Three years in vivo wear: Core-ceramic, veneers, and enamel antagonists

Objectives: Test the hypotheses that there are equivalent wear rates for enamel-versus-enamel and ceramic-versus-enamel, analyzing the in vivo wear of crown ceramics, their natural enamel antagonists, and the corresponding two contralateral teeth; and, that bite force does not correlate with the wear. Methods: A controlled, clinical trial was conducted involving patients needing full coverage crowns opposing enamel antagonists. Bite forces were measured using a bilateral gnathodynamometer. Single-unit restorations of metal/ceramic (Argedent 62, Argen Corp/IPS d.SIGN veneer); or, core-ceramic/veneer from either, Empress2/Eris, or e.max Press core/e.max Ceram glaze (ceramics: Ivoclar Vivadent, USA) were randomly assigned, fabricated and cemented. Impressions were made of the ceramic crowns, as well as each maxillary and mandibular quadrant at one week (baseline) and one, two and three years. Resulting models were scanned (3D laser scanner). Maximum wear was calculated by superimposing baseline with annual images. Results: There were a total of thirty-six crowns required for thirty-one patients. Each restoration had three associated enamel teeth: crown, (1) antagonist, (2) contralateral and (3) contralateral- antagonist. SAS PROC MIXED (α = 0.05) indicated no statistical significance for mean maximum wear among crown ceramics, enamel antagonists and contralaterals. However, enamel wear was statistically significant in relation to intraoral location (p = 0.04) and among years (p < 0.02). Analyzed alone, the enamel contralateral-antagonist exhibited significantly greater wear (p < 0.001). Considering all wear sites, there was no correlation with bite force (p = 0.15). Significance: The ceramics and their antagonists exhibited in vivo wear rates within the range of normal enamel. Future studies should examine the wear implications of the contralateral-antagonist enamel.