total transmission and contrast methods, they showed significantly different translucency levels: UT1.0&gt;ST1.0&gt;UT1.5&gt;L-DIS1.5 (total transmission P&lt;.001). Contrast ratio evaluation yielded similar results (P≤.006); however, the differences between ST1.0 and UT1.5 were not significant. Conclusions: Both the ST1.0 and UT1.0 crowns, even at the maximum thickness tested (UT1.5), showed significantly higher translucency than L-DIS. Zirconia translucency was improved by eliminating the tetragonal phase, which is responsible for the toughening effect; thus, further studies are advocated to investigate the mechanical resistance of cubic zirconia.

2017 - Different Methods for Inlay Production: Effect on Internal and Marginal Adaptation, Adjustment Time, and Contact Point [Articolo su rivista]
Rippe, Mp; Monaco, C; Volpe, L; Bottino, Ma; Scotti, R; Valandro, Lf.
abstract

The aim of this study was to evaluate the effect of different production methods of resin and ceramic inlays on marginal and internal adaptation, adjustment time, and proximal contacts. Forty premolars were selected, embedded (their roots), and prepared to receive inlays that were made as follows (n=10): LaRe—digital impression with a Lava C.O.S. scanner, followed by milling of Lava Ultimate block (composite resin) in a milling center; CeRe—digital impression with a Cerec 3D Bluecam scanner, followed by milling of Lava Ultimate block in Cerec; CeDis—digital impression with a Cerec 3D Bluecam scanner, followed by milling of IPS e.max CAD block (lithium disilicate) in Cerec; and PresDis—impression with polyvinyl siloxane, inlay made using the lost wax technique and IPS e.max Press pressed ceramic (lithium disilicate). Marginal and internal adaptations were measured using the replica technique. The inlay adjustments were performed using diamond burs in a contra-angle hand piece, and the time for adjustment was recorded using a timer, in seconds. The tightness of the proximal contact was measured using standardized metal blades. The statistical analyses for marginal fit data showed that at the cervical edge, CeDis (177.8 lm) had greater misfit than CeRe (116.7 lm), while all the groups had similar adaptation at the occlusal edge. The groups had similar internal fit at the pulpal wall, while LaRe (104.7 lm) . CeDis (66.7 lm) = CeRe (76.7 lm) at the axial wall. The groups restored with lithium disilicate ceramic took more time for adjustment when compared to the resin restorative material. The lowest proximal contact, in micrometers, was seen in the CeRe group (8.8 lm).

2017 - Hybrid manufacturing of metal framework for full arch dental restoration [Abstract in Atti di Convegno]
Ciocca, L; Parisi, C; Meneghello, R; Monaco, C; Baldissara, P
abstract

Purpose/aim: Selective Laser Melting (SLM) technology used for the production of a full-arch prosthetic restoration on implants generates geometry inaccuracies and surface roughness, which do not fulfill clinical requirements, with biological consequences on the osteointegration of implants. Modern approach to Additive Manufacturing (AM) for precision production integrates SLM and milling techniques in the so-called hybrid manufacturing process to produce a more accurate interface to implant. Materials and methods: The virtual (CAD) model of the framework was designed as for a full-arch prosthetic rehabilitation and served as the control of the experiment. Directly from the framework CAD model, eighteen specimens were produced by two different manufacturing centers using hybrid technology, (lab #1 and lab #2). This is a recently introduced productive process, which integrates the SLM, for the production of a semi-finished framework, and the milling technique, for the finishing operation at the interface to implant. Measurements of the frameworks were made in vitro according to a metrological approach that uses an opto-mechanical coordinate measuring machine (OCMM), a CAD-based reconstruction of actual interface, and a geometric error analysis to describe manufacturing inaccuracies. Each implant platform of framework was reduced to its center for the calculation of the relative (between implants) and absolute distances (between manufactured framework and its CAD model). Results:The relative 3D distances between implant platforms showed a mean error varying from 0 to 25!m for lab #1 and 0 to 38!m for lab #2; the 3D mean position error of the implant platforms with respect to the CAD modelwas 8–16!m for lab #1 and 9–22!mfor lab #2. No statistically significant difference was registered between the two groups. Considering both groups, the absolute values of inaccuracy were between 0.011mm and 0.019mm±0.005–0.010mm (SD). Conclusions:The hybrid technology used for the manufacturing of the metal framework for an implant-supported full-arch restoration showed acceptable levels of accuracy, regardless the specific hybrid system. Using the hybrid technology, the geometric error generated during the framework production is lower than 22!m, which is comparable to errors shown in the literature for direct CAD-CAM manufacturing from metal blanks.

2017 - Zirconia-based versus metal-based single crowns veneered with overpressing ceramic for restoration of posterior endodontically treated teeth: 5-year results of a randomized controlled clinical study [Articolo su rivista]
Monaco, C.; Llukacej, A.; Baldissara, P.; Arena, A.; Scotti, R.
abstract

Objectives The aim of this 5-year randomized controlled trial was to compare the longevity and clinical behavior of single posterior crowns made with pressable ceramic on zirconia and on metal frameworks, and if failures occur, to delineate the contributing factors. Methods 72 patients, who needed the covering of at least a molar and/or premolar, were included in the study. All teeth were endodontically treated, with absence of periapical lesion or active periodontitis. Ninety single crowns were made with zirconia or metal framework and covered with pressable veneering ceramics. Two independent examiners assessed the survival of restorations at 6 months, 1–4 and 5 years after restoration placement including periapical radiographs, intraoral photographs, and USPHS modified criteria. The statistical analyses were performed with the Kaplan-Meier method. Results One core fracture occurred in Zircad/Zirpress crowns and one metal ceramic crown was lost for root fracture. Chipping fracture of the veneering ceramic was detected in 2 metal-ceramic crowns and in 3 zirconia-based crowns. The Estimate Cumulative Survival (ECS) and the Estimate Cumulative Success (ECSs) with standard deviation (SE) were respectively 97,73 ± 2,19 and 92,64 ± 4,14 for zirconia-based crowns whereas 97,44 ± 2,39 and 91,11 ± 4,27 for porcelain fused to metal crowns. Conclusions The present randomized controlled trial shows that the survival of zirconia-based and metal-based single crowns is similar over a follow-up period of 5 years. No significant differences in esthetic, functional and biological outcomes were demonstrated between the two groups. The main failure mode was the chipping fracture of the veneering ceramic in both materials. Study number on ClinicalTrial.gov NCT02758457. Clinical significance According to the results of this clinical study, zirconia-based rehabilitations with overpressing veneering technique represent a valid alternative to metal-based for posterior single crown restorations.

2016 - A fully digital approach to replicate peri-implant soft tissue contours and emergence profile in the esthetic zone [Articolo su rivista]
Monaco, Carlo; Evangelisti, Edoardo; Scotti, Roberto; Mignani, G; Zucchelli, Giovanni
abstract

OBJECTIVE: This short communication reports on a novel digital technique designated - the "Fully Digital Technique (FDT)" - to take the impression of the peri-implant soft tissue and emergence profile with an intraoral scanner, digitally capturing both the three dimensional position of the implant platform and the coronal and gingival parts of the provisional retained restoration. MATERIALS AND METHODS: A first intraoral digital impression, which generated a standard triangulation language file (STL1), was taken using a standardized implant scanbody to detect the position of the implant. A second digital impression (STL2) with the provisional retained restoration in situ was performed in two steps: the first part of the scan captured all details of the vestibular and palatal sides of the provisional retained restoration and the adjacent teeth. The provisional retained restoration was then unscrewed, and the subgingival part of the restoration was scanned directly out of the mouth to determine its subgingival shape. STL1 and STL2 were imported into imaging software and superimposed using the "best fit" algorithm to achieve a new merged file (STL3) with the 3D implant position, the peri-implant mucosa, and emergence profile. The merged file was used to design the CAD/CAM customized abutment and to realize a stereolithographic model by 3D printing. RESULTS: The STL superimposition of digital impressions of the implant position and the provisional retained restoration constitute a novel technique to obtain a single STL file with the implant position and its peri-implant mucosal architecture. CONCLUSIONS: FDT is a rapid digital approach for achieving all information of the peri-implant soft tissue and emergence profile directly from the provisional retained restoration.

2016 - Effect of lithium disilicate veneers of different thickness on the degree of conversion and microhardness of a light-curing and a dual-curing cement [Articolo su rivista]
Scotti, Nicola; Comba, Allegra; Cadenaro, Milena; Fontanive, Luca; Breschi, Lorenzo; Monaco, Carlo; Scotti, Roberto
abstract

Purpose: Various materials and systems for bonding lithium disilicate to the tooth substrate are available to clinicians, who can adapt the materials to each clinical situation to maximize the performance of indirect esthetic restorations. This study aimed to evaluate the degree of conversion (DC) and the microhardness (MH) of a dual-curing and a light-curing cement under lithium disilicate discs of different thicknesses. Materials and Methods: A total of 48 lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) samples were prepared and divided into three groups (n = 16) according to the thickness (group A was 0.6 mm; group B was 1.0 mm; group C was 1.5 mm). Each group was further divided into two subgroups (n = 8) according to the resin cement employed, NX3 (Kerr) or Choice 2 (Bisco). A standardized quantity of cement was placed on the sample, and DC was evaluated with an attenuated total reflectance Fourier transformed infrared spectrophotometer (Nicolet IS10, Thermo Scientific). Twenty-four hours after DC was established, Vickers test was performed on the cement with a microindentometer (Leica Microsystems). Results were statistically analyzed with analysis of variance test and significance set at P < .05. Results: Statistical analysis showed cement type had a significant influence (P = .005) on DC. MH results were influenced by thicknesses only between 0.6 and 1.5 mm when light-cured cement was employed. Conclusion: The light-curing and the dualcuring cements reached comparable DCs between 0.6 and 1.5 mm. However, the light-curing resin showed a higher DC and MH.

2016 - Fracture strength of endodontically treated teeth restored with composite overlays with and without glass-fiber reinforcement [Articolo su rivista]
Monaco, Carlo; Arena, Antonio; Scotti, Roberto; Krejci, Ivo
abstract

Purpose: To evaluate the fracture strength and the failure mode of endodontically treated teeth restored with composite resin overlays with and without glass-fiber reinforcement. Materials and Methods: A total of 32 extracted molars were divided into four equal groups. In the NFR-NFRC (no foundation restoration, no fiber-reinforced composite) and NFR-FRC (no foundation restoration, fiber-reinforced composite) groups, only a 5-mm-thick composite resin layer sealed the pulp chamber floors, whereas in the FR-NFRC (foundation restoration, no fiber-reinforced composite) and FR-FRC (foundation restoration, fiber-reinforced composite) groups, a 3.0-mm foundation restoration was used. NFR-NFRC and FR-NFRC groups were restored with composite resin overlays, whereas NFR-FRC and FR-FRC groups were restored with fiber-reinforced composite resin overlays. All specimens were subjected to mechanical loading in a computer-controlled masticator and then the fracture resistance was evaluated. Differences in means were compared using two-way ANOVA and Tukey's test. The level of significance was set at α = 0.05. Results: All specimens successfully completed the fatigue test. The least fracture-resistant group was NFR-FRC, exceeded by FR-NFRC, NFR-NFRC, and FR-FRC, in that order, with FR-FRC being the most fracture-resistant group. Statistically significant differences were detected between the pairs NFR-NFRC/FR-FRC (p = 0.001), NFR-FRC/FR-FRC (p = 0.001), and FR-NFRC/FR-FRC (p = 0.001). Eight vertical root fractures occurred in group FR-NFRC, six in group NFR-NFRC, four in group NFR-FRC, and none occurred in group FR-FRC. Conclusions: Within the limitations of this in vitro study, the incorporation of glass fibers and the presence of a foundation restoration were found to increase the fracture resistance and can favorably influence the fracture mode.

2016 - Marginal Adaptation, Gap Width, and Fracture Strength of Teeth Restored With Different All-Ceramic Vs Metal Ceramic Crown Systems: An in Vitro Study [Articolo su rivista]
Monaco, C; Rosentritt, M; Llukacej, A; Baldissara, P; Scotti, R.
abstract

This study evaluated marginal adaptation before and after thermomechanical (TCML) loading, gap width and fracture strength of all-ceramic single crowns, as compared to porcelain-fused-to-metal (PFM). Thirty extracted premolars were prepared with a round shoulder of 1.0 mm depth. Specimens were restored with zirconia-ceramic (Group 1), lithium disilicate (Group 2) and metal-ceramic single crowns (Group 3). The replica of each sample was observed with a scanning electron microscope (SEM) to evaluate the crown-cement (c-c) and tooth-cement interface (t-c). After TCML, perfect margins decreased to 91.3% (c-c) and 93.9% (t-c) in Group 1, 94.6% (c-c) and 96.0% (t-c) in Group 2 and 73.5% (c-c) and 53.1% (t-c) in Group 3. The mean fracture strengths were 654.8 ± 98.1 N for Group 1, 551.3 ± 127 N for Group 2 and 501.43 ± 110.1 N for Group 3. All-ceramic systems could substitute for metal-ceramic crowns, but chipping of veneering ceramics, especially in zirconia-based crowns, should be investigated.

2015 - A Standardized Approach for the Early Restorative Phase After Esthetic Crown-Lengthening Surgery [Articolo su rivista]
Zucchelli, Giovanni; Mazzotti, Claudio; Monaco, Carlo
abstract

The aim of the present case series article was to provide a standardized approach for the early restorative phase after a crown-lengthening surgical procedure. Different advantages can be ascribed to this approach: the clinician can prepare a definitive prosthetic finishing line in the supragingival location; the early postsurgical temporization allows the conditioning of soft tissues, especially the interdental papillae, during their maximum growing phase; and the clinician can choose the time for the definitive prosthetic rehabilitation in a patient-specific manner according to the individual potential and duration of the soft tissue rebound. In this study, this standardized approach was applied to the treatment of two esthetic cases requiring crown-lengthening procedures.

2015 - Clinical evaluation of tooth-supported zirconia-based fixed dental prostheses: a retrospective cohort study from the AIOP clinical research group [Articolo su rivista]
Monaco, C; Caldari, M; Scotti, R.
abstract

The aim of this retrospective cohort study was to evaluate the clinical performance of tooth-supported zirconia-based fixed dental prostheses (FDPs) made by 15 members of the Italian Academy of Prosthetic Dentistry over a time period of up to 5 years.

2015 - Clinical evaluation of zirconia-based restorations on implants: a retrospective cohort study from the AIOP clinical research group [Articolo su rivista]
Monaco, C; Caldari, M; Scotti, R.
abstract

PURPOSE: The aim of this retrospective cohort study was to evaluate the clinical performance of zirconia-based implant-supported single crowns and fixed dental prostheses (FDPs) made by 15 members of the Italian Academy of Prosthetic Dentistry (AIOP) over a time period of up to 5 years. MATERIALS AND METHODS: One hundred thirty-one patients were treated with a total of 210 zirconia-based single crowns and FDPs on implants in anterior and posterior regions. A cohort group with parafunctional habits was compared with patients without parafunctional habits according to the esthetic, functional, and biologic United States Public Health Service criteria modified by the FDI World Dental Federation. RESULTS: The estimated cumulative survival (ECS) and standard error (SE) of all restorations on implants was 91.95% ± 1.39%, and the estimated cumulative success (ECSs) and SE was 88.37% ± 1.72%. The ECS of single crowns and FDPs was 91.25% ± 3.69% and 95.23% ± 2.28%, respectively, and the estimated cumulative success rates were 88.84% ± 2.05% and 87.96% ± 3.16%, respectively. Mechanical failures, including four zirconia core fractures, three hairline cracks, four chippings, and five delaminations of the ceramic veneering material, were recorded during a 1- to 5-year observation period. The odds ratio of 3.39 (95% confidence interval: 1.18 to 9.73) showed a moderate association between parafunction and failure. CONCLUSIONS: Zirconiabased implant-supported restorations showed encouraging clinical results over a period of up to 5 years, but more clinical data are needed before these restorations can be considered a viable treatment alternative. Mechanical failures were primarily observed in patients with parafunctions.

2015 - Microstructural study of microwave sintered zirconia for dental applications [Articolo su rivista]
Monaco, C; Prete, F.; Leonelli, Cristina; Esposito, L.; Tucci, A.
abstract

Conventional sintering techniques for zirconia-based materials, which are commonly used in dental reconstruction, may not provide uniform heating, with the consequent generation of microstructural flaws in the final component. A sintering system using microwave heating may represent a viable alternative. The purpose of this study was to compare the dimensional variation and physical and microstructural characteristics of commercial zirconia (Y-TZP), used as a dental restoration material, sintered in conventional and microwave furnaces. A physicalmineralogical-microstructural characterisation was carried out to evaluate the level of densification and the presence of flaws in the sintered specimens. Use of the microwave systems allowed the length of the sintering cycle to be reduced to a few minutes, compared with the several hours necessary with a 'traditional' heating system. Additionally, the maximum temperature used to reach the required density decreased from 1450-1480 °C with the electric furnace to 1200 °C in the microwave furnace. An important clinical implication is that the reduced sintering time could allow the introduction of zirconia in chair-side treatments, if used as a monolithic material.

2015 - Restoring Nonvital Premolars with Composite Resin Onlays: Effect of Different Fiber-reinforced Composite Layers on Marginal Adaptation and Fracture Load [Articolo su rivista]
Monaco, Carlo; Bortolotto, Tissiana; Arena, Antonio; Krejci, Ivo
abstract

PURPOSE: To evaluate the marginal adaptation and fracture load of composite resin onlays reinforced with different substructures.MATERIALS AND METHODS: Thirty-two extracted, caries-free premolars were selected for this study and endodontically treated. Group 1 was used as the control group, and the teeth were restored only with as-manufactured composite resin overlays. Group 2 teeth were restored with composite resin overlays with 3 fiber-reinforced composite (FRC) layers placed horizontally on the bottom of the restoration. Group 3 teeth were restored with composite resin overlays with 6 fiber-reinforced composite (FRC) layers placed as in group 2. Group 4 teeth were restored with composite resin overlays and FRC placed with an anatomical design. All specimens underwent SEM evaluation of their marginal adaptation before and after thermocycling and cyclic mechanical loading. All specimens were then subjected to a fracture test, recording the value for the initial (IF) and final (FF) failure. Differences in the means were compared using matched-pairs t-tests and one-way ANOVA. The level of significance was set at α = 0.05.RESULTS: No statistically significant difference between the four groups in terms of marginal adaptation was observed at the tooth/luting composite and luting composite/overlay interfaces before and after loading. The fracture loads of IF and FF, from most to least resistant were: group 4 (1431.8 ± 294.3 N/1710.1 ± 326.6 N), group 3 (1428.1 ± 251.4 N/1467.9 ± 242.4 N), group 2 (852.6 ± 413.5 N/1058.1 ± 251.5 N) and group 1 (899.8 ± 352.7 N/923.5 ± 318.8 N). Significant differences (p = 0.026) were observed comparing group 1 to groups 2 and 3, and group 1 to 4. Three irreparable fractures were found in group 3, four in group 2, and five in groups 1 and 4.CONCLUSIONS: The presence or absence of reinforcement and the different configuration of the reinforcement fibers affect fracture strength but only partially the failure modality. The presence or absence of reinforcement does not alter marginal adaptation.

2014 - Adhesion mechanisms at the interface between Y-TZP and veneering ceramic with and without modifier [Articolo su rivista]
Monaco, Carlo; Tucci, A; Esposito, L; Scotti, Roberto
abstract

Objective: This study investigated the mechanism of action at the interface between a commercially available Y-TZP and its veneering ceramic after final firing. Particular attention was paid, from a microstructural point of view, to evaluating the effects of different surface treatments carried out on the zirconia. Methods: In total, 32 specimens of presintered zirconia Y-TZP (LavaFrame, 3M ESPE, Germany) were cut with a low-speed diamond blade. The specimens were divided in two major groups, for testing after fracture or after mirror finishing, and were sintered following the manufacturer’s instructions. Each major group was then randomly divided into four subgroups, according to using or not using the dedicated framework modifier, with or without a preliminary silica coating (CoJet, 3 M ESPE). A suitable veneering ceramic was used for each group (Lava Ceram Overlay Porcelain, 3 M ESPE). A detailed microstructural study of the interfaces of the zirconia–veneering ceramic was performed using a scanning electron microscope equipped with an energy-dispersive X-ray spectrometer to evaluate chemical variation at the interfaces. Results: When the framework modifier was not applied on the Y-TZP surface, microdetachments, porosities, and openings in the ceramic layer were observed at the interlayers. A degree of diffusion of different elements through the interfaces from both the zirconia and veneering layers was detected. Conclusions: Application of the framework modifier can increase the wettability of the zirconia surfaces, allowing a continuous contact with the veneering layer. The microanalysis performed showed the presence of a reaction area at the interface between the different materials. Clinical significance: the increase of the wettability of the zirconia surface could improve the adhesion at interface with the veneering ceramic and reduce the clinical failure as chipping or delamination.

2014 - Effect of prophylactic polishing pastes on roughness and translucency of lithium disilicate ceramic [Articolo su rivista]
Monaco, Carlo; Arena, Antonio; Özcan, M.
abstract

This study evaluated the effect of prophylactic polishing pastes on the roughness and translucency of lithium disilicate ceramic. Sixty specimens were obtained from e.max CAD blocks. After ground finishing, each specimen was glazed and randomly divided into one of five groups, including one control group. They were then polished with one of four types of prophylactic paste. Group A: Nupro coarse, group B: Nupro medium, group C: Nupro fine, and group D: Cleanic. Specimens were polished with these pastes for 2 minutes with a prophy cup mounted on the handpiece under a constant load of 400 gr at 3,000 rpm. After polishing, the specimens were cleaned ultrasonically in distilled water and dried. The surface roughness (Ra, μm) was then measured using a surface profilometer. The translucency analysis was carried out on the glazed (control group) and polished specimens using a dental spectrophotometer. For each specimen, measurements were made once with a white and once with a black background. Group A showed significantly less surface roughness compared with the control group and groups B, C, and D. The control group showed significantly higher translucency compared with the other groups (P < .05). Despite the good abrasion resistance of e.max CAD lithium disilicate ceramic, prophylactic pastes produced a reduction in translucency. Surface roughness varied depending on the paste used. Polishing procedures should be carried out with caution to not compromise the esthetics achieved with prosthetic restorations.

2013 - Clinical evaluation of 1,132 zirconia-based single crowns: a retrospective cohort study from the AIOP clinical research group [Articolo su rivista]
Monaco, Carlo; Caldari, Mauro; Scotti, Roberto; AIOP Clinical Research, Group
abstract

The aim of this retrospective cohort study was to gather the outcomes of zirconia single crowns made by 16 members of the Italian Academy of Prosthetic Dentistry (AIOP) over a time period of up to 5 years. MATERIALS AND METHODS: A total of 398 patients treated in private practices with 1,132 zirconia-based single-crown restorations made on natural teeth from January 2005 to July 2010 were included. Three hundred forty-three anterior restorations (30.3%) and 789 posterior crowns (69.7%) were made with 16 types of zirconia, using primarily chamfer or knife-edge tooth preparation, and examined according to the esthetic, functional, and biologic criteria. To evaluate the relationship of parafunction with mechanical failure, patients with clenching or bruxism were not excluded from the study group. RESULTS: The cumulative survival rate of all restorations was 98.1%, while the cumulative success rate was 94.3%. Functional criteria had the highest number of failures. The odds ratio (OR) for all restorations was calculated to clarify the relationship between patients who were subject/not subject to parafunctions and technical complications; the OR was 2.60. An association between parafunction and mechanical failure was found in patients with severe parafunction. CONCLUSIONS: Porcelain-veneered zirconia single crowns with chamfer and knife-edge preparations showed good clinical results over a period of up to 5 years. Technical complications were few and were limited primarily to patients with parafunction.

2013 - Efficacy of surface treatments on the bond strength of resin cements to two brands of zirconia ceramic [Articolo su rivista]
Baldissara, P; Querzè, M; Monaco, C; Scotti, R; Fonseca, Rg.
abstract

Purpose: To compare the shear bond strengths (SBS) of two cements to two Y-TZP ceramics subjected to different surface treatments. Materials and Methods: Zirconia specimens were made from Lava (n = 36) and IPS e.max ZirCAD (n = 36), and their surfaces were treated as follows: no treatment (control), silica coating with 30-µm silica-modified alumina (Al2O3) particles (CoJet Sand), or coating with liners Lava Ceram for Lava and Intensive ZirLiner for IPS e.max ZirCAD. Composite resin cylinders were bonded to zirconia with Panavia F or RelyX Unicem resin cements. All specimens were thermocycled (6000 cycles at 5°C/55°C) and subjected to SBS testing. Data were analyzed by three-way ANOVA and Tukey's (HSD) post-hoc test (α = 0.05). Failure mode was analyzed by stereomicroscope and SEM. Results: CoJet Sand and liners promoted significantly higher SBS than their control groups, but had similar results to one another. Panavia F provided significantly higher SBS values than RelyX Unicem (p < 0.01) for nontreated zirconia specimens of both brands. When Lava and IPS e.max ZirCAD were abraded with CoJet Sand, RelyX Unicem promoted significantly higher SBS values than Panavia F (p < 0.001). There was no significant difference between the two cements when the zirconia specimens were treated with their respective liners. The nontreated specimens and those treated with CoJet Sand exhibited a high percentage of adhesive and mixed A failures, while the specimens treated with liners presented an increase in mixed A and mixed C failures as well as some cohesive failure in the bulk of Lava Ceram for both cements. Conclusion: CoJet Sand and liners provided the best surface treatment for Lava and IPS e.max ZirCAD. The best surface treatment/cement combinations were CoJet Sand/RelyX Unicem and liner/Panavia F. SBS of Panavia F and RelyX Unicem was not influenced by the zirconia brand.

2013 - Microstructural changes produced by abrading Y-TZP in presintered and sintered conditions [Articolo su rivista]
Monaco, Carlo; Tucci, A; Esposito, L; Scotti, Roberto
abstract

Abstract: Objective: To evaluate the effect of abrading before and after sintering using alumina-based abrasives on the surface of yttria-tetragonal zirconia polycrystals. Particular attention was paid to the amount of surface stress-assisted phase transformation (tetragonal -> monocliwmonoclinic)andthepresenceofmicrocracks. Methods: Pre-sintered zirconia ceramic specimens (ZirCAD; Ivoclar Vivadent) were first surface-ground flat with #600-800-1000-grit SiC paper. They were then surface-treated with different grain size abrasives before and after the sintering step. Samples that underwent no surface treatment were used as controls. For each condition, eight specimens were prepared. The physical/mechanical characteristics of zirconia material were determined by measuring density, porosity, grain size, hardness, and fracture toughness. The effects of surface treatments were assessed by surface roughness measurements, quantitative X-ray diffraction analysis, and scanning electron microscopy. Results: With increased dimensions of the abrasive particles, the abraded surfaces of zirconia specimens exhibited a widespread system of microcracks and an increased monoclinic zirconia quantity. These structural changes likely affect the aging of the material during its clinical service.

2012 - A clinical case report on indirect, posterior three-unit resin-bonded FRC FPD [Articolo su rivista]
Monaco, C
abstract

Abstract: Purpose: This paper describes a clinical, conservative approach and the details of cavity preparation for the replacement of a maxillary first premolar using a minimally invasive preparation combined with the adhesive approach. Material and Methods: A patient with a missing first premolar was treated with a 3-unit indirect fiber-reinforced composite (FRC) fixed dental prosthesis (FDP). The preparation on the canine was a slot combined with modified wing to increase the amount of fiber in the restoration. Glass fiber (Vectris; Ivoclar Vivadent) was used in an anatomical shape for the framework and incrementally veneered with resin composite (Adoro; Ivoclar Vivadent). The cavities were prepared by etching enamel and dentin with orthophosphoric acid, priming the dentin, and applying a three-step adhesive system and dual-cured luting resin (Variolink II, Ivoclar Vivadent). Finally, the indirect FRC FDP was finished and polished with 15-mu m diamond burs (Composhape, Intensiv) and a polishing kit. Results: The patient was satisfied with the esthetics and function of the restoration, which has served without repair for 5 years. At the 5-year clinical follow-up, the restoration was found to be clinically successfull. Conclusion: The correct cavity-preparation technique in combination with the FRC system could enhance the long-term survival of an inlay FDP.

2012 - Inlay-retained Zirconia Fixed Dental Prosthesis: Clinical and Laboratory Procedures [Articolo su rivista]
Monaco, Carlo; P., Cardelli; M., Bolognesi; Scotti, Roberto; M., Özcan
abstract

Many treatment options are currently available for single tooth replacement, such as metal-ceramic, all-ceramic, direct or indirect fiber-reinforced composite fixed dental prosthesis (FDPs) or implants. Inlay-retained FDPs could be indicated especially when adjacent teeth have preexisting restorations and where implant placement is not possible or not indicated. In such cases, indication of both metal-ceramic and fiber-reinforced composite FDPs has certain disadvantages. This paper describes the use of all-ceramic inlay-retained FDPs with zirconia frameworks, veneered with a press-on technique. The retainer margins were made of pressed ceramic to make adhesive luting possible. In deep cavities, a full contour press-on ceramic all around the retainers, increased the surface available for the adhesive approach.

2012 - The Connective Tissue Platform Technique for Soft Tissue Augmentation [Articolo su rivista]
Zucchelli, Giovanni; C., Mazzotti; V., Bentivogli; Mounssif, Ilham; Marzadori, Matteo; Monaco, Carlo
abstract

The presence of a localized alveolar ridge defect, especially in the maxillary anterior dentition, may complicate an esthetic rehabilitation. The goal of this case report is to describe a novel subepithelial connective tissue graft technique for soft tissue augmentation in Class III ridge defects. Surgical intervention consisted of in situ maintenance of a connective tissue "platform" at the edentulous space, which facilitated the stabilization and suturing of the connective tissue grafts used for soft tissue augmentation. Adequate graft thickness to treat the deep horizontal soft tissue loss was obtained by doubling the width of a de-epithelialized free gingival graft that was subsequently folded on itself. The soft tissue conditioning at the level of the pontic began 9 months after surgery by shaping the soft tissue with a bur and filling the space with flowable composite resin applied above the pontic. The final prosthetic phase began 14 months after surgery. A reproduction of the anatomical cementoenamel junction in the provisional and definitive restorations was performed to improve the soft tissue emergence profile. Nine months after surgery, a soft tissue augmentation of 5 mm in the vertical and 4 mm in the horizontal dimension was accomplished. The suggested surgical technique was able to accomplish horizontal and vertical soft tissue augmentation in a single surgical step.

2011 - Inlay-retained zirconia fixed dental prostheses: modified designs for a completely adhesive approach [Articolo su rivista]
Monaco, Carlo; P., Cardelli; M., Bolognesi; M., Ozcan
abstract

For single tooth replacement many techniques are currently available, such as implant dentistry and metal–ceramic or all-ceramic fixed partial dentures (FPDs). However, when implant placement is not possible or not indicated, an inlay-retained FPD (IFPD) can be chosen, especially when adjacent teeth have preexisting restorations. In these cases, both metal–ceramic and fiber-reinforced composite IFPDs have some disadvantages, including loss of retention. This paper discusses all-ceramic IFPDs with zirconia frameworks, veneered with a press-on technique. The marginal area of the restorations’ retainers are always made of pressed ceramic to allow for an adhesive luting procedure; when the cavities’ depths increase, a full contour ceramic press-on is allowed all around the retainers, increasing the surface available for the adhesive approach.

2011 - Multi-step adhesive cementation versus one-step adhesive cementation: push-out bond strength between fiber post and root dentin before and after mechanical cycling [Articolo su rivista]
Amaral, M; Rippe, Mp; Bergoli, Cd; Monaco, C; Valandro, Lf
abstract

Abstract: This study evaluated the effects of mechanical cycling on resin push-out bond strength to root dentin, using two strategies for fiber post cementation. Forty bovine roots were embedded in acrylic resin after root canal preparation using a custom drill of the fiber post system. The fiber posts were cemented into root canals using two different strategies (N = 20): a conventional adhesive approach using a three-step etch-and-rinse adhesive system combined with a conventional resin cement (ScotchBond Multi Purpose Plus + RelyX ARC ), or a simplified adhesive approach using a self-adhesive resin cement (RelyX U100). The core was built up with composite resin and half of the specimens from each cementation strategy were submitted to mechanical cycling (45 degree angle; 37 degrees C; 88 N; 4 Hz; 700,000 cycles). Each specimen was cross-sectioned and the disk specimens were pushed-out. The means from every group (n = 10) were statistically analyzed using a two-way ANOVA and a Tukey test (P = 0.05). The cementation strategy affected the push-out results (P < 0.001), while mechanical cycling did not (P = 0.3716). The simplified approach (a self-adhesive resin cement) had better bond performance despite the conditioning. The self-adhesive resin cement appears to be a good option for post cementation. Further trials are needed to confirm these results.

2011 - Pilot Evaluation of Four Experimental Conditioning Treatments to Improve the Bond Strength between Resin Cement and Y-TZP Ceramic [Articolo su rivista]
Monaco, Carlo; Cardelli, P; Scotti, Roberto; Valandro, Lf
abstract

Purpose: This study evaluated the bond strength between resin cement and Y-TZP ceramic (Yttrium-stabilized Tetragonal Zirconia Polycrystalline) submitted to different surface conditionings. Materials and Methods: Fifty Y-TZP ceramic discs (Ø= 10 mm) were allocated into five groups: Gr1 (control)-no conditioning; Gr2-tribochemical silica coating (30-&#956;m SiO(2) ) before sintering; Gr3-air abrasion with 50-&#956;m Al(2) O(3) before sintering; Gr4-air abrasion with 110-&#956; Al(2) O(3) before sintering; Gr5 - air abrasion with 50-&#956;m Al(2) O(3) after sintering. After specimen preparation, cylinders of composite resin were prepared and immediately cemented onto the ceramic. A shear test was performed. Results: One-way ANOVA indicated a statistically significant difference among the groups (p= 0.0019). The mean shear bond strengths (MPa) were: Gr1 = 4.7 ± 0.8,(b) Gr2 = 4.6 ± 0.9,(b) Gr3 = 6.4 ± 1.0,(a) Gr4 = 6.5 ± 1.8,(a) Gr5 = 6 ± 1.3(ab) (same superscript letter indicates statistical similarity). Adhesive fracture between the ceramic and resin cement was the most common failure. No complete cohesive fracture at the ceramic or composite cylinders was noted. Conclusion: Within the limitations of this study, additional surface treatment with air abrasion before and after sintering provided a significant increase in bond strength. Tribochemical silica coating before sintering was not effective as a surface treatment.

2010 - A systematic method for predetermined scanning electron microscope analysis in dental science [Articolo su rivista]
Marchionni, Silvia; Baldissara, Paolo; Monaco, Carlo; Scotti, Roberto
abstract

2010 - Immediate facial rehabilitation in cancer patients using CAD-CAM and rapid prototyping technology: a pilot study [Articolo su rivista]
Ciocca, Leonardo; Fantini, Massimiliano; Marchetti, Claudio; Scotti, Roberto; Monaco, Carlo
abstract

PURPOSE: This study describes the workflow in a procedure to create a provisional facial prosthesis for cancer patients using digital and rapid prototyping technologies without the need for supporting craniofacial implants. MATERIALS AND METHODS: An integrated workflow procedure aimed at the construction of provisional silicone prosthesis was used to rehabilitate a facial disfigurement in a patient who had undergone ablative surgery of the midface. A laser scan of the defect was obtained, and a digital model of the patient's face was constructed using virtual mirroring of the healthy side and referencing the "Nose Digital Library." RESULTS: The missing volume of the face was reconstructed, and a rapid-prototyped mold was devised to process the silicone prosthesis. A provisional eyeglasses-supported prosthesis designed with a CAD/CAM-projected titanium substructure was connected using the micro-components of implant prosthetic devices. CONCLUSIONS: The workflow described herein offers a viable procedure for quickly restoring facial defects by means of provisional prosthetic rehabilitation.

2010 - In Vitro Assessment of Single-Retainer Tooth-Colored Adhesively Fixed Partial Dentures for Posterior Teeth [Articolo su rivista]
T., Bortolotto; Monaco, Carlo; J., Onisor; I., Krejci
abstract

The purpose of this paper was to investigate, by means of marginal adaptation and fracture strength, three different types of single retainer posterior fixed partial dentures (FPDs) for the replacement of a missing premolar. Two-unit cantilever FPDs were fabricated from composite resin, feldspathic porcelain, and fiber-reinforced composite resin. After luting procedures and margin polishing, all specimens were subjected to a Scanning Electron Microscopic marginal evaluation both prior to and after thermomechanical loading with a custom made chewing simulator comprising both thermal and mechanical loads. The results indicated that the highest score of marginal adaptation, that is, the closest score to 100% of continuous margins, at the tooth-composite resin interface was attained by the feldspathic porcelain group (88.1% median), followed by the fiber-reinforced composite resin group (78.9% median). The worse results were observed in the composite resin group (58.05% median). Fracture strength was higher in feldspathic porcelain (196N median) when compared to resin composite (114.9N median). All the fixed prostheses made of fiber-reinforced composite resin detached from the abutment teeth before fracturing, suggesting that the adhesive surface’s retainer should be increased.

2009 - Fracture strength of single crowns made with different all ceramic systems [Articolo su rivista]
Monaco, C.; Rosentritt, M.; Ferri, C.; Llukacej, A.; Scotti, R.
abstract

OBJECTIVES. TO evaluate fracture strength of all-ceramic single crowns compared with metal-ceramic rehabilitation. Materials and methods. 32 premolars were endodontically treated, randomly divided into 4 groups and restored with fiber posts (FRC Postee, Ivoclar Vivadent) luted with dual curing composite resin cement (Multilink Automix, Ivoclar Vivadent). A composite build-up was realized using an adhesive bonding system (Adhese, Ivoclar Vivadent) and dual curing composite (MultiCore HB, Ivoclar Vivadent). All teeth were prepared in the same way: 2 mm of occlusal reduction; 1.5 mm of axial reduction; round shoulder of 1.0-mm depth with 8° convergence coronal to cement-enamel junction. Group I teeth were restored with all-ceramic crowns fabricated in zirconia core and pressable veneering ceramic (ZirCAD/ZirPress, Ivoclar Vivadent). Groups Il teeth were restored in the same way as in group I but with margin of pressable ceramic. Group III teeth were all made in lithium disilicate glass ceramic material (IPS E.max Press, Ivoclar Vivadent). Group IV teeth, as control group, were realized with a conventional framework in metal alloy (IPS D.sign 91, Ivoclar Vivadent) and pressable veneering ceramic (PoM, Ivoclar Vivadent). All crowns were luted with a self adhesive, dualcuring composite cement (Multilink Sprint, Ivoclar Vivadent). Thermal cycling and mechanical loading (TCML) were made to simulate a 5-year period of oral function [parameters: 6000 thermal cycles (5 C/55 C), 1,2x10 6 mastication cycles at 50 N using an artificial oral environment]. After TCML all crowns were loaded in axial direction under an angle of 135° up to failure in a universal testing machine (v = 1 mm/min, Zwick 1445). Statistical analysis was performed using the Turkey-Kramer and t'test at α=0,05 significance level. RESULTS. The mean values of fracture strength were 654 ± 98 N for Group I, 688 ± 181 N for Group II, 551 ± 126 N for Group III and 501 ± 110 N for Group IV. CONCLUSIONS. Fracture strength showed no difference between teeth restored with all-ceramic and metal-ceramic single crowns. All-ceramic restorations showed higher marginal adaptation compared to the control group. Lithium disilicate with resin luting agent can act as biomimetic material, optimizing the distribution of occlusal stress at the cervical margin.

2009 - Retention of quartz fiber posts using different luting cements [Relazione in Atti di Convegno]
Baldissara, P.; Monaco, C.; Valandro, L. F.; Scotti, R.
abstract

Objectives: To determine the effect on the pull-out strength of threads cut into the surface of quartz fiber post cemented with three luting materials. Methods: 42 human single-rooted, crownless teeth were treated endodontically and randomly assigned to six fiber posts groups: 1) to 3) were restored with Macro-Lock#3 posts (RTD); 4) to 6) with control posts made of the same material but lacking threads (RTD). The posts were cemented 12mm deep using Panavia(Kuraray), RelyX Unicem (3M ESPE), and Fuji Plus (GC) following the manufacturer instructions. The specimens were subjected to 5000 thermal cycles at 5 and 55°C and wet stored. Retentions were made on the emerging portion of the controls using a diamod bur, then a composite core was made using a mold. A pull-out stress was applied by clamping the core with an Instron machine (2mm/min speed). The pull-out strength was recorded for each group and compared (alpha=0.05). After the test, the specimens were observed under the stereomicroscope to determine failure patterns. Results: The Macro-Lock demonstrated higher retention with all the luting materials employed, statistically significant when RelyX and Fuji were used (P

2007 - Influence of artificial aging on the fracture strength and stiffness of Targis/Vectris fixed partial dentures [Articolo su rivista]
Baldissara, Paolo; Parisi, Candida; Monaco, Carlo; Scotti, Roberto
abstract

OBJECTIVE: To evaluate the effect of artificial aging on the fracture strength and stiffness of fiber-reinforced composite fixed partial dentures (FPDs). METHOD AND MATERIALS: Twelve FPDs were replicated using Targis/Vectris resin composite (Ivoclar Vivadent) and randomly divided in 2 groups. Group A was artificially aged for 900 hours in a weathering machine using dry/wet cycles and 534 W/m2 irradiations with wavelengths ranging from 300 to 800 nm. Group B (control) was stored in 100% relative humidity at 37 degrees C +/- 1 degree C for 900 hours. The FPDs were luted on metal abutments with Variolink II resin cement (Ivoclar Vivadent). The flexure stress was applied on the pontic at a descending speed of 1.0 mm/min until complete failure. Fracture strength, stiffness, and number of cracks produced on the FPDs were statistically analyzed. RESULTS: Targis veneering material in the control group fractured at a mean of 913 +/- 130 N, whereas in the aged group it failed at a mean of 722 +/- 154 N (P = .042). The mean fracture load of aged FPD frameworks was slightly lower than that of the controls: 1,532 +/- 237 N and 1,578 +/- 257 N, respectively (P = .758). The stiffness at 400 N was not significantly different between the 2 groups. The number of cracks at Targis failure was higher in aged groups. CONCLUSION: Accelerated aging significantly reduced the strength of the Targis veneering composite, increasing its brittleness; however, it had no effect on the inner Vectris framework.

2007 - SEM evaluation of in situ early bacterial colonization on a Y-TZP ceramic: a pilot study [Articolo su rivista]
Scotti, R.; Kantorski, K. Z.; Monaco, C.; Valandro, L. F.; Ciocca, L.; Bottino, M. A.
abstract

ths study evaluate the effect of surface glazing

2006 - A single visit treatment of fractured dens invaginatus - a case report [Articolo su rivista]
Caldari, M.; Monaco, C.; Ciocca, L.; Scotti, R.
abstract

2006 - Comparison of 2 bonding systems and survival of fiber-reinforced composite inlay fixed partial dentures [Articolo su rivista]
Monaco, Carlo; Ferrari, Marco; Caldari, Mauro; Baldissara, Paolo; Scotti, Roberto
abstract

Purpose: This randomized controlled study evaluated the clinical behavior of 3-unit inlay fixed partial dentures (IFPDs) made of the glass-fiber composite system SR Adoro/Vectris and luted with 2 different bonding systems over an observation period of 2 years. Materials and Methods: Thirty-nine glass-fiber–reinforced composite IFPDs were made to replace 1 missing maxillary or mandibular tooth. Nineteen IFPDs were randomly assigned to group A and luted with a 2-step bonding system (Excite DSC), while the other 20 IFPDs of group B were cemented with a 3-step adhesive (Syntac). Events like partial or total debonding of the IFPDs, fracture of the framework, or veneer and fiber exposures were considered failures. Color match, marginal discoloration, secondary caries, marginal adaptation, postoperative sensitivity, and surface texture were evaluated according to the United States Public Health Service modified criteria. Results: Two debondings and 2 fiber exposures occurred during the observation period. All failures occurred in group A. Some fatigue microcracks in the pontic area of the 2 detached IFPDs were observed under scanning electron microscopy. The postoperative sensitivity of group A was much higher than group B, and the abutments luted with Excite DCS showed postoperative sensitivity during the first month in 42.2% of cases. The sensitivity disappeared completely after 6 months. Statistical analysis (P < .05) indicated significant differences in postoperative sensitivity between the 2 groups. Conclusion: The IFPDs in combination with a 3-step adhesive demonstrated good clinical service in the short observation period. The microfractures of the layering material observed on the debonded IFPDs may suggest excessive flexibility of the fiber structures, which occurs if the framework is fabricated without observing the recommended dimensions.

2006 - Early plaque colonization on polished- and glazed-zirconium ceramic surface: Preliminary results [Articolo su rivista]
Scotti, R; ZANINI KANTORSKI, K; Monaco, C; Valandro, Lf; Bottino, Ma.
abstract

AIM: The purpose of this study was to evaluate the effect of ceramic surface polishing procedure on the early dental biofilm formation on zirconium ceramics. METHODS: Twenty samples (discs shape) of tetragonal zirconium polycrystal stabilized with yttrium ceramics (Y-TZP) for LAVA system were fabricated (5 mm diameter and 1.5 mm thickness). Two patients with high level of dental hygiene were selected for this study. Oral devices covering the crowns of the upper premolars and molars were fabricated for each participant. Glazed and polished samples of Y-TZP ceramics were fixed on the vestibular and palatal zones of the devices. After 20 min (8 samples) and 1 h (8 samples) in the oral environment, the samples were removed and analyzed in a scanning electron microscope. The surface topographies of 4 ceramic samples (2 glazed and 2 polished) were analyzed (control group: without exposition in oral environment). RESULTS: The glazed samples showed a more irregular surface than polished samples. Deposition of granular aggregates was verified on all the samples in the two times of the study analyzed. This granular material coated more intensely on irregular areas, and its thickness increased after 1 h. No difference was observed as to bacterial morphology in any time of the study. Cocci and rods-shaped prevailed. CONCLUSIONS: Glazed surfaces presented larger tendency to dental biofilm accumulation.

2006 - Fatigue resistance of the bond of a glass-infiltrated alumina ceramic to human dentin [Articolo su rivista]
Baldissara, Paolo; Valandro, L. F.; Monaco, Carlo; M., Ferrari; Bottino, M. A.; Scotti, Roberto
abstract

PURPOSE: To evaluate the fatigue resistance of the bond between dentin and glass-infiltrated alumina ceramic, using different luting protocols. MATERIALS AND METHODS: The null hypothesis is that the fatigue resistance varies with the luting strategy. Forty blocks of In-Ceram Alumina were prepared, and one surface of each block was abraded with 110-microm aluminum oxide particles. Then, the blocks were luted to flat dentin surfaces of 40 human third molars, using 4 different luting strategies (luting system [LS]/ceramic surface conditioning [CSC]) (n=10): (G1) [LS] RelyX-Unicem/[CSC] airborne abrasion with 110-microm Al2O3 particles; (G2) [LS] One-Step + Duo-Link (bis-GMA-based resin)/[CSC] etching with 4% hydrofluoric acid + silane agent; (G3) [LS] ED-Primer + Panavia F (MDP-based resin)/[CSC] Al2O3; (G4) [LS] Scotchbond1+RelyX-ARC (bis-GMA-based resin)/[CSC] chairside tribochemical silica coating (air abrasion with 30-microm SiOx particles + silane). After 24 h of water storage at 37 degrees C, the specimens were subjected to 106 fatigue cycles in shear with a sinusoidal load (0 to 21 N, 8 Hz frequency, 37 degrees C water). A fatigue survivor score was given, considering the number of the fatigue cycles until fracture. The failure modes of failed specimens were observed in a SEM. RESULTS: G3 (score = 5.9, 1 failure) and G4 (score = 6, no failures) were statistically similar (p = 0.33) and had significantly higher fatigue resistance than G1 (score = 3.9, 5 failures) and G2 (score = 3.7, 6 failures) (p &lt; 0.03). SEM analysis of fractured specimens of G1 and G2 showed that almost all the failures were between ceramic and cement. CONCLUSION: The MDP-based resin cement + sandblasting with Al2O3 particles (G3) and bis-GMA-based resin cement + tribochemical silica coating (G4), both using the respective dentin bonding systems, were the best luting protocols for the alumina ceramic. The null hypothesis was confirmed.

2006 - Fiber -reinforced composite: an alternative to the traditional prosthetic treatment [Articolo su rivista]
Monaco, C.; Zicari, F.; Scotti, R.
abstract

2006 - Fracture strength of endodontically treated teeth restored with composite overlays with and without reinfocement of glass fibers [Relazione in Atti di Convegno]
Monaco, C; Krejci, I; Ferrari, M; Rovereti, M; Scotti, R
abstract

2006 - Marginal adaptation of 1 fiber-reinforced composite and 2 all-ceramic inlay fixed partial denture systems [Articolo su rivista]
Monaco, Carlo; I., Krejci; T., Bortolotto; N., Perakis; M., Ferrari; Scotti, Roberto
abstract

PURPOSE: The aim of this in vitro study was to evaluate the marginal adaptation and retention of inlay fixed partial dentures (IFPDs) made with 1 fiber-reinforced composite and 2 different ceramic materials using quantitative scanning electron microscope analysis after thermal cycling and mechanical loading, which simulated approximately 5 years of oral service. MATERIALS AND METHODS: Eighteen IFPDs made with fiber-reinforced composite (SR Adoro/Vectris), zirconium oxide-TZP (Cercon), and magnesia partially stabilized zirconia (DC-Leolux) covered with silica-based ceramics were tested in this study. The specimens were mechanically loaded in the vestibular cusp of the pontic element in a computer-controlled masticator with 1,200,000 half-sinusoid mechanical cycles of maximum 49 N each at a frequency of 1.7 Hz. A total of 3,000 thermocycles at 5 degrees C and 55 degrees C, 2 minutes each, were performed simultaneously. The marginal adaptation was analyzed at the interface of the luting composite and the abutment inlay/onlay (CI) and at the interface of the tooth and the luting composite (TC). RESULTS: The percentages of continuous margin at the CI interface were 94.6 +/- 3.1 and 88 +/- 6.7 for Adoro/Vectris, 92.9 +/- 5 and 85.7 +/- 6.1 for Cercon, and 96.2 +/- 2.1 and 82.2 +/- 9.8 for DC-Leolux, respectively, before and after loading. The percentages of continuous margin at the TC interface were 86.7 +/- 6.7 and 62.5 +/- 16.4 for Adoro/Vectris, 93.3 +/- 3.4 and 83.2 +/- 5.9 for Cercon, and 96.1 +/- 2.4 and 75.3 +/- 7 for DC-Leolux. Statistically significant differences were found after loading between the fiber-reinforced composite and the 2 ceramic systems at the TC interface. CONCLUSION: Within the limitations of this experimental study with regard to the sample size and contacting vectors, the results showed that flexibility of the framework may play an important role in the marginal adaptation of the IFPDs. More rigid materials may transfer less stress to the margins, thus promoting a more stable adhesion to the dental tissues.

2006 - Single-session treatment of a major complication of dens invaginatus: a case report [Articolo su rivista]
M., Caldari; Monaco, Carlo; Ciocca, Leonardo; Scotti, Roberto
abstract

Dens invaginatus is a dental malformation that may give rise to several complications. Caries of the invagination can severely weaken the whole tooth, making it susceptible to fracture. Subgingival fractures are major complications threatening tooth survival and usually require periodontal/orthodontic/prosthetic treatment if long-term viability is to be ensured. This article describes a case of single-session restoration of a fractured invaginated tooth by means of endodontic treatment followed by fragment reattachment.

2005 - Adhesive inlay bridges with FRC: clinical and laboratory investigations [Relazione in Atti di Convegno]
Monaco, C.
abstract

2005 - CAD/CAM systems in complete crown restorations [Relazione in Atti di Convegno]
Scotti, R.; Monaco, C.; Ciocca, L.
abstract

2005 - Color Stability And Surface Quality Of Composite Treated With a NOIL Resin. An In Vivo Study [Relazione in Atti di Convegno]
Baldissara, P.; Paganelli, M.; Monaco, C.; Scotti, R.
abstract

2005 - E-Modulus and flexure strength of FRC: introducing Boron fibers [Relazione in Atti di Convegno]
Baldissara, P.; Quadrelli, M.; Monaco, C.; Scotti, R.
abstract

2005 - Indirect bonded restorations: inlays, inlay bridges and adhesive crowns [Relazione in Atti di Convegno]
Monaco, C.; Scotti, R.; Baldissara, P.
abstract

2005 - Randomized clinical trial of inlay fixed partial dentures [Relazione in Atti di Convegno]
Monaco, C.
abstract

2005 - Valutazione clinica prospettica a medio termine di corone In Ceram realizzate con il sistema CEREC 2 [Articolo su rivista]
Caldari, M.; Monaco, C.; Ciocca, L.; Scotti, R.
abstract

2004 - Ceramiche integrali: cementazione adesiva o tradizionale? [Abstract in Atti di Convegno]
Monaco, C.; Baldissara, P.; Ciocca, L.
abstract

2004 - Competenze extrasanitarie per l’elaborazione di epitesi facciali [Abstract in Atti di Convegno]
Ciocca, L.; Monaco, C.; Baldissara, P.
abstract

2004 - Composizione, microstruttura, e morfologie dei perni [Capitolo/Saggio]
Malferrari, S.; Monaco, C.
abstract

I capitolo descrive la composizione, microstruttura e la morfologia dei perni disponibili sul mercato.

2004 - Effetto del diametro dei perni in fibra sulla stabilizzazione del moncone protesico [Abstract in Atti di Convegno]
Baldissara, P.; Ciocca, |l.; Monaco, C.
abstract

2004 - Fatigue resistance of fiber posts and different cement/build-up materials [Relazione in Atti di Convegno]
Baldissara, P.; Melilli, D.; Monaco, C.; Ciocca, L.
abstract

2004 - La ricostruzione coronale del dente trattato endodonticamente [Capitolo/Saggio]
Monaco, C.
abstract

I materiali da restauro devono resistere agli stress indotti dalle forze masticatorie. Oltre alla conoscenza delle loro proprietà meccaniche, occorre considerare molteplici fattori, quali la capacità di adesione, la facilità di manipolazione, il tempo necessario per la loro applicazione e la capacità di sigillo quando si seleziona il prodotto da usare per la ricostruzione di un elemento dentale devitalizzato. Amalgama, resine composite e vetro ionomeri modificati, alcuni dei quali rinforzati con polveri metalliche sono stati impiegati come materiali da restauro del moncone protesico. , Il confronto tra questi prodotti, tramite tests di laboratorio e osservazioni cliniche, è di capitale importanza per valutare il loro comportamento e la loro durata una volta sottoposti a stress meccanici e termici in sede orale. Negli ultimi decenni la ricerca sui materiali da ricostruzione diretta, in accordo con i principi di adesione, ha fondamentalmente seguito due filoni concentrandosi da un lato sullo sviluppo dei cementi vetroionomerici e dall’altra parte sulle resine composite, ottenendo in alcuni casi materiali ibridi quali compomeri e vetro-ionomeri modificati con resine composite, i quali presentano caratteristiche meccaniche intermedie tra i due materiali di origine. E’ utile rappresentare le resine composite e i vetroionomeri su di una scala in maniera diametralmente opposta nell’ampio spettro delle formulazioni dei materiali. I prodotti ibridi (compomeri e vetro-ionomeri modificati) possono essere collocati in posizione intermedia sfruttando i vantaggi che i due materiali posti agli estremi possiedono4 (Fig. 1). L’adesione che questi differenti materiali hanno con i tessuti dentali, anche se di differente entità e forza di legame, accomuna questi prodotti per un’aspetto fondamentale: il sigillo del restauro. Fig. 1 Materiali utilizzabili per la ricostruzione del moncone protesico (modificato da Peters & McLean ) ____________________________________________________________________ La capacità di sigillare ermeticamente l’interfaccia dente-restauro è una delle caratteristiche fondamentali per un materiale da ricostruzione. E’ stato dimostrato che molti insuccessi protesici classificati come fallimenti endodontici, sono la diretta conseguenza del passaggio di batteri attraverso il lume canalare. L’infiltrazione, che può verificarsi durante le fasi provvisorie protesiche o l’esposizione alla saliva durante le fasi di preparazione di un perno indiretto espongono la guttapercha ad un impatto batterico elevato che può tramutarsi successivamente in insuccesso endodontico. La possibilità di ricostruire un elemento dentale con un perno in fibra appena terminata la terapia canalare e adattare il restauro provvisorio nella stessa seduta, riduce la possibilità di infiltrazione batterica. Prima di esaminare singolarmente tutti i prodotti e le tecniche utilizzate per la realizzazione del moncone protesico, occorre tuttavia ricordare che esistono alcuni fattori critici comuni a tutti i materiali che possono pregiudicare la durata della ricostruzione, quali la vicinanza del margine protesico con la linea di finitura della ricostruzione post-endodontica e la incacapacità di sigillo del restauro protesico provvisorio e definitivo. I margini del restauro protesico devono coprire almeno 2-3 millimetri la struttura dentale e non devono mai terminare sul materiale utilizzato per la ricostruzione del moncone. Queste considerazioni sono valide anche per ricostruzioni effettuate con perni in fibra e ricostruzioni in composito. Infatti la presenza di almeno 2 mm di dentina coronale residua è correlabile con una percentuale di successo clinico piu’ elevata . (Ferrari et al., 2000). I restauri protesici provvisori e a maggior ragione quelli definitivi devono, tramite il cemento, sigillare ermeticamente il margine attraverso un perfetto adattamento per poter controllare l’assorbimento di acqua e

2004 - Six Months Evaluation of Post-Operative Sensitivity in IFPDs [Relazione in Atti di Convegno]
Monaco, C.; Baldissara, P.; Caldari, M.; Scotti, R.
abstract

2003 - Clinical evaluation of fiber-reinforced composite inlay FPDs [Articolo su rivista]
Monaco, C.; Ferrari, M.; Miceli, G. P.; Scotti, R.
abstract

Purpose: This clinical study evaluated the behavior of inlay fixed partial dentures (IFPD) with conventional and modified framework designs over a period of 12 to 48 months. Materials and Methods: Forty-one glass fiber-reinforced composite IFPDs were made to replace one missing maxillary or mandibular tooth. The frameworks were made only with parallel fibers in 19 restorations (group 1) and built with parallel and woven fibers modifying the design of the pontic element in 22 IFPDs (group 2) according to the manufacturer's instructions. All restorations were evaluated by color match, marginal discoloration, secondary caries, surface texture, marginal adaptation, fracture, and postoperative sensitivity. Results: Three partial adhesive-cohesive veneering composite fractures occurred in the pontic element in group 1 after 3, 4, and 8 months, respectively. One cohesive fracture occurred in an abutment in group 2 after 46 months. Group 1 showed a 16% fracture failure rate; group 2 showed a 5% failure rate. However, no statistical difference was detected between the groups. IFPDs received the highest score at the following rates: color match 71%, marginal discoloration 96%, secondary caries 99%, surface texture 88%, marginal adaptation 98%, fracture 90%, and postoperative sensitivity 100%. Statistical analysis indicated significant deterioration of color match from baseline to last recall. Conclusion: There were nonsignificantly fewer fractures of the veneering composite with the modified design of the framework than with the conventional design. Repair of the fractured veneer of IFPDs may lengthen the lifespan of the restorations, but it is advisable only for slight damage.

2003 - Clinical evaluation of teeth restored with quartz fiber-reinforced epoxy resin posts [Articolo su rivista]
Malferrari, S.; Monaco, C.; Scotti, R.
abstract

Purpose: This prospective clinical follow-up evaluated the acceptability of quartz fiber-reinforced epoxy posts used in endodontically treated teeth over a 30-month period. Materials and Methods: In 132 patients, 180 endodontically treated teeth were restored using Æstheti-Plus quartz-fiber posts. The posts were luted with the All-Bond 2 adhesive system and C&amp;B Resin Cement according to the manufacturer's recommendations. The core was made with Core-Flo or Bis-Core, and all-ceramic crowns or metal-ceramic crowns were applied as final restorations. The parameters considered as clinical failure were displacement, detachment, or fracture of posts; core or root fracture; and crown or prosthesis decementation. Patients were reevaluated at 6, 12, 24, and 30 months. Results: One cohesive failure involving a margin of the composite core was observed after 2 weeks, and two adhesive fractures were seen after 2 months. These failures were located between the cement and the dentin walls of the canals. All three failures occurred during removal of the temporary crown. The percentage of failures was thus 1.7% over a 30-month period, but it was possible to successfully replace the restoration in all three failed cases. Conclusion: Over a 30-month period, the rehabilitation of endodontically treated teeth using quartz-fiber posts showed good clinical results. No crown or prosthesis decementation was observed, and no post, core, or root fractures were recorded.

2002 - SURFACE ROUGHNESS OF FIVE PARTIAL DENTURE MATERIALS [Abstract in Atti di Convegno]
Monaco, C.; Bortolini, Sergio; Cornacchione, D.
abstract

(SPEC ISS A) ABSTRACT A 172 N°1238 80TH GENERAL SESSION OF THE IADR 31ST ANNUAL MEETING OF THE AADR 26TH ANNUAL MEETING OF THE CADR 6-9, 2002 S.DIEGO, CALIFORNIA USA.

2001 - Short-Term Clinical Evaluation of Inlay and Onlay Restorations Made with a Ceromer [Articolo su rivista]
Monaco, C.; Baldissara, P.; Dall'Orologio, G. D.; Scotti, R.
abstract

Purpose: This prospective clinical trial evaluated the clinical acceptability of a new material, ceromer, used for inlay and onlay restorations in single- or multisurface cavities of posterior teeth. Materials and Methods: Forty-three Targis inlay and onlay restorations were placed in 25 patients and evaluated using the United States Public Health Service criteria. The laboratory work was conducted by three dental technicians according to the manufacturer's recommendations. Twenty-five restorations were luted with Syntac bonding system and Variolink II, and 18 were luted with Scotchbond Multi Purpose and Opal Luting Composite. The recalls were done at 6, 12, and 18 months. Restorations were evaluated for six parameters and scored as ideal (A), clinically acceptable (B), or clinically unacceptable (C). Results: Indirect restorations received, after 18 months, scores of A at the following rates: color match 77%; marginal discoloration 93%; secondary caries 100%; anatomic form 93%; and marginal integrity 95%. For these parameters, statistical analysis indicated no significant differences at baseline and after 18 months. Postoperative hypersensitivity was reported by seven patients at baseline, but it decreased and there was no hypersensitivity at 12- and 18-month follow-ups. Conclusion: Over an 18-month period the Targis restorative system yielded good clinical service.

2001 - VALUTAZIONE CLINICA DI PERNI IN FIBRA DI QUARZO LIGHT POST E ENDO LIGHT POST: RISULTATI PRELIMINARI [Articolo su rivista]
Malferrari, S; Monaco, C; Bortolini, Sergio
abstract

in questo studio clinico prospettico si e' valutata la sopravvivenza di cinquantatre elementi dentari trattati endodonticamente nel corso di dodici mesi e ricostruiti con perno endocanalare in fibre di quarzo Light-Post e Endo Light-Post. La riabilitazione del moncone e' stata ottenuta con un restauro in composito e successivo ripristino protesico in ceramica.

2000 - RESTAURI INDIRETTI: VALUTAZIONE CLINICA DI UN NUOVO MATERIALE CEROMERO [Articolo su rivista]
Monaco, C.; Bortolini, Sergio; Ciocca, L.
abstract

questo studio clinico ha lo scopo di valutare l'accettabilita' clinica in restauri indiretti tipo onlay di un nuovo materiale, il Targis (Ivoclar) appartenente alla categoria dei ceromeri, dandone i risultati a 18 mesi.