Cements for use in esthetic dentistry

The Effect of the Initiator/Activator/Accelerator Ratio on the Degree of Conversion, Film Thickness, Flow, and Cytotoxicity of Dual-Cured Self-Adhesive Resin Cements

Although self-adhesive resin cements are convenient and less technique-sensitive materials for dental clinicians, they exhibit a lower degree of conversion due to acidic components in their composition. Supplementation of the initiator, accelerator, and activator in self-adhesive resin cements has been suggested to compensate for the lower degree of conversion. This study aimed to evaluate the effects of different combinations of self-curing initiators, self-curing activators, and accelerators on the degree of conversion (DC) of self-adhesive resin cements. A dual-cured self-adhesive resin was prepared using six combinations of initiators, activators, and accelerators. The change in the DC over time was evaluated with and without light curing. The film thickness, flow properties, and cytotoxicity of each formulation were assessed. The results showed that all supplemental components had an effect on increasing the DC, but a greater increase in the DC was observed in the following order: activator, accelerator, and initiator. The cytotoxicity of the resin cements was related to the DC values, as resin cements with lower DC values exhibited higher cytotoxicity. The film thickness met the ISO standards for all groups. The results suggest that utilizing an activator is the most effective approach to enhance the DC in self-adhesive resin cement and that cytotoxicity tended to increase with lower DC values, whereas film thickness and flow properties demonstrated no correlation with DC values.

Self-adhesive resin cement versus conventional cements on the failure rate of indirect single-tooth restorations: A systematic review and meta-analysis of randomized clinical trials

STATEMENT OF PROBLEM

Cementation is one of the most critical steps that influence the failure rates of indirect restorations. Self-adhesive resin cements arose out of the need for technical simplification of this procedure to reduce the risk of operative errors, with good acceptance by clinicians. How the failure rate of indirect single-tooth restorations cemented with self-adhesive resin cements compares with the failure rate of those cemented conventionally is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis of randomized clinical trials was to compare self-adhesive resin cements versus conventional cements on the failure rates of indirect restorations.

MATERIAL AND METHODS

The review was registered at the International Prospective Register of Systematic Reviews (PROSPERO - CRD42020215577). The search strategy was adapted for 5 databases (PubMed, The Cochrane Library, EMBASE, Web of Science, and LILACS) and 1 nonpeer-reviewed literature source (clinicaltrials.gov). The strategy was guided by the problem/population, intervention, comparison, outcome (PICO) question: adults indicated for indirect restorations -P, self-adhesive resin cement -I, conventional cement-C, failure rates-O. The risk of bias was assessed using the Cochrane risk of bias (RoB2) tool and guidelines. Meta-analysis merged the results from included studies by pooling the hazard ratios and standard errors, available or estimated. The certainty of evidence was assessed by using the classification of recommendations, evaluation, development, and evaluation (GRADE) approach.

RESULTS

Nine randomized clinical trials were included in qualitative and quantitative analysis. Eight studies detected nonsignificant differences in failure rates between cements. Only 1 study reported a significantly higher failure rate on single-tooth ceramic crowns luted with self-adhesive resin cement. Nonsignificant differences were detected after the results from all studies had been pooled.

CONCLUSIONS

Based on clinical evidence, self-adhesive resin cements can be recommended for the cementation of indirect single-tooth restorations with a similar risk of failure to conventional cements.

Factors influencing the bond strength of additively manufactured crown materials in dentistry: A systematic review of in vitro studies

OBJECTIVE

The purpose of this systematic review was to investigate how different interventions can impact the bond strength of additively manufactured crown materials after cementation.

DATA/SOURCES

Four online databases Ovid MEDLINE, Scopus, Web of Science and Google Scholar were searched up to January 2023. Inclusion criteria were English-language publications, full-text, and in vitro studies only. Exclusion criteria were studies that did not assess the bonding of an additively manufactured crown material to cement or did not conduct any bond strength tests. An assessment of risk of bias was done in accordance with a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Each study was analysed and compared based on the interventions and bond strength results.

STUDY SELECTION

Six studies satisfied the inclusion and exclusion criteria, five of which evaluated photopolymerised resin and one that tested zirconia manufacturing via 3D printing. All studies observed a low risk of bias. The interventions applied included the type of surface pretreatments, airborne-particle abrasion pressure, cement type, taper of crown, and artificial aging. Three studies compared the bonding performance to milled materials.

CONCLUSIONS

The bond strength of crown materials additively manufactured from photopolymers presented high values and are comparable to milled materials. The systematic review demonstrated there was no definite superior cement type, but airborne-particle abrasion with alumina was generally recommended. There is a clear gap in the literature regarding the bond strength of additively manufactured crowns. Therefore, further research is necessary to evaluate its clinical applicability for permanent restorations.

CLINICAL SIGNIFICANCE

Factors influencing the bond strength of additively manufactured crown materials should be evaluated so dental professionals can adopt procedures that promote the strongest bond.

A comprehensive review of resin luting agents: Bonding mechanisms and polymerisation reactions

The field of dentistry is constantly evolving and increasingly embracing minimally invasive approaches. One such approach, which is bonding to the tooth structure, particularly enamel, has been shown to offer the most predictable outcomes. However, there are instances where significant tooth loss may limit treatment options for a restorative dentist. In these scenarios, indirect restoration might be the preferred treatment option. This literature review provides a comprehensive examination of the currently available resin luting agents and their bonding requirements. It provides valuable insights for dental professionals seeking an in-depth understanding of the current state of the field and the future prospects of dental adhesion.

Resin cement selection for different types of fixed partial coverage restorations: A narrative systematic review

OBJECTIVE

The aim of this study was to review the selection criteria of resin cements for different types of partial coverage restorations (PCRs) and investigate if the type of restorations or restorative materials affect the type of selected resin cement.

MATERIALS AND METHODS

An electronic search (1991-2023) was performed in PubMed, Medline, Scopus, and Google Scholar databases by combinations of related keywords.

RESULTS

A total of 68 articles were included to review the selection criteria based on the advantages, disadvantages, indications, and performance of resin cements for different types of PCRs.

CONCLUSIONS

The survival and success of PCRs are largely affected by appropriate cement selection. Self-curing and dual-curing resin cements have been recommended for the cementation of metallic PCRs. The PCRs fabricated from thin, translucent, and low-strength ceramics could be adhesively bonded by light-cure conventional resin cements. Self-etching and self-adhesive cements, especially dual-cure types, are not generally indicated for laminate veneers.

Risk Factors with Porcelain Laminate Veneers Experienced during Cementation: A Review

The clinical success of porcelain laminate veneers (PLVs) depends on many clinical and technical factors, from planning to execution, among which adhesive cementation is of significant importance. This procedure carries many risk factors if not optimally executed. The objective of this study was to document the clinical parameters affecting successful cementation procedures with a focus on the adhesive strength, integrity, and esthetics of the PLVs. A literature search was conducted through MEDLINE, complemented by a hand search using predefined keywords. Articles published in English between 1995 and 2023 were selected. According to this review, the success and longevity of PLVs rely in great part on the implementation of a precise cementation technique, starting from field isolation, adequate materials selection for adhesion, proper manipulation of the materials, the seating of the veneers, polymerization, and elimination of the excess cement. Several clinical steps performed before cementation, including treatment planning, preparation, impression, and adequate choice of the restorative material, could affect the quality of cementation. Scientific evidence suggests careful implementation of this process to achieve predictable outcomes with PLVs. The short- and long-term clinical success of adhesively luted PLVs is tributary to a deep understanding of the materials used and the implementation of clinical protocols. It is also contingent upon all the previous steps from case selection, treatment planning, and execution until and after the cementation.

Influence of nonthermal argon plasma on the micro-shear bond strength between resin cement and translucent zirconia

Background

Considering the potential of translucent zirconia for application in esthetic restorations, it is necessary to find effective methods with the least adverse effects to increase its bond strength to resin cement.

Aims

This study aimed to test if different conservative surface treatments and cement types could affect the micro-shear bond strength (μSBS), failure mode, and bonding interface between resin cement and translucent zirconia.

Materials and Methods

In this in vitro experimental study, translucent zirconia blocks were divided into four groups based on the surface treatment they received: no treatment, argon plasma, primer (Pr), and Pr + plasma. Each group was further divided into two subgroups based on the applied cement: PANAVIA F2 and Duo-Link cement. Fourteen cement columns with a diameter of 1 mm were placed on each block (n = 14); all the specimens were immersed in 37°C water for 24 h. Afterward, μSBS was evaluated (P < 0.05), and the mode of failure was determined by a stereomicroscope (×10). The cement-zirconia interface and the surface hydrophilicity (contact angle) were also evaluated.

Statistical Analysis

Two-way analysis of variance (ANOVA) was used to evaluate the effect of surface preparation, cement types, and incubator, simultaneously (P < 0.05). The bond strengths after incubation were analyzed by one-way ANOVA (P < 0.05). Failure mode, contact angle, and cement-zirconia interface were analyzed descriptively.

Results

The highest bond strength was seen in Pr surface treatment for Duo-Link cement; however, this group was not significantly different from Pr and PANAVIA F2 cement and Pr + plasma and Duo-Link cement (P = 0.075) groups. All plasma specimens in the incubator failed prematurely. The mode of failure in all specimens was adhesive. The lowest and highest contact angles were seen in Pr + plasma and the control groups, respectively.

Conclusion

The use of Pr could successfully improve the bond strength of resin cement to translucent zirconia while plasma was not an acceptable and durable substitute.

A Scoping Review on the Polymerization of Resin-Matrix Cements Used in Restorative Dentistry

In dentistry, clinicians mainly use dual-cured or light-cured resin-matrix cements to achieve a proper polymerization of the organic matrix leading to enhanced physical properties of the cement. However, several parameters can affect the polymerization of resin-matrix cements. The main aim of the present study was to perform a scoping review on the degree of conversion (DC) of the organic matrix, the polymerization, and the light transmittance of different resin-matrix cements used in dentistry. A search was performed on PubMed using a combination of the following key terms: degree of conversion, resin cements, light transmittance, polymerization, light curing, and thickness. Articles in the English language published up to November 2022 were selected. The selected studies' results demonstrated that restorative structures with a thickness higher than 1.5 mm decrease the light irradiance towards the resin-matrix cement. A decrease in light transmission provides a low energy absorption through the resin cement leading to a low DC percentage. On the other hand, the highest DC percentages, ranging between 55 and 75%, have been reported for dual-cured resin-matrix cements, although the polymerization mode and exposure time also influence the DC of monomers. Thus, the polymerization of resin-matrix cements can be optimized taking into account different parameters of light-curing, such as adequate light distance, irradiance, exposure time, equipment, and wavelength. Then, optimum physical properties are achieved that provide a long-term clinical performance of the cemented restorative materials.

A Pilot Study on Monomer and Bisphenol A (BPA) Release from UDMA-Based and Conventional Indirect Veneering Composites

This study aimed to investigate the release of common monomers from conventional (Dialog Vario, Enamel Plus HFO) and UDMA-based indirect veneering composites (VITA VM LC, GC Gradia). Ten cylindrical samples of each material were prepared (n = 40), immersed in HPLC grade water, and incubated for 24 h in an incubation shaker at 37 °C and 112 rpm. Extraction was performed following ISO 10993-12 and monomers were detected and quantified by HPLC-MS/MS. In all the samples, urethane dimethacrylate (UDMA) and bisphenol A (BPA) were quantifiable. Compared to water blanks, BPA levels were only elevated in the eluates from conventional composites. In all other samples, concentrations were in the range of extraneous BPA and were therefore clinically irrelevant. Low concentrations of Bisphenol A-glycidyl methacrylate (BisGMA) were found in one BPA-free composite and in both conventional materials. Statistical analyses showed that BPA-free materials released significantly less BisGMA and no BPA, while UDMA elution was comparable to elution from conventional materials. All measured concentrations were below reported effective cytotoxic concentrations. Considering these results, the substitution of BPA-derivatives with UDMA might be beneficial since BPA-associated adverse effects are ruled out. Further studies should be enrolled to test the biocompatibility of UDMA on cells of the oral environment.

The Effect of Feldspathic Thickness on Fluorescence of a Variety of Resin Cements and Flowable Composites

(1) Background: The shade of resin-based materials and ceramic thickness influence the optical color of laminate restorations. The purpose of this study is to evaluate—in vitro—the effect of resin-based cement shade and ceramic thickness on fluorescence of feldspathic laminate veneers; (2) Methods: 180 samples of feldspathic ceramic A2 shade with two different thicknesses (0.5 and 0.8 mm) were obtained. The samples were cemented to composite resin substrates with one of the following materials in different shades (n = 10): resin cement (Variolink Esthetic in Light, Neutral and Warm shades; or RelyX Veneer in B0.5 /white, Translucent and A3 Opaque/yellow opaque shades); flowable composite resin (G-aenial Flo in A2 and A3 shades) or a pre-heated composite resin (Filtek Supreme XTE, A3 body shade). The fluorescence spectra were obtained by means of a spectrofluorometer. Two-way ANOVA, Tukey, and Student’s t-tests were performed (α = 0.05); (3) Results: Fluorescence values were significantly influenced by the resin-based agent tested (p < 0.001), the thickness of ceramic (p < 0.001), and their interaction (p < 0.001). The lowest fluorescence values were achieved by RelyX Veneer resin cement regardless its shade and the ceramic thickness; (4) Conclusions: both the shade of resin-based agent and the feldspathic ceramic thickness influenced the fluorescence of laminate restorations.

Monomer Release from Dental Resins: The Current Status on Study Setup, Detection and Quantification for In Vitro Testing

Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

Physical, Mechanical, and Adhesive Properties of Novel Self-Adhesive Resin Cement

Objective

To evaluate a newly developed self-adhesive resin cement on physical, mechanical, and adhesive properties and compare it with other commercial self-adhesive resin cements.

Materials and Methods

Experimental self-adhesive resin cement (SARC) was formulated by our proprietary adhesive resin and filler technology. Maxcem Elite, RelyX Unicem 2, SpeedCem Plus, SmartCEM 2, and Calibra Universal 2 were selected for comparison. Working and setting times, film thickness, water sorption and solubility, flexural strength, and modulus were measured in accordance with ISO-4049. Consistency was tested according to modified ISO 4823. Shear bond strengths were conducted according to ISO 29022. The data were analyzed by one-way ANOVA and post hoc Tukey's tests (p ≤ 0.05).

Results

All cements showed about 2–4 min working time and about 3–6 min setting time except that RelyX Unicem 2 has a longer working time (9'58”) and setting time (10'18”). All cements meet ISO standards for film thickness (≤50 µm), water sorption (≤40 µg/mm³) except Maxcem Elite (46.19 µg/mm³), and water solubility (≤7.5 µg/mm³) except SmartCEM 2 (11.35 µg/mm³) and Calibra Universal (9.87 µg/mm³). Experimental SARC showed significantly higher flexural strength and modulus than other cements (p < 0.001). For self-curing, Experimental SARC has statistically higher bond strength than other cements (p < 0.001) except statistically the same as RelyX Unicem 2 (p > 0.05). For light-curing, Experimental SARC showed significantly higher bond strength than other cements (p < 0.001) except statistically the same as Maxcem Elite and RelyX Unicem 2 (p > 0.05). For dual-curing, the bond strength of Experimental SARC is significantly higher than that of other cements (p < 0.001).

Conclusion

The newly developed self-adhesive resin cement exhibited favorable bonding capability and physical and mechanical properties compared to other commercial self-adhesive resin cements and is a good option for cementation of indirect restorations with potential long-term clinical success.

Comparative Microleakage Evaluation through the Interfaces between the Tooth and Cement after Stainless Steel Crown Cementation in Primary Molars: An In Vitro Study

Introduction

The longevity of stainless steel crowns is related to perfect adaptation and long-term union between restoration and teeth. In this respect, evaluation of marginal leakage of luting cement is essential.

Aim and objective

To compare and evaluate the ability of new adhesive cement to prevent microleakage under stainless steel crowns on primary teeth.

Materials and methods

Forty-five specimens were embedded, standardized preparations were made onto selected extracted primary molars, and stainless steel crowns were adapted. Samples were assigned randomly to cement groups: Glass ionomer (GI), resin-modified glass-ionomer (RMGI), and Adhesive resin (AR) cement, followed by storage in water, artificially aging, staining, sectioning, and the linear dye penetration and proportion of microleakage evaluation.

Results

AR showed the lowest microleakage, followed in increasing order by RMGIC and GIC showed the greatest microleakage (p-value < 0.0001).

Clinical Significance

There are many kinds of luting agents that vary considerably from the viewpoint of solubility, strength, and ability to adhere to the tooth structure. Lack of adhesion of the luting cement to the tooth structure is one of the reasons for microleakage related to different types of crowns. Cement breakdown may result in the entrance of fluids and microorganisms along with the tooth restoration interface. In this study, attempts were made to simulate standard clinical procedures, although this is not a substitute for the complex oral environment, the results provide useful information to choosing the best cement materials.

Conclusion

Adhesive resin cement can be recommended for cementation of Stainless Steel Crowns because of added advantages over others.

How to cite this article

Gundewar MS, Saha S, Arora D, et al. Comparative Microleakage Evaluation through the Interfaces between the Tooth and Cement after Stainless Steel Crown Cementation in Primary Molars: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):159-163.

Does Resin Cement Type and Cement Preheating Influence the Marginal and Internal Fit of Lithium Disilicate Single Crowns?

This paper assesses the effect of cement type and cement preheating on the marginal and internal fit of lithium disilicate single crown. Methods: 40 maxillary premolars were selected, restored with lithium disilicate single crowns. Teeth were randomly assigned into four groups (n = 10) based on cement type (Panavia SA or LinkForce) and preheating temperature (25 °C or 54 °C). After fabrication of the restoration, cements were incubated at 25 °C or 54 °C for 24 h, and each crown was cemented to its corresponding tooth. After 24 h, all specimens were thermally aged to (10,000 thermal cycles between 5 °C and 55 °C), then load cycled for 240,000 cycles. Each specimen was then sectioned in bucco-palatal direction and inspected under a stereomicroscope at x45 magnification for marginal and internal fit evaluation. The data were statistically analyzed (significance at p ≤ 0.05 level). Results: At the mid-buccal finish line, mid-buccal wall, palatal cusp, mid-palatal wall, mid-palatal finish line, and palatal margin measuring points, there was a significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 25 °C and the group cemented with LinkForce at 25 °C, while there was no significant difference (p > 0.05) at the other points. At all measuring points, except at the palatal cusp tip (p = 0.948) and palatal margin (p = 0.103), there was a statistically significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 54 °C and the group cemented with LinkForce at 54 °C. Regardless of cement preheating, statistically significant differences were found in the buccal cusp tip, central groove, palatal cusp tip, and mid-palatal wall (p ≤ 0.05) in the lithium disilicate group cemented with Panavia SA at 25 °C and 54 °C, as well as the mid-palatal chamfer finish line and palatal margin in the LinkForce group cemented with Panavia SA at 25 °C and 54 °C. At the other measurement points, however, there was no significant difference (p > 0.05). Conclusions: The type of resin cement affects the internal and marginal fit of lithium disilicate crowns. At most measuring points, the cement preheating does not improve the internal and marginal fit of all lithium disilicate crowns.

Cement selection criteria for full coverage restorations: A comprehensive review of literature

BACKGROUND

Proper cement selection in fixed prosthesis plays a determinative role in providing long-term serviceability, retention, caries prevention, and patient satisfaction. This study, reviews different luting agent characteristics and their application based on different clinical situations and different types of full coverage restorations.

MATERIAL AND METHODS

An electronic search was conducted through PubMed, Medline, and Google scholar using following keywords or combinations: restoration, full coverage, PFM, porcelain fused to metal, all ceramic, zirconia, ceramic, casting, fixed partial denture, cement*, dental cement, cement selection, and retention. The most related articles were selected for review.

RESULTS

Choosing a proper luting agent is highly dependent on scientific knowledge regarding the characteristics of restorative materials and luting agents. Conventional cements could be indicated in various situations; however, some restorative materials or clinical situations call for resin-cements to provide predictable retention, support, and durability.

CONCLUSIONS

Conscious selection of retentive cement for each type of restoration/material is necessary to provide predictable successful treatment and reduce the potential complications. Key words:Adhesive cement, dental bridgework, dental cements, dental crowns, dental porcelain, prostheses and implants.

Push-Out Bond Strength Evaluation of Fiber-Reinforced Composite Resin Post Cemented with Self-Adhesive Resin Cement Using Different Adhesive Bonding Systems

The purpose of this in vitro study was to evaluate the push-out bond strength of fiber-reinforced resin posts using self-adhesive cements with different adhesive systems. A total of 50 single-rooted human maxillary premolars with fully developed apices and 15–16 mm straight root canals were selected. The teeth were divided into 10 groups with coronal and apical parts according to the adhesive bonding system and luting material used: one universal adhesive with MDP-containing self-adhesive resin cement; another universal adhesive with MDP-containing self-adhesive resin cement; universal primer with MDP-containing self-adhesive resin cement; universal primer with dual-cure resin cement; MDP-containing self-adhesive resin cement only (Control). Each specimen was subjected to a fatigue load of 600,000 cycles using a chewing simulator with sliding movement and cut horizontally for push-out bond strength testing. Statistical evaluation consisted of a one-way ANOVA test using SPSS v23.0. The highest bond strength (7.05 MPa) was obtained in the coronal part of the Single Bond universal group treated with MDP-containing self-adhesive resin cement and the lowest strength (4.77 MPa) was observed in apical part of MDP-containing self-adhesive resin cement group (Control). However, the one-way ANOVA results showed no significant difference between all 10 groups (p > 0.05). The self-adhesive cement without adhesive bonding showed no statistically different value compared to self-adhesive cements with adhesive bonding.

Influence of feldspar ceramic thickness on the properties of resin cements and restorative set

This in vitro study evaluated the influence of feldspathic ceramic thickness on the properties of light- and dual-cured resin cements. For each cement (RelyX Veneer, Allcem Veneer, RelyX Ultimate, and Allcem Dual), three ceramic specimens were prepared, with seven thicknesses for each (0.5, 1.0, 1.5, 2.0, 2.5, 3.0, and 3.5 mm). The degree of conversion, Vickers microhardness, irradiance power, color variation (ΔE₀₀ ), and translucency parameters were assessed. Microhardness and irradiance power were analyzed using analysis of variance (ANOVA) with post hoc Tukey's test, while ΔE₀₀ , translucency parameters, and degree of conversion were analyzed using ANOVA of ranks with post hoc Duncan's Multiple Range Test. The relationship between each of the dependent variables (degree of conversion, ΔE₀₀ , and translucency parameter tests) and the specimen thickness was described using linear regression for each of the four resin cements. The significance level for all analyses was set at 5%. RelyX Ultimate yielded the lowest degree of conversion values among all resin cements. Allcem Veneer produced the lowest microhardness values, without statistical differences between thicknesses, of up to 1 mm. Allcem Dual produced the highest ΔE₀₀ and translucency parameter values. Feldspathic ceramic thickness influenced the mechanical properties of resin cements and optical aspects of the restorative set.

Influence of photodynamic therapy and different lasers Er,Cr:YSGG and Er,YAG on dentin conditioning bonded to conventional and bioactive cement

AIM

The aim of the present study was to evaluate the bond integrity of bioactive cement (BA_c) in contrast to conventional cement Calibra (C) after dentin treated with different surface conditioners (PDT, EYL, ECL) MATERIALS AND METHODS: Sixty non-carious permanent mandibular molars were disinfected and embedded in acrylic resin till cement-o-enamel junction. For homogeneity the buccal surface were grounded and polished. Samples were categorized into three main groups based on conditioning technique. Samples in group 1 and 2 dentin conditioned with Er,Cr:YSGG (ECL), group 3 and 4 surface treated with Er:YAG (EYL) and group 5 and 6 treated with photodynamic therapy (PDT).On conditioned surface bonding agent was applied and light cured. Samples from group 1,3,5 were bonded to Calibra (C). Whereas, specimens in group 2,4,6 were conditioned with bioactive cement (BA_c) and subjected to ageing followed by shear bond strength testing (SBS) in universal testing machine. To detect significance difference between means of different groups analysis of variance (ANOVA) was performed followed by Tukey's post-hoc tests.

RESULTS

The maximum SBS was displayed in group 1, dentin conditioned with ECL and bonded to C (20.23 ± 0.47 MPa). Whereas, group 6, PDT of dentin to BA_c demonstrated lowest bond integrity among experimental groups (12.97 ± 0.25 MPa). Bond strength of group 1, ECL-C (21.55 ± 3.08 MPa) and group 3 EYL-C (19.11 ± 0.65 MPa) were comparable (p > 0.05). Group 5 samples treated with PDT, MB-C (13.41±0.32 MPa) and group 6, MB-BA_c (12.97 ± 0.25 MPa) were also comparable (p > 0.05) CONCLUSION: BAc bonded to dentin after surface conditioning with ECL, EYL and PDT presented lower SBS in comparison to conventional cement C. Further studies are required to extrapolate the current findings.

Comparison of two curing protocols during adhesive cementation: can the step luting technique supersede the traditional one?

This study aims to compare the degree of conversion of two different curing protocols used during adhesive cementation. The following resin luting agents were tested: Hri Flow (MF) and pre-heated Hri Micerium (MH); light-cure Nexus Third Generation (NX3L) and dual-cure Nexus Third Generation (NX3D); dual cured RelyX Ultimate (RXU) and light-cure RelyX Veneers (RXL). For each tested material, ten samples were prepared and divided into two groups which had different curing protocols (P1 and P2): in P1, samples were cured for 40 s; in P2, samples were cured for 5 s, and then, after 20 s, cured again for additional 40 s. The degree of conversion (DC) was evaluated both during the first 5 min of the curing phase and after 1, 2, 7, 14 and 28 days (p = 0.05). Different trends were observed in DC values after 5 min by comparing P1 and P2. In both P1 and P2, DC decreased as follows, MH > MF > NX3L > RXL > RXU > NX3D. There were significant differences of DC values among all resin luting agents (p < 0.05) in P1, while no significant differences existed between MH and MF, and NX3L and RXL in P2. At 1, 2, 7, 14 and 28 days the light curing luting agents had a higher DC than the dual luting agents (p < 0.05). P1 and P2 were not statistically different at each time point (p > 0.05). Both P1 and P2 protocols let achieve an acceptable DC after 28 days. The tested P2 can be safely used to lute indirect restorations, simplifying the removal of cement excesses.

Effect of Tack Cure on Polymerization Shrinkage of Resin-based Luting Cements

CLINICAL RELEVANCE

Self-cure after tack cure could result in a lower polymerization shrinkage in some resin-based luting cements, which is closely related to lower degree of cure.

SUMMARY

The Effect of Viscosity and Application Mode of Phosphoric Acid on Bond Strength of GlassFiber Post

Background

When a phosphoric acid is used, before applying an adhesive system, it is known that obtaining an effective adhesion to the root canal walls is a challenge. The aim of the present study was to evaluate the influence of phosphoric acid viscosity and application mode on the push-out bond strength (BS) values of fiberglass post to root dentin. The conditioning pattern on the root dentin was also evaluated.

Materials and Methods

The roots of 44 endodontically treated premolars were divided into 4 groups, of eleven teeth each, according to the combination of the main factors: phosphoric acid viscosity (liquid or gel) and application mode (passive or sonic). After application of the two-step etch-and-rinse adhesive system, the fiberglass posts were cemented with a dual-cure resin-cement. Roots were sectioned transversely into six 1-mm slices for push-out BS test at 0.5 mm/min. Some roots of each group were selected for evaluation of the conditioning pattern by scanning electron microscopy. BS results (three-way ANOVA and Tukey’s test) and the conditioning pattern (Kruskal–Wallis test and Mann–Whitney test) were statistically evaluated (α= 0.05).

Results

The highest BS value was observed with a liquid phosphoric acid under sonic application mode (p < 0.05), being all other groups similar to one another (p < 0.05). Also, the highest BS value was observed in the cervical third, followed by the medium and the apical thirds (p < 0.05). The sonic application produced better smear layer removal and opening of dentinal tubules for both viscosities (p = 0.015).

Conclusion

A better bonding of fiberglass posts to root canals can be achieved when the post spaces are conditioned with a liquid phosphoric acid under sonic application.

Yttria-stabilized tetragonal zirconia polycrystal/resin luting agent bond strength: Influence of Titanium dioxide nanotubes addition in both materials

PURPOSE

To evaluate the shear bond strength (SBS) between Y-TZP and a resin luting agent, after 1 of 2 enhancing strategies with TiO_2--nts was applied, either to the resin luting agent or the Y-TZP mass, in different concentrations.

METHODS

In the Strategy TiO₂-nts on ceramic, the resin luting agent Panavia F2.0™ (Kuraray) and an experimental Y-TZP with added concentrations of TiO_2--nts (0%, 1%, 2%, and 5% vol/vol) and a commercial Y-TZP, comprised 5 different groups (n = 10). In the Strategy TiO₂-nts on cement, the resin luting agent RelyX U200™ (3 M ESPE) was added with different concentrations of TiO_2--nts (0%, 0.3%, 0.6%, 0.9% wt/wt) luted to a commercial Y-TZP, comprising 4 different groups (n = 10). The Y-TZP discs were included in acrylic bases, and a cylinder (3 × 3 mm) of the correspondent luting agent for each respective group was applied over them. After 24 h, specimens were subjected to SBS assessments in a universal testing machine. Field emission scanning electron microscopy and energy dispersive X-ray spectroscopy analyses were also performed on Y-TZP surfaces. Data were analyzed via analysis of variance and Tukey tests (α = 0.05).

RESULTS

TiO₂-nts on ceramic influenced the bond strength significantly, but not linearly; TiO₂-nts on cement did not influence bond strength when analyzed separately, nor in comparison with the first.

CONCLUSION

Y-TZP enhancements with TiO₂-nts led to a higher SBS with Panavia F2.0, a 5% TiO_2--nt concentration presented the highest bond strength. Modified Rely X U200 did not improve SBS.

Influence of N-(2-hydroxyethyl)acrylamide addition in light- and dual-cured resin cements

OBJECTIVE

To develop experimental light-cured (L) and dual-cured (D) resin cements containing N-(2-hydroxyethyl)acrylamide and evaluate the physicochemical and optical properties.

METHODS

Experimental resin cements were formulated using bisphenol A-glycidyl dimethacrylate (70%) and 2-hydroxyethyl methacrylate (30%), in the control groups, and, bisphenol A-glycidyl dimethacrylate (70%) and N-(2-hydroxyethyl)acrylamide (30%). Polymerization kinetics were evaluated by differential scanning calorimetry (n = 3), softening in solvent (ΔKHN) evaluated by the difference of Knoop microhardness before (KHN₁) and after (KHN₂) ethanol solution immersion (n = 5), radiopacity in mmAl (n = 5), film thickness (n = 3) and color stability were evaluated. Mechanical properties as ultimate tensile strength (UTS) and micro-shear bond strength (μSBS) were analyzed immediately and after 6 months. Results were analyzed using ANOVA, Tukey's test and Student's t-test (α = 0.050).

RESULTS

The L_HEAA1 group had no statistical difference from the control group regarding polymerization kinetics, KHN₁, ΔKHN and color stability (p > 0.050). In dual-cured cements, the acrylamide groups presented a lower degree of conversion and higher ΔKHN than the D_HEMA0.6 group, which obtained a higher rate of polymerization (p < 0.050). There was no statistical difference in radiopacity and film thickness (p > 0.050). Dual-cured cements with N-(2-hydroxyethyl)acrylamide showed higher color change than methacrylates. Immediate mechanical properties were lower for acrylamide groups (p < 0.050), with higher hydrolytic stability.

CONCLUSIONS

The addition of N-(2-hydroxyethyl)acrylamide negatively affected the properties of the dual-cured resin cements. LHEAA1 did not differ in physicochemical and optical properties from the control, with higher hydrolytic stability.

CLINICAL SIGNIFICANCE

The results of the study indicate that acrylamides increased mechanical properties over time independently of the curing system mode, with more hydrolytic stability. The clinical performance of experimental resin cements should be evaluated.

Effects of Polymerization Mode and Interaction with Hydroxyapatite on the Rate of pH Neutralization, Mechanical Properties, and Depth of Cure in Self-Adhesive Cements

Objective The aim of the study was to evaluate the physicochemical properties of self-adhesive resin cements associated with hydroxyapatite (HAp) according to the polymerization activation.

Materials and Methods Specimens of cements (PermaCem 2.0 [DMG]; MaxCem Elite [Kerr], and RelyX U200 [3M ESPE]) were distributed into three groups: activation mode; self-cured and dual-cured modes; and association or not with HAp powder mode. The pH neutralization was evaluated as a function of time. Flexural strength and elastic modulus were also tested (0.5 mm/min.). The depth of cure was also analyzed using the scraping test (ISO 4049). Infrared spectroscopy was also used to collect the spectra of specimens to evaluate the chemical bonds. Statistical comparisons were conducted at 5% of significance.

Results The aggressiveness of the self-adhesive resin cements evaluated varied among the materials with a tendency for neutralization. Self-cure groups exhibited lower pH throughout the entire evaluation when compared with that of the dual-cure ones, irrespective of the addition of HAp. MaxCem Elite when photoactivated was the only cement influenced by the addition of the HAp in terms of mechanical properties. The self-adhesive cements tested presented equivalent depth of cure based on the ISO 4049 requirements, regardless of the evaluated factors.

Conclusions Based on the parameters evaluated, the results demonstrated that most of the self-adhesive cements remained unaltered or improved when mixed with HAp, regardless of the activation mode.

An auxiliary factor for increasing the retention of short abutments

BACKGROUND

Retention is an essential factor in the sustainability of the prosthesis, especially for short abutment. Despite, the availability of several auxiliary applications, achieving a clinically good retention for cast crowns in prepared short teeth remains a major challenge for the practicing dentist.

OBJECTIVES

This study tests a new method for applying frustum-shaped grooves on short prepared abutments and compares them with traditional setting grooves.

METHODS

Forty-eight copper machine-milled short dies with 3.5 mm length and 12o conversion with a chamfer finish line of 0.7 mm were prepared to mimic short prepared molars and distributed into 4 groups. A control group with two opposing setting grooves and two groups with dual opposing frustums, one of which was prepared to receive two integrated metal protrusions inside the casting that fit the frustums. Frustums were prepared with Komet bur No. 807 with dimensions 0.9 mm at the base and 0.7 mm at the occlusal surface. A direct wax-up was carried out on all dies and all castings were cemented with zinc phosphate cement. A pull-off test was applied until separation. Data were analysed to compare the correlation of the four groups using one-way ANOVA and Bonferroni test (p ≤ 0.05).

RESULTS

The mean retentive values in Newton were as follows: the control group, 457.80; the setting grooves group, 461.07; the frustum group, 597.59; and the frustum group with the two metal protrusions, 919.80. The retention was increased by 65% in frustum group and doubled in frustum group with the metal protrusions.

CONCLUSIONS

The results showed a statistical significance in retention in the frustum groups with and without metal protrusion over the retention of the control and the setting grooves groups.

Influence of the depth of intraradicular dentin on the pushout bond strength of resin materials

AIM

The aim of the present study was to evaluate the pushout bond strength between glass-fiber posts to different regions of intraradicular dentin with different materials for adhesive cementation.

METHODS

After endodontic filling, 40 teeth were divided into five groups according to adhesive cementation: Adper Single Bond 2 + RelyX ARC, Excite DSC + RelyX ARC (EXC), Adper SE Plus + RelyX ARC (SEP), RelyX Unicem, and Set. After the bonding process, roots were sectioned obtaining slices to be analyzed from each third. The bond strength was measured using the pushout test in a universal testing machine (Emic DL 3000) at a cross-head speed of .5 mm/minutes in different areas of the post space (cervical, middle, and apical). Data were subjected to analysis of variance and Fisher's test (α = .05).

RESULTS

The highest values for the pushout bond strength were found for the SEP group in all experimental conditions, without a significant difference for the EXC group in the middle and apical regions. There was a decrease in pushout bond strength in the cervical-apical direction for all groups, except the EXC group, which did not show a difference among the different regions.

CONCLUSIONS

The different interactions of the resin materials and the intraradicular depth influenced the bond strength of adhesives materials to dentin substrate.

Assessing the effect of ceramic additives on the physical, rheological and mechanical properties of conventional glass ionomer luting cement - An in-vitro study

Aim

To evaluate the effect of the addition of conventional ceramics on the physical, rheological and mechanical properties of conventional glass ionomer luting cement.

Materials and methods

5%, 10%, 15% and 20% (w/w) of Enamel and Body conventional ceramic additives (E44 Enamel and B96/c4 Body) were reinforced in the two commercially available glass ionomer luting cement – GC Fuji I (GC Corporation Tokyo, Japan) and Ketac Cem Radiopaque (3M ESPE AG). Setting time, film thickness and compressive strength of the cement was measured according to the American Dental Association Specification number 96 for luting cement. Enthalpy change of the cement reaction was measured with the help of Differential Scanning Calorimetry analysis. Compatibility between the sizes of powder particles was measured with the help of a particle size analyzer.

Results

5% of ceramic additive could not improve much of the compressive strength. Compressive strength increased significantly (p < 0.05) with the addition of 10% of ceramic additive, beyond which, there was a gradual decrease in strength. Although the setting time and film thickness were also shown to increase due to the additive, the former did not exceed the limit specified by the American Dental Association Specification number 96 (2–8 min for setting time and 25 microns for film thickness).

Conclusion

Addition of 10% of conventional ceramics resulted in a significant increase in the compressive strength of GIC Luting Cement without any significant compromise in its setting time. The substantial increase in film thickness is a major limitation. Use of ceramic additives with physical properties compatible with that of the glass ionomer cement may aid in increasing the compressive strength without compromising its setting time or film thickness.

Influence of the composition and shades of ceramics on light transmission and degree of conversion of dual-cured resin cements

Objective

Since the transmittance of ceramics can influence the degree of conversion (DC) of resin cements, ceramics composition and shade should be considered in the selection of resin cement. This in vitro study aimed to evaluate the effect of the transmittance of different composition, opacities and shades of ceramics on the degree of conversion of two dual-cured resin cements.

Methodology

Sixty discs were prepared from low translucency (LT) and medium opacity (MO) lithium disilicate ceramic, and zirconia ceramic (Z). Each group was subdivided into 5 subgroups (n=4) in shades A2, A3.5, B2, C2 and D3. The transmittance measurement was performed in a spectrophotometer. The Variolink II and Rely X U200 resin cements were photoactivated by LED (1400 mW/cm2) for 40 s through the ceramic discs and without the discs (control group). The DC was measured with infrared FTIR spectroscopy, immediately after light activation. Data were analyzed with Kruskall-Wallis and one-way ANOVA, following post-hoc comparisons by Tukey test and Pearson’s correlation test (P<0.05).

Results

LT ceramic exhibited higher transmittance values compared to MO and Z ceramics. LTA2 and LTB2 showed statistically higher transmittance values compared to MOA2, MOA3.5 and ZA3.5. For Variolink II, the ceramic interposition did not influence the DC, since there were no statistical differences between groups with ceramic interposition and the control group. For Rely X U200 cement, the interposition of some ceramics types/shades (LTA3.5, MOA2, MOA3.5 and ZA3.5) significantly decreased the DC values compared to control group. A positive correlation was found between the ceramic transmittance and DC values of both tested cements. Conclusions. The transmittance and DC values of the cements were influenced by composition and shades of the ceramics. The higher the transmittance of ceramics, the higher the DC values for both cements.

Fracture Resistance of Remaining Buccal Cusps in Maxillary Premolar Ceramic Onlay Restorations

Preparation designs for bondable partial coverage restorations are varied. As little as 1 mm of thickness of a remaining buccal cusp can be kept when restoring maxillary premolars with bondable partial coverage restorations.

What is the Best Available Luting Agent for Implant Prosthesis?

Cement-retention is a viable option in restoring dental implants. A wide range of dental cements with different properties are commercially available for use in the cementation of implant prostheses. The selection of a dental cement for proper clinical application can be challenging. This article overviews the commercially available dental cements used in cement-retained implant-supported prostheses. Guidelines for cement selection are presented according to abutment and prosthetic material. Cementation techniques to reduce excess cement in peri-implant tissues are also mentioned.

Evaluation of Dual-Cure Resin Cement Polymerization under Different Types and Thicknesses of Monolithic Zirconia

Purpose

The aim of the present study was to investigate the effects of the type and thickness of the zirconia material on the microhardness of the underlying dual-cure resin cement.

Materials and Methods

Eight disk-shaped zirconia specimens with a 4-mm diameter and four varying thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were fabricated from two different monolithic zirconia materials: posterior monolithic zirconia (Prettau) and anterior monolithic zirconia (Prettau Anterior). Dual-cure resin cement specimens with a 4-mm diameter and 5-mm height were prepared using Teflon cylinder molds and activated by light beneath the eight zirconia disks and without any zirconia disk for 20 s (n=12). A total of 108 specimens were embedded in acrylic. Vickers hardness of each specimen was measured at three different depths using a microhardness device with a 50-g load. All data were statistically evaluated using three-way ANOVA, one-way ANOVA, independent samples t-tests, and Bonferroni corrected post hoc tests (α=.05).

Results

Dual-cure resin cement's microhardness was significantly higher for the samples polymerized beneath anterior monolithic zirconia compared to posterior monolithic zirconia. The hardness decreased as the thickness increased for both types of zirconia; the latter was attributed to an attenuated curing efficiency.

Conclusion

Microhardness of the dual-cure resin cement is influenced by both the type and the thickness of the monolithic zirconia restoration. Polymerization efficiency for resin cement cured under anterior monolithic zirconia may be superior to cured beneath posterior monolithic zirconia.

Influence of Ambient Temperature and Light-curing Moment on Polymerization Shrinkage and Strength of Resin Composite Cements

Objective:

The purpose of this study was to establish a clinically appropriate light-curing moment for resin composite cements while achieving the highest indirect tensile strength and lowest polymerization shrinkage.

Methods and Materials:

Polymerization shrinkage of seven resin composite cements (Multilink Automix, Multilink Speed Cem, RelyX Ultimate, RelyX Unicem 2 Automix, Panavia V5, Panavia SA plus, VITA Adiva F-Cem) was measured at ambient temperatures of 23°C and 37°C. Testing was done for autopolymerized and light-cured specimens after light application at either 1, 5, or 10 minutes after mixing. Indirect tensile strength of all cements was measured after 24 hours of storage at temperatures of 23°C and 37°C, for autopolymerized and light-cured specimens after light application 1, 5, or 10 minutes after mixing. To illustrate filler size and microstructures, SEM images of all cements were captured. Statistical analysis was performed with one-way ANOVA followed by post hoc Fisher LSD test (α=0.05).

Results:

Final polymerization shrinkage of the resin composite cements ranged from 3.2% to 7.0%. An increase in temperature from 23°C to 37°C as well as the light-curing moment resulted in material dependent effects on the polymerization shrinkage and indirect tensile strength of the cements. Polymerization shrinkage of the cements did not correlate with the indirect tensile strength of the cement in the respective groups. Highest indirect tensile strengths were observed for the materials containing a homogeneous distribution of fillers with a size of about 1 μm (Multilink Automix, Panavia V5, VITA Adiva F-Cem).

Conclusion:

The magnitude of the effect of light-curing moment and temperature increase on polymerization shrinkage and indirect tensile strength of resin composite cements is material dependent and cannot be generalized.

Effect of Different Adhesive Strategies and Time on Microtensile Bond Strength of a CAD/CAM Composite to Dentin

PURPOSE

The aim of this study was to evaluate the effect of adhesive strategy and time on the microtensile bond strength of a computer-aided design/computer-aided manufacturing (CAD/CAM) composite to dentin.

METHODS AND MATERIALS

Sixty CAD/CAM composite blocks were bonded to human dentin with simplified bonding agents using etch-and-rinse and self-etching approaches and amine-based and amine-free resin cements, with and without the application of a dual-cure activator (DCA; n=10): SBP-ARC (Adper Single Bond Plus + RelyX ARC), SBP-RXU (Adper Single Bond Plus + RelyX Ultimate), SBP-DCA-RXU (Adper Single Bond Plus + DCA + RelyX Ultimate), SBU-ARC (Scotchbond Universal + RelyX ARC), SBU-RXU (Scotchbond Universal + RelyX Ultimate), and SBU-DCA-ARC (Scotchbond Universal + DCA + RelyX ARC). Each specimen was light cured for 40 seconds under load and stored in distilled water at 37°C for seven days. Stick-shaped specimens (1.0 mm²) were obtained. Half of the specimens underwent microtensile bond strength testing, and the other half were subjected to the same tests after six months of storage. Failure mode was determined using an optical microscope (40×). The data were analyzed by a two-way analysis of variance followed by the Games-Howell test and Student t-test (preset alpha of 0.05).

RESULTS

After seven days, SBU-RXU presented the highest mean bond strength, statistically different from only SBU-ARC (p<0.05). Most of the groups exhibited a statistically significant reduction in bond strength after 6 months (p<0.05), except SBP-RXU and SBU-ARC (p>0.05).

CONCLUSION

The adhesive strategy, with different associations between adhesive systems and resin cements, as well as the use of a DCA, affected the bond strength of both amine-free and amine-based resin cements to a CAD/CAM composite.

Effect of Ceramic Interposition and Post-activation Times on Knoop Hardness of Different Shades of Resin Cement

The aim of this study was to evaluate Knoop hardness of different shades of a resin cement light-cured directly or through ceramic discs, measured 15 min or 24 h after light exposure, and at different depths. Specimens of a commercial resin cement (Variolink Veneer) in seven shades, were fabricated in an elastomeric mold, covered with a mylar strip, a 0.7 mm thick ceramic disc (IPS e.max Press) was placed and the cement was light-activated for 20 s using a blue LED (Radii-Cal). The cured resin cement specimens were transversely wet-flattened to their middle portion and microhardness (Knoop) values were recorded at 15 min after light exposure and after deionized water storage at 37 ºC for 24 h. Five indentations were made in the cross-sectional area at 100 and 700 μm depths from the top surface. Ten specimens were made for each test conditions. Data were submitted to ANOVA split-plot design (shade, post-cure time, mode of activation and depth), followed by Tukey post hoc test (α=0.05). Significant differences for shade (p<0.0001), mode of activation (p<0.001), post-cure time (p<0.0001) and depth (p<0.0001) were detected. No significant interactions (p>0.05) were found, except for shade x post-cure time (p<0.0045) and mode of activation x post-cure time (p<0.0003). Resin cement shade has a significant effect on Knoop hardness. Indirect activation through a ceramic material reduced significantly Knoop hardness. Hardness Knoop significantly increased after 24 h in all cements shades compared to values obtained after 15 min. Resin cement depth significantly reduced Knoop hardness.

In Vitro Fracture Strength of Teeth Restored with Lithium Disilicate Onlays with and without Fiber Post Build-Up

To our knowledge there is no data about the mechanical performance of indirect restoration adhesively cemented on teeth without an adequate build-up to provide the correct geometrical configuration. The aim of this study was to compare the fracture strength of human teeth restored with lithium disilicate onlays, with and without fiber post build-up.

METHODS

Twenty human mandibular molars were horizontally sectioned and divided into two groups (n = 10). No treatment was applied in group A. Teeth in group B were endodontically treated, built-up using fiber post and composite core and prepared with a circumferential chamfer providing a 1 mm circumferential ferrule. Lithium disilicate onlays were pressed and luted on teeth using dual-curing luting composite. Teeth were tested under static load. Failures were classified as restorable or not restorable. Failure loads were analyzed with one-way analysis of variance. Failure modes were compared using Pearson's Chi-square tests.

RESULTS

The mean fracture loads were 1383.5 N for group A and 1286.3 N for group B. No difference was found (p = 0.6). Ninety per cent of fractures were classified as not restorable in both groups, with no difference (p = 0.8).

CONCLUSIONS

For teeth restored with adhesive procedures and lithium disilicate onlays, the presence of build-up with fiber post to provide retention and resistance form does not influence the fracture strength.

Dental Cements for Luting and Bonding Restorations: Self-Adhesive Resin Cements

Self-adhesive resin cements combine easy application of conventional luting materials with improved mechanical properties and bonding capability of resin cements. The presence of functional acidic monomers, dual cure setting mechanism, and fillers capable of neutralizing the initial low pH of the cement are essential elements of the material and should be understood when selecting the ideal luting material for each clinical situation. This article addresses the most relevant aspects of self-adhesive resin cements and their potential impact on clinical performance. Although few clinical studies are available to establish solid clinical evidence, the information presented provides clinical guidance in the dynamic environment of material development.

Titanium dioxide nanotubes addition to self-adhesive resin cement: Effect on physical and biological properties

OBJECTIVES

This study has investigated the influence of Titanium dioxide nanotubes (TiO₂-nt) addition to self-adhesive resin cement on the degree of conversion, water sorption, and water solubility, mechanical and biological properties.

METHODS

A commercially available auto-adhesive resin cement (RelyX U200™, 3M ESPE) was reinforced with varying amounts of nanotubes (0.3, 0.6, 0.9wt%) and evaluated at different curing modes (self- and dual cure). The DC in different times (3, 6, 9, 12 and 15min), water sorption (Ws) and solubility (Sl), 3-point flexural strength (σf), elastic modulus (E), Knoop microhardness (H) and viability of NIH/3T3 fibroblasts were performed to characterize the resin cement.

RESULTS

Reinforced self-adhesive resin cement, regardless of concentration, increased the DC for the self- and dual-curing modes at all times studied. The concentration of the TiO₂-nt and the curing mode did not influence the Ws and Sl. Regarding σf, concentrations of both 0.3 and 0.9wt% for self-curing mode resulted in data similar to that of dual-curing unreinforced cement. The E increased with the addition of 0.9wt% for self-cure mode and H increased with 0.6 and 0.9wt% for both curing modes. Cytotoxicity assays revealed that reinforced cements were biocompatible.

SIGNIFICANCE

TiO₂-nt reinforced self-adhesive resin cement are promising materials for use in indirect dental restorations. Taken together, self-adhesive resin cement reinforced with TiO₂-nt exhibited physicochemical and mechanical properties superior to those of unreinforced cements, without compromising their cellular viability.

Marginal Adaptation and Quality of Interfaces in Lithium Disilicate Crowns — Influence of Manufacturing and Cementation Techniques

Purpose: To evaluate the cement line thickness and the interface quality in milled or injected lithium disilicate ceramic restorations and their influence on marginal adaptation using different cement types and different adhesive cementation techniques.

Methods and Materials: Sixty-four bovine teeth were prepared for full crown restoration (7.0±0.5 mm in height, 8.0 mm in cervical diameter, and 4.2 mm in incisal diameter) and were divided into two groups: CAD/CAM automation technology, IPS e.max CAD (CAD), and isostatic injection by heat technology, IPS e.max Press (PRESS). RelyX ARC (ARC) and RelyX U200 resin cements were used as luting agents in two activation methods: initial self-activation and light pre-activation for one second (tack-cure). Next, the specimens were stored in distilled water at 23°C ± 2°C for 72 hours. The cement line thickness was measured in micrometers, and the interface quality received scores according to the characteristics and sealing aspects. The evaluations were performed with an optical microscope, and scanning electron microscope images were presented to demonstrate the various features found in the cement line. For the cement line thickness, data were analyzed with three-way analysis of variance (ANOVA) and the Games-Howell test (α=0.05). For the variable interface quality, the data were analyzed with the Mann-Whitney U-test, the Kruskal-Wallis test, and multiple comparisons nonparametric Dunn test (α=0.05).

Results: The ANOVA presented statistical differences among the ceramic restoration manufacturing methods as well as a significant interaction between the manufacturing methods and types of cement (p&lt;0.05). The U200 presented lower cement line thickness values when compared to the ARC with both cementation techniques (p&lt;0.05). With regard to the interface quality, the Mann-Whitney U-test and the Kruskal-Wallis test demonstrated statistical differences between the ceramic restoration manufacturing methods and cementation techniques. The PRESS ceramics obtained lower scores than did the CAD ceramics when using ARC cement (p&lt;0.05).

Conclusions: Milled restorations cemented with self-adhesive resin cement resulted in a thinner cement line that is statistically different from that of CAD or pressed ceramics cemented with resin cement with adhesive application. No difference between one-second tack-cure and self-activation was noted.

Blue-Light Transmittance of Esthetic Monolithic CAD/CAM Materials With Respect to Their Composition, Thickness, and Curing Conditions

Determining the amount of blue light (360-540nm) passing through nine monolithic computer-aided design/computer-aided manufacturing (CAD/CAM) materials depends on material thickness, initial irradiance, and the distance between the curing unit and the specimen's surface. A total of 180 specimens of two thicknesses (1 mm and 2 mm, n=10/subgroup) were fabricated from TelioCAD, VITA CAD-Temp (VCT), experimental nanocomposite, LAVA Ultimate (LU), VITA ENAMIC (VE), VITA MarkII (VM), IPS EmpressCAD (IEC), IPS e.maxCAD (IEM), and CELTRA DUO (CD). The irradiance passing through the CAD/CAM materials and thicknesses was measured using a light-emitting-diode curing unit with standard-power, high-power, and plasma modes by means of a USB4000 spectrometer. The curing unit was placed directly on the specimen's surface at 2- and 4-mm distances from the specimen's surface. Data were analyzed using a multivariate analysis and one-way analysis of variance with the post hoc Scheffé test (p&lt;0.05). The highest transmitted irradiance was measured for VM and LU, followed by VCT and IEC, while the lowest values showed VE, followed by IEM and CD. The highest transmitted irradiance was recorded by exposing the material to the plasma mode, followed by the high- and standard-power modes. The measured irradiance was decreased by increasing the specimen's thickness from 1 to 2 mm. Fewer differences were measured when the curing unit was placed at 0 or 2 mm from the specimen's surface, and the irradiance passing through the specimens was lower at a distance of 4 mm.

Comparison of immediate and delayed light-curing on nano-indentation creep and contraction stress of dual-cured resin cements

STATEMENT OF PROBLEM

Polymerization protocol of dual-cured resin cements plays a great role in the success of restorations. Knowledge about the effect of light-curing protocol on the contraction stress value and the mechanical properties would assist in the development, selection and handling of the resin cement material.

PURPOSE

This study was undertaken to assess the effects of two different light-curing protocols on the polymerization shrinkage stress and nano-creep of two current dual-cured resin cements.

MATERIALS AND METHODS

Twenty-four soda-lime glass disks, measuring 1mm in thickness, with a perforation in their center that measured 3mm in diameter, received four Vickers indentations at a distance of 500µ from the margin. The indent cracks were measured before and at 15-, 30- and 60-min intervals after restoration of the cavity with either CLEARFIL™ SA or RelyX™ Ultimate cement. Twelve specimens were prepared from each resin cement and divided into two groups according to the curing protocol used: immediate and delayed light-curing. Stresses at the indent impression were calculated by considering glass fracture toughness and the increase in crack length. Stress at the bonded interface was calculated using the Lame equation for thick-walled cylinder under an internal pressure. Nano-indentation hardness, modulus of elasticity and creep of each cement were measured under a 10-mN load for 20s holding time. The specimens were stored in distilled water at 37°C for 24h before the nano-indentation tests. Data were analyzed with two-way and repeated-measures ANOVA (α≤0.05).

RESULTS

Curing protocol had a significant effect on both resin cements; higher stress values were recorded with the immediate curing mode (P=0.033). Curing mode did not exert a significant effect on the modulus of elasticity (P=0.595) and hardness (P=0.454) of resin cements. However, in relation to creep, it exhibited significant effects (P<0.0001).

CONCLUSIONS

Immediate light-curing resulted in higher polymerization stress and lower nano-creep values compared to the delayed protocol with the resin cements assessed.

Comparative study of the radiopacity of resin cements used in aesthetic dentistry

PURPOSE

The aim of this study was to compare the radiopacity of 6 modern resin cements with that of human enamel and dentine using the Digora digital radiography system, to verify whether they meet the requirements of ANSI/ADA specification no. 27/1993 and the ISO 4049/2000 standard and assess whether their radiopacity is influenced by the thickness of the cement employed.

MATERIALS AND METHODS

Three 3-thickness samples (0.5, 1 and 1.5 mm) were fabricated for each material. The individual cement samples were radiographed on the CCD sensor next to the aluminium wedge and the tooth samples. Five radiographs were made of each sample and therefore five readings of radiographic density were taken for each thickness of the materials. The radiopacity was measured in pixels using Digora 2.6 software. The calibration curve obtained from the mean values of each step of the wedge made it possible to obtain the equivalent in mm of aluminium for each mm of the luting material.

RESULTS

With the exception of Variolink Veneer Medium Value 0, all the cements studied were more radiopaque than enamel and dentin (P<.05) and complied with the ISO and ANSI/ADA requirements (P<.001). The radiopacity of all the cements examined depended on their thickness: the thicker the material, the greater its radiopacity.

CONCLUSION

All materials except Variolink Veneer Medium Value 0 yielded radiopacity values that complied with the recommendations of the ISO and ANSI/ADA. Variolink Veneer Medium Value 0 showed less radiopacity than enamel and dentin.

Correlation between clinical performance and degree of conversion of resin cements: a literature review

Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used.