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

Degree of conversion of dual-cured composite luting agents: The effect of transition metal-based touch-cure activators

PURPOSE

The aim of the study was (a) to assess the effect of universal adhesives and tooth primers with novel touch-cure activators on the conversion of dual-cured resin composite luting agents (RLAs) polymerized under the self-curing mode, and (b) to investigate the source of the catalytic effect exerted by the activators.

MATERIALS AND METHODS

The materials selected were the adhesive RLAs Panavia V5/Tooth Primer (PV5/TP5), Variolink Esthetic DC/Adhese Universal DC (VLE/ADC), and the self-adhesive RLAs GCem ONE/AE Primer (GCO/AEP), RelyX Universal/Scotchbond Universal Plus (RXU/SUP) and Panavia SA Universal/Clearfil Universal Bond Quick (PSU/CUQ), the later serving as a control with an aryl-sulfinate activator. Coronal dentin specimens were prepared (n = 5/material), treated with the corresponding primers/adhesives (non-irradiated) and covered with a 100 μm-thick RLA layer (SC+A group). Three specimen series were additionally prepared (n = 3 × 5/material): A self-cured without the primers/adhesives (SC group), a dual-cured (20 s irradiation) with the corresponding primers/adhesives (DC+A group) and a dual-cured without primers/adhesives (DC group). All specimens were stored for 15 min (37 °C/dark/60 %RH). After demolding the degree of C = C conversion (DC%, top RLA surfaces) was measured by ATR-FTIR spectroscopy. The primer/adhesive liquids were further analyzed by ICP-MS and the microbrush tips of ADC by SEM-EDS.

RESULTS

The touch-cure activators increased the DC% in all self-cured RLAs but failed to reach the values of the corresponding dual-cured RLAs. The effect of the activators in dual-cured specimens was negligible. The ICP-MS analysis showed the presence of V (AEP, TP5, ADC) and Cu (SUP) transitional metals in the activators, with V been located at the free ends of ADC tip bristles. The V activators demonstrated the highest DC% improvement in self-cured specimens.

CONCLUSION

The new touch-cure activators significantly increased the conversion of the self-cured RLAs. Therefore, this step should be considered as universally applicable and not selective, as currently proposed for the self-adhesive luting agents by the manufacturers.

Residual stresses in glass crowns generated by polymerization and water sorption of resin cements

This study investigated residual stresses in glass crowns cemented with resin cements. Glass caps were cemented to cylindrical cores using a conventional resin composite cement, a self-adhesive resin cement, or a methyl methacrylate (MMA)-based cement in dual-cure or self-cure mode. The cemented caps were stored in 37°C water for 28 days, and stresses on the cap surface were repeatedly measured. The water sorption, water solubility, and elastic modulus of the cements were also measured. Polymerization of the cements initially generated compressive stresses on the surfaces. Dual-curing or a greater modulus yielded greater initial stress. The stresses gradually decreased over time and lingered on the surfaces at 28 days with all the cements. Greater sorption tended to lead to greater stress reduction; however, the MMA-based cement exhibited less stress reduction despite exhibiting the greatest sorption. The use of a resin composite cement or dual-curing is recommended to reinforce crown restorations.

Effects of a relined fiberglass post with conventional and self-adhesive resin cement

Objectives

This study was conducted to evaluate the mechanical properties of relined and non-relined fiberglass posts when cemented to root canal dentin using a conventional dual-cure resin cement or a self-adhesive resin cement.

Materials and Methods

Two types of resin cements were utilized: conventional and self-adhesive. Additionally, 2 cementation protocols were employed, involving relined and non-relined fiberglass posts. In total, 72 bovine incisors were cemented and subjected to push-out bond strength testing (n = 10) followed by failure mode analysis. The cross-sectional microhardness (n = 5) was assessed along the root canal, and interface analyses (n = 3) were conducted using scanning electron microscopy (SEM). Data from the push-out bond strength and cross-sectional microhardness tests were analyzed via 3-way analysis of variance and the Bonferroni post-hoc test (α = 0.05).

Results

For non-relined fiberglass posts, conventional resin cement exhibited higher push-out bond strength than self-adhesive cement. Relined fiberglass posts yielded comparable results between the resin cements. Type II failure was the most common failure mode for both resin cements, regardless of cementation protocol. The use of relined fiberglass posts improved the cross-sectional microhardness values for both cements. SEM images revealed voids and bubbles in the incisors with non-relined fiberglass posts.

Conclusions

Mechanical properties were impacted by the cementation protocol. Relined fiberglass posts presented the highest push-out bond strength and cross-sectional microhardness values, regardless of the resin cement used (conventional dual-cure or self-adhesive). Conversely, for non-relined fiberglass posts, the conventional dual-cure resin cement yielded superior results to the self-adhesive resin cement.

Effect of filler contents on the bond strength of CAD/CAM resin crowns: New resin primer versus conventional silane agents

Purpose This study aims to evaluate the effects of resin primers containing methyl methacrylate (MMA) and silane agent on the bonding effectiveness of indirect resin composite blocks with three different filler contents.Methods A commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite block and two experimental resin composite blocks with different filler contents were alumina-blasted and two surface treatments (primer and silane agent) were applied. The resin cement was built up, and the micro-tensile bond strength (μTBS) was measured after 24 hours, 1 month or 3 months of water storage (n = 24 per group). The fracture surfaces after μTBS measurements and resin block/cement interface were observed by scanning electron microscopy (SEM).Results The primer treatment group showed a significantly higher bond strength than the silane group only in F0 (filler content 0 wt%) group (P < 0.001). In the primer group, F0 and F41 (filler content 41 wt%) groups showed significantly higher bond strengths than F82 (filler content 82 wt%) group (P < 0.001). In contrast, in the silane group, F41 group showed significantly higher bond strength than F0 and F82 groups (P < 0.001), and F82 group showed significantly higher bond strength than F0 group (P < 0.001). SEM revealed that the matrix resin was partially destroyed on the fracture surface of the primer group, and an uneven interface surface was observed compared with that of the silane group.Conclusions MMA-containing primers showed higher bonding effectiveness to CAD/CAM resin composite blocks than the silane treatment.

Effect of preheating on the viscosity of composite resins

Aim

To determine the effects of time and temperature on the viscosity of preheated composite resins.

Materials and Methods

Eleven composite resins were heated to 60°C, and temperature analyses were performed at intervals of 1 min until they had cooled to 25°C. The permanent oscillatory shear test was performed at 25°C, 35°C, 50°C, and 60°C for three composite resins under a shear rate of 1s-1. One- and two-way analysis of variance were used for the analysis (α = 0.05).

Results

There was no significant interaction between the composite resin and time (P = 0.9304), and only the main effect time was significantly different (P < 0.0001). A difference was observed between T0 and T6 (P < 0.001), but not after T7. The increase in temperature resulted in a viscosity reduction (P < 0.05). At 25°C, Beautifil II presented higher viscosity. Palfique LX5 showed a significant viscosity reduction with increasing temperature compared with the others (P < 0.05). For Beautifil II and Z100, there was no difference at temperatures of 50°C and 60°C, while for Palfique LX5, no statistical difference was observed at 35°C, 50°C, and 60°C.

Conclusions

Ten minutes of preheating were sufficient to reach a temperature of 60°C, reducing viscosity by at least 84%. However, 5 min after removal, the composite resin cooled to room temperature.

Clinical Significance

Preheating composite resin has potential benefits. To determine how this approach will work in clinical practice, it is important to define the effects of time and temperature in the protocol of this technique and understand its limitations.

Analysis of subgingival microbiota and IL-1β, TNF-α and CX3CL1 levels in gingival crevicular fluid of fixed dental prostheses

Prosthetic biomaterials can affect the composition of the subgingival microbiota and consequently the production of proinflammatory cytokines, causing damage to the periodontium. A total of 40 patients were divided into two groups: 20 with monolithic zirconia (MZ) prostheses and 20 with porcelain fused to metal (PFM) with nickel-chromium (Ni-Cr) alloy prostheses. Subgingival plaque and gingival crevicular fluid samples were taken. The Checkerboard technique for DNA-DNA hybridization and the enzyme-linked immunosorbent assay technique were performed. Teeth with MZ presented a lower percentage of bleeding on probing and tooth mobility compared to teeth with PFM with Ni-Cr alloy. Prosthodontic teeth harbored higher total levels of the 18 bacterial species than non-prosthodontic teeth. There was a higher prevalence of S. gordonii and V. parvula species in PFM with Ni-Cr alloy compared to MZ. There was an increase in IL-1β, TNF-α and CX3CL1 levels in PFM with Ni-Cr alloy compared to MZ. MZ is a candidate biomaterial with fewer negative effects on the periodontium, allowing for longer prostheses longevity in the mouth.

Comparative Evaluation of Microtensile Bond Strength in Three Different Dentin Luting Agents: An In vitro Study

Aim

Long-term clinical success on indirect restorations is largely determined by bonding efficiency of the luting agent, with adhesion to dentin being the main challenge. Therefore, aim of this study was to assess the microtensile bond strength when using flowable resin composite, preheated resin composite and dual self-adhesive resin cement as dentin luting agents.

Materials and Methods

Occlusal thirds of molar teeth were cut and randomly divided into 3 groups to be cemented: RelyX™U200, Filtek™ Z250 XT- preheated to 70° and Filtek Flow™ Z350XT. They were then thermocycled 5000 times between 5+/-2°C and 55+/-2°C. Subsequently, 10 microbars per group were prepared. The 30 samples were placed in saline solution for 24 hours at room temperature prior to microtensile test. This was performed with a digital universal testing machine at a crosshead speed of 0.5 mm/min. The bond strength values obtained were analyzed in Megapascals (MPa). Measures of central tendency such mean and measures of dispersion such standard deviation were used. In addition, the Kruskall Wallis non-parametric test with Bonferroni post hoc test was applied, considering a significance value of 5% (P < 0.05), with type I error.

Results

The dentin microtensile bond strengths of preheated resin composite, flowable resin composite and dual self-adhesive cement were 6.08 ± 0.66 Mpa, 5.25 ± 2.60Mpa and 2.82 ± 1.26Mpa, respectively. In addition, the preheated resin composite exhibited significantly higher microtensile bond strength compared to the dual self-adhesive cement (P < 0.001). While the flowable resin composite showed no significant difference with the dual self-adhesive cement (P = 0.054) and the preheated resin composite (P = 0.329).

Conclusions

The microtensile bond strength in dentin was significantly higher when using a preheated resin composite at 70°C as a luting agent compared to dual self-adhesive cement. However, the preheated resin composite showed similar microtensile bond strength compared to the flowable resin composite.

Toothbrushing effects on the surface roughness and cement volume loss of bonded enamel-ceramic interface

This study evaluated the effect of toothbrushing on enamel-cementing material-ceramic bonded interfaces, using different cementing materials.

MATERIALS AND METHODS

Thirty enamel and thirty ceramic blocks were bonded with cementing materials to produce the samples that were bonded with three types of cementing materials: 1- RelyX Ultimate resin cement (REXU), 2- RelyX Unicem 2 self-adhesive resin cement (REU2) and 3- heated Z100 restorative composite (60°C). Bonded interfaces of the samples were toothbrushed and the surfaces of the 3 cementing materials were evaluated for roughness (RG, in µm), roughness profile (RP, in µm), and volume loss (VL, in µm3) (baseline and after 20,000 and 60,000 toothbrushing cycles). Data were evaluated by Generalized Linear Analysis (two factors: "material" and "toothbrushing cycle") and Bonferroni test (α=0.05).

RESULTS

REXU and Z100 exhibited lower RG than that presented by REU2, except after 60,000 toothbrushing cycles when only Z100 differed from REU2. The increase in toothbrushing cycles increased the RG and RP for all materials. REU2 also showed higher RP than those showed by REXU and Z100 when it was analyzed regarding the enamel. The VL of Z100 was the lowest with 20,000 toothbrushing cycles, regarding the enamel and ceramic. For 60,000 cycles, REXU showed the lowest VL regarding the ceramic, and REU2 had the highest VL regarding the enamel and ceramic.

CONCLUSION

In general, REXU and Z100 showed the best results regarding the evaluations performed and the REU2 exhibited the highest RG, RP, and VL.

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.

Fracture resistance of CAD/CAM blocks cemented on dentin using different cementation strategies

PURPOSE

To determine whether the fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin-based composites and polymer-infiltrated ceramic network materials cemented on dentin is influenced by the restoration thickness and composite cement application strategy.

METHODS

Disc-shaped specimens (Ø = 7 mm) of 0.8 mm and 1.5 mm thicknesses were milled from two CAD/CAM materials: resin-based composite (RBC, Cerasmart 270) and polymer-infiltrated ceramic network (PICN, Vita Enamic). The discs (n = 8 per group) were cemented on flattened dentin using three different cementation strategies: 1) self-adhesive composite cement (RelyX U200) in light-curing mode (LC-SAC), 2) universal adhesive (Single Bond Universal) with composite cement (RelyX Ultimate) in auto-curing mode (AC cement), and 3) adhesive and composite cement as in 2) but in light-curing mode (LC cement). The restorative surface was indented perpendicularly with a compressive load using a universal testing machine until fracture. The fracture resistance (N) of RBC and PICN was separately analyzed using two-way ANOVA and Tukey's post-hoc test (α = 0.05).

RESULTS

The fracture resistance of each material was significantly influenced by the material thickness and cementation strategy (P < 0.05). Irrespective of the material type and cementation strategy, thicker materials exhibit higher fracture resistance. For RBC, the fracture resistance of the LC cement group was significantly higher than that of AC cement only at 0.8 mm thickness. For PICN, the LC-cement cementation strategy produced superior fracture resistance, regardless of the restoration thickness.

CONCLUSIONS

The fracture resistance of Cerasmart 270 was higher for the thicker material; the fracture resistance of LC cement was higher than that of AC cement at 0.8 mm thickness cemented to dentin. In comparison, LC cement showed the highest fracture resistance for Vita Enamic for both material thicknesses.

Resin composite cements: Current status and a novel classification proposal

OBJECTIVES

Currently, a classification of resin cements that includes relatively recently formulated ("universal") cements is lacking. Furthermore, the terminology used to define different resin cements in the scientific reports is inconsistent. Accordingly, this work aims to: (i) propose a novel classification of resin composite cements; (ii) disambiguate the term "universal cements" and (iii) present an overview of the properties of these cements.

METHODS

An analysis of peer-reviewed literature (PubMed search), as well as market research on definitive resin composite cements were performed.

RESULTS

A tendency toward simplified and versatile luting materials was observed both in the scientific literature and on the dental market with the advent of self-adhesive/one-step resin cements. However, additional priming procedures were necessary to improve their bonding performance in certain clinical situations. Hence, several cements that can be applied both in adhesive and self-adhesive mode were introduced. These cements are associated with a universal adhesive resin, that can be used as a tooth and/or restorative material primer, without the need for other priming systems, regardless of the substrate. These systems should be considered truly universal. Therefore, we hereby suggested a new classification of resin-based cements: (1) adhesive/multi-step; (2) self-adhesive/one-step; (3) universal cements (one- or multi-step). Despite promising in vitro results, clinical trials and long-track laboratory studies are necessary to confirm the reliability of the universal cements.

CONCLUSIONS

This review presented the current advances in the field of resin-based cements, which are reflected in the proposed classification. The term "universal cement" was disambiguated, which will help standardize the terminology used in published research.

CLINICAL SIGNIFICANCE

The classification of resin-based cements and a better understanding of the proper terminology will help standardize the terminology in published research, as well as improve the understanding of the clinical practitioners of the different indications and possible modalities of use of the available cements.

Effect of resin cement selection on fracture resistance of chairside CAD-CAM lithium disilicate crowns containing virgilite: A comparative in vitro study

STATEMENT OF PROBLEM

Studies on the fracture performance of a recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate ceramic containing virgilite with different cements are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the fracture resistance of crowns made of a recently introduced chairside CAD-CAM lithium disilicate containing virgilite cemented with different types of adhesive luting cement.

MATERIAL AND METHODS

Sixty complete coverage crowns for a maxillary right central incisor were milled out of a lithium disilicate with virgilite (CEREC Tessera) (n=48) and a traditional lithium disilicate (e.max CAD) (n=12) using a chairside CAD-CAM system (Primescan). The central incisor tooth preparation included a 1.5-mm incisal reduction, a 1.0-mm axial reduction, and a 1.0-mm chamfer finish line. The restorations were bonded with different types of resin cement to 3D printed dies of the tooth preparation and were divided into 5 groups (n=12 per group): e.max CAD with Multilink Automix (E.Mu); Tessera with Multilink Automix (T.Mu); Tessera with Calibra (T.Ca); Tessera with Unicem (T.Un); and Tessera with Speedcem (T.Sp). The cemented restorations were stored in water for 30 days and then loaded until they were fractured in compression. The load at fracture was analyzed with a 1-way analysis of variance (ANOVA) and the honestly significant difference (HSD) Tukey test (α=.05).

RESULTS

The mean fracture resistance of traditional lithium disilicate and virgilite lithium disilicate anterior crowns significantly differed depending on the type of resin cement used (P<.05). Group E.Mu displayed the highest values (946.35 ±155 N), followed by group T.Un (819.59 ±232 N), group T.Sp (675.52 ±153 N), and group T.Mu (656.95 ±193 N). The lowest values were displayed by group T.Ca (567.94 ±184 N).

CONCLUSIONS

The fracture resistance of lithium disilicate containing virgilite and traditional lithium disilicate crowns cemented with the same cement displayed statistically similar values. However, significant differences were observed when the virgilite lithium disilicate crowns were cemented with different types of adhesive luting cement. The crowns in the T.Ca group displayed the lowest fracture resistance.

Fracture resistance of monolithic translucent zirconia crown bonded with different self-adhesive resin cement: influence of MDP-containing zirconia primer after aging

OBJECTIVES

Successful ceramic restorations depend on the strong bonding with resin cement and even stress distribution. The aim of this study was to evaluate the impact of adding MDP-containing zirconia primer before self-adhesive resin cements with different functional acidic monomers on fracture resistance of monolithic zirconia crown.

MATERIALS AND METHODS

Eighty defect-free human maxillary premolars were divided according to the cement type and application of MDP-containing zirconia primer into eight groups (n = 10): Calibra Universal (C), Calibra Universal combined with zirconia primer (CZ), RelyX U200 (R), RelyXU200 combined with zirconia primer (RZ), Panavia SA Cement Plus (P), Panavia SA Cement Plus combined with zirconia primer (PZ), Multilink Speed (M), and Multilink Speed combined with zirconia primer (MZ). After teeth preparation and fabrication of zirconia crowns, each crown was bonded to its corresponding tooth. All specimens were subjected to 10,000 thermocycles between 5 and 55°C, followed by cyclic load (50 N) for 240,000 cycles. Each specimen was subjected to a static axial load until fracture using universal testing machine and the fracture load was recorded. The fracture mode studied and recorded. The fracture load results were analyzed using two-way ANOVA test (α = 0.05).

RESULTS

A significant interaction (P = 0.038) of combining MDP-containing zirconia primer and cement type on fracture resistance of monolithic zirconia crown was detected. The mean fracture load values of zirconia crown were significantly influenced by the combined application of the MDP-containing zirconia primer with Calibra Universal (P = 0.01), RelyX U200 (P < 0.001), and Multilink Speed (P = 0.038), while there was no significant difference with Panavia SA Cement Plus (P = 0.660). There was significant difference (F = 20.69, P < 0.001) between the mean fracture loads of groups with self-adhesive cements (C, R, P, and M groups). The highest fracture load was recorded with RZ group (2446.90 ± 126.72 N) while the lowest fracture load was recorded with C group (1623.18 ± 149.86 N).

CONCLUSIONS

The self-adhesive resin cement with different acidic functional monomer affects the fracture resistance of monolithic zirconia crown. Application of MDP-containing primer could improve the fracture resistance of monolithic zirconia crown with most self-adhesive cements. The application of an MDP-containing primer had no impact on the fracture resistance of monolithic translucent zirconia crown bonded by MDP-containing self-adhesive resin cement.

Effect of Photo-polymerization Delay on the Bond Strength and Microhardness of Dual-polymerizing Resin Cements

STATEMENT OF PROBLEM

To fully maximize the potential of dual-polymerizing resin cements, a thorough understanding of how the light- and chemical-polymerizing components interact in a resin system is required. Disorder in the polymerization process between the two components may hurt one of the components versus the other, affecting the overall properties and performance of the resin cements.

PURPOSE

Evaluate photo-polymerization delay time on dentin shear-bond strength and Vickers microhardness of dual-polymerizing resin cements.

METHODS AND MATERIALS

Shear bond strength (SBS) of self-adhesive (RelyX Unicem 2, 3M ESPE) and adhesive (RelyX Ultimate, 3M ESPE) dual-polymerizing resin cements were evaluated. Dentin specimens (n=80) were prepared for the SBS test according to ISO standard 29022:2013. Teeth were randomly allocated into eight groups based on the type of cement, and photo-polymerization delay times (0, 2, 5, and 10 minutes). Vickers microhardness test (HV) was performed following ASTM E384-17 (n=32) prepared based on cement type and photo-polymerization delay times; specimens were tested after 24 hours of storage. Statistical analysis was performed using two-way ANOVA to determine the individual and combined effects of resin cement type and photo-polymerization delay time on SBS and HV.

RESULTS

Resin cement and photo-polymerization delay times for the adhesive cement at 0- and 2-minute pairings had significantly higher SBS means than all other combinations (p<0.0001). Resin cement type was also statistically significant (p<0.0001). Resin cement type and photo-polymerization delay times were not significant (p=0.3550) for HV.

CONCLUSIONS

Photo-polymerization delay time affected dentin SBS with higher bond strength when photo-polymerization delay time was performed between 2 and 5 minutes with a self-adhesive resin cement, and between 0 and 2 minutes with an adhesive resin cement. Delaying photo-polymerization time to 10 minutes led to inferior dentin SBS and HV for both self-adhesive and adhesive dual-polymerizing resin cements.

Effect of the type of resin cement on the fracture resistance of chairside CAD-CAM materials after aging

PURPOSE

The study objective was to evaluate the influence of the type of resin cement on the flexural strength and load to fracture of two chairside CAD-CAM materials after aging.

MATERIALS AND METHODS

A polymer-infiltrated ceramic network (PICN) and a nanoceramic resin (RNC) were used to produce the specimens. Two types of dual-cure resin cements, a self-adhesive and a universal, were investigated. Bilayer specimens were produced (n = 10) and aged for 6 months in a humid environment before the biaxial flexural strength test (σ_f). Bonded specimens were subjected to a mechanical aging protocol (50 N, 2 Hz, 37℃ water, 500,000 cycles) before the compressive load test (L_f). σ_f and L_f data were analyzed using two-way ANOVA and Tukey tests (α = .05). Chi-square test was used to analyze the relationship between failure mode and experimental group (α = .05).

RESULTS

The type of resin cement and the interaction between factors had no effect on the σ_f and L_f of the specimens, while the type of restorative material was significant. RNC had higher σ_f and L_f than PICN. There was a significant association among the type of cracks identified for specimens tested in L_f and the restorative material.

CONCLUSION

The type of resin cement had no effect on the flexural strength and load to fracture of the two investigated CAD-CAM chairside materials after aging.

Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics

BACKGROUND

Enhancement of students' knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students' and interns' basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections.

MATERIALS AND METHODS

A cross-sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019-June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi-square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%.

RESULTS

The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri-angles, cotton rolls and saliva ejectors. Dual-cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement-retained implant-supported restorations.

CONCLUSIONS

Students' knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.

Effectiveness of Self-Adhesive Resin Luting Cement in CAD-CAM Blocks-A Systematic Review and Meta-Analysis

Self-adhesive resin cements (SARCs) are used because of their mechanical properties, ease of cementation protocols, and lack of requirements for acid conditioning or adhesive systems. SARCs are generally dual-cured, photoactivated, and self-cured, with a slight increase in acidic pH, allowing self-adhesiveness and increasing resistance to hydrolysis. This systematic review assessed the adhesive strength of SARC systems luted to different substrates and computer-aided design and manufacturing (CAD/CAM) ceramic blocks. The PubMed/MedLine and Science Direct databases were searched using the Boolean formula [((dental or tooth) AND (self-adhesive) AND (luting or cement) AND CAD-CAM) NOT (endodontics or implants)]. Of the 199 articles obtained, 31 were selected for the quality assessment. Lava Ultimate (resin matrix filled with nanoceramic) and Vita Enamic (polymer-infiltrated ceramic) blocks were the most tested. Rely X Unicem 2 was the most tested resin cement, followed by Rely X Unicem > Ultimate > U200, and μTBS was the test most used. The meta-analysis confirmed the substrate-dependent adhesive strength of SARCs, with significant differences between them and between SARCs and conventional resin-based adhesive cement (α < 0.05). SARCs are promising. However, one must be aware of the differences in the adhesive strengths. An appropriate combination of materials must be considered to improve the durability and stability of restorations.

Antibacterial and physical properties of resin cements containing MgO nanoparticles

Cariogenic bacteria and dental plaque biofilm at prosthesis margins are considered a primary risk factor for failed restorations. Resin cement containing antibacterial agents can be beneficial in controlling bacteria and biofilm. This work aimed to evaluate the impact of incorporating magnesium oxide nanoparticles (MgONPs) as an antibacterial filler into dual-cure resin cement on bacteriostatic activity and physical properties, including mechanical, bonding, and physicochemical properties, as well as performance when subjected to a 5000-times thermocycling regimen. Experimental resin cements containing MgONPs of different mass fractions (0, 2.5%, 5%, 7.5% and 10%) were developed. Results suggested that the inclusion of MgONPs markedly improved the materials' bacteriostatic effect against Streptococcus mutans without compromising the physical properties when its addition reached 7.5 wt%. The mechanical properties of the specimens did not significantly decline after undergoing aging treatment, except for the flexural properties. In addition, the cements displayed good bonding performance and the material itself was not prone to cohesive fracture in the failure mode analysis. Furthermore, MgONPs possibly have played a role in decelerating material aging during thermocycling and enhancing bonding fastness in the early stage of cementation, which requires further investigation. Overall, developing MgONPs-doped resin cements can be a promising strategy to improve the material's performance in inhibiting cariogenic bacteria at restoration margins, in order to achieve a reduction in biofilm-associated secondary caries and a prolonged restoration lifespan.

Longevity of metal-ceramic single crowns cemented onto resin composite prosthetic cores with self-adhesive resin cement: an update of a prospective analysis with up to 106 months of follow-up

OBJECTIVES

To evaluate the longevity of metal-ceramic single crowns cemented onto resin composite prosthetic cores using a self-adhesive resin cement in a prospective clinical descriptive study.

METHODS

A total of 152 teeth were endodontically treated and received resin composite prosthetic cores and metal-ceramic crowns cemented with a self-adhesive resin cement. The patients included in the sample were recalled for clinical and radiography evaluation in an up-to-106-month period after the final cementation procedures, with an average of 62 months of follow-up. 91.5% of the sample (142 teeth) were evaluated regarding the treatment survival rate, analyzed considering the loss of crown retention (crown debonding) and tooth loss as the primary outcome. In addition, post debonding, and root fracture occurrences were also recorded as secondary outcomes to evaluate the success rate of the prosthetic treatment. The aesthetic parameters were also evaluated according to the FDI criteria. The Kaplan-Meier method and Cox regression with 95% confidence interval were applied for the statistical analysis.

RESULTS

Regarding the primary outcome, the metal-ceramic crowns cemented with self-adhesive resin cement presented a high survival rate (91.5%), with 8 crown debondings and 3 tooth losses (1 due to caries and 2 due to periodontal disease) occurring after the evaluation period. For secondary outcomes, 9 root fractures and 4 post debondings occurred, generating a success rate of 72%. All crowns had a score 1 on the FDI criteria, indicating that they were clinically excellent or very good regarding the aesthetic parameters.

CONCLUSION

The metal-ceramic crowns luted with a self-adhesive resin cement presented a survival rate of 91.5% after an average of 62 months of follow-up. Furthermore, the restorations remained aesthetically satisfactory over time, without changes that would indicate prosthetic retreatment. A success rate of 72% was obtained considering the secondary outcome, mainly related to intraradicular retainer failures (root fractures or post debonding).

CLINICAL SIGNIFICANCE

The self-adhesive resin cement is clinically indicated for cementation of metal-ceramic crowns onto resin composite prosthetic cores.

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.

In vitro evaluation of a silane containing self-adhesive resin luting agent

OBJECTIVES

To investigate the setting characteristics, wettability and bonding capacity with a lithium disilicate ceramic of a silane containing self-adhesive resin luting agent (Panavia SA Universal-PU).

METHODS

The degree of conversion (DC %) and extent of acid neutralization (SY %) of PU were measured on dual- (DC) and self-cured (SC) specimens after 10, 30 and 60 min storage by ATR-FTIR spectroscopy, whereas the presence of silanols was traced by curve-fitting the 60 min spectra, using the silane-free analog (Panavia SA Plus-PS) as a control. The role of a dedicated adhesive (Clearfil Universal Bond Quick-CU) in assisting the early DC % in PU-SC was investigated on 10 min-stored specimens. The water contact angles on polished and HF acid-etched lithium disilicate surfaces (IPS e.max Press), were assessed before and after silanization by unset PU or a silane primer (Ultradent Silane-SL). Finally, the shear strength of PU-DC specimens bonded to the acid-etched ceramic surfaces was determined before and after SL treatment.

RESULTS

The DC % was higher in DC than SC (PU, PS; all time intervals), in PU-SC than PS-SC (30, 60 min) and in the CU assisted PU-SC group. The SY % was lower in DC than SC (PU, PS) and higher in PS-SC than PU-SC groups. Silanols were found only in unset PU and PU-DC groups. SL treatment provided higher water contact angles on polished and acid-etched ceramic surfaces and higher shear bond strength on acid-etched ceramic surfaces than PU (p < 0.05 for all comparisons).

SIGNIFICANCE

Although the degree of conversion of the silane containing luting agent was improved in the self-curing mode, especially in the adhesive assisted group, it was still inferior to light-curing. Acid-neutralization and presence of silanols were affected by the setting modes. The use of a silane primer enhanced the hydrophobicity and bond strength of the silane containing luting agent with the etched ceramic substrate.

Incidence of endodontic therapy after complete or partial coverage glass-ceramic restorations with a follow-up time of over 30 years: A prospective clinical study

STATEMENT OF PROBLEM

Long-term clinical data are lacking on the comparison of the incidence of endodontic therapy in adhesively luted complete and partial coverage glass-ceramic restorations, as well as on the effect of technique and clinical variables.

PURPOSE

The purpose of this prospective clinical study was to assess the long-term incidence of teeth requiring endodontic therapy after receiving either complete or partial coverage glass-ceramic restorations.

MATERIAL AND METHODS

Participants requiring single anterior complete, posterior complete, or posterior partial (inlay or onlay) coverage restoration, or a combination of these on a vital tooth were recruited from a clinical private practice. Only the participants who chose glass-ceramic partial and complete coverage restorations without the need of endodontic therapy were included in the study. The overall clinical performance of these glass-ceramic restorations was assessed by clinical factors determined at recall. The effect of various clinical parameters (type of restoration, dental arch, tooth position in the dental arch, age and sex of participant, and ceramic thickness) was evaluated by using Kaplan-Meier survival curves to account for attrition bias and other reasons for failure. The statistical significance of differences between parameters was determined by using the log rank test (α=.05).

RESULTS

A total of 1800 participants requiring 4511 glass-ceramic anterior and posterior restorations were evaluated. The mean age of the participants at the time of restoration placement was 62 (range 20 to 99 years, 710 men and 1090 women). Of 4511 restorations, 1476 were anterior complete coverage, 2119 posterior complete coverage, and 916 posterior partial coverage. Endodontic therapy after restoration placement was needed for 76 restorations (10 anterior complete, 50 posterior complete, and 16 posterior partial). The total time at risk was 50 436 years providing an estimated need for endodontic therapy risk of 0.15% per year. The estimated 35-year cumulative survival was 97.36%. The majority of endodontic treatments (67%, 52/76) occurred in the first 5 years. The estimated cumulative survival of anterior complete coverage, posterior complete coverage, posterior partial inlay, and posterior partial onlay restorations was 98.89% (n=1476, 10 endodontic treatments), 96.38% (n=2119, 50 endodontic treatments), 96.78% (n=553, 11 endodontic treatments), and 98.53% (n=363, 5 endodontic treatments), respectively. Statistically significant differences occurred between anterior complete coverage, posterior complete coverage, and posterior partial coverage inlay restorations, with a higher incidence in posterior complete coverage and posterior partial inlay restorations (P<.05). First molars had the highest rate of endodontic therapy after restoration in both arches. Age and restoration thickness were significant factors, recording statistically higher number of endodontic treatments in participants >52 years and restorations with all surfaces ≥1 mm (P<.05). Other clinical variables, dental arch and sex of the participants, were not significantly related to endodontic treatments (P>.05).

CONCLUSIONS

The clinical performance of 4511 units over 30 years in service was excellent, with the estimated cumulative survival of 97.36%. Posterior complete coverage and posterior partial inlay restorations had a significantly higher need for endodontic therapy than anterior complete coverage restorations. Their overall clinical performance relative to endodontic treatment was excellent with a cumulative survival of 96.38% and 96.78% over 30 years. There was no difference in the endodontic treatment rate between posterior complete and partial coverage restorations. Thickness of the restoration affected the endodontic treatment rate, with ≥1 mm resulting in higher incidence. The age of the participants influenced the endodontic treatment rate, with higher incidence in the >52-year age group. Other confounding clinical variables did not have a significant effect on the endodontic treatment rate.

Update on Dental Luting Materials

A dental luting material aids in the retention and stability of indirect restorations on the prepared tooth structure. In dentistry, clinicians are using a wide range of luting materials for the cementation of indirect restorations. Zinc oxide eugenol and non-eugenol cements, zinc phosphate cement, zinc polycarboxylate cement, glass ionomer cement and resin cements are common dental cements used in dentistry. Each luting material or cement possesses unique properties and clinical implications. An ideal luting cement should be biocompatible, insoluble, resistant to thermal and chemical assaults, antibacterial, aesthetic, simple and easy to use. It should have high strength properties under tension, shear and compression to resist stress at the restoration-tooth interface, as well as adequate working and setting times. So far, no luting material possesses all of these properties of an ideal cement. Scientists have been modifying the conventional luting cements to improve the material's clinical performance and developing novel materials for clinical use. To achieve the best clinical outcome, clinicians should update their knowledge and gain a good understanding of the luting materials so that they can make a wise clinical decision on the material selection and obtain an insight into the development of luting cements. Therefore, the objective of this study is to provide a discussion on the physical, chemical, adhesive and aesthetic properties of common luting materials. The clinical indications of these luting materials are suggested based on their properties. In addition, overviews of the modification of the conventional luting materials and the newly developed luting materials are provided.

Internal and Marginal Adaptation of Adhesive Resin Cements Used for Luting Inlay Restorations: An In Vitro Micro-CT Study

Adequate internal adaptation and marginal sealing of resin luting cements are of particular importance for the success of cemented ceramic inlays. The purpose of this study was to investigate the initial adaptation of different resin cements at the tooth-inlay restoration interface at enamel versus dentin surfaces. Thirty-two extracted human molars were allocated to four groups. One Class II cavity was prepared in each tooth. In each group, half of the cavities’ gingival floors were on enamel while the other halves were on cementum. Lava Ultimate CAD/CAM inlays were luted to the cavities using the following adhesive systems: RelyX Unicem, RelyX Ultimate, eCement, and Variolink Esthetic DC. After staining teeth with silver nitrate solution, marginal and internal gap volumes were determined using micro-CT images. Statistical analyses were conducted by independent t test and one-way ANOVA followed by post hoc Tukey test (p < 0.05). The internal and marginal gap volume values were the highest for Variolink Esthetic DC at the dentin surface (0.629 ± 0.363) and (2.519 ± 1.007), respectively, and the lowest for RelyX Unicem at the enamel surface (0.005 ± 0.004) and (0.009 ± 0.003), respectively. The internal and marginal adaptation on the enamel surface for RelyX Unicem and RelyX Ultimate resin cements were comparable to each other and to eCement but significantly better than Variolink Esthetic DC cement. Regardless of the adhesive resin system used, adaptation on enamel is superior to that on dentin surfaces.

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement

Purpose

The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses.

Methods and Materials

This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe’s test. One-way ANOVA was also performed for comparison of the Vickers hardness results.

Results

Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p&lt;0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p&lt;0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p&lt;0.05).

Conclusion

Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

Retention of Manually or CAD/CAM-customized Fiberglass Posts Luted to Enlarged Root Canals with Different Resin Cements

The aim of this laboratory study was to evaluate the pull-out force of a prefabricated fiberglass post (PP), relined fiberglass post (RP), or milled fiberglass post (MP) luted with Multilink N (MN), RelyX Unicem 2 (RXU2) or RelyX Ultimate (RU) to enlarged root canals. The thickness of the resin cements and the presence of voids in the resin cement film were observed. The root canals of 90 bovine incisors were enlarged, endodontically treated, and randomly divided into 9 groups (n=10) according to the post type and resin cement. The specimens were scanned using micro-CT to analyze the thickness of the resin cement and the presence of voids. The specimens were submitted to mechanical cyclic loading (500,000 cycles at 50 N load) and subjected to pull-out force testing. Two-way ANOVA and Tukey's test analyzed the pull-out force and resin cement thickness data. Kruskal-Wallis and Bonferroni tests analyzed the void scores. The interaction between factors (post x resin cement) was significant (p=0.0001) for the pull-out force. Higher pull-out forces were obtained for RP and MP compared to PP. The post factor was significant (p=0.0001) for resin cement thickness, which was higher for PP (1054 μm), followed by MP (301 μm) and RP (194 μm). More void formation occurred for PP, being less for RP, differing significantly among the posts. Post customization (RP and MP) decreased resin cement thickness and void formation, favoring a higher pull-out force. Resin cements requiring an adhesive application (MN and RU) favored higher pull-out force than self-adhesive resin cement (RXU2).

Acid resistance of self-adhesive resin luting cements - changes in surface texture parameters and microhardness

OBJECTIVES

When consumed in excess, acidic foods and beverages can cause dental erosions leading to irreversible loss of tooth substance. In many cases, prosthetic rehabilitation of the damaged teeth is mandatory. The aim of this in vitro study was to investigate, for the first time on this scale, the resistance of various commonly used self-adhesive resin luting cements (Bifix SE, VOCO; G-Cem LinkAce, GC; RelyX Unicem, 3 M Oral Care; SpeedCEM Plus, Ivoclar ) against acidic media, and to find out whether they can withstand long-term exposure. These results were compared with an adhesive resin luting cement (Panavia V5, Kuraray) that functioned as reference gold standard. Furthermore we applied area roughness parameters for surface texture analysis in the present investigation, to highlight their advantages for investigations on the surface quality of resin luting cements.

METHODS

Six specimens with identical diameter (10 mm) and thickness (3 mm) were prepared from each self-adhesive and adhesive resin luting cement and forwarded to an incubation in various acidic media for a period of 232 h. Conductivity and pH-values of each acidic medium was analyzed for each material group prior (t 0) and after exposure (t 1). The specimens were examined for Vickers microhardness and surface quality. For the evaluation of surface roughness, the parameters Sa, Sdr, Spc Spk, Sk, and Svk were investigated by using different filtered surfaces (S-L; S-F) according to ISO 25 178. Statistical analysis was conducted at a significance level of α = 0.050.

RESULTS

For the evaluation of the acid resistance of self-adhesive resin luting cements investigations on conductivity and pH-value assessment of storage solution appear unsuitable, while the assessment of microhardness and surface analysis revealed valid data. It could be shown that changes in surface texture of the resin luting cements can be determinend in qualitative and quantitative manner. While the microhardness and surface quality of some resin luting cements hardly changed, others showed significantly reduced values in microhardness and changes in their surface quality (p < 0.001).

SIGNIFICANCE

The data of the current study emphasize the relevance of interactions between resin luting cements and acids and suggest further laboratory and clinical studies to elucidate its impact on the clinical performance of the materials investigated.

Degree of conversion of resin-cements (light-cured/dual-cured) under different thicknesses of vitreous ceramics: systematic review

PURPOSE

This systematic review synthesized and analyzed the scientific evidence on the degree of conversion (DC) obtained by Fourier-transform infrared spectroscopy (FTIR) of light-cured and dual-cured resinous cements, photopolymerized under different thicknesses of vitreous ceramics.

STUDY SELECTION

The study protocol of this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017069319). A comprehensive search (PubMed/MEDLINE, Scopus, EMBASE, and LILACS) was performed for papers including an in vitro design and indexed from January 2007 to December 2020 according to the study purposes. A quality appraisal (specific instrument) and descriptive analysis of the articles that met the inclusion criteria were conducted.

RESULTS

Nine included studies were analyzed. Two of them used feldspathic ceramics, six used lithium disilicate, and one used both (comparing different types and opacities of ceramics). Three studies found a higher DC in dual cements, while one did not find any significant differences, and five studies found a higher DC in light-cured resin cements. Light-cured cements showed a better DC in relation to dual-cured cements in vitreous ceramic restorations with thicknesses up to 2 mm.

CONCLUSION

According to the findings, the use of good photoactivation is the most relevant variable to achieve an adequate DC in light-cured and dual-cured resin cements. The use of vitreous ceramic restorations with a thickness of less than 2 mm (light-curing cements) shows a better DC. Standardized in vitro studies are required to generate accurate scientific evidence.

PEEK and fiberglass intra-radicular posts: influence of resin cement and mechanical cycling on push-out bond strength

OBJECTIVES

To evaluate the bond strength of four types of posts (pre-fabricated fiberglass post, fiberglass post anatomized with composite resin, milled fiberglass post, and milled polyetheretherketone (PEEK) post), and two types of resin cements (conventional and self-adhesive) by assessing immediate bond strength and post-mechanical aging at each root third.

MATERIALS AND METHODS

Bovine endodontically treated roots (16 groups, n = 8) were prepared and the posts were produced and luted; the specimens of aging groups were cycled (300,000 cycles under 50 N load at 1.2 Hz frequency); six slices of each root were obtained; push-out test was performed by using a universal testing machine (500 N load at 1 mm/min cross speed); fracture pattern was classified into five levels. The statistical analyses used were three-way ANOVA, Tukey's test (for bond strength), and Fisher's test (for fracture pattern) (α < 0.05).

RESULTS

Differences were found between the cements for posts (conventional: p < 0.001; self-adhesive: p = 0.002), whereas no difference was found for root region (p = 0.941; p = 0.056, respectively); analysis of each root showed significant differences for cements (p < 0.001), posts (p < 0.001), and mechanical cycling (p = 0.001); in terms of double interaction, differences were found for posts and mechanical cycling (p = 0.005); no other interactions were observed (double or triple); the fracture pattern showed difference between the groups for both cements.

CONCLUSIONS

Milled PEEK posts seem to be a good clinical option, but they require improvement of CAD-CAM technology and advances towards their adhesion.

CLINICAL RELEVANCE

Milled posts are promising and can reduce clinical time for rehabilitation of extensively destroyed teeth.

Comparison of the Mechanical Properties and Push-out Bond Strength of Self-adhesive and Conventional Resin Cements on Fiber Post Cementation

OBJECTIVES

The purpose of this study was to compare the mechanical properties and push-out bond strength of self-adhesive resin cements (SACs) and a conventional resin cement (CRC).

METHODS AND MATERIALS

Eighty bovine incisors were divided into four groups for cementation of a fiberglass post (Whitepost - FGM Dental Group, Coral Springs, FL) with different resin cements: three SACs (Maxcem Elite, MAX - Kerr; Calibra Universal, CAL - Dentsply; and RelyX Unicem 2, RUN - 3M Oral Care) and one CRC (RelyX Ultimate, RXU - 3M Oral Care). The groups were subdivided into two groups each (n=10) for evaluation of the push-out bond strength test (POBS) after 24 hours of water storage or after thermal aging (5000 cycles), following 24 hours of storage. The failure modes were evaluated using a stereomicroscope. Flexural strength (FS) and modulus of elasticity (EM) were determined using a three-point bending. Also, pH of the cements was measured over 48 hours and filler morphology was observed by scanning electron microscopy. Appropriate statistical analyses were performed by SPSS 21.0 (SPSS Inc., Chicago, IL, USA), with a significance level set at 5%. Results: RXU presented the highest POBS at both evaluation times. Among the SACs, RUN and CAL presented significantly lower POBS than MAX in cervical and middle-thirds at the 24-hour evaluation, and in all root regions after thermocycling. Adhesive failure between the cement and dentin were the most prevalent fractures at both times evaluated. MAX presented the lowest FS and RUN showed the highest EM. The pH reached the minimal point at the 30-minute evaluation for RXU and MAX. For RUN and CAL, the minimal pH was observed at the 60-minute evaluation. RXU and RUN presented spherical and regular filler particles, while MAX and CAL presented irregularly shaped and sized filler particles.

CONCLUSIONS

The mechanical behavior of SACs is not superior to CRC; however, among all the SACs evaluated, MAX presented the highest POBS and stability after thermocycling evaluation. MAX also reached the closest neutral pH after 48 hours. Therefore, SACs with low initial pH and strong neutralization reactions are recommended, because these characteristics may lead to better mechanical properties and stability.

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.

A systematic review and meta-analysis on using preheated resin composites as luting agents for indirect restorations

OBJECTIVES

This systematic review investigated the hypothesis that preheated resin composites (RCs) used as luting agents improve the mechanical properties, physicochemical performance, and color of indirect ceramic restorations.

MATERIALS AND METHODS

Literature search was performed in three databases (Medline/PubMed, Scopus, and Web of Science) and in the grey literature (OpenGrey, ProQuest, and Catalog of Theses & Dissertations from CAPES). Eligibility criteria included only studies comparing at least one preheated RC used as a luting agent with resin cements.

RESULTS

Data regarding the mechanical properties, physicochemical characteristics, and color were analyzed qualitatively, and the microtensile bond strength and film thickness were also evaluated by meta-analysis. The search strategy identified 3894 papers, and 28 were full-text screened. Seven studies were included in the review, and 5 were included in the meta-analysis. No significant difference was found for microtensile bond strength (P = 0.14). Preheated RCs showed significantly higher film thickness than resin cements (P = 0.001).

CONCLUSION

Overall, the use of preheated RCs as luting agents offers similar to poorer performance than using resin cements for bonding indirect restorations.

CLINICAL RELEVANCE

Despite the claim that preheated RC could be used as a luting agent, further studies should investigate the effect of clinically unacceptable film thickness.

Final esthetic result of ceramic restorations cemented with different colors of cement

OBJECTIVE

The purpose of this study is to evaluate the color changes of lithium disilicate ceramics when cemented with different brands of cement by varying the thickness of the ceramic.

MATERIALS AND METHODS

Forty ceramic discs, shade A2, were fabricated with 0.5 and 0.8 mm thickness. Forty composite resin discs, shade A3, were also produced. The ceramic samples were cemented to the composite resin discs, with two colors of resin cement, Neutral and Warm. A spectrophotometer evaluation was made. Translucency and color change analysis was performed by calculating the ΔE. A two-way analysis of variance test and multiple comparisons were performed using the Bonferroni method with a 95% confidence interval.

RESULTS

There are statistically significant differences between the two ceramic thicknesses with different brands of cement (p < .001). In addition, using the translucency analysis it was found that there are statistically significant differences between the two ceramic thicknesses in both types of cement (p < .001).

CONCLUSIONS

The use of different cementation materials on lithium disilicate ceramics appears to have little visible influence at the clinical level. Different ceramic thicknesses have a clinically visible influence on the final restoration color.

Influence of inorganic composition and filler particle morphology on the mechanical properties of self-adhesive resin cements

Objectives

This study aimed to evaluate the influence of inorganic composition and filler particle morphology on the mechanical properties of different self-adhesive resin cements (SARCs).

Materials and Methods

Three SARCs including RelyX Unicem-2 (RUN), Maxcem Elite (MAX), and Calibra Universal (CAL) were tested. Rectangular bar-shaped specimens were prepared for flexural strength (FS) and flexural modulus (FM) and determined by a 3-point bending test. The Knoop microhardness (KHN) and top/bottom microhardness ratio (%KHN) were conducted on the top and bottom faces of disc-shaped samples. Sorption (Wsp) and solubility (Wsl) were evaluated after 24 hours of water immersion. Filler morphology was analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (EDS). FS, FM, %KHN, Wsp, Wsl, and EDS results were submitted to 1-way analysis of variance and Tukey’s post-hoc test, and KHN also to paired t-test (α = 0.05).

Results

SARC-CAL presented the highest FS value, and SARC-RUN presented the highest FM. SARC-MAX and RUN showed the lowest Wsp and Wsl values. KHN values decreased from top to bottom and the SARCs did not differ statistically. Also, all resin cements presented carbon, aluminum, and silica in their composition. SARC-MAX and RUN showed irregular and splintered particles while CAL presented small and regular size particles.

Conclusions

A higher mechanical strength can be achieved by a reduced spread in grit size and the filler morphology can influence the KHN, as well as photoinitiators in the composition. Wsp and Wsl can be correlated with ions diffusion of inorganic particles.

Effects of NanoAg-ACP Microparticles as Bioactive Fillers on the Mechanical and Remineralization Properties of Dental Resin Cement

PURPOSE

To investigate the potential of adding silver-nanoparticle-containing amorphous calcium phosphate microparticles as bioactive fillers into commercially available non-bioactive dental resin cement.

MATERIALS AND METHODS

Experimental cement was formulated by adding 7.5% silver-nanoparticle-containing amorphous calcium phosphate microparticles to Multilink Automix resin cement (Ivoclar Vivadent). The experimental cement was evaluated for shear bond strength (N=11 per group) and demineralization/remineralization (N=16 per group), with BioCem^® Universal BioActive cement (NuSmile) as the positive control and Multilink Automix cement as the negative control. One-way analysis of variance and post hoc tests were used to assess the significance of differences among or between the groups RESULTS: : The addition of silver-nanoparticle-containing amorphous calcium phosphate microparticles at the level of 7.5% by weight into Multilink Automix did not have a statistically significant effect on the shear bond strength (p>0.05), but statistically significantly increased the depth of remineralization on both dentin and enamel (p=0.01 and p<0.001, respectively.) when compared to Multilink Automix alone. The experimental cement prepared in the present study was comparable to BioCem^® on the depths of remineralization on both dentin and enamel (p=0.59 and p=0.99, respectively).

CONCLUSION

When incorporated into non-bioactive commercial dental resin cements as bioactive fillers at the level of 7.5% by weight, silver-nanoparticle-containing amorphous calcium phosphate microparticles could provide remineralization potential without affecting the shear bond strength. This article is protected by copyright. All rights reserved.

Shear bond strengths of two newly marketed self-adhesive resin cements to different substrates: A light and scanning electron microscopy evaluation

The purpose of this in vitro study was to compare the shear bond strengths (SBSs) of two newly marketed self-adhesive resin cements (RCs) to enamel, dentin, and lithium disilicate (LiSi) glass ceramic block. Forty-eight enamel and 48 dentin substrates were obtained from sound human molars. Additionally, 6 × 7 × 5 -mm- sized 24 specimens were produced from LiSi glass ceramic blocks. The tooth specimens were randomly assigned into four groups (n = 12) according to the surface treatments: (1) G-CEM ONE (GCO), (2) G-CEM ONE Adhesive Enhancing Primer (GCO-AEP) + GCO, (3) RelyX Universal (RXU), and (4) Scotchbond Universal Plus (SUP) + RXU. LiSi specimens were randomly divided into two groups (n = 12): (1) G-MultiPrimer (GMP) + GCO and (2) SUP + RXU. Following the RC applications, all specimens were kept in 100% humidity at 37°C for 24 hr and then submitted for SBS testing in a universal testing machine (1 mm/min). Data were analyzed by Welch's, one-way analysis of variance and two independent samples t tests. The nature of failures was examined under a light microscope, and scanning electron microscopy analyses were also performed for interfaces. GCO and RXU showed similar SBS to enamel (p > .05), and the use of adhesives resulted in improved SBS (p < .05). No difference was detected between GCO-AEP + GCO and SUP + RXU. The GCO-AEP + GCO exhibited the highest SBS to dentin (p < .05), followed by GCO ≥ SUP + RXU > RXU (p < .05). There was no significant difference between SBSs of two RCs to LiSi blocks (p > .05). No cohesive failure was determined for the tested groups by light microscope. The use of adhesives prior to the application of self-adhesive RCs improved their bonding to tooth tissues. GCO demonstrated superior SBS to dentin, whereas both self-adhesive RCs generated similar SBS to enamel and LiSi glass ceramic surfaces.

The effects of different silicatization and silanization protocols on the bond durability of resin cements to new high-translucent zirconia

OBJECTIVE

The aim of this study was to assess the influence of different silicatization protocols with various silane treatment methods on the bond performance to high-translucent zirconia.

MATERIALS AND METHODS

High-translucent zirconia specimens were assigned to five groups according to mechanical surface pretreatment: as-sintered (Con), 0.2 MPa alumina sandblasting (AB2), tribochemical silica coating (TSC), 0.2 and 0.4 MPa glass bead air abrasion (GB2) and (GB4). Each group was subjected to 4 different cementation protocols: Panavia SA Universal (SAU), Panavia SA plus (SAP), silane + SAP (S-SAP), and Universal adhesive + SAP (U-SAP). Tensile bond strength (TBS) was measured after 24 h and 10,000 thermocycling (TC). Surface topography, surface energy, and elemental composition of the abraded zirconia surface analyses were completed. TBS data was analyzed using the Weibull analysis method. Surface roughness and surface energy were compared by one-way ANOVA analysis of variance (α = 0.05).

RESULTS

After 24 h, higher TBS was achieved with all cementation protocols in AB2 and TSC, also, in GB2 with all protocols except U-SAP, and in GB4 with SAU and S-SAP. After aging, GB4/S-SAP, GB2/S-SAP, AB2/U-SAP, and TSC/S-SAP showed the highest bond strength. GB groups showed the lowest surface roughness and highest surface energy.

CONCLUSION

Glass bead abrasion achieved the durable bond strength to high-translucent zirconia using a separate silane coupling agent while altered surface chemistry, surface energy, and roughness without effect on morphology.

CLINICAL RELEVANCE

Glass bead air abrasion is an alternative to alumina sandblasting and tribochemical silica coating and improves bond strength to high translucent zirconia.

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.

Bonding Reactions of Dental Self-Adhesive Cements with Synthetic Hydroxyapatite as a Function of the Polymerization Protocol

Objectives

This study evaluated the influence of the cement composition and different polymerization protocols on the bonding chemical interaction of self-adhesive cements with synthetic hydroxyapatite.

Materials and Methods

Two commercial self-adhesive resin cements (RelyX U200 and Maxcem Elite) were selected, manipulated, mixed with hydroxyapatite dry powder (HAp), dispensed into molds, and distributed into three groups according to polymerization protocols: immediate photoactivation (IP); delayed photoactivation, 10 min self-curing and light-curing (DP); and chemical activation (CA, no light exposure). The detailed chemical information, at atomic scale, on the surface and deeper into the bulk of self-adhesive cement/hydroxyapatite mixtures was evaluated with X-ray photoelectron spectroscopy (XPS).

Results

Chemical elements were detected in both cements, such as Na, O, Ca, C, P, and Si. Other elements were detected in minor concentrations. RelyX U200 exhibited the most intense formation of calcium salts products when the cement/HAp mixtures were photoactivated (immediate or delayed). RelyX U200/HAp mixture under delayed photoactivation (DP) also exhibited higher binding energy between calcium moieties of the HAp and methacrylates in the cement. A higher energy difference in the interaction of HAp with the cement comparing the bulk and surface areas was observed when RelyX U200 underwent the delayed photoactivation protocol. Maxcem Elite exhibited an increased chemical reactivity when either chemically activated or immediately photoactivated and a higher binding energy of the carboxyl groups bonded to the calcium of HAp when chemically activated.

Conclusions

The interaction of cements with hydroxyapatite is chemical in nature and leads to the formation of calcium salts, which may favor better integrity and longevity of adhesive restorations. The polymerization protocol affects the chemical interaction in mixtures of self-adhesive cements and hydroxyapatite, influencing the formation of these salts and the establishment of intermolecular interactions between the HAp and the cements.

Effect of Er:YAG Laser and Reduced Time of Acid Etching on Bond Strength of Self-adhesive Resin Cement to MTA and Biodentine

Introduction: Considering the recent trend to use mineral trioxide aggregate (MTA) and Biodentine and resin cements, more conservative approaches concurrent with adequate bond strength have always been requested. The present study aimed to evaluate the effect of pretreatment with Er:YAG laser etching versus acid-etching for 5 and 15 seconds on the micro shear bond strength of self-adhesive resin cement (SRC) to MTA and Biodentine. Materials and Methods: Forty-eight samples of each cement (MTA and Biodentine) were prepared and distributed into four groups based on surface pretreatment: 1) control, no treatment; 2) Er:YAG laser etching with energy of 60 mJ; 3) 5-second acid-etching; 4) 15-second acid-etching. All specimens were cemented using SRC. Microshear bond strengths were tested following 24-hour water storage. Debonded specimens were examined and surface topography was assessed using an atomic force machine (AFM). Data analysis was performed using the two-way ANOVA and Tukey multiple comparisons test. Results: The three testing groups of laser etch and 5-s and 15-s acid-etch demonstrated a significantly higher SBS than the control group (P < 0.05) with negligible differences among them (P > 0.05). Furthermore, Biodentine showed better adhesive bonding than MTA in all groups. Conclusion: Laser etching of 60 mJ and 5-s acid-etching were as beneficial as 15-s acid-etching in terms of bond strength of SRC to MTA and Bodentine.

Characteristics of Dental Resin-Based Composites in Leukemia Saliva: An In Vitro Analysis

BACKGROUND

The aim was to analyze, in vitro, four resin based composite systems (RBCs) immersed in saliva of leukemia patients before starting chemotherapy regiments.

MATERIAL AND METHODS

Saliva was collected from 20 patients (4 healthy patients, 16 leukemia patients). Resin disks were made for each RBC and were immersed in the acute leukemia (acute lymphocytic (ALL), acute myeloid (AML)), chronic leukemia (chronic lymphocytic (CLL), chronic myeloid (CML)), Artificial saliva and Control environment, and maintained for seven days. At the end of the experiment, the characteristics and the effective response of saliva from the studied salivas' on RBCs was assessed using water sorption, water solubility, residual monomer and scanning electron microscopy (SEM). Data analysis was performed and a p-value under 0.05 was considered statistically significant.

RESULTS

The behaviour of RBCs in different immersion environments varies according to the characteristics of the RBCs. RBCs with a higher filler ratio have a lower water sorption. The solubility is also deteriorated by the types of organic matrix and filler; the results of solubility being inversely proportional on the scale of negative values compared to sorption values. Chromatograms of residual monomers showed the highest amount of unreacted monomers in ALL and AML, and the Control and artificial saliva environments had the smallest residual monomer peaks. Because of the low number of differences between the experimental conditions, we further considered that there were no important statistical differences between experimental conditions and analysed them as a single group.

CONCLUSION

The influence of saliva on RBCs depends on the type of leukemia; acute leukemia influenced the most RBCs by changing their properties compared to chronic leukemia.

Immediate and long-term microshear bond strength of resin-based cements to core build-up materials

Background

To evaluate the microshear bond strength (μ-SBS) between resin-based cements and core build-up materials after water storage.

Material and Methods

Cylinders (1x1 mm) of conventional dual-cure resin cement (RelyX ARC, 3M ESPE), universal dual-cure resin cement (RelyX Ultimate, 3M ESPE) or self-adhesive resin cement (RelyX U200, 3M ESPE) were adhered to disks (6x2 mm) made with commercial core build-up materials (Bis-Core, Bisco or LuxaCore Z, DMG) or conventional nanocomposite resin (Filtek Z350 XT, 3M ESPE). The specimens (n=10) were submitted to μ-SBS test using a universal testing machine and fracture pattern analysis at 48 hours or after 9 months of water storage. The data were evaluated by three-way ANOVA for repeated measures and Tukey’s test (α=0.05).

Results

After 48 hours, regardless of the resin-based cement used, the μ-SBS to the conventional resin composite (Filtek Z350 XT) was greater compared to other materials. However, after 9 months, there was a statistically significant decrease in μ-SBS values between the conventional resin composite and evaluated luting agents. The μ-SBS values of core build-up commercial materials (Bis-Core and LuxaCore Z) did not change over time. Regardless of the composite used and storage time, there was no statistically significant difference between the resin-based cements. After 48 h, the most prevalent failure was mixed for all groups. However, after 9 months, the core build-up materials showed a predominantly mixed fracture pattern whereas the resin composite presented an adhesive pattern.

Conclusions

Commercial core build-up materials achieved stable bonding performance with resin-based cements over time.

Key words:Composite resins, resin cement, dental restoration failure.

Application of Texture and Fractal Dimension Analysis to Evaluate Subgingival Cement Surfaces in Terms of Biocompatibility

Biocompatibility is defined as “the ability of a biomaterial, prosthesis, or medical device to perform with an appropriate host response in a specific application”. Biocompatibility is especially important for restorative dentists as they use materials that remain in close contact with living tissues for a long time. The research material involves six types of cement used frequently in the subgingival region: Ketac Fil Plus (3M ESPE, Germany), Riva Self Cure (SDI, Australia) (Glass Ionomer Cements), Breeze (Pentron Clinical, USA) (Resin-based Cement), Adhesor Carbofine (Pentron, Czech Republic), Harvard Polycarboxylat Cement (Harvard Dental, Great Britain) (Zinc polycarboxylate types of cement) and Agatos S (Chema-Elektromet, Poland) (Zinc Phosphate Cement). Texture and fractal dimension analysis was applied. An evaluation of cytotoxicity and cell adhesion was carried out. The fractal dimension of Breeze (Pentron Clinical, USA) differed in each of the tested types of cement. Adhesor Carbofine (Pentron, Czech Republic) cytotoxicity was rated 4 on a 0–4 scale. The Ketac Fil Plus (3M ESPE, Germany) and Riva Self Cure (SDI, Australia) cements showed the most favorable conditions for the adhesion of fibroblasts, despite statistically significant differences in the fractal dimension of their surfaces.

Influence of restorative material and cement on the stress distribution of endocrowns: 3D finite element analysis

Purpose

This study aimed to evaluate the influence of different types of restorative materials and resin cements on the stress distribution in the regions of the restoration, cement layer and dental remnant in endodontically treated posterior endocrowns.

Methods

A 3D finite element analysis (FEA) model of the first mandibular molar that was restored with an endocrown designed by computer-aided design (CAD) software was generated. Three kinds of restorative materials (Vita Enamic (VE), IPS e.max CAD (EMX) and Grandio blocs (GR)) and two types of cementing materials (NX3 and Maxcem Elite Chroma (MX)) were analysed with such a model. The food layer was also designed before vertical (600 N) forces were applied to simulate physiological masticatory conditions. Thermal expansion was used to simulate the polymerization shrinkage effects of cement layers. The results were obtained by colorimetric graphs of the maximum principal stress in the restoration and tooth remnant. The failure risk of the cement layer was also calculated based on the normal stress.

Results

The elastic modulus was positively correlated with the tensile stress peak values in the restoration, mainly at the intaglio surface. However, in the cervical enamel and cement layer, restorative material with a higher elastic modulus generated lower peak stress values. The cement with a higher elastic modulus resulted in higher stress peak values inside the cement layer. The combination of EMX (restorative material) and NX3 (cement material) in the cement layer resulted in the lowest failure risk.

Significance

The ceramic material EMX with a higher elastic modulus appeared to be more effective at protecting the cement layer and residual enamel tissue. Based on the analysis of the failure risk of the cement layer, the combination of EMX and NX3 was recommended as an optional material for endocrowns for endodontically treated posterior teeth.

Effects of shades of a multilayered zirconia on light transmission, monomer conversion, and bond strength of resin cement

OBJECTIVE

To evaluate the influence of shades of a multilayered zirconia on light transmission, resin cement degree of conversion, and shear bond strength of resin cement.

MATERIALS AND METHODS

The light transmission through opaque (OPQ) and translucent (TNS) regions of Katana UTML zirconia (Kuraray Noritake Dental) were evaluated for using a spectroradiometer (n = 5). Degree of conversion of dual-cure resin cement (Panavia V5, Kuraray Noritake Dental) was measured after light-activation through OPQ or TNS regions and direct exposure. Composition of the zirconia was analyzed with energy dispersive x-ray spectroscopy (EDS). Shear bond strength (SBS) was evaluated on the OPQ and TNS regions after 24 h and 1 year from specimen preparation (n = 15).

RESULTS

The OPQ region produced higher irradiance loss (95.1%) than TNS one (92.9%), and lower degree of conversion (52.4%) than TNS (71.2%) at 24 h post-light activation. EDS analysis did not show differences on the microstructure of the OPQ and TNS regions. There were no significant differences on the SBS between zirconia regions. For both zirconia regions, a significant reduction on the SBS occurred after aging, being 31.7% for OPQ and 38% for TNS.

CONCLUSION

Both OPQ and TNS regions affected the light transmission through the multilayered zirconia. The OPQ region yielded the highest light attenuation and the lowest degree of conversion of resin cement. Different regions of the zirconia did not influence the SBS. Clinical significance Although opaque and translucent regions of the multilayered zirconia reduced the light transmission from LED curing unit and the degree of conversion of resin cement, the regions did not affect the resin cement adhesion.

Effect of Sonic Activation on Push-Out Bond Strength of Fiber Post: An In Vitro Study

This study aimed to evaluate the effectiveness of conventional and sonic activation techniques on push-out bond strength of fiber post cemented with two different monomers containing self-adhesive resin cement (SARC). Four groups (n = 19 each) were made based on the type of SARC (Rely X U200 and Panavia SA) and technique (conventional and sonic activation). After placing the fiber post, each root was sectioned into 2 mm coronal, middle, and apical portions, and a push-out bond strength test was performed using a universal testing machine. The least push-out bond strength (13.0 ± 0.9 MPa) was found in Rely X U200 conventional technique and highest with Panavia SA sonic activation technique (15.4 ± 0.9 MPa). A significant difference was found in push-out bond strength at coronal (p = 0.002), middle (p = 0.002), and apical (p = 0.001) root sections using Rely X U200 cement with sonic activation as compared to the conventional technique. However, no difference (p > 0.05) was noticed between conventional and sonic activation techniques in Panavia SA cement at any root level. Sonic activation can be used as an adjunct with a manual technique to increase bond strength. However, it was noted that 10-MDP monomer containing SARC performed well regardless of techniques.

Curvature-dependent shear bond strength of different attachment materials for orthodontic lingual indirect bonding

To evaluate the shear bond strength (SBS) of different attachment materials used for lingual bonding, the influence of artificial aging and the radii of curvature of the enamel surface on SBS, 192 third molars were photographed to determine the radius of curvature of the oral surface. After phosphoric acid etching a cylindrical test piece was bonded to the oral enamel using a mold that was filled with a chemically curing (Maximum Cure, Transbond IDB Premix) or a dual-curing (Nexus NX3, RelyX Unicem2) attachment material. SBS was tested after 24 h, 500 thermal cycles or 90 days at 37 °C with a universal testing machine. Computed tomography scans were performed to determine the bonded surface and calculate SBS. Values ranged from 8.3 to 20.9 MPa. RelyX Unicem2 showed the highest SBS values at baseline, 500 thermal cycles and after 90 days (p < 0.001). Ninety days of wet storage significantly reduced SBS of Maximum Cure (p = 0.028). The radius of curvature correlated positively with SBS (r_s = 0.204, p = 0.005). The SBS of all attachment materials was sufficient for clinical use, even after artificial aging. RelyX Unicem2 showed almost twice as high SBS values as the other attachment materials.

Effect of Water Storage on Hardness and Interfacial Strength of Resin Composite Luting Agents Bonded to Surface-Treated Monolithic Zirconia

Background: Durable bonding between resin composite luting agents (CLA) and zirconia is still a matter of controversy. The purpose of this study was to evaluate the effect of water storage on hardness and interfacial strength of three CLA, a non-adhesive (Multilink Automix/ML), an adhesive (Panavia F 2.0/PF) and a self-adhesive (PermaCem 2.0/PC), bonded to polished (CL) and grit-blasted (AL: 50 μm alumina, SJ: Sil-Jet + Monobond Plus silane) monolithic zirconia surfaces. Methods: CLA specimens (n = 5/cement, condition) were prepared, stored under dry conditions or immersed in water, and Vickers hardness (VH) measurements were obtained at 1 h, 24 h, 1 week and 3 weeks intervals. Optical profilometry was used to determine the roughness parameters (Sa, Sz, Sdr, Sci) of zirconia surfaces (n = 5/treatment). A shear strength test (SBS, n = 10 × 2/cement) was performed to assess the strength and fractography of the cements bonded to zirconia after isothermal water storage and thermal-cycling (TC). Results: PF demonstrated significantly lower VHN after water storage at all time intervals, PC at 1 w, 3 w and ML at 3 w. SJ and AL showed significantly higher values from CL in all roughness parameters. Weibull analysis revealed the following significance in σ_ο ranking within the same material: AL, SJ, ALTC > SJTC, CL > CLTC (PF); SJ, SJTC, AL, ALTC > CL, CLTC (PC) and SJ, SJTC > AL > ALTC > CL, CLTC (ML). Within the same surface treatment subgroups, the significance in σ_o ranking was PC, ML > PF (before/after TC) for SJ; PC > PF > ML (before TC), PC, PF > ML (after TC) for AL, and PC > PF > ML (before/after TC) for CL. For the m ranking, the only significant difference within each material group was found in PC (AL > ALTC) and for the same surface treatment in AL (PC > ML). Conclusion: There are significant differences in the water plasticization susceptibility of the CLA tested; the materials with adhesive monomers were the most affected. Tribo-chemical silica coating combined with a silane coupling agent was the most efficient bonding treatment for the non-adhesive and the self-adhesive materials. The adhesive CLA performed better on alumina-blasted than on tribo-chemically coated surfaces.