Novel-design ultra-thin CAD/CAM composite resin and ceramic occlusal veneers for the treatment of severe dental erosion

Ultra-thin bonded posterior occlusal veneers represent a conservative alternative to traditional inlays and complete coverage crowns for the treatment of severe erosive lesions. There is a lack of data regarding selection of the most appropriate material and its influence on fatigue resistance, which may affect restoration longevity.The purpose of this study was to assess the influence of CAD/CAM restorative material (ceramic vs. composite resin) on fatigue resistance of ultra-thin occlusal veneers.A standardized nonretentive tooth preparation (simulating advanced occlusal erosion) was applied to 40 extracted molars including removal of occlusal enamel, and immediate dentin sealing (Optibond FL). All teeth were restored with a 0.6 mm-thick occlusal veneer (Cerec3 chairside CAD/CAM system). Reinforced ceramics (Empress CAD and e.max CAD) and composite resins (Paradigm MZ100 and XR (experimental blocks)) were used to mill the restorations (n=10). The intaglio surfaces were HF-etched and silanated (reinforced ceramics) or airborne-particle abraded and silanated (composite resins). Preparations were airborne-particle abraded and etched before restoration insertion. All restorations were adhesively luted with preheated Filtek Z100. Cyclic isometric loading was applied at 5 Hz, beginning with a load of 200N (x5,000), followed by stages of 400, 600, 800, 1000, 1200 and 1,400N at a maximum of 30,000 cycles each. The number of cycles at initial failure (first cracks) was recorded. Specimens were loaded until catastrophic failure (lost restoration fragment) or to a maximum of 185,000 cycles. Groups were compared using the life table survival analysis (α=.008, Bonferroni-method).Empress CAD and e.max CAD initially failed at an average load of 500N and 800N, respectively with no specimen withstanding all 185,000 load cycles (survival 0%); with MZ100 and XR the survival rate was 60% and 100%, respectively.Both composite resins (MZ100 and XR) increased the fatigue resistance of ultra-thin occlusal veneers (P<.001) when compared to the ceramics evaluated (Empress CAD and e.max CAD).