Insights into “bonding” of all-ceramics influenced by cement, sandblasting and water storage time

Effect of Different Surface Treatment Methods on Bond Strength of Dental Ceramics to Dental Hard Tissues: A Systematic Review

For long-term successful use of ceramic materials in dental procedures, it is necessary to ensure reliable bonding of restorations to dental substrates. This can be achieved by the application of a proper luting cement and through additional surface conditioning. The present systematic review summarizes the most up-to-date evidence on the use of different surface modification methods to enhance the bond strength of dental ceramics to the hard tissues of the teeth. The authors of the review searched the Web of Science, Scopus, and MEDLINE databases to identify relevant articles published between 1 January 2010 and 1 January 2020. A total of 4892 records were identified, and after screening, the full text of 159 articles was evaluated, which finally resulted in the inclusion of 19 studies. The available reports were found to be heterogeneous in terms of materials and methodology, and therefore, only within-studies comparison was performed instead of comparison between studies. A statistically significant difference in the bond strength between the samples treated with different methods of surface conditioning, or between conditioned and nonconditioned samples, was revealed by most of the studies. Predominantly, the studies showed that a combination of mechanical and chemical methods was the most effective way of enhancing bond strength. Artificial aging and luting cement were also identified as the factors significantly influencing bond strength.

Endodontic Access Effect on Full Contour Zirconia and Lithium Disilicate Failure Resistance

Objectives:

To evaluate the effect of endodontic access on the failure load resistance of both adhesively and conventionally luted, full-contour monolithic yttria-stabilized zirconium dioxide (Y-TZP) and adhesively luted lithium disilicate (LD) crowns cemented on prepared teeth.

Methods and Materials:

Seventy-two human maxillary molars were prepared per respective guidelines for all-ceramic crowns with one group (n=24) restored with LD and the other (n=48) receiving Y-TZP crowns. Preparations were scanned using computer-aided design/computer-aided milling (CAD/CAM) technology, and milled crowns were sintered following manufacturer recommendations. All LD crowns and half (n=24) of the Y-TZP crowns were adhesively cemented, while the remaining Y-TZP specimens were luted using a conventional glass ionomer cement (GIC). One LD group, one Y-TZP adhesive group, and one GIC-luted group (all n=12) then received endodontic access preparations by a board-certified endodontist: the pulp chambers were restored with a dual-cure, two-step, self-etch adhesive and a dual-cure resin composite core material. The access preparations were restored using a nano-hybrid resin composite after appropriate ceramic margin surface preparation. After 24 hours, all specimens were loaded axially until failure; mean failure loads were analyzed using Mann-Whitney U test (α=0.05)

Results:

Endodontic access did not significantly reduce the failure load of adhesively luted LD or Y-TZP crowns, but Y-TZP crowns with GIC cementation demonstrated significantly less failure load.

Conclusions:

These initial findings suggest that endodontic access preparation may not significantly affect failure load resistance of adhesively luted Y-TZP and LD crowns. Definitive recommendations cannot be proposed until fatigue testing and coronal seal evaluations have been accomplished.

Future of dental biomaterials: Gazing into Bob's crystal ball

In February 2019, the American Prosthodontics Society asked me to "ponder" the future of dental biomaterials. This talk was titled, "Gazing Into Bob's Crystal Ball". My basic approach was guided by the words of Confucius, "Study the past if you would define the future." As I have often studied and lectured on how many of our important materials got into dentistry, it was a natural assignment. In this article, I review how key materials came to be used in dental practice and organize these "sources" into an extended classification, assuming future materials will likely derive from one of these. Then, I identify important examples in each category and then expound on likely future developments, some already in progress. These include increasing the use of and benefiting from automated systems; better engineering with existing materials by means of failure analysis (from clinically retrieved specimens); iterative improvements in materials and practices, again based on observations from clinical behavior; the use of scaffolds for both hard- and soft-tissue repair; and the development of "smart" materials. I hope this contribution survives the test of time. Please note that, importantly, this list includes not just materials but often-overlooked steps in processing that will affect their properties and clinical durability.

Fatigue behavior and surface characterization of a Y-TZP after laboratory grinding and regeneration firing

This study evaluated the effect of grinding and regeneration firing on the flexural fatigue limit and surface characterization of Lava™ Y-TZP ceramic. Forty bar-shaped specimens with 20 × 4.0 × 1.2 mm constituted the as-sintered group (AS = control group), and 80 specimens with 20 × 4.0 × 1.5 mm were ground with cylindrical laboratory stone under water-cooling (WG) or in a dry condition (G) to reach 1.2 mm in thickness. Half of specimens were submitted to regeneration firing (1000 °C, 30 min), forming the groups AS/R, WG/R and G/R. Fatigue limit (500,000 cycles, 10 Hz) was determined by staircase method in a 4-point flexural fixture. Data were analyzed by 2-way ANOVA and Tukey HSD tests (α = 0.05). The surface topography (n = 3) and fracture area (n = 3) were evaluated by SEM. Samples were also analyzed by Rietveld refinement from X-ray diffraction data. ANOVA revealed significant differences (P < .001) for grinding protocol, regeneration firing and their interaction. In the groups not submitted to regeneration firing, the mean flexural fatigue limit of WG was higher (P < .05) than that of G and AS, with no statistical difference between each other (P > .05). After regeneration firing the inequality WG>AS>G (P < .05) was observed. The regeneration firing increased the fatigue limit of AS group and decreased those of G and WG groups (P < .05). Grinding protocols created evident grooves on zirconia surface. Failures initiated on tensile side of all specimens. The percentages (wt%) of monoclinic phase before cyclic loading were: AS (7.4), AS/R (6.5), G (2.8), G/R (0.0), WG (4.4), WG/R (0.0); and after cyclic loading: AS (8.6), AS/R (1.2), G (2.4), G/R (5.7), WG (6.3), WG/R (0.0). Wet grinding did not compromise the fatigue limit of zirconia, increasing its mechanical strength. Regeneration firing reduced the fatigue limit of ground samples, despite reducing the amount of monoclinic phase in all experimental conditions.

Zinc phosphate as a definitive cement for implant-supported crowns and fixed dentures

Implant-supported dental prostheses can be retained by a screw or cement. Implant-supported fixed partial dentures have a passive fit. A passive fit means there is an internal gap between the abutment surface and the intaglio of the retainer to insure that there is no lateral pressure on the supporting implants or friction upon seating of the prosthesis. This gap is filled with cement for retention of the prosthesis. Any lateral pressure may cause marginal bone loss or periimplantitis. Also, there is usually a microscopic gap at the margin of a crown retainer that exposes the cement to oral fluids. The solubility of zinc phosphate (ZOP) cement is a definite liability due to the risk for cement dissolution. In fixed prostheses, the dissolution of the cement of one or more retainers would cause a transfer of the occlusal load to the retained unit(s). The resulting rotation and lifting of the cement-retained implants from occlusal and parafunctional loads could cause loss of osseointegration of the abutment-retained implant(s). ZOP cement may not be indicated for implant-supported fixed partial dentures or splints. Cement dissolution in single unit probably only involves re-cementation, if the patient does not swallow or aspirate the crown.

An insight into current concepts and techniques in resin bonding to high strength ceramics

BACKGROUND

Reliable bonding between high strength ceramics and resin composite cement is difficult to achieve because of their chemical inertness and lack of silica content. The aim of this review was to assess the current literature describing methods for resin bonding to ceramics with high flexural strength such as glass-infiltrated alumina and zirconia, densely sintered alumina and yttria-partially stabilized tetragonal zirconia polycrystalline ceramic (Y-TZP) with respect to bond strength and bond durability.

METHODS

Suitable peer reviewed publications in the English language were identified through searches performed in PubMed, Google Search and handsearches. The keywords or phrases used were 'resin-ceramic bond', 'silane coupling agents', 'air particle abrasion', 'zirconia ceramic' and 'resin composite cements'. Studies from January 1989 to June 2015 were included.

RESULTS

The literature demonstrated that there are multiple techniques available for surface treatments but bond strength testing under different investigations have produced conflicting results.

CONCLUSIONS

Within the scope of this review, there is no evidence to support a universal technique of ceramic surface treatment for adhesive cementation. A combination of chemical and mechanical treatments might be the recommended solution. The hydrolytic stability of the resin ceramic bond should be enhanced.

Various Effects of Sandblasting of Dental Restorative Materials

BACKGROUND

Sandblasting particles which remain on the surfaces of dental restorations are removed prior to cementation. It is probable that adhesive strength between luting material and sandblasting particle remnants might exceed that with restorative material. If that being the case, blasting particles adhere to sandblasted material surface could be instrumental to increasing adhesive strength like underlying bonding mechanism between luting material and silanized particles of tribochemical silica coating-treated surface. We hypothesize that ultrasonic cleaning of bonding surfaces, which were pretreated with sandblasting, may affect adhesive strength of a resin luting material to dental restorative materials.

METHODS

We therefore observed adhesive strength of resin luting material to aluminum oxide was greater than those to zirconia ceramic and cobalt-chromium alloy beforehand. To measure the shear bond strengths of resin luting material to zirconia ceramic and cobalt-chromium alloy, forty specimens of each restorative material were prepared. Bonding surfaces were polished with silicon abrasive paper and then treated with sandblasting. For each restorative material, 40 sandblasted specimens were equally divided into two groups: ultrasonic cleaning (USC) group and non-ultrasonic cleaning (NUSC) group. After resin luting material was polymerized on bonding surface, shear test was performed to evaluate effect of ultrasonic cleaning of bonding surfaces pretreated with sandblasting on bond strength.

RESULTS

For both zirconia ceramic and cobalt-chromium alloy, NUSC group showed significantly higher shear bond strength than USC group.

CONCLUSIONS

Ultrasonic cleaning of dental restorations after sandblasting should be avoided to retain improved bonding between these materials.

Effect of sandblasting and residual stress on strength of zirconia for restorative dentistry applications

Sandblasting is a commonly used surface treatment technique for dental crowns to improve the adhesion of the mating parts of a restoration. The goal of this work is to study the effect of different sandblasting conditions on the mechanical properties of 3mol% yttria stabilized tetragonal zirconia (3Y-TZP), such as biaxial strength, surface elastic modulus, contact hardness and residual stresses induced by sandblasting. The specimens were sandblasted considering two different particle sizes (110, 250μm), two pressures (2 and 4bar) and two impact angles (30° and 90°). Biaxial strength of 3Y-TZP increases when sandblasted with 110µm particles while its decreases with 250µm particles for impact angle of 90°. Strength increases slightly when sandblasting with 30° impact angle regardless of the size of the particle. Elastic modulus and contact hardness were not affected by sandblasting with 110µm particles, and compressive residual stresses are produced down to a depth of ~10µm.

Influence of resin cement polymerization shrinkage on stresses in porcelain crowns

OBJECTIVE

The aim of this study was to analyze the influence of polymerization shrinkage of the cement layer on stresses within feldspathic ceramic crowns, using experimentally validated FEA models for (1) increasing occlusal cement thickness; and, (2) bonded versus non-bonded ceramic-cement interfaces.

METHODS

2-D axial symmetric models simulated stylized feldspathic crowns (1.5mm occlusal thickness) cemented with resin-cement layers of 50-500μm on dentin preparations, being loaded (500N) or not. Ceramic-cement interface was either bonded or not. Cement was bonded to the dentin in all models. Maximum axial shrinkage of 0%, 1%, 2%, 3%, 4% and 4.65% were simulated. The first principal stresses developing in the cementation surface at the center and at the occluso-axial line-angle of the crown were registered.

RESULTS

Polymerization shrinkage of the cement increased tensile stresses in the ceramic, especially in loaded non-bonded crowns for thicker cement layers. Stresses in loaded non-bonded crowns increased as much as 87% when cement shrinkage increased from 0% to 4.65% (100-187MPa), for a 500μm-thick cement. Increasing polymerization shrinkage strain raised the tensile stresses, especially at the internal occlusal-axial line-angle, for bonded crowns.

SIGNIFICANCE

Changes in the polymerization shrinkage strain (from 0% to 4.65%) have little effect on the tensile stresses generated at the cementation surface of the ceramic crowns, when the occlusal cement thickness is thin (approx. 50μm for bonded crowns). However, as the cement becomes thicker stresses within the ceramic become significant.