Bonding effectiveness of adhesive luting agents to enamel and dentin

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 curing mode and time on degree of conversion of one conventional and two self-adhesive resin cements

This study evaluated the effect of curing mode (auto- and dual-polymerizing mode) and time interval (5, 10 and 15 minutes) on the degree of conversion of resin cements. One conventional dual-cured resin cement (Panavia F 2.0 [Kuraray Medical Inc]) and two self-adhesive cements (RelyX Unicem [3M ESPE] and BisCem [BISCO, Inc]) were evaluated. The products (n = 5) were manipulated according to the manufacturer's instructions and applied to the surface of a horizontal attenuated reflectance unit attached to an infrared spectrometer. The materials were either light-cured for 40 seconds (dual-polymerizing mode) or allowed to auto-polymerize. The degree of conversion was calculated according to changes in the aliphatic-to-aromatic peak ratios prior to and 5, 10 and 15 minutes after light-activation or after mixing when the specimens were allowed to auto-polymerize. Data (%) were analyzed by two-way repeated measure ANOVA (curing mode and time interval) and Tukey's post-hoc test (alpha = 0.05%). The light-activating mode led to a higher degree of conversion values than the self-curing mode in self-adhesive cements (RelyX Unicem and BisCem), while there was no difference in the degree of conversion between the self- and light-cured groups of Panavia F 2.0 resin cement. All products showed a higher degree of conversion at 15 minutes postcuring than any other evaluation interval. The self-adhesive cements provide a higher degree of conversion values when light-activated. After 15 minutes of polymerization initiation, the degree of conversion was higher in all resin cements, regardless of the curing mode.

Effect of curing mode on bond strength of self-adhesive resin luting cements to dentin

In this study, the in vitro bond strength of dual-curing resin cements to indirect composite restorations when the cement was either light polymerized or allowed to only autopolymerize was evaluated. Occlusal dentin surfaces of 56 extracted human third molars were flattened to expose coronal dentin. Teeth were assigned to eight groups (n = 7) according to resin cement products and polymerization modes: conventional cement (Panavia F 2.0; Kuraray Medical) and self-adhesive cements [RelyX Unicem (3M ESPE), BisCem (Bisco), and G-Cem (GC Corp.)]. Cements were applied to prepolymerized resin discs (2-mm-thick Sinfony; 3M ESPE), which were subsequently bonded to the prepared dentin surfaces. The restored teeth were either light-polymerized through the overlying composite according to manufacturers' instructions or were allowed to only self-cure. After 24 h, the teeth and restorations were sectioned to obtain multiple bonded beams (1.0 mm(2)) and tested in tension at a crosshead speed of 0.5 mm/min until failure. Data (MPa) were analyzed by two-way ANOVA and Tukey test (alpha = 0.05). Light activation of some cement systems (G-Cem and Panavia F 2.0) increased the bond strength, while the curing mode did not affect the bond strength for some (RelyX Unicem and BisCem). The bond strength in the autopolymerized mode varied among products. In general, the use of self-adhesive resin cements did not provide significantly higher bond strengths than that of a conventional material, and two self-adhesive cements yielded significantly lower bond values (regardless of cure mode) than the other products.

Dentin treatment effects on the bonding performance of self-adhesive resin cements

The effects of dentin surface treatments on the microtensile bond strengths and on the interfacial characteristics of self-adhesive resin cements were investigated. Flat dentin surfaces were obtained from human molars and were treated as follows: (i) no treatment of dentin; (ii) 0.1 M EDTA scrubbed for 60 s; or (iii) 10% polyacrylic acid applied for 30 s. Three self-adhesive cements were used to lute composite overlays on deep-coronal dentin surfaces in the presence of simulated pulpal pressure (15 cm of H(2)O). Bonded specimens were cut into beams 1 mm thick and stressed in tension until failure. Fractured sticks were examined under a scanning electron microscope. Additional specimens were stained with Masson's trichrome and observed under light microscopy for interfacial evaluations. The bond strength to dentin of the hydrophobic and solvent-free cement (RelyX Unicem) was unaffected by the tested dentin treatments. The bond strength of the 2-hydroxyethyl methacrylate (HEMA)-based cement (Bis-Cem) decreased after treatment of dentin with EDTA and/or polyacrylic acid. The hydrophilic and water-containing cement (G-Cem) attained a higher bond strength when luted on polyacrylic acid-conditioned dentin. In conclusion, smear layer removal, opening of dentinal tubules, and the water content of dentin differently influence the bond strengths and the interfacial characteristics of self-adhesive cement-dentin interfaces.

Effect of chlorhexidine application on long-term shear bond strength of resin cements to dentin

PURPOSE

The purpose of this study was to investigate the effect of chlorhexidine [CH] on dentin bond strength of three resin cements after 1 year of water storage.

METHODS

A flat middle dentin surface was prepared on 120 extracted premolars. The teeth were randomly divided into 6 groups of 20 specimens each according to the resin cement used: Panavia F2.0, Variolink II, and RelyX Unicem, with or without CH application. After cementation of an indirect composite rod [Z250], one subgroup [n=10] was tested after 24h in water at 37 ° C and the other subgroup [n=10] was tested after 1 year storage in water plus thermocycling. A shear bond strength [SBS] test was performed. The data [in MPa] were analyzed with ANOVA and Tukey tests [P<0.05].

RESULTS

Three-way ANOVA [resin cement, CH and time] indicated that Variolink II had the highest strength [16.65 ± 3.60] and RelyX Unicem had the lowest strength [9.30 ± 4.07]. Chlorhexidine application increased SBS [13.31 ± 4.61] compared to samples without CH [12.16 ± 5.04] [P=0.04]. Initial SBS [15.63 ± 4.37] was significantly higher than after 1 year of storage [9.85 ± 3.36] [P<0.001]. Separate two-way ANOVA for 24-h and 1-year data showed that cement had a significant effect but CH and its interaction had no significant effect at 24h, whereas at 1 year the two factors and their interaction differed significantly [P ≤ 0.001].

CONCLUSIONS

Chlorhexidine 2% can diminish the loss of bonding effectiveness over time associated to etch-and-rinse and self-etch cements, although it appears not have any effect on self-adhesive cement.

Effects of different ceramic and composite materials on stress distribution in inlay and onlay cavities: 3-D finite element analysis

To reduce loss of tooth tissue and to improve esthetic results, inlay and onlay restorations are good treatment choices for extensive cavities in posterior teeth. The aim of this paper was to evaluate, by means of three-dimensional finite element analysis, the effects of restorative material and cavity design on stress distribution in the tooth structures and restorative materials. Two different nanofilled composites and two different all-ceramic materials were used in this study. A permanent molar tooth was modeled with enamel and dentin structures. 3-D inlay and onlay cavity designs were created. Von Mises, compressive, and tensile stresses on the restorative materials, core materials, enamel, and dentin were evaluated separately. On the effect of restorative material, results showed that in the case of materials with low elastic moduli, more stress was transferred to the tooth structures. Therefore, compared to the nanofilled composites, the all-ceramic inlay and onlay materials tested transferred less stress to the tooth structures. On the effect of cavity design, the onlay design was more efficacious in protecting the tooth structures than the inlay design.

Crown pull-off test (crown retention test) to evaluate the bonding effectiveness of luting agents

OBJECTIVE

The purpose of this review was to assess the influencing factors which affect laboratory tests that evaluate the effectiveness of luting agents on the retention of crowns in prepared dentin and - based on the results of the review - to propose a reasonable experimental setup.

MATERIALS AND METHODS

The database MEDLINE was systematically searched for laboratory methods that evaluated the effectiveness of luting agents by pulling off crowns from prepared extracted teeth.

RESULTS

Eighteen studies were included into the systematic review. The studies varied largely with regard to tooth type (molars, premolars), number of specimens (9-25), stump height (3-6mm), convergence angle (4.8-33 degrees ), standardization and measurement of preparation surface, seating force (25-200N), artificial ageing, crosshead speed for tensile force and statistical analysis. The coefficient of variation of the test results varied from 3% to 100%. The most important influencing factors for the crown dislodgement were stump height and convergence angle as well as the luting agent. Panavia and RelyX Unicem generally produced the highest values followed by glass ionomer and zinc phosphate cements. When pooling and normalizing the data, the mean difference between glass ionomer and resin-based materials as well as between glass ionomer and zinc phosphate cements was statistically significant (Wilcoxon, p<0.05). Seating force, roughness, type of cutting bur and use of a desensitizing agent had all a negligible effect on the test results. Artificial ageing like thermocycling had no influence with glass ionomer cements whereas for resin-based cements thermocycling and prolonged water storage generated similar a failures stress than thermocycling alone. The comparison with clinical results did not reveal conclusive evidence that the results of the laboratory methods completely reflect the results of prospective clinical trials in conjunction with single crowns and fixed dental prostheses. A reasonable experimental setup includes: at least 20 specimens per group, stump height 3mm, convergence angle 20 degrees , thermocycling of specimens (5000x), avoidance of shearing forces during dislodgement and failure probability statistics (Weibull).

CONCLUSIONS

The results of pull-off tests with crowns that are cemented with luting agents varied largely and reflect only partially the results from clinical trials. The most influencing factors (standardized tooth preparation, avoidance of shearing stress during dislodgement of crown) had to be controlled to get meaningful results.

The effect of moisture on the shear bond strength of gold alloy rods bonded to enamel with a self-adhesive and a hydrophobic resin cement

The aim of this in vitro study was to investigate the influence of enamel moisture on the shear bond strength (SBS) of a hydrophobic resin cement, Maximum Cure (MC), and a self-adhesive resin cement, Multilink Sprint (MLS), after etching of the enamel. Forty cylindrical gold alloy rods were used to simulate the Incognito lingual bracket system. They were bonded to the enamel of 40 human teeth embedded in self-cured acrylic resin. Twenty were bonded with MC (10 on dry and 10 on wet enamel) and 20 with MLS (10 on dry and 10 on wet enamel). The SBS of MC and MLS was determined in a universal testing machine and the site of bond failure was defined by the adhesive remnant index (ARI). A Kruskal-Wallis test was performed followed by Games-Howell post hoc pairwise comparison tests on the SBS results (P < 0.05) and a chi-square test was used for the analysis of ARI scores (P < 0.05). On dry enamel, no significant differences between MC (58 +/- 5 MPa) and MLS (64 +/- 13 MPa) were noted. On wet enamel, the adherence of MC (6 +/- 8 MPa) and MLS (37 +/- 13 MPa) significantly decreased but to a lesser extent for MLS. The ARI scores corroborated these results. In conclusion, MC did not tolerate moisture. MLS was also affected but maintained sufficient adherence.

Bond strength durability of self-etching adhesives and resin cements to dentin

OBJECTIVES

To evaluate the microtensile bond strength (microTBS) of one- (Xeno III, Dentsply) and two-step (Tyrian-One Step Plus, Bisco) self-etching adhesive systems bonded to dentin and cemented to chemically cured (C&B Metabond) or light-cured paste of a dual-cure resin cement (Variolink II, Ivoclar) within a short (24 h) and long period of evaluation (90 days).

MATERIAL AND METHODS

Forty recently extracted human molars had their roots removed and their occlusal dentin exposed and ground wet with 600-grit SiC paper. After application of one of the adhesives, the resin cement was applied to the bonded surface and a composite resin block was incrementally built up to a height of 5 mm (n=10). The restored teeth were stored in distilled water at 37 degrees C for 7 days. The teeth were then cut along two axes (x and y), producing beam-shaped specimens with 0.8 mm(2) cross-sectional area, which were subjected to microTBS testing at a crosshead speed of 0.05 mm/min and stressed to failure after 24 h or 90 days of storage in water. The microTBS data in MPa were subjected to three-way analysis of variance and Tukey's test (alpha= 0.05).

RESULTS

The interaction effect for all three factors was statistically significant (three-way ANOVA, p<0.001). All eight experimental means (MPa) were compared by the Tukey's test (p<0.05) and the following results were obtained: Tyrian-One Step Plus /C&B/24 h (22.4+/-7.3); Tyrian-One Step Plus /Variolink II/24 h (39.4+/-11.6); Xeno III/C&B/24 h (40.3+/-12.9); Xeno III/Variolink II/24 h (25.8+/-10.5); Tyrian-One Step Plus /C&B/90 d (22.1+/-12.8) Tyrian-One Step Plus/VariolinkII/90 d (24.2+/-14.2); Xeno III/C&B/90 d (27.0+/-13.5); Xeno III/Variolink II/90 d (33.0+/-8.9).

CONCLUSIONS

Xeno III/Variolink II was the luting agent/adhesive combination that provided the most promising bond strength after 90 days of storage in water.

An In Vitro Comparison of Different Cementation Strategies on the Pull-out Strength of a Glass Fiber Post

A three-step etch&rinse adhesive system, combined with a dual-cured resin cement and a simplified self-adhesive resin cement, appears to be a good strategy for fiber post cementation.

The Influence of Luting Systems on the Microtensile Bond Strength of Dentin to Indirect Resin-based Composite and Ceramic Restorations

Compared to self-etch and self-adhesive luting systems, the two etch-and-rinse luting agents evaluated in the current study provided more reliable bonding when used to bond indirect resin-based composite restorations to sound dentin. On the contrary, the self-adhesive luting system showed the highest mean bond strength for the cementation of glass ceramic restorations.

Limited Decalcification/Diffusion of Self-adhesive Cements into Dentin

Resin cement diffusion into dentin may differ as a function of the pre-treatment regimen. Since self-adhesive cements do not require substrate pre-treatment for luting, penetration of and interaction with the underlying dentin are questioned. We hypothesized that differences in the resin cement diffusion into dentin may exist among current commercial adhesive cements. Composite cylinders were luted on mid-coronal dentinal surfaces by an etch-and-rinse cement (Calibra), a self-etching system (Panavia F 2.0), and 4 self-adhesive cements (Multilink Sprint, Rely X Unicem, G-Cem, Bis-Cem). Dentin/cement interfacial characteristics were analyzed by a staining technique (Masson’s trichrome) and by scanning electron microscopy. Conventional acid etching resulted in partially infiltrated adhesive interfaces differing from those achieved with the application of self-etching primer. No hybrid layer and/or resin tag formation was detectable at the interfaces bonded with self-adhesive cements. Limited decalcification/infiltration was observed for self-adhesive cements into the underlying dentin. Self-adhesive cements were not able to demineralize/dissolve the smear layer completely.

Shear bond strength of four resin cements used to lute ceramic core material to human dentin

PURPOSE

This study evaluated the effect of four resin cements on the shear bond strength of a ceramic core material to dentin.

MATERIALS AND METHODS

One hundred twenty molar teeth were embedded in a self-curing acrylic resin. The occlusal third of the crowns were sectioned under water cooling. All specimens were randomly divided into four groups of 30 teeth each according to the resin cement used. One hundred twenty cylindrical-shaped, 2.7-mm wide, 3-mm high ceramic core materials were heat-pressed. The core cylinders were then luted with one of the four resin systems to dentin (Super-Bond C&B, Chemiace II, Variolink II, and Panavia F). Half of the specimens (n = 15) were tested after 24 hours; the other half (n = 15) were stored in distilled water at 37 degrees C for 1 day and then thermocycled 1000 times between 5 degrees C and 55 degrees C prior to testing. Shear bond strength of each specimen was measured using a universal testing machine at a crosshead speed of 1 mm/min. The bond strength values were calculated in MPa, and the results were statistically analyzed using a two-way analysis of variance (ANOVA) and Tukey HSD tests.

RESULTS

The shear bond strength varied significantly depending on the resin cement used (p < 0.05). The differences in the bond strengths after thermocycling were not remarkable as compared with the corresponding prethermal cycling groups (p > 0.05). Significant interactions were present between resin cement and thermocycling (p < 0.05). After 24 hours, the specimens luted with Variolink II (5.3 +/- 2.2 MPa) showed the highest shear bond strength, whereas the specimens luted with Chemiace II (1.6 +/- 0.4 MPa) showed the lowest. After thermocycling, the bond strength values of specimens luted with Chemiace II (1.1 +/- 0.1 MPa) and Super-Bond C&B (1.7 +/- 0.4 MPa) decreased; however, this was not statistically significant (p > 0.05). The increase in the shear bond strength values in the Panavia F (4.5 +/- 0.7 MPa) and Variolink II (5.5 +/- 2.1 MPa) groups after thermocycling was also not statistically significant (p > 0.05).

CONCLUSION

Variolink II and Panavia F systems showed higher shear bond strength values than Chemiace II and Super-Bond C&B. They can be recommended for luting ceramic cores to dentin surfaces.

A two-stage shape optimization process for cavity preparation

OBJECTIVES

Clinical data indicate that previously restored teeth are more likely to fracture under occlusal loads. The reason for this is attributed to the high stresses at the tooth-restoration interface, especially following debonding of the restoration from the tooth. This work aims to minimise these interfacial stresses by optimizing the cavity shape using modern shape optimisation techniques.

METHODS

Shape optimisation methods based on the principle of biological adaptive growth were incorporated into a finite element program and used to optimize the design of cavity preparations as previous work had successfully used one such method to minimise stresses at the internal line angles of conventional restorations with defective bonds. The overall shapes of the cavity preparations were maintained while the profiles of the internal line angles were modified. In the present study, the overall shape of the cavity preparation was also subject to modification in the optimization process. A topological optimization method which placed the restorative material according to the stress distribution was first used to obtain a draft design for the cavity shape, assuming perfect bonding at the tooth-restoration interface. The draft shape was then refined using the method employed in the previous study, to allow for deterioration in the interfacial bond strength. These optimization methods were incorporated into the commercial finite element package ABAQUS as a User Material Subroutine (UMAT) to automate the optimization process.

RESULTS

Compared with the conventional design, the stress level at the tooth-restoration interface in the optimized design was reduced significantly, irrespective of the bonding condition.

CONCLUSIONS

Finite-element based shape optimization methods provide a useful tool for minimizing the interfacial stresses in dental restorations. The longevity of restored teeth using the optimized designs is therefore expected to be prolonged.

Effect of pre-cure temperature on the bonding potential of self-etch and self-adhesive resin cements

OBJECTIVES

To assess whether the pre-cure temperature of resin cements significantly influenced the bonding potential to dentin.

METHODS

Forty extracted molars were randomly divided into 8 groups (n=5): Groups (1-4) RelyX Unicem (RU, 3 M ESPE) and Groups (5-8) Panavia F 2.0 (PF, Kuraray Co.), at pre-cure temperatures of 4, 24, 37, and 60 degrees C, respectively. Cements were used in dual-cure mode for luting composite overlays (Paradigm MZ100, 3 M ESPE) to dentin. Microtensile bond strength testing and scanning electron microscope (SEM) observations of cement-dentin interfaces were performed.

RESULTS

Group 4 had to be eliminated as RU at 60 degrees C underwent such an accelerated curing that was already set at the time of dispensing. The bond strengths (MPa) measured at refrigerator, room, and intraoral temperature were, respectively: RU 5.4+/-1.7, 11.4+/-6.1, 10.6+/-4.2; PF 7.4+/-3.7, 13.9+/-6.2, 12+/-5.2. The statistical analysis revealed that both luting agents developed a significantly weaker adhesion when used at refrigerator temperature (p<0.05). No statistically significant differences in bond strength were recorded when either cement was used at 24 or 37 degrees C (p>0.05). Pre-heating of PF to 60 degrees C resulted in a significant increase in bond strength (20.7+/-9.4 MPa; p<0.05). SEM observations disclosed an enhanced potential of PF to form a hybrid layer as the temperature increased over 4 degrees C. RU exhibited a less porous and more homogeneous layer at intraoral than at refrigerated temperature.

SIGNIFICANCE

It is advisable to let refrigerator-stored resin cements warm up to at least room temperature prior to clinical use. Pre-heating to 60 degrees C enhances the bonding potential of PF.

Strength estimation of different designs of ceramic inlays and onlays in molars based on the Tsai-Wu failure criterion

STATEMENT OF PROBLEM

Successful restoration of large molar defects is a serious clinical problem. Studies on the strength of teeth restored with ceramic restorations of various designs have provided conflicting results.

PURPOSE

The purpose of this study was to determine the shapes of large MOD ceramic restorations in molars most likely to prevent failure and to produce a favorable distribution of contact stresses between the cement and teeth during mastication.

MATERIAL AND METHODS

The study was performed using a finite element analysis with contact elements. Eight 2-dimensional models of mandibular first molars with the following designs of MOD ceramic restorations were created: an inlay with a butt joint margin, an inlay with a beveled margin, an onlay with a butt joint margin, and an onlay with a rounded shoulder margin. The restorations had 3-mm or 5-mm isthmus widths. Models of opposing maxillary crowns were also developed. Computational simulation of mastication of boluses in the frontal plane was conducted, during which the stresses occurring in the ceramic restorations, cement, and tooth structure were calculated. The Tsai-Wu failure criterion was used to evaluate the strength of the materials. Contact stresses at the adhesive interface between the tooth structure and resin cement around these restorations were analyzed.

RESULTS

According to the Tsai-Wu failure criterion, the margin of the beveled inlay and the surrounding tissue could be damaged during masticatory simulation. At the junction of the butt joint margin inlay and enamel, contact tensile stresses appeared. The lowest inverse of the Tsai-Wu strength ratio index appeared in the onlay with a rounded shoulder margin. At the adhesive interfaces around margins of large onlays, compressive contact stresses occurred.

CONCLUSIONS

For the large molar MOD ceramic restorations tested, the lowest values of the inverse of the Tsai-Wu strength ratio index and a favorable distribution of contact stresses between restoration and tissues appeared in the onlay with a rounded shoulder margin.

Interfacial characteristics of adhesive luting resins and composites with dentine

PURPOSE

To evaluate the interfacial characteristics of five adhesive resin luting agents with dentine including tensile bond strength, failure mode, extent of demineralisation, morphological changes and hybrid layer formation.

MATERIALS AND METHODS

The products tested were Bistite II DC (BDC), C&B Super-Bond (CBM), M-Bond (MBD), Panavia-F (PAF) and Rely-X Unicem (RXU). For tensile bond strength measurements (TBS), metallic rods were bonded to standardised dentine surface areas (n=10), thermal-cycled (3000x 5-55 degrees C, 4 cycles/min) and debonded at 1mm/min crosshead speed. The failure mode was examined on dentine surfaces by LV-SEM (n=10), whereas the thickness of the hybrid layer by HV-SEM (n=4). FT-IR microscopy (n=4) and ESEM (n=4) were used to assess the extent of demineralisation and the morphological changes induced on dentine by the conditioning and priming treatments.

RESULTS

TBS (MPa) values were BDC (13.01), MBD (9.19) and PAF (7.07) significantly different from CBM (4.79) and RXU (4.47). The percentage of debonded dentine area covered with resin showed the highest values in BDC (47.80) and MBD (38.12) significantly different from CBM (17.20), PAF (16.47), and RXU (16.50). The extent of demineralisation for CBM was 100%. No statistical differences were found among BDC (60.86%), MBD (60.22%) and PAF (51.99%). RUX (45.03%) showed the lowest value. CBM induced the most pronounced tubule funneling and intertubular dissolution, followed by PAF, BDC and MDB. RXU partially removed the smear layer without opening tubule orifices. The thickest hybrid layer was found in CBM (4.17microm) followed by MBD (2.39microm). No statistically significant differences were found between PAF (0.95microm) and BDC (1.12microm), whereas RXU showed no detectable hybrid layer.

SIGNIFICANCE

Significant differences were found in the interfacial properties among the materials tested, that may lead to differences in their clinical performance.

Partial Ceramic Crowns: Influence of Ceramic Thickness, Preparation Design and Luting Material on Fracture Resistance and Marginal Integrity In Vitro

For fracture resistance and the marginal integrity of adhesively bonded partial ceramic crowns (PCC), the choice of ceramic thickness and luting material are more important than preparation design. PCC fabricated from industrially sintered feldspathic ceramic should have at least a thickness of 1.5–2.0 mm in stress bearing areas.