A novel approach for improvement of the interfacial binding of ceramics for dental materials: Chemical treatment and oxygen plasma etching

Dental silicate ceramics surface modification by nonthermal plasma: A systematic review

OBJECTIVES

Nonthermal atmospheric or low-pressure plasma (NTP) can improve the surface characteristics of dental materials without affecting their bulk properties. This study aimed to systematically review the available scientific evidence on the effectiveness of using NTP for the surface treatment of etchable, silica-based dental ceramics before cementation, and elucidate its potential to replace the hazardous and technically demanding protocol of hydrofluoric acid (HF) etching.

METHODS

A valid search query was developed with the help of PubMed's Medical Subject Headings (MeSH) vocabulary thesaurus and translated to three electronic databases: PubMed, Web of Science, and Scopus. The methodological quality of the studies was assessed according to an adapted version of the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Thirteen in vitro study reports published between 2008 and 2023 were selected for the qualitative and quantitative data synthesis. The implemented methodologies were diverse, comprising 19 different plasma treatment protocols with various device settings. Argon, helium, oxygen, or atmospheric air plasma may significantly increase the wettability and roughness of silicate ceramics by plasma cleaning, etching, and activation, but the treatment generally results in inferior bond strength values after cementation compared to those achieved with HF etching. The technically demanding protocol of plasma-enhanced chemical vapor deposition was employed more commonly, in which the surface deposition of hexamethyl disiloxane with subsequent oxygen plasma activation proved the most promising, yielding bond strengths comparable to those of the positive control. Lack of power analysis, missing adequate control, absence of examiner blinding, and non-performance of specimen aging were common methodological frailties that contributed most to the increase in bias risk (mean MINORS score 15.3 ± 1.1).

SIGNIFICANCE

NTP can potentially improve the adhesive surface characteristics of dental silicate ceramics in laboratory conditions, but the conventional protocol of HF etching still performs better in terms of the resin-ceramic bond strength and longevity. More preclinical research is needed to determine the optimal NTP treatment settings and assess the aging of plasma-treated ceramic surfaces in atmospheric conditions.

Effects of Plasma Treatment on the Strength of Bonding to Ceramic Surfaces in Orthodontics-A Comprehensive Review

Over the past several decades, orthodontic treatment has been increasingly sought out by adults, many of whom have undergone restorative dental procedures that cover enamel. Because the characteristics of restorative materials differ from those of enamel, typical bonding techniques do not yield excellent restoration-bracket bonding strengths. Plasma treatment is an emerging surface treatment that could potentially improve bonding properties. The purpose of this paper is to evaluate currently available studies assessing the effect of plasma treatment on the shear bond strength (SBS) and failure mode of resin cement/composite on the surface of ceramic materials. PubMed and Google Scholar databases were searched for relevant studies, which were categorized by restorative material and plasma treatment types that were evaluated. It was determined that cold atmospheric plasma (CAP) treatment using helium and H2O gas was effective at raising the SBS of feldspathic porcelain to a bonding agent, while CAP treatment using helium gas might also be a potential treatment method for zirconia and other types of ceramics. More importantly, CAP treatment using helium has the potential for being carried out chairside due to its non-toxicity, low temperature, and short treatment time. However, because all the studies were conducted in vitro and not tested in an orthodontic setting, further research must be conducted to ascertain the effectiveness of specific plasma treatments in comparison to current orthodontic bonding treatments in vivo.

Effect of nonthermal argon plasma treatment on the surface properties and phase transformation of zirconia

PURPOSE

This study aims to evaluate the effect of applying different parameters of nonthermal argon plasma (NTAP) on the surface roughness and phase transformation of yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramics.

METHODS

A total of 60 zirconia samples were prepared and randomly divided into six groups according to their surface treatments (n = 10). Group 1: control group; Group 2: argon plasma with a flow rate of 5 lt/min for 4 min; Group 3: 8 lt/min for 4 min; Group 4: 8 lt/min for 2 min; Group 5: 5 l/min for 2 min; Group 6: air abrasion with Al2O3 particle. The surface roughness was measured with a profilometer, and surface topography was observed using scanning electron microscopy (SEM). X-ray diffraction (XRD) analysis was performed to investigate the phase transformation.

RESULTS

The air abrasion group showed the highest surface roughness. The lowest relative monoclinic phase amount (Xm) was observed in the control group (0.4%), and the highest Xm value was observed in group 6 (7.8%).

CONCLUSION

While the air abrasion group showed the highest average surface roughness, it also caused the highest phase transformation. With a flow rate of 8 lt/min for 2 min NTAP treatment increased the surface roughness without causing significant phase transformation.

In Vitro Evaluation of the Shading Effect of Various Zirconia Surface Stains on Porcelain Crowns

Human teeth display various colors under natural light. Dental restorations, such as zirconia crowns, are generally used to rehabilitate the oral function of patients with tooth loss due to trauma or natural tooth falls. However, significant improvements in the color and translucency of zirconia are required to meet the clinical needs for dental restoration. In the past, a large amount of ceramic powder has been used to improve the appearance of zirconia. However, the interface between the ceramic powder and zirconia makes them prone to falling off. Therefore, the aesthetics of zirconia crowns remains a major challenge. Recently, substantial advances have been made in the field of dental materials, as special staining agents for zirconia have been introduced as alternatives to ceramic powders. Therefore, this study tested zirconia-specific staining agents that were used to produce zirconia samples with A1 and A3 colors. A dental colorimetric plate was used as the control group to assess the staining effects of the different brands of staining agents. Meanwhile, two hypotheses were proposed: that the staining effects of these special staining agents for zirconia met the criteria for clinical application and that there was no significant difference between the different staining agents for zirconia. The results showed that the coatings of different brands of staining agents were ultrathin, with a thickness of approximately 27–78 µm. In addition, the coloring effects of the zirconia staining agents were not significantly different from those of the colorimetric plates. After staining, the zirconia samples had decreased surface roughness and contact angle values, which improved surface smoothness and cleanliness. In summary, the results support the hypothesis of this study that zirconia stains can be used as an alternative to the current fabrication methods for clinical dental restorations. We sought to identify the clinical techniques that are easier to perform and to overcome the current problem of dental technicians requiring considerable dentin space for staining. It is expected that the results of this study will be useful in clinical dental restorations.