Flexural Strength, Elastic Modulus, and pH Profile of Self-etch Resin Luting Cements

Effect of Artificial Aging and Surface Treatment on Bond Strengths to Dental Zirconia

The objective of this project was to study the influence of artificial aging and surface treatment on the microtensile bond strengths (μTBS) between zirconia and a phosphate monomer–based self-adhesive cement. Thirty zirconia disks (IPS e.max ZirCAD, Ivoclar Vivadent) were randomly assigned to two aging regimens: AR, used as received, which served as a control, and AG, artificial aging to simulate low-temperature degradation. Subsequently, the disks of each aging regimen were assigned to three surface treatments: NT, no surface treatment; CO, surface silicatization with CoJet sand (3M ESPE); and ZP, zirconia surface treated with Z-Prime Plus (Bisco Inc). Thirty discs were made of Filtek Z250 (3M ESPE) composite resin and luted to the zirconia discs using RelyX Unicem (3M ESPE). The specimens were sectioned with a diamond blade in X and Y directions to obtain bonded beams with a cross-section of 1.0 ± 0.2 mm. The beams were tested in tensile mode in a universal testing machine at a speed of 0.5 mm/min to measure μTBS. Selected beams were selected for fractographic analysis under the SEM. Statistical analysis was carried out with two-way analysis of variance and Dunnett T3 post hoc test at a significance level of 95%. The mean μTBS for the three AR subgroups (AR-NT, AR-CO, and AR-ZP) were significantly higher than those of the corresponding AG groups (p<0.0001). Both AR-CO and AR-ZP resulted in statistically significant higher mean bond strengths than the group AR-NT (p<0.006 and p<0.0001, respectively). Both AG-CO and AG-ZP resulted in statistically significant higher mean bond strengths than the group AG-NT (both at p<0.0001). Overall, AG decreased mean μTBS. Under the SEM, mixed failures showed residual cement attached to the zirconia side of the beams. CO resulted in a characteristic roughness of the zirconia surface. AR-ZP was the only group for which the amount of residual cement occupied at least 50% of the interface in mixed failures.

Does inhibition of proteolytic activity improve adhesive luting?

Endogenous enzymes may be involved in the biodegradation of adhesive restoration-tooth interfaces. Inhibitors of matrix metalloproteinases (MMPs) have been suggested to retard the bond-degradation process. Limited data are available on whether composite cements may also benefit from MMP inhibitors. Therefore, the aim of this study was to determine the effect of two MMP inhibitors--chlorhexidine digluconate (CHX) and galardin--on the microtensile bond strength (μTBS) of two self-adhesive composite cements to dentin. Ceramic specimens were cemented to bur-cut dentin surfaces using the self-adhesive composite cements RelyX Unicem 2 (3M ESPE) or Clearfil SA (Kuraray), or the etch-and-rinse composite cement Nexus 3 (Kerr) that served as the control. The surfaces were left untreated or were pretreated with MMP inhibitors (2% CHX or 0.2 mM galardin). The μTBS was determined 'immediately' and upon ageing (water storage for 6 months). Statistical analysis revealed a significant effect of the factors 'composite cement' and 'storage', as well as all interactions, but no effect of the MMP inhibitors. After 6 months of ageing, the μTBS decreased for all cements, except for the multistep etch-and-rinse luting composite when it was applied without MMP inhibitors. The MMP inhibitors could not prevent the decrease in μTBS upon ageing and therefore do not improve the luting durability of the composite cements tested.

Mechanical performance of endodontic restorations with prefabricated posts: sensitivity analysis of parameters with a 3D finite element model

Many studies have investigated the effect of different parameters of the endodontically restored tooth on its final strength, using in vitro tests and model simulations. However, the differences in the experimental set-up or modelling conditions and the limited number of parameters studied in each case prevent us from obtaining clear conclusions about the relative importance of each parameter. In this study, a validated 3D biomechanical model of the restored tooth was used for an exhaustive sensitivity analysis. The individual influence of 20 different parameters on the mechanical performance of an endodontic restoration with prefabricated posts was studied. The results bring up the remarkable importance of the loading angle on the final restoration strength. Flexural loads are more critical than compressive or tensile loads. Young's modulus of the post and its length and diameter are the most influential parameters for strength, whereas other parameters such as ferrule geometry or core and crown characteristics are less significant.

Fiber post placement with core build-up materials or resin cements-an evaluation of different adhesive approaches

OBJECTIVE

To compare push-out bond strength of fiber-posts luted with different adhesive approaches to root canal dentin.

MATERIALS AND METHODS

Forty maxillary first incisors were decoronated and endodontically treated. Specimens were randomly distributed into five groups (n = 8) and fiber-posts (DentinPost coated, Komet) were inserted using five different luting materials: etch-and-rinse adhesive systems and corresponding core-and-post material in groups 1 (DentinBond/DentinBuild, Komet) and 2 (XP Bond + SCA/Core-X flow, Densply), self-adhesive resin cements in groups 3 (RelyX Unicem, 3M Espe) and 4 (SmartCem 2, Dentsply) and a self-etch adhesive/resin cement in group 5 (ED-Primer II/Panavia F 2.0, Kuraray). The roots were sectioned into eight 1 mm thick serial slices and within 48 h push-out bond strength was investigated. Statistical analyses were performed using non-parametrical Kruskal-Wallis H-test and Mann-Whitney U-test for differences between experimental groups at p < 0.05. The failure modes were analyzed using Chi square test.

RESULTS

The bond strength [MPa] (mean/min-max) for groups 3 (12.35/3.60-32.44), 4 (13.52/4.48-30.69) and 2 (11.15/5.23-35.58) were significantly higher (p < 0.001) compared to groups 1 (6.66/2.34-24.89) and 5 (7.41/0.28-34.18). Adhesive failure between dentin and luting agent was the most frequent failure mode.

CONCLUSIONS

Bond strength of fiber-posts adhesively luted to root canal dentin was significantly higher when self-adhesive resin cements were used. One (group 2) of the tested core-and-post materials/etch-and-rinse adhesive achieved comparable bond strength values.

Microtensile bond strength of self-adhesive luting cements to ceramics

The purpose of this paper was to compare the bond strengths of the self-adhesive luting cements between ceramics and resin cores and examine their relation to the cement thickness. Three self-adhesive luting cements (Smartcem, Maxcem, and G-CEM) and a resin cement (Panavia F 2.0) for control were used in the paper. The thickness of the cements was controlled in approximately 25, 50, 100, or 200 μm. Each 10 specimens were made according to the manufacturers' instructions and stored in water at 37°C. After 24 hours, microtensile bond strength (μTBS) was measured. There were significant differences in cements. Three self-adhesive cements showed significantly lower μTBSs than control that required both etching and priming before cementation (Tukey, P < 0.05). The cement thickness of 50 or 100 μm tended to induce the highest μTBSs for each self-adhesive luting cements though no difference was found.

Influence of polymerization mode and C-factor on cohesive strength of dual-cured resin cements

OBJECTIVES

The aim of this study is to determine the influence of the C-factor and the mode of polymerization on the cohesive strength of various dual-cure resin cements.

METHODS

Three curing conditions were tested; chemical curing with free shrinkage conditions (C=0), and constraint shrinkage conditions (C=25), and dual-curing with free shrinkage conditions (C=0). Opaque polyethylene, brass (pretreated with Clearfil SE bond), and transparent polyethylene tubes respectively, were filled with the different cements. The tubes were 20mm long with an inner diameter of 1.6 or 1.8mm. Five cements, DC Core Automix, Panavia F 2.0, Maxcem, Multilink, and RelyX Unicem, were tested with ten specimens per group. The specimens were trimmed to an hour-glass shape with a neck diameter of 1mm, stored in water (37°C, 24h), and subjected to microtensile testing (1mmmin(-1)). SEM analysis was carried out on chemically cured samples of DC Core Automix C=0 and C=25. Data were statistically analyzed (Two-way ANOVA, Tukey's post hoc test, p<0.05).

RESULTS

Most cements showed no significant differences between the curing modes. A high C-factor negatively influences the cohesive strength of some cements. SEM analysis shows that chemical curing of DC Core Automix in a high C-factor environment leads to more and larger microvoids in the cement.

SIGNIFICANCE

Constraint shrinkage conditions, i.e. a high C-factor, can negatively influence the physical properties of a dual-cured resin cement, which would clinically be the case in the confined space of a root canal or post space preparation.

Influence of post-cure time on the microhardness of self-adhesive resin cements inside the root canal

PURPOSE

To compare the microhardness of several dual-cure, self-adhesive resin cements used to lute fiber posts at 24 hours and seven days after cementation.

METHODS

Bovine incisors were selected to lute 15 fiber posts that were 12 mm long (FRC Postec Plus size 3, Ivoclar-Vivadent). Five resin cements were tested: Multilink Automix (Ivoclar-Vivadent), without light-curing, and the self-adhesive resin cements Maxcem Elite (Kerr), RelyX Unicem (3M ESPE), G-Cem (GC), and Smartcem 2 (Dentsply), which were light-cured for 40 seconds (LED Bluephase, Ivoclar-Vivadent). Each root was embedded in chemically cured acrylic resin and stored at 37°C for 24 hours. The roots were transversally sectioned into nine specimens that were each 1 mm thick, with three specimens corresponding to each root third. Indentations (100g, 30 seconds) were performed on each section in the resin cement, at 24 hours and seven days after cementation, using a Vickers digital microdurometer (Buehler). Data were analyzed by two-way analysis of variance, Student-Newman-Keuls test, and paired t-test (p<0.05).

RESULTS

A significant influence was found (p<0.05) for the resin cement evaluated, the root third, and their interactions on microhardness values at 24 hours and seven days after post cementation. RelyX Unicem and G-Cem exhibited the highest microhardness values, whereas Multilink Automix presented the lowest. All resin cements suffered a decrease in microhardness according to root canal depth, with the exception of G-Cem and Multilink Automix at 24 hours and Smartcem 2 after seven days. After seven days, the evaluated resin cements showed a significant increase in microhardness values, with the exception of Maxcem Elite and Smartcem 2 at the coronal third.

CONCLUSIONS

Microhardness of the self-adhesive resin cements when used to lute fiber posts was material-dependent and higher values were obtained in the coronal third, revealing their sensitivity to light irradiation. More information regarding the polymerization reaction of these cements is warranted. According to the current results, microhardness values were significantly higher one week after post luting.

Numerical analysis of the biomechanical behaviour of a weakened root after adhesive reconstruction and post-core rehabilitation

OBJECTIVES

The purpose of this study was to perform a finite element analysis to determine whether adhesive reconstruction is able to restore the original biomechanical behaviour of weakened roots, in terms of fracture resistance, when compared with post/crown-restored teeth with intact roots.

METHODS

A three-dimensional model of a maxillary central incisor was created. The model simulated an endodontically treated tooth restored with a glass-fibre post, a composite-resin core and a metal crown (Model 1). Based on Model 1, a new volume was created in the root cervical third that represented the area where the dentine structure was lost, resulting in a structurally damaged root (Model 2). A 100N load was applied to the palatal surface at 130° from the long axis of the tooth. After processing (Ansys(®) 10.0 - Canonsburg, PA, USA), the principal normal stress data were analyzed (S1, tensile; S3, compressive).

RESULTS

The models demonstrated a similar S1 distribution concentrated in the lingual cervical region but different S1 levels (Model 1: 28.7MPa; Model 2: 35.3MPa). The S3 distribution indicated differences in behaviour between the models (Model 1: -18 to -27MPa along the buccal root surface; Model 2: -25 to -32MPa on the post buccal surface and along the buccal root wall).

CONCLUSIONS

Although the stress distribution within the root walls remained below the ultimate stress limit of the root dentine, the adhesive reconstruction of the weakened roots did not recover the load resistance of structurally intact roots.

CLINICAL SIGNIFICANCE

The decision of when to prosthetically rehabilitate weakened roots with cervical dentine structural tissue loss is a challenge for clinicians. A 'monoblock' adhesive reconstruction has been proposed for root reinforcement. During treatment planning, the possibility of restoring the mechanical resistance of the root must be evaluated if successful long-term results are to be achieved.

Influence of immediate dentin sealing on the shear bond strength of pressed ceramic luted to dentin with self-etch resin cement

Objectives. To examine the effect of immediate dentin sealing (IDS), with dentin bonding agents (DBAs) applied to freshly cut dentin, on the shear bond strength of etched pressed ceramic luted to dentin with RelyX Unicem (RXU) cement. Method. Eighty extracted noncarious third molars were ground flat to expose the occlusal dentin surfaces. The teeth were randomly allocated to five groups (A to E) of sixteen teeth each. Groups A to D were allocated a dentin bonding agent (Optibond FL, One Coat Bond, Single Bond, or Go!) that was applied to the dentin surface to mimic the clinical procedure of IDS. These specimen groups then had etched glass ceramic discs (Authentic) luted to the sealed dentin surface using RXU. Group E (control) had etched glass ceramic discs luted to the dentin surface (without a dentin bonding agent) using RXU following the manufacturer's instructions. All specimens were stored for one week in distilled water at room temperature and then shear stressed at a constant cross-head speed of 1 mm per minute until failure. Statistical analysis was performed by ANOVA followed by post hoc Tukey HSD method (P < 0.05) applied for multiple paired comparisons. Results. The shear bond strength results for group A to E ranged from 6.94 ± 1.53 to 10.03 ± 3.50 MPa. One-way ANOVA demonstrated a difference (P < 0.05) between the groups tested and the Tukey HSD demonstrated a significant (P < 0.05) difference between the shear bond strength (SBS) of Optibond FL (Group A) and Go! (Group D). There was no statistical difference (P > 0.05) in the SBS between the test groups (A-D) or the control (group E). Conclusion. IDS using the dentin bonding agents tested does not statistically (P > 0.05) affect the shear bond strength of etched pressed ceramic luted to dentin with RXU when compared to the control.

Premolars restored with posts of different materials: fatigue analysis

Previous works studied the effect of the material and the dimensions of the post on the biomechanical performance (fracture strength and stress distribution) of restored teeth, under static loads. The aim of this work was to study the effect of the post material (glass fibre and stainless steel) on restored teeth, which have the final crown, under dynamic conditions. The use of a biomechanical model, including a fatigue analysis from FEA, is presented as a powerful method to study the effect of the material of the intraradicular post. The inclusion of the fatigue analysis allows for a more realistic study that takes into account the dynamic nature of masticatory forces. At the same time, the results obtained are easier to interpret by both dentists and mechanical engineers. No differences were found, with the load and number of cycles considered, between glass fibre and stainless steel as material for the intraradicular post used in premolars restorations.

Luting glass ceramic restorations using a self-adhesive resin cement under different dentin conditions

Objectives

The aim of this study was to investigate the bond strength of ceramic restorations luted using a self-adhesive resin cement (RelyX Unicem, 3M ESPE) under different dentin conditions.

Material and Methods

In the experimental groups, ceramic restorations were luted to bovine incisors with RelyX Unicem under the following conditions: [Dry dentin]: surface was dried using air stream for 15 s; [Moist dentin]: excess dentin moisture was removed with absorbent paper; [Bonding agent]: Clearfil SE Bond (Kuraray) self-etching adhesive system was previously applied to dentin. In the Control group, cementation was done using an etch-and-rinse adhesive (Excite DSC) and Variolink II resin cement (Ivoclar Vivadent). Photoactivation of the resin cements was performed with UltraLume LED 5 unit (Ultradent). The restorations (n=5 per group) were sectioned into beams and microtensile testing was carried out. Data were subjected to ANOVA and Tukey's test (p<0.05). Failure modes were classified under Scanning Electron Microscopic (SEM) (×120 magnification).

Results

The bond strength was dependent on the moisture status of the dentin. Bond strength in the "dry dentin group" was significantly lower than that of all other groups, which showed similar results. A predominance of mixed failures was detected for the control group, while a predominance of adhesive failures was observed for the "bonding agent" and "dry dentin" groups. The "moist dentin" group presented predominantly cohesive failures within the luting material. The previous application of a self-etching adhesive showed no significant effect.

Conclusions

Only excess dentin moisture should be removed for the cementation of ceramic restorations with self-adhesive resin cements.

Microleakage of Posterior Composite Restorations Lined with Self-adhesive Resin Cements

Two self-adhesive resin cements resulted in minimal microleakage scores when used as liners in Class II composite restorations.

Influence of material and diameter of pre-fabricated posts on maxillary central incisors restored with crown

Numerous research works have studied the effect of post-design parameters on the mechanical behaviour of restored teeth without reaching any clear conclusions. Previous works by the authors ascertained the effect of material and post-dimensions for non-crowned restored teeth. The aim of this work was to study the effect of post-material and diameter for crowned teeth. First, an experimental fracture strength test was performed on eighteen extracted human maxillary central incisors. Teeth were decoronated, treated endodontically and restored (nine with glass fibre posts and nine with stainless steel posts). Several post-diameters were used. The final crown restoration was carried out using a reinforced glass-ceramic material. Failure loads were recorded and results were compared using the one-way anova. Secondly, the finite element technique was used to model the restored teeth and to compare the estimated stress distributions. The addition of the crown did not affect the strength of the restoration to any significant extent and post-diameter did not influence the biomechanical performance of either of the post-systems. The crown acts as a protector, thus eliminating the influence of the post-diameter that was found previously when using stainless steel posts, but it does not completely rule out the possibility of a root fracture. Significantly, lower failure loads were found experimentally for teeth restored with stainless steel posts. The stress distributions predicted by the model corroborated these findings and allowed the authors to propose the use of glass fibre posts as a more robust restorative technique.