Influence of surface treatments on bond strength of metal and ceramic brackets to a novel CAD/CAM hybrid ceramic material

Effect of different surface conditioning methods and low pH solutions on the shear bond strength of orthodontic brackets to newly introduced CAD/CAM materials

Aim

To evaluate the shear bond strength (SBS) of ceramic and metallic orthodontic brackets bonded to lithium disilicate ceramics or hybrid ceramics and subjected to different surface conditioning treatments.

Materials and methods

In total, 300 specimens were fabricated from GC LiSi (lithium disilicate) and GC Cerasmart (hybrid) ceramic blocks. The specimens were divided into four groups according to the following surface treatments: hydrofluoric acid (HF); sandblasting with 50 μm aluminum oxide; Monobond Etch and Prime; and erbium-doped yttrium aluminum garnet (Er-YAG) laser. Metal (Victory Series) and ceramic (Clarity) brackets were bonded using an orthodontic adhesive resin (Transbond XT; 3M Unitek, CA, USA). The specimens were then stored in three different mediums (artificial saliva, mouth rinse, and gastric juice) and thermocycled. An SBS test was performed after 1 week. The surface morphology was examined after the conditioning treatments using a scanning electron microscope. Data were analyzed using analysis of variance, t-test, and Duncan test.

Results

The SBS data revealed that the type of computer-aided design/computer-aided manufacturing (CAD/CAM) block and surface conditioning method significantly affected the SBS. The highest SBS was recorded (10.112 MPa) for the HF-treated hybrid ceramic blocks stored in the saliva medium, while the lowest SBS (1.862 MPa) was reported for the Er-YAG laser-treated lithium disilicate ceramic blocks stored in the gastric juice medium. GC Cerasmart exhibited better bond strength than that of GC LiSi; however, no significant difference was observed between the ceramic and metal brackets.

Conclusion

The CAD/CAM material, surface conditioning method, and medium affect the SBS.

Different surface treatments on recently introduced CAD-CAM resin-modified ceramics: Implications on bond strength

STATEMENT OF PROBLEM

The diverse chemical composition of recently introduced resin-modified ceramics complicates the establishment of a universally accepted clinical bonding protocol.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of different surface treatments of resin-modified ceramics on the bond strength to a resin cement.

MATERIAL AND METHODS

Sixteen 10×12×3-mm resin-modified ceramic slices were obtained from each material (Cerasmart; GC, Shofu Block HC; Shofu, Vita Enamic; Vita, Evolux hybrid; BlueDent, Alium; Alium). Slices were assigned to 4 groups based on surface treatments: Control (no treatment), airborne-particle abrasion with Al2O3 (Al2O3), conditioning with 9% HF (HF), and Al2O3+HF. After treatments and silane coupling agent (Monobond N; Ivoclar) application, 7 resin cement cylinders (Choice 2 veneer; Bisco) were built on each slice and light polymerized for 20 seconds. Half of the specimens (n=14 cylinders) were stored for 24 hours, and the other half were thermocycled (20 000 cycles, 5 °C to 55 °C, 30-second dwell time). Microshear bond strength was tested and analyzed with 3-way ANOVA and the Tukey HSD test (α=.05), and failure patterns were classified. Surface morphology after treatments was observed with scanning electron microscopy and Raman spectroscopy.

RESULTS

After 24 hours, all treatments induced higher bond strength (P<.05) than in the control in Evolux. Al2O3+HF caused higher bond strength (P<.05) than in the control in Cerasmart and Shofu, and higher bond strength than Al2O3 in Cerasmart. However, it resulted in lower bond strength (P<.05) than Al2O3 in Alium. After thermocycling, irrespective of the resin-modified ceramic, all treatments induced higher bond strength (P<.05) than in the control. HF induced lower bond strength (P<.05) than Al2O3 in Alium. Al2O3+HF caused the highest bond strength (P<.05) in Evolux and higher bond strength (P<.05) than HF in Vita Enamic. Adhesive failures were prevalent under control conditions, and mixed failures were common after treatments. Al2O3 induced surface alterations in all resin-modified ceramics. HF notably altered Vita Enamic, while it had no noticeable impact on the other resin-modified ceramics. Al2O3+HF caused a considerable alteration in Vita Enamic and modified the other resin-modified ceramics. Vita Enamic had the characteristic vibrational bands of inorganic compounds, while the other resin-modified ceramics exhibited distinct bands associated with organic compounds.

CONCLUSIONS

Airborne-particle abrasion with Al2O3 followed by HF yielded the highest bond strength, regardless of the resin-modified ceramic, except for Alium, which demonstrated better bond strength after airborne-particle abrasion with Al2O3. 9% HF for 30 seconds caused notable surface alterations in Vita Enamic, negatively impacting its bond strength. Vita Enamic was the only resin-modified ceramic displaying both organic and inorganic composition, while the other resin-modified ceramics showed predominantly organic composition.

Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns

OBJECTIVES

The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments.

METHODS

A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 μm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05).

RESULTS

Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials.

CONCLUSIONS

The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials.

CLINICAL RELEVANCE

Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.

Effectiveness of surface polishing after debonding of metal brackets from different CAD-CAM materials

PURPOSE

The purposes of this study were to compare and evaluate the surface texture of different restorative computer-aided design and computer-aided manufacturing (CAD/CAM) materials before bonding and after debonding of metal orthodontic brackets.

MATERIALS AND METHODS

A total of 60 rectangular ceramic test specimens (n = 20 in each group) were prepared using feldspathic ceramic blocks (FLD; served as control), hybrid ceramic blocks (HC), and lithium disilicate ceramic blocks (LDC). Surface roughness (Ra) analysis was conducted using a profilometer before bonding the metal brackets. After the debonding and polishing procedures, a second surface roughness analysis was conducted on each specimen. The shear bond strength (SBS) test was applied to each specimen using a universal test machine for debonding the metal brackets. The debonded specimens were examined under a stereomicroscope and scored using a 4-step adhesive remnant index (ARI). The Ra and SBS values and the ARI scores were saved, and the data were analyzed statistically at a significance level of 0.05. One specimen from each group was examined under atomic force microscopy to visualize surface roughness. Furthermore, one specimen from each group was additionally prepared for scanning electron microscopy analysis.

RESULTS

Statistically significant differences in SBS measurements were observed between all three groups. The highest SBS values were obtained from the FLD group, the lowest from the LDC group. The HC group showed significantly (P = 0.001) lower Ra values than the LDC and FLD groups after debonding and polishing. No significant differences were observed in the ARI scores between the groups.

CONCLUSIONS

Hybrid ceramics could be a suitable alternative for fixed restorations in adult patients receiving subsequent treatments with fixed orthodontic appliances.

Different surface treatment strategies on etchable CAD-CAM materials: Part II-Effect on the bond strength

STATEMENT OF PROBLEM

Bonding to recently launched polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials has been challenging. Evidence regarding etching strategies for dual-phase CAD-CAM materials is sparse, but adequate bonding is crucial for the clinical success and longevity of a restoration.

PURPOSE

The purpose of this 2-part in vitro study was to evaluate and compare the effect of surface treatment strategies on the microshear bond strength and work of adhesion of polymer-based and ceramic materials. In addition, chemical elements present on the surface and the interface morphology after using those strategies were also assessed.

MATERIALS AND METHODS

Two CAD-CAM polymer and 1 CAD-CAM ceramic materials were selected for this in vitro study. The materials were subjected to different surface treatment strategies, including airborne-particle abrasion and the application of 9% hydrofluoric acid. Specimens were submitted to microshear bond strength before and after thermocycling, and the failure mode was classified. The work of adhesion was calculated based on the water-to-air surface tension of 72.8 mN.m-1 and the Young- Dupré equation. The surfaces were submitted to energy-dispersive X-ray spectroscopy, and the interfaces were analyzed using a scanning electron microscope. Data were subjected to 2-way ANOVA and the Tukey post hoc test (α=.05).

RESULTS

The highest microshear bond strength means were observed for the polymer-based materials when hydrofluoric acid or airborne-particle abrasion was applied. The 3 materials tested showed a decrease in microshear bond strength after thermocycling, except for applying airborne-particle abrasion to 1 of the polymer-based material tested. The ceramic material tested showed a high microshear bond strength with the application of airborne-particle abrasion and hydrofluoric acid combined. The work of adhesion varied across the materials and presented high means when hydrofluoric acid was used.

CONCLUSIONS

A combination of airborne-particle abrasion plus hydrofluoric acid should be considered for polymer-based or feldspathic ceramic CAD-CAM materials. In this in vitro study, both etching procedures combined produced higher bonding values for all materials tested.

Shear Bond Strength of Metal and Ceramic Brackets Depending on Etching Protocol in Direct Bonding Technique

Successful orthodontic therapy, apart from a proper treatment plan, depends on optimal bracket-enamel adhesion. Among numerous factors affecting adhesion, the type of bracket and preparation of the tooth's surface are crucial. The aim of this study was to compare the shear bond strength (SBS) of metal and ceramic brackets to the enamel's surface using direct bonding. Forty extracted human premolars were divided into four groups according to the etching method (etch-and-rinse and self-etch) and bracket type. The SBS and adhesive remnant index (ARI) were determined. The ceramic brackets achieved the highest SBS values both in the self-etch (SE) and etch-and-rinse (ER) protocols. Higher SBS values for ceramic and metallic brackets were found in the ER protocol. In all tested groups, the achieved SBS value was satisfactory to withstand orthodontic and occlusal forces. There was no significant difference in the ARI score between study groups (p = 0.71). The fracture occurred between the bracket base and adhesive material in both types of brackets, which decreased the risk of enamel damage during debonding.

Influence of surface treatments on the bond strength of metal brackets to CAD/CAM materials and discoloration after various refinishing procedures : Scanning electron microscopy and atomic force microscopy study

PURPOSE

This study evaluated the shear bond strength (SBS) of a metal bracket bonded to three different computer-aided design/computer-aided manufacturing (CAD/CAM) restoration materials pretreated with different surface treatments. In addition, the surface topography and color change of the restorations after debonding with two different tungsten carbide burs were examined.

METHODS

A total of 216 plates were cut from three different CAD/CAM blocks, each of which was divided into three subgroups with different pretreatment methods: (1) acid etching, (2) sandblasting, and (3) laser irradiation. Incisor metal brackets were bonded. The SBS test was performed, and the failure types were classified. Then, samples were randomly divided into two subgroups according to the adhesive removal procedure to be used: a tungsten carbide bur with 12 blades or 24 blades (n = 12). Color change was calculated based on the ∆E00, and surface morphology was evaluated via SEM and AFM analysis.

RESULTS

The SBS data revealed that the type of CAD/CAM material and the applied surface treatment significantly affected bond strength. The highest SBS values were detected for the Grandio Blocs (VOCO GmbH, Cuxhaven, Germany; 14.3 ± 4.4 MPa), and the lowest was observed for Cerasmart (GC Europe, Leuven, Belgium; 12.0 ± 4.0 MPa). The ∆E00 results demonstrated significant differences only as a result of the applied surface treatment. The ∆E00 value in all groups was above the 1.77 threshold.

CONCLUSION

CAD/CAM material types and surface treatments affected the bond strength, but the interactions of these factors did not. The chosen surface treatment also significantly affected the ∆E00 after the polishing was done.

Influence of different surface treatment on bonding of metal and ceramic Orthodontic Brackets to CAD-CAM all ceramic materials

BACKGROUND

Developing efficient bonding techniques for orthodontic brackets and all-ceramic materials continues to pose a clinical difficulty. This study aimed to evaluate the shear bond strengths (SBS) of metal and ceramic brackets to various all-ceramic CAD-CAM materials, such as lithium disilicate CAD (LDS-CAD), polymer-infiltrated ceramic (PIC), zirconia-reinforced lithium silicate glass ceramic (ZLS), and 5YTZP zirconia after different surface treatments and thermal cycling.

MATERIALS AND METHODS

The samples were divided into two groups to be bonded with ceramic and metal lower incisor brackets. Each group was subdivided into a control group devoid of any surface treatment, 10% HF acid (HFA) etching, ceramic etch & prime (MEP), Al2O3 air abrasion, and medium grit diamond bur roughening. After surface treatment, brackets were bonded with composite resin cement, thermal cycled, and tested for shear bond strength. The failed surfaces were evaluated with a digital microscope to analyse the type of failure. The data were statistically analysed using a one-way ANOVA and Tukey HSD tests at p < 0.05.

RESULTS

The highest mean bond strengths were found with HFA etching in LDS-CAD (13.17 ± 0.26 MPa) and ZLS (12.85 0.52 MPa). Diamond bur recorded the lowest mean bond strength roughening across all the ceramic groups. There were significant differences in mean shear bond values per surface treatment (p < 0.001) and ceramic materials.

CONCLUSION

Among the surface treatment protocols evaluated, HFA etching and MEP surface treatment resulted in enhanced bond strength of both ceramic and metal brackets to CAD-CAM all ceramic materials.

Shear Bond Strength between Orthodontic Brackets and Monolithic 4Y-TZP: An In Vitro Study

The aim of this study was to evaluate the effect of different surface treatments on the shear bond strength (SBS) between metal orthodontic brackets and monolithic zirconia surfaces bonded with resin composite. Fifty monolithic zirconia (4Y-TZP) disks were sintered and glazed. Specimens were divided into five groups (n = 10) for different surface treatments: control, nano second fiber laser, sandblasting, grinding and tribochemical coating (CoJet Sand 30-μm). Metal orthodontic brackets were bonded to monolithic zirconia surface by two-component orthodontic adhesive. After 500 cycles of thermocycling, shear bond strength values were measured by a universal testing machine at a cross head speed of 0.5 mm/min. The data was recorded as MPa and statistically analyzed with One-way ANOVA, Levene's LSD tests with Bonferroni corrections. The significance level was α = 0.05. The surface topography of one specimen of each group was evaluated by scanning electron microscopy (SEM). Statistically significant difference was observed among study groups (p = 0.018). The lowest shear bond strength was observed in the control group (3.92 ± 1.9). Tribochemical coating showed the highest bond strength (7.44 ± 2.9), which was statistically different from the control and nano second laser (4.3 ± 1.4) groups but not statistically different from grinding (6.15 ± 3.1) or sandblasting (6.47 ± 3.3). SEM images showed comprehensive results of each surface treatment on monolithic zirconia. All failure modes were recorded as adhesive between the composite resin and monolithic zirconia. Based on the findings of this study, it can be concluded that grinding, sandblasting and tribochemical coating techniques showed clinically acceptable bond strength within the range of 6-8 MPa. These surface treatments can be considered suitable for achieving a durable bond between metal orthodontic brackets and monolithic 4Y-TZP ceramic surfaces.

Effect of Various Beverages on Adhesion of Repaired CAD/CAM Restorative Materials

(1) Background: The purpose of this study was to determine the effect of commonly consumed beverages on the bond strength of three different computer-aided design-computer-aided manufacturing (CAD/CAM) resin-ceramic hybrid materials repaired with resin-based composite (RBC) materials. (2) Materials and Methods: Rectangular prism specimens (N = 138) measuring 6 mm × 5 mm × 2 mm were obtained from GC Cerasmart (GC), Lava Ultimate (LU), and Vita Enamic (VE) blocks. These blocks were polished and then subjected to thermal cycling (10,000 cycles, 5 °C to 55 °C). After the surface treatment was applied, the average surface roughness value was measured. All the surfaces were repaired with RBC. Thermal cycling was performed for the second time. Each group was then distributed into three subgroups according to the beverage used: tea (t), cola (c), and distilled water (0) (n = 15). The specimens were stored in these solutions for 28 days and then subjected to the shear bond strength (SBS) test. Statistical analysis was performed using a two-way ANOVA test with Bonferroni adjustment. (3) Results: The surface roughness of the materials presented no significant difference after different surface treatments (p > 0.05). No significant difference was observed among the materials (p > 0.05). Tea and cola presented similar SBS values (p > 0.05). Both were significantly lower than distilled water (p < 0.001, p < 0.001, respectively). (4) Conclusions: Consumption of beverages reduces the bond strength in surfaces repaired with RBC to CAD/CAM resin-ceramic hybrid materials. (5) Clinical Significance: Repairing damaged resin matrix dental restorations with RBC is advantageous in terms of time and cost by achieving adequate bond strengths. Frequently consumed beverages reduce the bond strength of repaired CAD/CAM resin-ceramic hybrid materials.

Tensile and shear bond strengths of a stainless steel used in orthodontic brackets bonded to bovine enamel using two types of resin cement

The purpose of this study was to examine the relationship between the bond strength of stainless steel with two types of resin cements (MMA- and composite-based) on bovine enamel depending on the directionality of the applied force. The specimens were either placed in water or subjected to thermal cycles (TC), and the shear or tensile bond strengths (SBS or TBS) were determined. The SBS showed significantly greater than the TBS for both types of cement, and the SBS and TBS for composite-based cement had larger than MMA-based one. No significant difference in SBS was observed in the cements even after being subjected to TC. Cohesive failures of the cement and bovine enamel in the composite-based group, while adhesive failures were observed in MMA-based one. Consequently, the direction of the force at both cements affected the retention of stainless steel, and MMA-based cement was preferred when prioritizing less enamel damages.

Comparative evaluation of shear bond strength of orthodontic brackets bonded to three-dimensionally-printed and milled materials after surface treatment and artificial aging

Objective

This study aimed to evaluate the shear bond strength (SBS) of orthodontic brackets bonded to three-dimensionally (3D)-printed materials after various surface treatments and artificial aging compared with that bonded to computer-aided design/computer-aided manufacturing (CAD-CAM) polymethyl methacrylate (PMMA)-milled materials.

Methods

Eighty cylindrical specimens were 3D printed and divided into the following four subgroups (n = 20 each) according to the surface treatment and artificial aging procedure. Group A, sandblasted with 50 μm aluminum oxide particles (SA) and aging; group B, sandblasted with 30 μm silica-coated alumina particles (CO) and aging; group C, SA without aging; and group D, CO without aging. For the control group, 20 CAD-CAM PMMA-milled cylindrical specimens were sandblasted with SA and aged. The SBS was measured using a universal testing machine (0.25 mm/min), examined at ×2.5 magnification for failure mode classification, and statistically analyzed (p = 0.05).

Results

The retention obtained with the 3D-printed materials (groups A-D) was higher than that obtained with the PMMA-milled materials (control group). However, no significant difference was found between the study and control groups, except for group C (SA without aging), which showed significantly higher retention than the control group (PMMA-SA and thermocycling) (p = 0.037). Study groups A-D predominantly exhibited a cohesive specimen mode, indicating specimen fracture.

Conclusions

Orthodontic brackets bonded to 3D-printed materials exhibit acceptable bonding strengths. However, 3D-printed materials are prone to cohesive failure, which may result in crown fractures.

Aspects and Principles of Material Connections in Restorative Dentistry-A Comprehensive Review

The combination of two dissimilar materials has always been a serious problem in dentistry. In order to meet this challenge, it is necessary to combine both chemical methods (treatment with silanes, (meth)acrylic functional monomers) and the development of the surface of the joined material in a physical way, e.g., by sandblasting with alumina, alumina with silica, acid etching, the use of lasers and other means. The purpose of this literature review is to present all methods of joining dental composites with other materials such as ceramics, metal, another composite material. This review covers articles published within the period 2012-2022 in journals indexed in the PubMed database, written in English and describing joining different dental materials to each other. All the critical steps of new joint preparation have been addressed, including proper cleaning of the joint surface, the application of appropriate primers capable of forming a chemical bond between ceramics, zirconium oxide or metals and alloys, and finally, the application of new composite materials.

The Effect of a 10-MDP-Based Dentin Adhesive as Alternative for Bonding to Implant Abutment Materials

Bonding to different dental restorative materials is challenging. This study aimed to evaluate the effect of a 10-MDP-based dentin adhesive on the shear bond strength (SBS) of self-adhesive resin cement (RC) to implant abutment materials. One hundred and twenty specimens were obtained from zirconia (ZO), cobalt-chromium alloy (CoCr), and commercially pure titanium (Ti), which were treated as follows (n = 10): control group-non-treated (CG), 10-MDP-based dentin adhesive (SB), light-cured SB (SB-LC), and zirconia primer (ZP). Blocks of RC were buildup and, after 24 h, were tested for bond strength. Data of SBS (MPa) were submitted to two-way ANOVA and Tukey test (α = 0.05). There was no difference in SBS among materials for CG and ZP, higher SBS were recorded for Ti SB and Ti SB-LC compared to ZO upon the same surface treatments. For the comparisons among treatments, SB-LC showed the highest SBS for CoCr. For ZO and Ti, higher SBS were recorded with SB and SB-LC. No cohesive failures were observed. It was concluded that the surface treatment with 10-MDP-based materials increased the bond strength of the resin cement to abutment materials, which showed to be material dependent.

Effectiveness of surface treatment on bond strength of ceramic brackets to two types of CAD/CAM-prepared nanohybrid composites

OBJECTIVES

The aim of this study was to assess the influence of surface treatment on the shear bond strength of two different adhesive-coated orthodontic ceramic brackets to computer-aided design/computer-aided manufacturing (CAD/CAM) nanohybrid composite.

METHODS

A total of 120 specimens (10 mm × 10 mm × 3 mm) were prepared from each type of CAD/CAM block (Grandio [GR], VOCO Cuxhaven, Germany; Lava Ultimate [LU], 3M ESPE, St. Paul, MN, USA). For each type of CAD/CAM block, the plates were divided into four groups based on the applied surface treatment: hydrofluoric acid (HF), grinding bur (GB), silica coating with CoJet system (CS), and titanium tetrafluoride (TiF₄) 2 wt/v%. Maxillary central incisors of adhesive-coated ceramic orthodontic brackets (APC Flash-free Clarity Advanced Ceramic, 3M Unitek, Monrovia, CA, USA) were bonded using Transbond XT Primer (3M Unitek, Monrovia, CA, USA). Shear bond strength was conducted, and the modes of failure were assessed utilizing the adhesive remnant index. Surface roughness and topography of treated CAD/CAM were evaluated. Data were statistically analyzed using two-way analysis of variance (ANOVA) and Tukey's test. The Weibull analysis was conducted on shear bond strength data.

RESULTS

Surface treatment with 2% TiF₄ wt/v revealed significantly higher bond strength (GR, 14.51 ± 2.57 MPa; LU, 11.19 ± 2.17 MPa) than other groups for both types of CAD/CAM restorative materials (p < 0.05). Adhesive failures were the predominant mode of failure. Surface treatment with CS revealed higher surface roughness than other groups (p < 0.05).

CONCLUSIONS

Surface treatment with 2% TiF₄ wt/v enhanced the adhesion between orthodontic ceramic brackets to GR and LU CAD/CAM composite restorative materials. GR CAD/CAM nanohybrid composite had higher bond strength than LU to ceramic orthodontic brackets.

What Is the Most Effective Technique for Bonding Brackets on Ceramic-A Systematic Review and Meta-Analysis

Background: There has been an increase in demand for orthodontic treatment within the adult population, who likely receive restorative treatments using ceramic structures. The current state of the art regarding the most effective method to achieve an appropriate bond strength of brackets on ceramic surfaces isn’t consensual. This systematic review aims to compare the available surface treatments to ceramics and determine the one that allows to obtain the best bond strength. Methods: This systematic review followed the PRISMA guidelines and the PICO methodology was used, with the question “What is the most effective technique for bonding brackets on ceramic crowns or veneers?”. The research was carried out in PubMed, Web of Science, Embase and Cochrane Library databases. In vitro and ex vivo studies were included. The methodological quality was evaluated using the guidelines for reporting of preclinical studies on dental materials by Faggion Jr. Results: A total of 655 articles searched in various databases were initially scrutinized. Sevety one articles were chosen for quality analysis. The risk of bias was considered medium to high in most studies. The use of hydrofluoric acid (HF), silane and laser afforded the overall best results. HF and HF plus laser achieved significantly highest bond strength scores in felsdphatic porcelain, while laser was the best treatment in lithium disilicate ceramics. Conclusions: The most effective technique for bonding brackets on ceramic is dependent on the type of ceramic.

Combination of a silane coupling agent and resin primer reinforces bonding effectiveness to a CAD/CAM indirect resin composite block

The effects of silanization and resin primer application on CAD/CAM indirect resin composite block bonding were investigated. KATANA AVENCIA P blocks (Kuraray Noritake Dental) were treated with a silane coupling agent and/or a resin primer. The contact angles (CAs) of resin primer were observed before and after silanization. Panavia V5 (Kuraray Noritake Dental) was built after each treatment. Bond strengths were measured, and the interface was analyzed by energy dispersive X-ray spectroscopy (EDS). The CA showed that silane treatment improved the wettability of the resin primer to the resin block. The combination treatment of the silane and resin primer showed significantly higher bond strength than no treatment, only in the silanization or resin primer group (p<0.001 each). EDS analysis showed that the resin primer penetrated both cement and block sides. The combination of the silane and resin primer improved bonding effectiveness between the resin block and resin cement.

Effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets to CAD/CAM provisional materials

OBJECTIVES

To evaluate the effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets bonded to materials used for the fabrication of CAD/CAM provisional crowns.

MATERIALS AND METHODS

Specimens (n = 160) from each provisional material (CAD-Temp and C-Temp) were categorized into four groups according to the surface treatment methods: C (no surface treatment), HP (37% H₃PO₄), DB (mechanical roughening by diamond bur), and SB (mechanical roughening by blasting). Maxillary central incisor ceramic brackets (Clarity™ Advanced ceramic brackets, 3 M Unitek) were bonded to the conditioned provisional materials according to the used adhesive system (n = 20), APC PLUS or APC flash-free. All specimens were evaluated for shear bond strength testing (SBS) and the adhesive remnant index (ARI). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

C-Temp significantly recorded higher SBS than CAD-Temp (24.0 and 16.0 MPa, respectively) (p < 0.001). DB and SB groups utilizing flash-free adhesive significantly recorded higher SBS (18.2 and 24.0 MPa, respectively) (P < 0.05) compared to other groups in the tested materials. Higher ARI scores were recorded in CAD-Temp and flash-free adhesive.

CONCLUSIONS

Mechanical surface treatments and flash-free adhesive would enhance SBS of ceramic orthodontic brackets to CAD/CAM provisional materials. The higher ARI scores reported with CAD-Temp and flash-free adhesive reduce chair time for excess removal.

CLINICAL RELEVANCE

Bonding of orthodontic brackets to provisional restorations is a challenge for orthodontists in adult comprehensive cases that could be improved by an appropriate provisional material, surface treatments, and adhesive system.

The impact of different surface treatments on the shear bond strength of orthodontic metal brackets applied to different CAD/CAM composites

Background

To investigate the shear bond strength (SBS) of orthodontic metal brackets applied to different CAD/CAM composites treated with different surface treatments.

Material and Methods

Specimens of two CAD/CAM composites were obtained of Lava Ultimate (LU; n=60) and Brilliant Crios (BC; n=60) which were randomly separated into six subgroups (n=10) according to the surface treatment: control (CTL); sandblasting (SB); sandblasting and silane (SBSL); hydrofluoric acid (HF); hydrofluoric acid and silane (HFSL); and Monobond Etch&Prime (MEP). The mandibular central incisor metal brackets were bonded with a light-cure adhesive. The SBS data were analyzed using the two-way analysis of variance and Turkey’s test, while the adhesive remnant index (ARI) by the Kruskal–Wallis, all the significance was set at 5%.

Results

A higher SBS was found for BC in comparison with LU (p< 0.05). All the surface treatments increased the SBS in comparison with CTL (p< 0.0001). Treatment with HF, SBSL and HFSL (p> 0.05) showed a higher SBS, which was followed by MEP and SB (p> 0.05), all in comparison with CTL (p< 0.0001). For ARI, a significant effect was detected only for the surface treatment (p< 0.01), and not for CAD/CAM resin (p> 0.05). Significant differences were detected between CTL to HF, and HF to MEP, as well.

Conclusions

The SBS is highly affected by the surface treatment and also by the CAD/CAM composite. The surface treatment improves the SBS and should be encouraged when orthodontic brackets are bonded to CAD/CAM composites.

Key words:CAD/CAM composite resin, brackets, shear bond strength, surface treatment, bonding.

Orthodontic Attachment Adhesion to Ceramic Surfaces

Ceramic materials are constantly evolving, achieving good functionality and aesthetics. Bonding to ceramics may be difficult because of high toxicity procedures and risk of surface damage. The review aims to answer several research questions: Is there a golden standard for bonding to ceramic? Are there adhesives or types of photopolymerization lamps that produce a higher bond strength on certain types of ceramics rather than others? Articles focusing on the bonding process of orthodontic attachments to ceramic surfaces searched in Pubmed, Medline and Embase, published between 1990 and 2018 were revised. Exclusions concerned bonding to non-ceramic surfaces, bonding to ceramic surfaces that are not destined for orthodontics or laser usage. Forty-nine articles that matched the inclusion criteria were researched. The following categories of original research articles were compared and discussed: metallic brackets bonding to ceramic surfaces, ceramic brackets to ceramic surfaces, bonding to new types of ceramics, such as zirconia, lithium disilicate, different photopolymerisation devices used on bonding to ceramics. Some types of adhesive may achieve minimal bond strength (6-8 MPa) even on glazed ceramic. Ceramic surface preparation may be done by sandblasting or hydrofluoric acid (60s application and 9.6%) with generally similar results. Studies rarely show any statistical difference and there are reduced number of samples in most studies. Ceramic brackets show better adhesion to ceramic surfaces and the same bonding protocol is advised. A higher bond strength may lead to ceramic surface. Few studies focus on newer types of ceramics; additional research is necessary. There is no clear evidence that a certain type of photopolymerization device produces higher shear bond strength values.

In vitro testing of shear bond strength of orthodontic brackets bonded to different novel CAD/CAM ceramics

Background. The present study aimed to evaluate the bond strength of metal bracket (MB) and ceramic bracket (CB) bonded to different CAD/CAM ceramic substrates etched with hydrofluoric acid (HFA) vs. phosphoric acid (PA).

Methods. A total of 120 CAD/CAM ceramic blocks in 12 groups were fabricated from three different CAD/CAM ceramic materials: VITABLOCS Mark II, VITAENAMIC, and IPS e.max CAD. Each ceramic material group was divided into two etching groups: one treated with 9.5% HFA and the other treated with 37%. Sixty metal and CBs of the upper right central incisor were bonded to the HFA-treated blocks. Another 60 metal and CBs were bonded to the PA treated blocks. All the bonded specimens were thermocycled before shear bond strength (SBS) testing. Then the bond failure mode was recorded

Results. There were no significant differences in SBS values between the three CAD/CAM ceramic materials. The HFA-treated specimens exhibited significantly higher SBS values than the PA-treated specimens. Also, the SBS values of CBs were significantly higher than the metal brackets (MBs). The adhesive remnant index (ARI) score was 4 for most of the groups, indicating that almost no adhesive remained on the porcelain surface.

Conclusion. The CAD/CAM ceramic type did not influence SBS; however, HFA exhibited significantly higher SBS compared to PA.

Which surface treatment promotes higher bond strength for the repair of resin nanoceramics and polymer-infiltrated ceramics? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis of in vitro studies was to determine the best surface treatment protocols for the repair of PICs and RNCs.

MATERIAL AND METHODS

The PubMed, Scopus, and Web of Science electronic databases were searched to select in vitro studies in English up to March 2020. Studies with fewer than 5 specimens, those that did not evaluate the BS of PICs or RNCs, and those with aging for fewer than 30 days and 5000 cycles were excluded. Data sets were extracted, and the mean differences were analyzed by using a systematic review software program.

RESULTS

Among 284 potentially eligible studies, 21 were selected for full-text analysis, and 9 were included in the systematic review, of which 6 were used in the meta-analysis. The meta-analyses were performed for each treatment surface versus their respective control group and their combinations according to material: RNCs and PICs. For RNCs, airborne-particle abrasion with aluminum oxide (Al₂O₃) treatment was statistically higher than tribochemical silica airborne-particle abrasion (CoJet) (P=.02, I²=90%) and that in the hydrofluoric acid (HF) (P<.001, I²=0%) groups and was statistically similar to diamond rotary instrument grinding (P=.40, I²=54%). For PICs, the treatment with hydrofluoric acid (HF) was statistically significantly higher than with CoJet (P=.03, I²=62%) and airborne-particle abrasion with Al₂O₃ (P<.001, I²=98%).

CONCLUSIONS

The best surface treatment protocol for repair varied according to the restorative material. HF followed by silanization is suggested for PICs, and airborne-particle abrasion with Al₂O₃ or preparation with a diamond rotary instrument for RNCs.

Bond strength of metal brackets to feldspathic ceramic treated with different surface conditioning methods: an in vitro study

Purpose:

To compare MEP which is originally manufactured for increasing bond strength between organic resins and ceramic with conventional surface treatment methods in preparation of leucite-reinforced FC surfaces regarding shear bond strength (SBS) of stainless steel brackets and the mode of bond failure.

Materials and methods:

Forty specimens that were fabricated from FC material and glazed were randomly assigned to four surface conditioning methods: (1) CoJet Sand; (2) MEP; (3) HF acid etching followed by silane coupling agent; (4) Diamond bur followed by silane coupling agent. The SBS was determined using universal testing machine. Bond failure sites were classified according to Adhesive Remnant Index (ARI).

Results:

No statistically significant difference (p less than 0.05) was found in SBS between the groups while significant intergroup differences were detected concerning ARI scores (p less than 0.001). Group 1 had ARI score 1 and 2 indicating mode of failure at the adhesive interface with greater percentage of the adhesive left on bracket base. The other groups had higher frequency of ARI score 3 and 2. The quantity of the ARI retained on the ceramic surface was highest in Group 3, followed by Group 4 and Group 2.

Conclusion:

MEP can be a suitable alternative for bonding metal brackets to FC surface.

Bond Strength of Metallic or Ceramic Orthodontic Brackets to Enamel, Acrylic, or Porcelain Surfaces

Bonding strategies within different brackets and dental materials are still a challenge concerning adhesion and dental surface damage. This study compared the shear and tensile bond strength of orthodontic ceramic and metallic brackets to enamel, acrylic, and ceramic surfaces after thermal cycling. Dental surfaces were divided into three groups: enamel, ceramic, and acrylic. Each group received stainless-steel and ceramic brackets. After thermal cycling, specimens were randomly divided into two subgroups considering tensile (TBS) or shear bond strength (SBS) test. After the mechanical testing, scanning electron and optical microscopy were performed, and the adhesive remnant index (ARI) was determined. The two-way ANOVA full factorial design was used to compare TBS, SBS, and ARI on the surface and bracket type (α = 0.05). There were significant differences in TBS, SBS, and ARI values per surface (p < 0.001 and p = 0.009) and type of bracket (p = 0.025 and p = 0.001). The highest mean SBS values were recorded for a ceramic bracket bonded to an acrylic surface (8.4 ± 2.3 MPa). For TBS, a ceramic bracket bonded to acrylic showed the worst performance (5.2 ± 1.8 MPa) and the highest values were found on a metallic bracket bonded to enamel. The adhesion of metallic or ceramic brackets is enough for clinical practice although the damage of the enamel surface after debonding is irreversible and harmful for the aesthetic outcome of the teeth.

Adhesive luting to hybrid ceramic and resin composite CAD/CAM Blocks:Er:YAG Laser versus chemical etching and micro-abrasion pretreatment

PURPOSE

To evaluate the effect of Er:YAG laser on the roughness, surface topography, and bond strength to resin luting cement based on chemical and micro-abrasion pretreatments of different computer-aided design/computer-aided manufacturing materials.

METHODS

A polymer-infiltrated-ceramic-network (PICN) material (Vita Enamic, VE), three indirect resin composite (Cerasmart, CS; Shofu HC, SH; Lava Ultimate, LU), and one lithium disilicate ceramic (IPS e.max CAD, EM) blocks were subjected to one of the following pretreatments: no treatment (NC ), Er:YAG etching with one of two powers (either 3 or 6 W), hydrofluoric acid (HF) etching, self-etching ceramic primer (ME), or micro-abrasion (MA). The shear bond strength (SBS) of resin luting cement to pretreated materials was tested. Surface roughness was measured via atomic force microscopy, and surface topography was analyzed via scanning electron microscopy. Two-way analysis of variance, Tukey post-hoc test, and Pearson correlation were applied.

RESULTS

Etching EM and VE with HF or the ME resulted in the highest SBS values in their groups (P < 0.05). LU, SH, VE, and CS indicated similar SBS values when treated with 3 W, 6 W, and MA. The highest surface roughness (Sa ) values were obtained for the LU, CS, and VE groups when treated with 6 W, whereas the lowest Sa values were obtained for CS when treated with the ME and EM when treated with the ME or 3 W. Only SH and CS indicated a significant correlation between surface rough ness and bond strength.

CONCLUSIONS

Er:YAG laser etching is comparable to micro-abrasion when treating resin composite blocks and may induce fewer surface cracks. HF etching remains the gold standard for the treatment of glass-based ceramics and PICNs.

Comparison of lithium disilicate-reinforced glass ceramic surface treatment with hydrofluoric acid, Nd:YAG, and CO2 lasers on shear bond strength of metal brackets

OBJECTIVES

To evaluate and compare the effects of different surface conditioning methods of lithium disilicate-reinforced ceramic on shear bond strength (SBS) of metallic brackets.

MATERIALS AND METHODS

Thirty-six lithium disilicate ceramic blocks mounted in acrylic resin blocks were assigned to 3 groups (n = 12): 9.6% hydrofluoric acid (HF); neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; and carbon dioxide (CO₂) laser. The glass ceramic surfaces were primed with a silane, and the brackets were bonded using a light-cured composite resin. SBS test was carried out in a universal testing machine at 0.5 mm/min crosshead speed until the brackets were debonded. The remaining adhesive was evaluated under a stereomicroscope in terms of the adhesive remnant index (ARI). The surface hardness was determined with a 100-gr force using a microhardness tester. Glass ceramic surface changes were evaluated using the scanning electron microscope. One-way ANOVA and post hoc Tamhane tests were used to compare microhardness values, and Kruskal-Wallis and Mann-Whitney U tests were used to analyze SBS values and ARI.

RESULTS

The median and interquartile range of SBS values in 3 groups were 6.48 (1.56-15.18), 1.26 (0.83-1.67), and 0.99 MPa (0.70-2.10), respectively. Microhardness analysis revealed significant differences between the CO₂ laser and intact porcelain groups (P = 0.003), without significant differences between the other groups. Group 1 exhibited the highest ARI.

CONCLUSION

Neither CO₂ nor Nd:YAG lasers resulted in adequate surface changes for bonding of brackets on ceramics compared with the samples conditioned with HF. CO₂ laser decreased the microhardness of ceramics.

CLINICAL RELEVANCE

Surface conditioning with HF resulted in clinically acceptable SBS values.

Effects of plastic bracket primer on the shear bond strengths of orthodontic brackets

Background/purpose

To assess the usefulness of plastic bracket primer (PBP) for improving the bond strength of plastic brackets (PBs) using three types of orthodontic brackets, including PBs, metal brackets (MBs), and ceramic brackets (CBs).

Materials and methods

A total of 162 premolars were gathered and divided equally into six groups of 27. Three groups were tested with the application of PBP (PB+, MB+, and CB+), and three groups were tested without primer (groups PB-, MB-, and CB-). All the groups were bonded using BeautiOrtho Bond II self-etching adhesive. The shear bond strength (SBS) was measured and the bond failure mode was evaluated using the adhesive remnant index after debonding.

Results

There were significant differences in the mean SBS between groups PB-, MB and CB-, between PB+ and CB+, and between MB+ and CB+. Group PB + had a significantly higher mean SBS than group PB-. The occurrence of bond failure at the enamel and adhesive interface was more frequent in groups PB+ and CB- than in group PB-; and in groups PB+ and CB + than in group MB+.

Conclusion

Plastic bracket primer can increase the bond strength of PBs to the level of metal brackets, but not to the level of ceramic brackets.

Bond Strength of Metal and Ceramic Brackets on Resin Nanoceramic Material With Different Surface Treatments

Objective

This study aimed to evaluate the effects of different surface conditoning methods on surface texture and shear bond strength (SBS) of brackets bonded to resin nanoceramic material.

Methods

Ceramic specimens were divided into two groups as metal brackets and ceramic brackets. In each group, the following five subgroups were conditoned with orthophosphoric acid (OPA), hydrofluoric acid (HFA), silica coating with Cojet, Nd: Yag laser, and Femtosecond (Fs) laser. Extra samples were used for scanning electron microscopy and 3D profilometer evaluation.

Results

All surface conditioning methods caused optimum or higher SBS. Metal brackets had higher SBS than porcelain brackets, but this difference reached statistical significance only in Fs laser group. OPA caused surface modification comparable to HFA because of polymer content of resin nanoceramic. Although Fs laser and Cojet conditioning caused optimum or higher SBS, surface damage of these methods to the resin nanoceramic specimens clearly seen on 3D profilometer.

Conclusion

HFA and Nd: Yag laser are effective surface conditioning methods for resin nanoceramics. OPA combined with silane application caused optimum SBS and can be used as an alternative to HFA. Surface texture changes should be considered to determine surface damage while deciding the optimum surface conditioning method for ceramics other than SBS.

Adhesion procedures for CAD/CAM indirect resin composite block: A new resin primer versus a conventional silanizing agent

PURPOSE

The purpose of this study was to evaluate the effectiveness of both a resin primer containing methyl methacrylate (MMA) and a silanizing agent on bonding to indirect resin composite blocks, using two types of build-up hybrid resin composites.

METHODS

SHOFU BLOCK HC (Shofu) specimens were blasted with alumina, after which one of two surface treatments was applied: CERA RESIN BOND (Shofu, the Silane group) or HC primer (Shofu, the MMA group). Resin composites made using either Solidex Hardura (SDH, Shofu) or Ceramage Duo (CMD, Shofu) were built up and micro-tensile bond strength (μTBS) values were measured after storage in water for either 24h or 6 months (n=24 per group). The fracture surfaces after μTBS measurements and the resin block/build-up resin interfaces were observed by scanning electron microscopy (SEM).

RESULTS

The bond strength of the Silane/SDH group significantly decreased after 6 months (p<0.001), whereas in the MMA group there was no significant loss after 24h or 6 months (p=0.99). In the CMD group, the bond strength after 6 months was significantly lowered in both the Silane group (p<0.001) and the MMA group (p<0.001), but the latter still showed greater adhesion. SEM images demonstrated that the matrix resin was partially destroyed at the fracture surfaces of the MMA group and fracture surface unevenness was observed.

CONCLUSIONS

A primer containing MMA produced stronger bonding to CAD/CAM resin even after long-term aging compared to a silane treatment.

Effects of contact compressive force on bracket bond strength and adhesive thickness : Study using orthodontic resins with different viscosities

PURPOSE

To assess the effect of the contact compressive force to seat orthodontic brackets on shear bond strength (SBS) and adhesive thickness using adhesive resins with different viscosities.

METHODS

A total of 184 premolars were divided equally into eight groups of 23. Transbond XT and Beauty Ortho Bond paste viscous self-etching adhesive systems were used with contact compressive forces of 0.5, 1, 2, and 3 N (groups 1-4 and groups 5-8, respectively) via a push-pull tension gauge. SBS and adhesive thickness were measured in each adhesive system for each contact compressive force.

RESULTS

Significant differences existed in the SBSs between the adhesive systems for each contact compressive force and the SBSs were significantly higher in groups 1 (17 MPa) and 2 (16 MPa) than in groups 3 (14 MPa) and 4 (13 MPa). Significant differences existed for the adhesive thickness between the adhesive systems for the three contact compressive forces less than 3 N. The adhesive in group 1 (0.184 mm) was significantly thicker than that in groups 2-4 (from 0.098 to 0.129 mm). In groups 2 (0.129 mm) and 3 (0.121 mm) it was thicker than in group 4 (0.098 mm), and in group 5 (0.119 mm) it was thicker than in groups 6-8 (from 0.087 to 0.088 mm).

CONCLUSIONS

The high-viscosity adhesive Transbond XT exhibited higher SBSs than the low-viscosity Beauty Ortho Bond paste. For the adhesive Transbond XT, lower contact compressive forces produced greater adhesive thicknesses and higher SBSs. For the Beauty Ortho Bond paste, no significant changes in the adhesive thickness or SBS values were observed for contact compressive forces greater than 0.5 N.

Effectiveness of current adhesive systems when bonding to CAD/CAM indirect resin materials: A review of 32 publications

The purpose of this review was to assess the available literature regarding bonding between current adhesive systems and computer-aided design/computer-aided manufacturing (CAD/CAM) indirect resin materials, to provide clinicians with a comparative overview of the relevant bonding procedures. An electronic search was performed through PubMed based on the keywords CAD/CAM and dental bonding. Additional relevant literature was obtained from the citations in the articles. A total of 313 papers were identified, of which 281 were excluded as being unsuitable, and an additional 3 papers were identified, giving a total of 32 articles that are included in this review. Based on this survey, it is recommended that microretentive surfaces should be generated by either blasting or hydrofluoric acid etching. This initial process should be followed by silanization to ensure chemical adhesion prior to bonding to CAD/CAM indirect resin composite materials (including Lava Ultimet, KATANA AVENCIA block, Gradia Block, Cerasmart, Paradigm, and Block HC) and CAD/CAM polymer-infiltrated ceramics (such as Vita Enamic). The use of materials containing methyl methacrylate (MMA) also appears to improve the bonding of CAD/CAM poly(methyl methacrylate) (PMMA) resin materials (including XHIPC-CAD/CAM, artBloc Temp, and Telio).

Effect of tribochemical silica coating or multipurpose products on bonding performance of a CAD/CAM resin-based material

OBJECTIVES

Nanocomposite ceramics have been widely used in clinical practice; however, a standard, recommended bonding protocol has not been determined yet. The present study aimed to evaluate application of tribochemical silica coating or multipurpose products on bonding performance of a CAD/CAM resin-based material (known as nanocomposite ceramic).

MATERIALS AND METHODS

Nanocomposite ceramic specimens were fabricated and assigned into 11 groups to build bonded specimens (n = 15) according to surface treatments (none; air particle abrasion with 50-μm alumina followed by application of a silane coupling agent or a universal adhesive; tribochemical silica coating followed by application of a silane coupling agent or a universal adhesive) and resin luting cements (conventional resin cement, RelyX Veneer; self-adhesive resin cement RelyX Unicem) used. Micro-shear bond strength (μ-SBS) was measured after 24-h water storage or ageing with 10,000 thermocycles plus additional 90-d water storage. Surface roughness after alumina air abrasion and tribochemical silica coating were determined using a profilometer. Surface morphology and element variation were observed by using a scanning electron microscope (SEM)/energy dispersion spectrum (EDS). X-ray photoelectron spectroscopy (XPS) was used to characterize nanocomposite ceramic powders conditioned with silane coupling agent or the universal adhesive used in the μ-SBS test. The nanocomposite ceramic plates received alumina air abrasion, tribochemical silica coating, or without, were determined using X-ray diffraction (XRD).

RESULTS

Nanocomposite ceramic treated with alumina air abrasion achieved the highest surface roughness, followed by those treated with tribochemical silica coating. Newly formed Si-O-Si bonds on the nanocomposite ceramic surface were detected by XPS after treatment with silane coupling agent or universal adhesive, and a Zr-O-P bond was detected after treating with universal adhesive. μ-SBS was significantly affected by bond strategies and ageing. Ageing by thermocycling and water storage significantly decreased μ-SBS. μ-SBS values derived by use of a universal adhesive or self-adhesive resin cement alone were no lower than the values derived by use of a silane coupling agent alone. Pre-silanization further enhanced the bonding improvement of universal adhesive or self-adhesive resin cement. However, tribochemical silica coating failed to provide higher μ-SBS compared with alumina air abrasion. XRD detected no monoclinic zirconia phase after alumina air abrasion or tribochemical silica coating, suggesting that these two roughening methods did not lead to phase transformation of zirconia fillers.

CONCLUSIONS

Combination of presilanization and universal adhesives improve resin bonding of nanocomposite ceramics. Tribochemical silica coating is not superior to alumina air abrasion for pretreated nanocomposite ceramics.

Effect of the Composition of CAD/CAM Composite Blocks on Mechanical Properties

The aim of this study was to evaluate the effect of the composition of CAD/CAM blocks on their mechanical properties. Nine different CAD/CAM blocks, enamel and dentine, were tested. Sixteen samples of each material were separated for Vickers microhardness test (n=6, 5 readings per specimen), nanohardness test (n=6, 5 readings per specimen), filler weight (n=3), and SEM imaging (n=1). Data were statistically analysed using one-way ANOVA. Vita Mark II ceramic showed significantly higher values of hardness (in both nano- and microscale) and elastic modulus (6.83 GPa, 502 kg/mm², and 47.7 GPa), respectively, than other materials. CAD/CAM composite blocks showed comparable values of hardness and elastic modulus to those of dentine but lower than those of enamel and ceramics. SEM images highlighted different filler-matrix microstructure of CAD/CAM composite blocks. It was concluded that (1) hardness and elastic moduli are positively correlated with ceramic filler percentage and microstructure and (2) CAD/CAM composite materials have comparable hardness and elastic moduli to tooth structure.

Surface Roughness of Ceramic-Resin Composites After Femtosecond Laser Irradiation, Sandblasting or Acid Etching and Their Bond Strength With and Without Silanization to a Resin Cement

OBJECTIVES:

The aim of this study was to investigate the effects of femtosecond laser irradiation, sandblasting, or acid etching treatments on the surface roughness of ceramic-resin composites and also shear bond strength (SBS) with and without silanization to a resin cement.

METHODS:

Samples of Vita Enamic (VE; Vita Zahnfabrik, Bad Säckingen, Germany) and Lava Ultimate (LU; 3M ESPE, Seefeld, Germany) were classified into control (no treatment), sandblasting, hydrofluoric acid, and femtosecond laser groups (n=30). Surface roughness was determined using two-dimensional contact profilometry. Surface topography was evaluated using a three-dimensional contact profilometer and a scanning electron microscope. Then groups were divided into two subgroups with similar surface roughness values, including control (C), control + silane (C-S), sandblasting (SB), sandblasting + silane (SB-S), hydrofluoric acid (HF), hydrofluoric acid + silane (HF-S), femtosecond laser (FS), and femtosecond laser + silane (FS-S) groups (n=15). Panavia F 2.0 resin cement was applied to the sample surfaces using an SDI SBS rig (SDI Limited, Bayswater, Australia). The SBS test was performed after water storage (24 h, 37°C) and thermocycles (2000 cycles, 5°C to 55°C), and failure modes were evaluated.

RESULTS:

The highest surface roughness was observed in the FS group, and the highest SBS was observed in the FS-S group for both VE and LU ( p<0.001). Silanization improved the SBS of VE significantly ( p<0.001) in all surface treatments but did not improve that of LU except in the FS group ( p=0.004). There was a significantly moderate negative correlation in the VE/SB group ( p=0.012) and a moderate positive correlation in the VE/HF group ( p=0.049).

CONCLUSIONS:

Femtosecond laser irradiation was found to be more effective than sandblasting or acid etching in increasing the surface roughness, and it was also the most effective surface treatment with silanization on the SBS of a resin cement to the ceramic-resin composites.

Assessment the Bond Strength of Ceramic Brackets to CAD/CAM Nanoceramic Composite and Interpenetrating Network Composite after Different Surface Treatments

Adult orthodontics may confront problems related to the bonding performance of orthodontic brackets to new generation restorative materials used for crown or laminate restorations. The aim of the present study was to investigate the shear bond strength of ceramic brackets to two new generation CAD/CAM interpenetrating network composite and nanoceramic composite after different surface treatments. Er,Cr:YSGG Laser, hydrofluoric acid (9%), sandblasting (50 μm Al₂O₃), and silane were applied to the surfaces of 120 CAD/CAM specimens with 2 mm thickness and then ceramic brackets were bonded to the treated surfaces of the specimens. Bond strength was evaluated using the shear bond strength test. According to the results, CAD/CAM block types and surface treatment methods have significant effects on shear bond strength. The lowest bond strength values were found in the specimens treated with silane (3.35 ± 2.09 MPa) and highest values were found in the specimens treated with sandblast (8.92 ± 2.77 MPa). Sandblasting and hydrofluoric acid surface treatment led to the most durable bonds for the two types of CAD/CAM blocks in the present study. In conclusion, different surface treatments affect the shear bond strength of ceramic brackets to CAD/CAM interpenetrating network composite and nanoceramic composite. Among the evaluated treatments, sandblasting and hydrofluoric acid application resulted in sufficient bonding strength to ceramic brackets for both of the CAD/CAM materials.

Effects of three silane primers and five adhesive agents on the bond strength of composite material for a computer-aided design and manufacturing system

Objective

The objective of this study was to evaluate the effects of combinations of silane primers and adhesive agents on the bond strength of a composite block for a computer-aided design and manufacturing system.

Material and Methods

Three silane primers [Clearfil Ceramic Primer (CP), Super-Bond PZ Primer (PZ), and GC Ceramic Primer II (GP)] were used in conjunction with five adhesive agents [G-Premio Bond (P-Bond), Repair Adhe Adhesive (R-Adhesive), Super-Bond D-Liner Dual (SB-Dual), Super-Bond C&B (SB-Self), and SB-Dual without tributylborane derivative (SB-Light)]. The surface of a composite block (Gradia Block) was ground with silicon carbide paper. After treatment with a silane primer, a adhesive agent was applied to each testing specimen. The specimens were then bonded with a light-curing resin composite. After 24 h, the shear bond strength values were determined and compared using a post hoc test (α=0.05, n=8/group). We also prepared control specimens without primer (No primer) and/or without adhesive agent (No adhesive).

Results

PZ/SB-Dual and GP/SB-Dual presented the highest bond strength, followed by GP/P-Bond, CP/SB-Dual, CP/R-Adhesive, No primer/SB-Dual, GP/R-Adhesive, CP/P-Bond, No primer/R-Adhesive, PZ/R-Adhesive, CP/SB-Self, PZ/P-Bond, PZ/SB-Self, and GP/SB-Self in descending order of bond strength. No primer/P-Bond, No primer/SB-Self, and all specimens in the SB-Light and No adhesive groups presented the lowest bond strengths.

Conclusion

A dual-curing adhesive agent (SB-Dual) containing a tributylborane derivative in combination with a silane primer (GP or PZ) presents a greater bond strength between the composite block and the repairing resin composite than the comparators used in the study.

Effects of different etching methods and bonding procedures on shear bond strength of orthodontic metal brackets applied to different CAD/CAM ceramic materials

OBJECTIVE

To investigate the shear bond strength (SBS) of orthodontic metal brackets applied to different types of ceramic surfaces treated with different etching procedures and bonding agents.

MATERIALS AND METHODS

Monolithic CAD/CAM ceramic specimens (N = 120; n = 40 each group) of feldspathic ceramic Vita Mark II, resin nanoceramic Lava Ultimate, and hybrid ceramic Vita Enamic were fabricated (14 × 12 × 3 mm). Ceramic specimens were separated into four subgroups (n = 10) according to type of surface treatment and bonding onto the ceramic surface. Within each group, four subgroups were prepared by phosphoric acid, hydrofluoric acid, Transbond XT primer, and Clearfill Ceramic primer. Mandibular central incisor metal brackets were bonded with light-cure composite. The SBS data were analyzed using three-way analysis of variance (ANOVA) and Tukey HSD tests.

RESULTS

The highest SBS was found in the Vita Enamic group, which is a hybrid ceramic, etched with hydrofluoric acid and applied Transbond XT Adhesive primer (7.28 ± 2.49 MPa). The lowest SBS was found in the Lava Ultimate group, which is a resin nano-ceramic etched with hydrofluoric acid and applied Clearfill ceramic primer (2.20 ± 1.21 MPa).

CONCLUSIONS

CAD/CAM material types and bonding procedures affected bond strength ( P < .05), but the etching procedure did not ( P > .05). The use of Transbond XT as a primer bonding agent resulted in higher SBS.

Effects of tributylborane-activated adhesive and two silane agents on bonding computer-aided design and manufacturing (CAD/CAM) resin composite

The present study was conducted to evaluate the effects of an experimental adhesive agent [methyl methacrylate-tributylborane liquid (MT)] and two adhesive agents containing silane on the bonding between a resin composite block of a computer-aided design and manufacturing (CAD/CAM) system and a light-curing resin composite veneering material. The surfaces of CAD/CAM resin composite specimens were ground with silicon-carbide paper, treated with phosphoric acid, and then primed with either one of the two silane agents [Scotchbond Universal Adhesive (SC) and GC Ceramic Primer II (GC)], no adhesive control (Cont), or one of three combinations (MT/SC, MT/GC, and MT/Cont). A light-curing resin composite was veneered on the primed CAD/CAM resin composite surface. The veneered specimens were subjected to thermocycling between 4 and 60 °C for 10,000 cycles, and the shear bond strengths were determined. All data were analyzed using analysis of variance and a post hoc Tukey-Kramer HSD test (α = 0.05, n = 8). MT/SC (38.7 MPa) exhibited the highest mean bond strengths, followed by MT/GC (30.4 MPa), SC (27.9 MPa), and MT/Cont (25.7 MPa), while Cont (12.9 MPa) and GC (12.3 MPa) resulted in the lowest bond strengths. The use of MT in conjunction with a silane agent significantly improved the bond strength. Surface treatment with appropriate adhesive agents was confirmed as a prerequisite for veneering CAD/CAM resin composite restorations.

Micro-shear bond strength of different resin cements to ceramic/glass-polymer CAD-CAM block materials

PURPOSE

The aim of this study was to evaluate the effects of hydrofluoric acid treatment on bond strength of resin cements to three different types of ceramic/glass containing CAD-CAM block composite materials.

METHODS

CAD-CAM block materials of polymer infiltrated (Vita Enamic), resin nanoceramic (Lava Ultimate) and nanoceramic (Cerasmart) with a thickness of 1.5mm were randomly divided into two groups according to the surface treatment performed. In Group 1, specimens were wet-ground with silicon carbide abrasive papers up to no. 1000. In Group 2, 9.6% hydrofluoric acid gel was applied to ceramics. Three different resin cements (RelyX, Variolink Esthetic and G-CEM LinkAce) were applied to the tubes in 1.2-mm thick increments and light-cured for 40s using LED light curing unit. Half of the specimens (n=10) were submitted to thermal cycling (5000 cycles, 5-55°C). The strength measurements were accomplished with a universal testing machine (Lloyd Instruments) at a cross-head speed of 0.5mm/min until the failure occurs. Failure modes were examined using a stereomicroscope and scanning electron microscope. The data were analyzed with multivariate analysis of variance (MANOVA) and Tukey's post hoc tests (α=0.05).

RESULTS

There were significant differences between ceramics and resin cements (p<0.001). However, hydrofluoric acid gel treatment had no effect on bond strength values (p=0.073). In addition, thermal cycling significantly decreased bond strength values of resin cements to ceramics (p<0.001).

CONCLUSIONS

Use of appropriate resin cement systems with different ceramic/glass-polymer materials might promote the bonding capacity of these systems.

Effect of surface treatments on shear bond strength of resin composite bonded to CAD/CAM resin-ceramic hybrid materials

PURPOSE

The purpose of this study was to assess the effect of surface treatments on shear bond strength of resin composite bonded to thermocycled and non-thermocycled CAD/CAM resin-ceramic hybrid materials.

MATERIALS AND METHODS

120 specimens (10×10×2 mm) from each material were divided into 12 groups according to different surface treatments in combination with thermal aging procedures. Surface treatment methods were airborne-particle abrasion (abraded with 50 micron alumina particles), dry grinding (grinded with 125 µm grain size bur), and hydrofluoric acid (9%) and silane application. According to the thermocycling procedure, the groups were assigned as non-thermocycled, thermocycled after packing composites, and thermocycled before packing composites. The average surface roughness of the non-thermocycled specimens were measured after surface treatments. After packing composites and thermocycling procedures, shear bond strength (SBS) of the specimens were tested. The results of surface roughness were statistically analyzed by 2-way Analysis of Variance (ANOVA), and SBS results were statistically analyzed by 3-way ANOVA.

RESULTS

Surface roughness of GC were significantly lower than that of LU and VE (P<.05). The highest surface roughness was observed for dry grinding group, followed by airborne particle abraded group (P<.05). Comparing the materials within the same surface treatment method revealed that untreated surfaces generally showed lower SBS values. The values of untreated LU specimens showed significantly different SBS values compared to those of other surface treatment groups (P<.05).

CONCLUSION

SBS was affected by surface treatments. Thermocycling did not have any effect on the SBS of the materials except acid and silane applied GC specimens, which were subjected to thermocycling before packing of the composite resin.