On the interfacial fracture resistance of resin-bonded zirconia and glass-infiltrated graded zirconia

OBJECTIVE

A major limiting factor for the widespread use of zirconia in prosthetic dentistry is its poor resin-cement bonding capabilities. We show that this deficiency can be overcome by infiltrating the zirconia cementation surface with glass. Current methods for assessing the fracture resistance of resin-ceramic bonds are marred by uneven stress distribution at the interface, which may result in erroneous interfacial fracture resistance values. We have applied a wedge-loaded double-cantilever-beam testing approach to accurately measure the interfacial fracture resistance of adhesively bonded zirconia-based restorative materials.

METHODS

The interfacial fracture energy GC was determined for adhesively bonded zirconia, graded zirconia and feldspathic ceramic bars. The bonding surfaces were subjected to sandblasting or acid etching treatments. Baseline GC was measured for bonded specimens subjected to 7 days hydration at 37°C. Long-term GC was determined for specimens exposed to 20,000 thermal cycles between 5 and 55°C followed by 2-month aging at 37°C in water. The test data were interpreted with the aid of a 2D finite element fracture analysis.

RESULTS

The baseline and long-term GC for graded zirconia was 2-3 and 8 times greater than that for zirconia, respectively. More significantly, both the baseline and long-term GC of graded zirconia were similar to those for feldspathic ceramic.

SIGNIFICANCE

The interfacial fracture energy of feldspathic ceramic and graded zirconia was controlled by the fracture energy of the resin cement while that of zirconia by the interface. GC for the graded zirconia was as large as for feldspathic ceramic, making it an attractive material for use in dentistry.

Comparison of shear bond strength of orthodontic brackets using various zirconia primers

Objective

The aim of this study was to compare the shear bond strength (SBS) of orthodontic brackets bonded to zirconia surfaces using three different zirconia primers and one silane primer, and subjected to thermocycling.

Methods

We designed 10 experimental groups following the surface treatment and thermocycling. The surface was treated with one of the following method: no-primer (NP), Porcelain Conditioner (PC), Z-PRIME Plus (ZP), Monobond Plus (MP) and Zirconia Liner Premium (ZL) (n=20). Then each group was subdivided to non-thermocycled and thermocycled groups (NPT, PC, ZPT, MPT, ZLT) (n=10). Orthodontic brackets were bonded to the specimens using Transbond™ XT Paste and light cured for 15 s at 1,100 mW/cm². The SBS was measured at a 1 mm/min crosshead speed. The failure mode was assessed by examination with a stereomicroscope and the amount of bonding resin remaining on the zirconia surface was scored using the modified adhesive remnant index (ARI).

Results

The SBS of all experimental groups decreased after thermocycling. Before thermocycling, the SBS was ZL, ZP ≥ MP ≥ PC > NP but after thermocycling, the SBS was ZLT ≥ MPT ≥ ZPT > PCT = NPT (p > 0.05). For the ARI score, both of the groups lacking primer (NP and NPT) displayed adhesive failure modes, but the groups with zirconia primers (ZP, ZPT, MP, MPT, ZL, and ZLT) were associated with mixed failure modes.

Conclusions

Surface treatment with a zirconia primer increases the SBS relative to no-primer or silane primer application between orthodontic brackets and zirconia prostheses.

Effect of Resin Cement Mixing Method on the Retention Strength of a CAD/CAM Zirconia Crowns

Several treatments have been suggested to improve the retention of zirconia-based restorations luted with different cements. Resin cements are believed to improve crown retention under certain circumstances. The aim of the present study was to examine the effect of three cements with different mixing methods on the retention of CAD/CAM zirconia crowns. Thirty extracted human molars were randomly divided into three groups and prepared for all-ceramic crowns (6° taper, 4-mm height and a 1.2 mm rounded shoulder finish line). A zirconia crown (Tizian CAD/CAM) was fabricated for each tooth. The crowns were air-abraded using airborne particles, adjusted, and cemented to the corresponding tooth with one of the following cements: Panavia F2 (PAN group), RelyX Unicem (UNH group) or RelyX Unicem Aplicap (UNA group). After 3,000 rounds of thermal cycling, retention was measured using a specific retentive jig and a universal testing machine. The retention strength was measured by dividing the retention force by the surface area of each tooth. The means of the pull-out test results for each group were compared using analysis of variance and Tukey's HSD test (α = 0.05). The mode of failure was examined using a stereomicroscope. The mean retention value was 6.45 (0.34) MPa for the UNA group, 4.99 MPa (0.47) for the UNH group, and 4.45 (0.39) for the PAN group; the differences among the three test groups were significant. A mixed failure was observed in 83.3 % of specimens, while no cohesive failure occurred in the crowns. Within the limitations of the present study, of the three tested cements, Relyx Unicem Aplicap cement was associated with the highest retention force for Tizian zirconia crowns.

Surface Treatments of Zirconia to Enhance Bonding Durability

This article reviewed the surface treatments used most often to improve adhesion between zirconia and adhesive cements, focusing on their capacity to provide long-term bonding. Traditional and new treatments for zirconia bonding were searched. Some new treatments were discussed along with topographical views of the modified zirconia. New methods, such as selective infiltration etching and the low-fusing glassy porcelain application are promising, but more research is needed.

The effect of various sandblasting conditions on surface changes of dental zirconia and shear bond strength between zirconia core and indirect composite resin

PURPOSE

To measure the surface loss of dental restorative zirconia and the short-term bond strength between an indirect composite resin (ICR) and zirconia ceramic after various sandblasting processes.

MATERIALS AND METHODS

Three hundred zirconia bars were randomly divided into 25 groups according to the type of sandblasting performed with pressures of 0.1, 0.2, 0.4 and 0.6 MPa, sandblasting times of 7, 14 and 21 seconds, and alumina powder sizes of 50 and 110 µm. The control group did not receive sandblasting. The volume loss and height loss on zirconia surface after sandblasting and the shear bond strength (SBS) between the sandblasted zirconia and ICR after 24-h immersion were measured for each group using multivariate analysis of variance (ANOVA) and Least Significance Difference (LSD) test (α=.05). After sandblasting, the failure modes of the ICR/zirconia surfaces were observed using scanning electron microscopy.

RESULTS

The volume loss and height loss were increased with higher sandblasting pressure and longer sandblasting treatment, but they decreased with larger powder size. SBS was significantly increased by increasing the sandblasting time from 7 seconds to 14 seconds and from 14 seconds to 21 seconds, as well as increasing the size of alumina powder from 50 µm to 110 µm. SBS was significantly increased from 0.1 MPa to 0.2 MPa according to the size of alumina powder. However, the SBSs were not significantly different with the sandblasting pressure of 0.2, 0.4 and 0.6 MPa. The possibilities of the combination of both adhesive failure and cohesive failure within the ICR were higher with the increases in bonding strength.

CONCLUSION

Based on the findings of this study, sandblasting with alumina particles at 0.2 MPa, 21 seconds and the powder size of 110 µm is recommended for dental applications to improve the bonding between zirconia core and ICR.

Effect of various surface preparations on bond strength of a gingiva-colored indirect composite to zirconia framework for implant-supported prostheses

To evaluate the effects of various surface preparations on shear bond strength of a gingiva-colored indirect composite material and zirconia framework. Zirconia disks were prepared with one of nine surface treatments: hydrofluoric acid etching (HF), heating at 1,000°C for 10 min (HT), wet-grinding with 600- and 1500-grit SiC paper (SiC 600 and 1500), alumina-blasting at 0.1, 0.2, 0.4 and 0.6 MPa (AB 0.1, 0.2, 0.4, and 0.6), and no treatment (NT). An indirect composite material was bonded to zirconia. Shear bond strengths were measured. Bond strength was significantly higher in AB 0.2, 0.4, and 0.6 groups than in other groups at 0 and 20,000 thermocycles. Post-thermocycling bond strength was lower in NT, HF, and HT groups than in other groups. Alumina-blasting with 0.2 MPa or higher yielded sufficient durable bond strength between gingiva-colored indirect composite and zirconia frameworks. Hydrofluoric acid etching and heat treatment did not achieve durable bond strengths.

Retention Forces between Titanium and Zirconia Components of Two-Part Implant Abutments with Different Techniques of Surface Modification

BACKGROUND

The adhesive connection between titanium base and zirconia coping of two-part abutments may be responsible for the failure rate. A high mechanical stability between both components is essential for the long-term success.

PURPOSE

The aim of the present in-vitro study was to evaluate the influence of different surface modification techniques and resin-based luting agents on the retention forces between titanium and zirconia components in two-part implant abutments.

MATERIALS AND METHODS

A total of 120 abutments with a titanium base bonded to a zirconia coping were investigated. Two different resin-based luting agents (Panavia F 2.0 and RelyX Unicem) and six different surface modifications were used to fix these components, resulting in 12 test groups (n = 10). The surface of the test specimens was mechanically pretreated with aluminium oxide blasting in combination with application of two surface activating primers (Alloy Primer, Clearfil Ceramic Primer) or a tribological conditioning (Rocatec), respectively. All specimens underwent 10,000 thermal cycles between 5°C and 55°C in a moist environment. A pull-off test was then conducted to determine retention forces between the titanium and zirconia components, and statistical analysis was performed (two-way anova). Finally, fracture surfaces were analyzed by light and scanning electron microscopy.

RESULTS

No significant differences were found between Panavia F 2.0 and RelyX Unicem. However, the retention forces were significantly influenced by the surface modification technique used (p < 0.001). For both luting agents, the highest retention forces were found when adhesion surfaces of both the titanium bases and the zirconia copings were pretreated with aluminium oxide blasting, and with the application of Clearfil Ceramic Primer.

CONCLUSION

Surface modification techniques crucially influence the retention forces between titanium and zirconia components in two-part implant abutments. All adhesion surfaces should be pretreated by sandblasting. Moreover, a phosphate-based primer serves to enhance long-term retention of the components.

Effect of surface treatments on the bond strength of veneering ceramic to zirconia

AIM

The purpose of this study was to evaluate the effect of different surface treatments on the bond strength of veneering ceramic to zirconia.

METHODS

Square (15 mm x 10 mm x 2 mm) zirconia specimens (n=18) received one of the following surface treatments: Group 1, sandblasting; Group 2, Clearfil ceramic primer application; Group 3, grinding; Group 4, alloy primer application; and Group 5, RelyX ceramic primer application. The zirconia core specimens were layered with a veneering porcelain (5 mm x 3 mm x 3 mm). Mean shear bond strength values (MPa) were calculated. Data were analyzed with one-way ANOVA and Tukey's post hoc pairwise comparisons (α=0.05). Fractured surfaces of the specimens were examined with scanning electron microscope (SEM).

RESULTS

This study showed that bond strengths of the metal primer-treated zirconia specimens (Group 4) were significantly higher than those of the other paired groups. The application of metal primer affected the specimens' failure mode. SEM analysis demonstrated that Group 4 had mainly cohesive fractures, while the other groups showed approximately equal levels of adhesive and mixed fracture types. The mean and SD values for shear bond strengths ranged from 8.90 ± 3.42 MPa (Group 2) to 19.74 ± 4.96 MPa (Group 4).

CONCLUSIONS

In conclusion, the application of a metal primer to a zirconia core increased the bond strength of veneering ceramics. The use of chemical agents to improve the strength of the zirconia core's bond to veneering ceramic may have more benefits than the use of mechanical pretreatments.

Resin cementation of zirconia ceramics with different bonding agents

The aim of this study was to evaluate the effects of sandblasting and different chemical bonding agents on shear bond strength of zirconia and conventional resin cement. In this study, 35 zirconia specimens were treated as follows: Group I: control; Group II: sandblasting; Group III: sandblasting + Monobond S; Group IV: sandblasting + Monobond Plus; Group V: sandblasting + Z-Prime Plus. The specimens in each group were bonded with conventional composite resin cement Variolink II. After cementation, specimens were stored in distilled water (at 37 °C) for 24 h and shear test was performed. The highest shear bond strength values were observed in Groups IV and V. The lowest shear bond strength values were observed in Group I. Using 10-methacryloyloxy-decyl dihydrogenphosphate monomer-containing priming agents, e.g. Monobond Plus and Z-PRIME Plus, combined with sandblasting can be an effective method for resin bonding of zirconia restorations.

Improved Resin-Zirconia Bonding by Room Temperature Hydrofluoric Acid Etching

This in vitro study was conducted to evaluate the shear bond strength of “non-self-adhesive” resin to dental zirconia etched with hydrofluoric acid (HF) at room temperature and to compare it to that of air-abraded zirconia. Sintered zirconia plates were air-abraded (control) or etched with 10%, 20%, or 30% HF for either 5 or 30 min. After cleaning, the surfaces were characterized using various analytical techniques. Three resin cylinders (Duo-Link) were bonded to each treated plate. All bonded specimens were stored in water at 37 °C for 24 h, and then half of them were additionally thermocycled 5000 times prior to the shear bond-strength tests (n = 12). The formation of micro- and nano-porosities on the etched surfaces increased with increasing concentration and application time of the HF solution. The surface wettability of zirconia also increased with increasing surface roughness. Higher concentrations and longer application times of the HF solution produced higher bond-strength values. Infiltration of the resin into the micro- and nano-porosities was observed by scanning electron microscopy. This in vitro study suggests that HF slowly etches zirconia ceramic surfaces at room temperature, thereby improving the resin–zirconia bond strength by the formation of retentive sites.

In vitro shear bond strength of two self-adhesive resin cements to zirconia

STATEMENT OF PROBLEM

Although the use of anatomic-contour zirconia restorations has expanded in the recent past, disagreement still exists as to reliable cementation techniques and materials.

PURPOSE

The purpose of this in vitro study was to compare the immediate and artificially aged shear bond strength of 2 commercially available self-adhesive resin cements to zirconia: one with silica coating and silanation as a zirconia surface treatment and the other contained a phosphate monomer, which eliminated the need for a separate primer.

MATERIAL AND METHODS

Sixty composite resin rods (2.5 mm in diameter and 3 mm in length) were fabricated from a nano-optimized composite resin by using a polypropylene mold, then light polymerized with a light-emitting diode. zirconia plates (10×10×4mm) were sectioned from an yttrium-stabilized zirconia puck, sintered, and then mounted in autopolymerizing acrylic resin custom tray material. Composite resin rods were cemented to the zirconia plates with 2 different cements. The surface treatment of zirconia followed the manufacturers' instructions for each cement. The specimens were tested for shear bond strength at 3 aging conditions: immediate, after 24 hours of moist storage, and after 30 days of moist storage with 10000 thermocycles. Specimens were loaded to failure in a universal testing machine, and the data were analyzed with 2-way ANOVA (α=.05). Weibull parameters (modulus and characteristic strength) also were calculated for each group.

RESULTS

Two-way ANOVA revealed that only the aging condition significantly affected the bond strength to zirconia. The cement and the interaction of the cement and aging did not significantly affect the shear bond strength to zirconia. The highest bond strength for both cements was achieved at 24 hours, whereas the lowest bond strength values were recorded in the immediate groups.

CONCLUSIONS

No significant differences in bond strength to zirconia were observed between a cement with a silane priming step and an methacryloxydecyl dihydrogen phosphate-containing cement without a separate primer. Aging had a significant effect on the shear bond strength of the 2 self-adhesive resin cements to zirconia.

Surface treatment of feldspathic porcelain: scanning electron microscopy analysis

PURPOSE

Topographic analysis of treated ceramics provides qualitative information regarding the surface texture affecting the micromechanical retention and locking of resin-ceramics. This study aims to compare the surface microstructure following different surface treatments of feldspathic porcelain.

MATERIALS AND METHODS

This in-vitro study was conducted on 72 porcelain discs randomly divided into 12 groups (n=6). In 9 groups, feldspathic surfaces were subjected to sandblasting at 2, 3 or 4 bar pressure for 5, 10 or 15 seconds with 50 µm alumina particles at a 5 mm distance. In group 10, 9.5% hydrofluoric acid (HF) gel was applied for 120 seconds. In group 11, specimens were sandblasted at 3 bar pressure for 10 seconds and then conditioned with HF. In group 12, specimens were first treated with HF and then sandblasted at 3 bar pressure for 10 seconds. All specimens were then evaluated under scanning electron microscopy (SEM) at different magnifications.

RESULTS

SEM images of HF treated specimens revealed deep porosities of variable sizes; whereas, the sandblasted surfaces were more homogenous and had sharper peaks. Increasing the pressure and duration of sandblasting increased the surface roughness. SEM images of the two combined techniques showed that in group 11 (sandblasted first), HF caused deeper porosities; whereas in group 12 (treated with HF first) sandblasting caused irregularities with less homogeneity.

CONCLUSION

All surface treatments increased the surface area and caused porous surfaces. In groups subjected to HF, the porosities were deeper than those in sandblasted only groups.

Novel zirconia surface treatments for enhanced osseointegration: laboratory characterization

Purpose. The aim of this study was to evaluate three novel surface treatments intended to improve osseointegration of zirconia implants: selective infiltration etching treatment (SIE), fusion sputtering (FS), and low pressure particle abrasion (LPPA). The effects of surface treatments on roughness, topography, hardness, and porosity of implants were also assessed. Materials and Methods. 45 zirconia discs (19 mm in diameter × 3 mm in thickness) received 3 different surface treatments: selective infiltration etching, low pressure particle abrasion with 30 µm alumina, and fusion sputtering while nontreated surface served as control. Surface roughness was evaluated quantitatively using profilometery, porosity was evaluated using mercury prosimetry, and Vickers microhardness was used to assess surface hardness. Surface topography was analyzed using scanning and atomic force microscopy (α = 0.05). Results. There were significant differences between all groups regarding surface roughness (F = 1678, P < 0.001), porosity (F = 3278, P < 0.001), and hardness (F = 1106.158, P < 0.001). Scanning and atomic force microscopy revealed a nanoporous surface characteristic of SIE, and FS resulted in the creation of surface microbeads, while LPPA resulted in limited abrasion of the surface. Conclusion. Within the limitations of the study, changes in surface characteristics and topography of zirconia implants have been observed after different surface treatment approaches. Thus possibilities for enhanced osseointegration could be additionally offered.

Influence of zirconia surface treatment on veneering porcelain shear bond strength after cyclic loading

STATEMENT OF PROBLEM

The influence of yttria-stabilized tetragonal zirconia polycrystal surface treatment on veneering porcelain shear bond strength after cyclic loading is not fully understood.

PURPOSE

The purpose of this study was to investigate the influence of yttria-stabilized tetragonal zirconia polycrystal surface treatment on veneering porcelain shear bond strength and cyclic loading on the shear bond strength between the 2 materials.

MATERIAL AND METHODS

A total of 48 cylinder-shaped yttria-stabilized tetragonal zirconia polycrystal specimens were fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM), sintered for 8 hours at 1500°C, ground with 320-grit diamond paper, and divided into 4 groups (n = 12) according to surface treatment as follows: no treatment/control; heat treatment of 650°C to 1000°C at 55°C/min; airborne-particle abrasion with 50-μm alumina at 0.4 MPa pressure for 10 seconds; or heat treatment after abrasion. A veneering porcelain cylinder was built and fired on the prepared yttria-stabilized tetragonal zirconia polycrystal specimens. The shear bond strength was tested with a universal testing machine. Six specimens from each group were subjected to cyclic loading (10000 cycles, 1.5 Hz, 10 N load) before testing.

RESULTS

The mean ± SD ranged from 10.7 ± 15.4 to 34.1 ± 10.0. Three-way ANOVA found no statistically significant (P > .05) effect of surface treatment and cyclic loading on shear bond strength. The Sidak multiple comparisons procedure found that cyclic loading specimens had significantly lower shear bond strength than noncyclic loading specimens after airborne-particle abrasion without heat treatment (P = .013).

CONCLUSIONS

Within the limitations of this study, the shear bond strength between yttria-stabilized tetragonal zirconia polycrystal and veneering porcelain was not significantly affected by surface treatment. Airborne-particle abrasion without subsequent heat treatment should be avoided as a surface treatment in fabrication methods.

Evaluation of the shear bond strength of resin cement to Y-TZP ceramic after different surface treatments

The purpose of this study was to evaluate the effect of various surface treatments on the shear bond strength of Y-TZP (Yttria-Tetragonal Zirconia Polycrystal) ceramics with zirconia primer and two different resin cements both containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP). Zirconia blocks (LAVA, 3M ESPE, St. Paul, MN) were polished and assigned to five groups according to the surface treatment: (1) no further treatment (control); (2) airborne abrasion with Al2 O3 particles; (3) Z-PRIME Plus (Bisco, Schaumburg, IL) applied on polished zirconia; (4) Z-PRIME Plus applied on zirconia after airborne abrasion; and (5) tribochemical silica-coating performed with the CoJet system (3M ESPE) followed by application of ESPE®-Sil (3M ESPE). Each group was further divided into one of two resin cements: Panavia F2.0 (Kuraray, Kurashiki, Okayama, Japan) and Clearfil SA Luting (Kuraray). Resin cement placed inside a gel-cap was polymerized on the zirconia surface. Shear bond strength was tested with a universal testing machine at 0.5 mm/min. One-way analysis of variance and paired t-test were done. (p < 0.05), and scanning electron microscope (SEM) images were taken. Zirconia primer applied after airborne abrasion significantly increased the shear bond strength resulting in the highest value for both resin cements. Control groups for both cements showed the weakest value for shear bond strength. No significant differences were found between the shear bond strengths of the individual resin cements applied to zirconia surfaces treated the same way. In conclusion, the combined surface treatment of airborne abrasion followed by a zirconia primer is recommended for zirconia bonding with Panavia F2.0 and Clearfil SA Luting cements.

Ceramic dental biomaterials and CAD/CAM technology: state of the art

PURPOSE

Ceramics are widely used as indirect restorative materials in dentistry because of their high biocompatibility and pleasing aesthetics. The objective is to review the state of the arts of CAD/CAM all-ceramic biomaterials.

STUDY SELECTION

CAD/CAM all-ceramic biomaterials are highlighted and a subsequent literature search was conducted for the relevant subjects using PubMed followed by manual search.

RESULTS

Developments in CAD/CAM technology have catalyzed researches in all-ceramic biomaterials and their applications. Feldspathic glass ceramic and glass infiltrated ceramic can be fabricated by traditional laboratory methods or CAD/CAM. The advent of polycrystalline ceramics is a direct result of CAD/CAM technology without which the fabrication would not have been possible.

CONCLUSIONS

The clinical uses of these ceramics have met with variable clinical success. Multiple options are now available to the clinicians for the fabrication of aesthetic all ceramic restorations.

Bonding of resin cement to zirconia with high pressure primer coating

Objectives

To investigate the effect of air-drying pressure during ceramic primer coating on zirconia/resin bonding and the surface characteristics of the primed zirconia.

Methods

Two ceramic primers (Clearfil Ceramic Primer, CCP, Kuraray Medical Inc. and Z-Prime Plus, ZPP, Bisco Inc.) were applied on the surface of air-abraded zirconia (Katana zirconia, Noritake) and dried at 4 different air pressures (0.1–0.4 MPa). The primed zirconia ceramic specimens were bonded with a resin-based luting agent (SA Luting Cement, Kuraray). Micro-shear bond strengths of the bonded specimens were tested after 3 days of water storage or 5,000× thermocycling (n = 12). Failure modes of the fractured specimens were examined with scanning electron miscopy. The effects of air pressure on the thickness of the primer layers and the surface roughness (S_a) of primed zirconia were evaluated using spectroscopic ellipsometry (n = 6), optical profilometry and environmental scanning electron microscopy (ESEM) (n = 6), respectively.

Results

Clearfil Ceramic Primer air-dried at 0.3 and 0.4 MPa, yielding significantly higher µSBS than gentle air-drying subgroups (p<0.05). Compared to vigorous drying conditions, Z-Prime Plus air-dried at 0.2 MPa exhibited significantly higher µSBS (p<0.05). Increasing air-drying pressure reduced the film thickness for both primers. Profilometry measurements and ESEM showed rougher surfaces in the high pressure subgroups of CCP and intermediate pressure subgroup of ZPP.

Conclusion

Air-drying pressure influences resin/zirconia bond strength and durability significantly. Higher air-drying pressure (0.3-0.4 MPa) for CCP and intermediate pressure (0.2 MPa) for ZPP are recommended to produce strong, durable bonds between resin cement and zirconia ceramics.

Resin bond to indirect composite and new ceramic/polymer materials: a review of the literature

STATEMENT OF THE PROBLEM

Resin bonding is essential for clinical longevity of indirect restorations. Especially in light of the increasing popularity of computer-aided design/computer-aided manufacturing-fabricated indirect restorations, there is a need to assess optimal bonding protocols for new ceramic/polymer materials and indirect composites.

PURPOSE OF THE STUDY

The aim of this article was to review and assess the current scientific evidence on the resin bond to indirect composite and new ceramic/polymer materials.

MATERIALS AND METHODS

An electronic PubMed database search was conducted from 1966 to September 2013 for in vitro studies pertaining the resin bond to indirect composite and new ceramic/polymer materials.

RESULTS

The search revealed 198 titles. Full-text screening was carried out for 43 studies, yielding 18 relevant articles that complied with inclusion criteria. No relevant studies could be identified regarding new ceramic/polymer materials. Most common surface treatments are aluminum-oxide air-abrasion, silane treatment, and hydrofluoric acid-etching for indirect composite restoration. Self-adhesive cements achieve lower bond strengths in comparison with etch-and-rinse systems. Thermocycling has a greater impact on bonding behavior than water storage.

CONCLUSIONS

Air-particle abrasion and additional silane treatment should be applied to enhance the resin bond to laboratory-processed composites. However, there is an urgent need for in vitro studies that evaluate the bond strength to new ceramic/polymer materials.

CLINICAL SIGNIFICANCE

This article reviews the available dental literature on resin bond of laboratory composites and gives scientifically based guidance for their successful placement. Furthermore, this review demonstrated that future research for new ceramic/polymer materials is required.

Intraoral treatment of veneering porcelain chipping of fixed dental restorations: a review and clinical application

BACKGROUND

Every dental ceramic system can experience failure of the veneering porcelain. However, the increasing popularity of all-ceramic crowns and fixed dental prostheses (FDPs) seems to have led to an increasing need to repair chipped veneering porcelain.

OBJECTIVES

The authors compared different methods to repair fractured ceramic restorations (porcelain-fused-to-metal and all-ceramic) and explain the basic principles of adhesion in these systems. They also evaluated the frequency and causes of failure in dental ceramic systems.

METHODS

This review is based on the results of PubMed and Google Scholar searches, as well as on a hand search of the scientific literature, resulting in 300 articles from 1977 to 2012. The authors used multiple key words (ceramic, repair, bonding, hydrofluoric acid, air abrasion, silane, phosphates, silicon dioxide) and different strategies (connecting different key words with OR, NOR and AND and truncation of the stem of words) to search the databases.

RESULTS

Because of differences in the material composition of ceramic systems (composed of metal, alumina or zirconia, glass-ceramics and feldspathic ceramics), different treatments are required for the exposed material surfaces after chipping. Use of hydrofluoric acid etching, air abrasion, tribochemical coating, silanization and metal primers or zirconia primers seem to be the most successful conditioning methods for durable bonding and repair.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Intraoral repair of a restoration offers a satisfying option for the patient when the restoration cannot be removed or replaced. Its success depends largely on the conditioning methods used for the fractured surfaces.

Contamination of dental zirconia before final firing: effects on mechanical properties

Plate-like specimens were prepared, using a diamond saw, from Cercon -a pre-sintered yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) block. These specimens were treated with 10 kinds of dental materials which acted as contaminants, and then sintered at 1,350°C or 1,450°C. After the final firing, specimens were subjected to a three-point flexural test and Vickers hardness test. Their surfaces were also characterized by scanning electron microscopy and X-ray diffractometry. Phosphorus-containing contaminants reduced the three-point flexural strength and hardness of final sintered zirconia due to the formation of YPO4 and phase transformation from tetragonal to monoclinic zirconia. Gypsum also reduced both mechanical properties due to the formation of CaZrO3 and phase transformation from tetragonal to cubic zirconia. Other contaminants showed no adverse effects on the mechanical properties of final sintered zirconia.

A Review of Surface Treatment Methods to Improve the Adhesive Cementation of Zirconia-Based Ceramics

In spite of high mechanical strength, zirconia-based ceramics (ZrO2) has poor bond strength after conventional bond cementation procedures, requiring different surface treatment methods (STMs). This review gathered information about the STM for adhesive cementation (AC) to ZrO2 in the PubMed database, considering in vitro studies pertaining to AC for acid-resistant ceramics (ZrO2) limited to peer-reviewed papers published in English between 1965 and 2013 in dental journals. Different STMs have been proposed for ZrO2: air-abrasion (laboratory or chairside) with silica- (Si-) coated aluminum particles, the use of materials containing phosphate monomers, primer or silane application, laser irradiation, Si vapor phase deposition, and selective infiltration etching. In conclusion, STMs improve bond strength of resin luting cement to ZrO2 mainly when tested in short time. STMs must be correlated to the type of ZrO2 and the resin cement.

An in vitro comparison of shear bond strength of zirconia to enamel using different surface treatments

PURPOSE

The purpose of this in vitro study was to compare the shear bond strength of an airborne-particle abraded zirconia, an acid-etched zirconia (Piranha solution), an Alloy Primer treated zirconia, and a silaned zirconia to enamel, all bonded with a phosphate-methacrylate resin luting agent.

MATERIALS AND METHODS

Seventy extracted intact human molars were collected, cleaned, and mounted in autopolymerizing acrylic resin, with the experimental surface of the teeth exposed. The specimens were randomly divided into seven groups of zirconia specimens (4 mm diameter, 2 mm thick). Group 1: Airborne-particle abrasion; group 2: Airborne-particle abrasion and Z-PRIME Plus; group 3: Airborne-particle abrasion and alloy primer; group 4: Piranha solution 7:1; group 5: Piranha solution 7:1 and Z-PRIME Plus; group 6: Piranha solution 7:1 and Alloy primer; group 7: CoJet and silane. All specimens were luted with a phosphate-methacrylate resin luting agent (Panavia F2.0) and stored in distilled water for 1 day, then thermocycled (5°C and 55°C) for 500 cycles and tested for shear bond strength (SBS), measured in MPa, with a universal testing machine at a 0.55 mm/min crosshead speed. All specimens were inspected under a scanning electron microscope to determine mode of failure. The mean values and standard deviations of all specimens were calculated for each group. A one-way ANOVA was performed, and multiple pairwise comparisons were then completed with post hoc Tukey test (alpha = 0.05).

RESULTS

The airborne-particle abrasion and Z-PRIME Plus group resulted in a significantly higher SBS than the other groups (21.11 ± 6.32 MPa) (p < 0.001). The CoJet and silane group (15.99 ± 8.92 MPa) and airborne-particle abrasion and alloy primer group (11.07 ± 4.34 MPa) showed high shear bond strength but not statistically significant from the airborne-particle abrasion group (14.23 ± 5.68 MPa). Failure mode was predominately mixed in groups 1, 2, 3, and 7 with islands of retained resin on the zirconia and enamel surfaces; however, groups 4, 5, and 6 showed mostly adhesive failures, which left the zirconia surface free of the adhesive materials. No cohesive failures of the substrates (ceramic, resin, or enamel) were observed.

CONCLUSION

Airborne-particle abrasion followed by the application of a zirconia primer produced the highest bond strength to enamel. Therefore, it can be recommended as a promising surface treatment method to achieve a durable bond to densely sintered zirconia ceramics.

Effect of Nd: YAG laser irradiation on surface properties and bond strength of zirconia ceramics

This study investigated the effect of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser irradiation on surface properties and bond strength of zirconia ceramics. Specimens of zirconia ceramic pieces were divided into 11 groups according to surface treatments as follows: one control group (no treatment), one air abrasion group, and nine laser groups (Nd: YAG irradiation). The laser groups were divided by applying with different output power (1, 2, or 3 W) and irradiation time (30, 60, or 90 s). Following surface treatments, the morphological characteristics of ceramic pieces was observed, and the surface roughness was measured. All specimens were bonded to resin cement. After, stored in water for 24 h and additionally aged by thermocycling, the shear bond strength was measured. Dunnett's t test and one-way ANOVA were performed as the statistical analyses for the surface roughness and the shear bond strength, respectively, with α = .05. Rougher surface of the ceramics could be obtained by laser irradiation with higher output power (2 and 3 W). However, cracks and defects were also found on material surface. The shear bond strength of laser groups was not obviously increased, and it was significantly lower than that of air abrasion group. No significant differences of the shear bond strength were found among laser groups treated with different output power or irradiation time. Nd: YAG laser irradiation cannot improve the surface properties of zirconia ceramics and cannot increase the bond strength of the ceramics. Enhancing irradiation power and extending irradiation time cannot induce higher bond strength of the ceramics and may cause material defect.

Heat treatment following surface silanization in rebonded tribochemical silica-coated ceramic brackets: shear bond strength analysis

OBJECTIVE

This study aimed to evaluate the effects of heat treatment on the tribochemical silica coating and silane surface conditioning and the bond strength of rebonded alumina monocrystalline brackets.

MATERIAL AND METHODS

Sixty alumina monocrystalline brackets were randomly divided according to adhesive base surface treatments (n=20): Gc, no treatment (control); Gt, tribochemical silica coating + silane application; Gh, as per Gt + post-heat treatment (air flux at 100ºC for 60 s). Brackets were bonded to the enamel premolars surface with a light-polymerized resin and stored in distilled water at 37ºC for 100 days. Additionally, half the specimens of each group were thermocycled (6,000 cycles between 5-55ºC) (TC). The specimens were submitted to the shear bond strength (SBS) test using a universal testing machine (1 mm/min). Failure mode was assessed using optical and scanning electron microscopy (SEM), together with the surface roughness (Ra) of the resin cement in the bracket using interference microscopy (IM). 2-way ANOVA and the Tukey test were used to compare the data (p>0.05).

RESULTS

The strategies used to treat the bracket surface had an effect on the SBS results (p=0.0), but thermocycling did not (p=0.6974). Considering the SBS results (MPa), Gh-TC and Gc showed the highest values (27.59±6.4 and 27.18±2.9) and Gt-TC showed the lowest (8.45±6.7). For the Ra parameter, ANOVA revealed that the aging method had an effect (p=0.0157) but the surface treatments did not (p=0.458). For the thermocycled and non-thermocycled groups, Ra (µm) was 0.69±0.16 and 1.12±0.52, respectively. The most frequent failure mode exhibited was mixed failure involving the enamel-resin-bracket interfaces.

CONCLUSION

Regardless of the aging method, Gh promoted similar SBS results to Gc, suggesting that rebonded ceramic brackets are a more effective strategy.

Influence of air-abrasion and subsequent heat treatment on bonding between zirconia framework material and indirect composites

The purpose of this study was to evaluate the influence of air-abrasion and subsequent heat treatment on the shear bond strength of the bond between indirect composites and a zirconia material. Four surface preparations were employed; ground flat, then heated to regenerate the crystal phase (C); air-abraded with alumina for 10 s (S10), for 20 s (S20), and air-abraded for 10 s and heated (H). Disks were primed with Alloy Primer and bonded either with Estenia or with Gradia composite. XRD analysis suggested that the monoclinic zirconia content was increased by air-abrasion, and decreased by heating. The surface roughness of S10, S20 and H disks was similar. Nevertheless, H groups showed lower bond strengths than the S10 and S20 groups both before and after thermal cycling. Although alumina air-abrasion considerably enhanced bonding between zirconia and indirect composites, subsequent heat treatment had a negative effect on the durability of bond strength.

Evaluation of Chemical Treatment on Zirconia Surface with Two Primer Agents and an Alkaline Solution on Bond Strength

Objectives

This study evaluated the effect of an alkaline solution and two 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-based primer agents on bond strength to zirconia (yttria-stabilized tetragonal zirconium polycrystal [Y-TZP]) through the shear bond strength (SBS) test.

Materials and Methods

Sixty square-shaped Y-TZP samples were embedded in an acrylic resin mold, polished, and randomly assigned to one of six groups (n=10) according to treatment surface: group CR, no treatment (control); group NaOH, 0.5 M NaOH; group AP, Alloy Primer; group ZP, Z-Primer Plus; group NaOH-AP, 0.5 M NaOH + Alloy Primer; and group NaOH-ZP, 0.5 M NaOH + Z-Primer Plus. The resin cement (Rely X U100) was applied inside a matrix directly onto the Y-TZP surface, and it was light-cured for 40 seconds. The samples were stored in distilled water at 37°C for 24 hours prior to the test, which was performed in a universal machine at a crosshead-speed of 0.5 mm/min. The data were analyzed by one-way analysis of variance and Tukey tests (p&lt;0.05). Light stereomicroscopy and scanning electron microscopy were used to assess the surface topography and failure mode.

Results

The SBS was significantly affected by the chemical treatment (p&lt;0.0001). The AP group displayed the best results, and the use of NaOH did not improve SBS results relative to either AP or ZP. The samples treated with Alloy Primer displayed mainly mixed failures, whereas those conditioned with Z-Primer Plus or with 0.5 M NaOH presented a balanced distribution of adhesive and mixed failure modes.

Conclusions

The use of a NaOH solution may have modified the reactivity of the Y-TZP surface, whereas the employment of a MDP/6-4-vinylbenzyl-n-propyl amino-1,3,5-triazine-2,4-dithione–based primer enhanced the Y-TZP bond strength.

Influence of Y-TZP ceramic treatment and different resin cements on bond strength to dentin

OBJECTIVES

Evaluating the bond strength (σ) of resin cement systems (RXA - RelyX ARC; RXU - RelyX U100; and PF - Panavia F) to dentin and yttria-stabilized zirconia-based ceramic (YZ - In-Ceram YZ) after different surface treatments and aging.

METHODS

Occlusal dentin of 54 human molars was exposed and conditioned following manufacturers' instructions. Fifty-four YZ blocks were sintered and divided into two groups according to surface treatment: PA - airborne particle abrasion, and SC - tribochemical silica coating. All treated YZ blocks were cemented to dentin using one of the cement systems (RXA, RXU, and PF) following manufacturers' recommendations, which includes specific silane agents. Teeth-cement-ceramic blocks were stored in 37°C distilled water for 24h before cutting into non-trimming bar-shaped specimens (adhesive area, A=1±0.1mm(2)). Specimens (n≥12) were assigned to one of the following conditions: N - no storage; W - stored in 37°C distilled water for 60days; and TC - thermal cycling (5-55°C; 10,000 cycles). All specimens were loaded in tension (F) to failure using a universal testing machine. The σ (F/A) was calculated and data were statistically analyzed using ANOVA and Tukey tests (α=0.05). Fracture surfaces were examined to determine the failure mode.

RESULTS

RXA-SC and PF-PA specimens showed the greatest mean σ values after N (13.9 and 13.0MPa, respectively) and TC (12.9 and 14.8MPa, respectively). SC-treated showed greater mean σ values than PA-treated YZ specimens after W.

SIGNIFICANCE

Regardless of the cement used, W and TC did not significantly reduce the σ of SC-treated YZ resin bonded to dentin.

Self-adhesive resin cements—part I

A recent Medline search revealed 214 publications related to the search term "self-adhesive resin cements." The Journal published a Critical Appraisal on these materials by Burgess and colleagues in late 2010 (J Esthet Restor Dent 2010;22:412-9). One hundred fifty-eight of those were published in 2009 or later, so the knowledge base on this subject is growing rapidly. With that in mind, we thought it would be helpful to provide an update. The update will be presented in two parts. Here in Part I, the specific topics addressed are bonding to tooth structure, bonding to zirconia ceramics, and effects of curing mode.