Correlation between microstructure of CAD/CAM composites and the silanization effect on adhesive bonding

Do all ceramic and composite CAD-CAM materials exhibit equal bonding properties to implant Ti-base materials? An Interfacial Fracture Toughness Study

OBJECTIVES

To compare the interfacial fracture toughness (IFT) with or without aging, of four different classes of CAD-CAM ceramic and composite materials bonded with self-adhesive resin cement to titanium alloy characteristic of implant abutments.

METHODS

High translucent zirconia (Katana; KAT), lithium disilicate-based glass-ceramic (IPS. emax.CAD; EMX), polymer-infiltrated ceramic network material (PICN) (Vita Enamic; ENA), and dispersed filler composite (Cerasmart 270; CER) were cut into equilateral triangular prisms and bonded to titanium prisms with identical dimensions using Panavia SA Cement Universal. The surfaces were pretreated following the manufacturers' recommendations and developed interfacial area ratio (Sdr) of the pretreated surfaces was measured. IFT was determined using the Notchless Triangular Prism test in a water bath at 36 °C before and after thermocycling (10,000 cycles) (n = 40 samples/material).

RESULTS

IFT of the materials ranged from 0.80 ± 0.25 to 1.10 ± 0.21 MPa.m1/2 before thermocycling and from 0.71 ± 0.24 to 1.02 ± 0.25 MPa.m1/2 after thermocycling. There was a statistical difference between IFT of CER and the two top performers in each scenario: KAT and EMX before aging, and KAT and ENA after aging. Thermocycling significantly decreased IFT of EMX. The Weibull modulus of IFT was similar for all materials and remained so after thermocycling. Sdr measurements revealed that ENA (7.60)>Ti (4.97)>CER (2.85)>KAT (1.09)=EMX (0.96).

SIGNIFICANCE

Dispersed filler CAD-CAM composite showed lower performance than the other materials. Aging only affected IFT of Li-Si glass-ceramic, whereas zirconia and PICN performed equally well, probably due to their chemical bonding potential and surface roughness respectively.

A Comparison of the Shear Bond Strength between a Luting Composite Resin and Both Machinable and Printable Ceramic-Glass Polymer Materials

This study aims to compare the shear bond strength (SBS) and Weibull characteristics between a luting composite resin and both printable and two different machinable ceramic-glass polymer materials. A total of 36 substrates were prepared, with 12 in each group. Printable substrates (12 mm × 12 mm × 2 mm) were printed by using permanent crown resin (3D-PR). Machinable substrates were obtained from Cerasmart 270 (CS) and Vita Enamic (VE) blocks (2 mm in thickness). The bonding surfaces of substrates were polished and airborne abraded (50 µm Al2O3). A self-adhesive luting composite resin (RelyX U200, 3M ESPE, St. Paul, MN, USA, SLC) was applied on substrates with the help of a cylindrical (Ø3 × 3 mm) mold. The SBS test was conducted using a universal test machine. The SBSs of three materials were compared using a one-way analysis of variance (ANOVA) (α = 0.05). The Weibull modulus was calculated for each material. The Kruskal-Wallis and chi-square tests were carried out for the failure mode analysis. There was no significant difference between the SBSs of the three materials (p = 0.129). The Weibull modulus was 3.76 for the 3D-PR, 4.22 for the CS, and 6.52 for the VE group. Statistical analysis showed no significant difference between the failure modes of the groups (p = 0.986). Mixed-failure fractures were predominantly observed in all three groups. The results show that the SBS of the SLC to printable 3D-PR is comparable to that of CS and VE material. Failure modes of printable 3D-PR show similar results with two different machinable ceramic-glass polymers.

How the repair bonding strength of hybrid ceramic CAD/CAM blocks is influenced by the use of surface treatments and universal adhesives

We examined how different methods of surface treatment and different universal adhesives with or without extra silane affected the repair bonding strength of hybrid ceramic CAD/CAM restorations. Cerasmart specimens (n=320) were subjected to thermocycling and assigned to the following surface pretreatment protocols: control, diamond bur (DB), hydrofluoric acid (HF), and tribochemical silica coating (TSC). Half the specimens received a coating of silane, followed by application of the universal adhesives Futurabond M+ (FMU), Tokuyama Universal Bond (TUB), Single Bond Universal (SBU), or Clearfil Universal Bond Quick (CUQ) (n=10). A hybrid composite resin was used to simulate repair; then the specimens underwent further thermocycling. Shear bond strength (SBS) was determined and modes of failure were examined. The TSC-CUQ silane (-) group showed the highest SBS values. The best repairs were obtained when the surface was treated with TSC, with the exception of the DB-TUB silane (-) group. TUB increased SBS more than the other adhesives. Additional silane decreased SBS in the HF-TUB and TSC-CUQ groups, while increasing it in the TSC-TUB and DB-FMU groups (p<0.05).

Bonding Pretreatment of Aesthetic Dental CAD-CAM Materials through Surface Etching with a Mixed Aqueous Solution of Ammonium Fluoride and Ammonium Hydrogen Sulfate

Hydrofluoric acid (HF) is commonly used as an etchant for the pretreatment of dental computer-aided design/computer-aided manufacturing (CAD-CAM) materials, such as glass-ceramics and resin composites. Despite its effectiveness, the harmful and hazardous nature of HF has raised significant safety concerns. In contrast, ammonium fluoride (AF) is known for its relatively low toxicity but has limited etching capability. This study explored the potential of ammonium hydrogen sulfate (AHS), a low-toxicity and weak acid, to enhance the etching ability of aqueous AF solutions for the bonding pretreatment of CAD-CAM materials. This study investigated five types of aesthetic CAD-CAM materials: lithium disilicate glass, feldspathic porcelain, polymer-infiltrated ceramic networks, resin composites, and zirconia. Seven experimental etchants were prepared by varying the amount of AHS added to aqueous AF solutions, with each etchant used to etch the surfaces of the respective CAD-CAM materials. The treated surfaces were analyzed using scanning electron microscopy and confocal laser scanning microscopy. Additionally, the shear bond strength (SBS) of the CAD-CAM materials treated with a luting agent (resin cement) was evaluated. The results indicated that the AF1/AHS3 (weight ratio AF:AHS = 1:3) etchant had the most substantial etching effect on the surfaces of silica-containing materials (lithium disilicate glass, feldspathic porcelain, polymer-infiltrated ceramic networks, and resin composites) but not on zirconia. The SBS of the materials treated with the AF1/AHS3 etchant was comparable to that of the commercial HF etchant. Hence, an AF/AHS mixed solution could effectively etch silica-containing CAD-CAM materials, thereby enhancing their bonding capabilities.

Development of zirconia-based polymer-infiltrated ceramic network for dental restorative material

Polymer-infiltrated ceramic network (PICN) materials have gained considerable attention as tooth restorative materials owing to their mechanical compatibility with human teeth. However, the mechanical strength of contemporary PICN materials is lower than those of conventional resin composites and ceramics. This study aims to develop novel high-strength PICN for use as a dental restorative material. Zirconia-based PICN (EXP) was fabricated using 3 mol% yttria tetragonal polycrystalline zirconia powder and resin monomers via slip casting, followed by sintering and polymer infiltration. Comprehensive analyses of the microstructure, mechanical properties, and physicochemical properties of EXP were performed using scanning electron microscopy with energy-dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, inorganic content measurements, three-point bending test, Vickers hardness test, two-body wear test, shear bond strength (SBS) test, surface free energy analysis, and water sorption/solubility test. Commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) materials, including resin composite (CERASMART), silicate-based PICN (ENAMIC), and zirconia ceramic (e.max ZirCAD), were used for comparison. The analyses highlight the dual network structure of EXP, which comprised a zirconia skeleton and an infiltrated resin phase. EXP exhibits a flexural strength of 346.0 ± 46.0 MPa, flexural modulus of 44.0 ± 3.7 GPa, and Vickers hardness of 440.1 ± 51.2 VHN. The mechanical properties of EXP are significantly higher than those of CERASMART and ENAMIC but lower than those of ZirCAD. Notably, the EXP hardness closely mimics that of the human enamel. The wear volume, SBS, and water sorption/solubility of EXP are comparable to those of CERASMART and ENAMIC. Therefore, EXP has potential applications as a tooth restorative material.

The effect of in-office bleaching agents on the Vickers hardness and surface topography of polished and unpolished CAD/CAM composite materials

In-office bleaching, using hydrogen peroxide, is effective to remove dental enamel stains. However, bleaching agents can deteriorate surface properties of CAD-CAM materials. This in vitro study aimed to investigate the effect of in-office bleaching agents on Vickers hardness and surface topography of polished and unpolished dental CAD-CAM composite materials (Grandio blocs, Lava Ultimate, BRILLIANT Crios, Cerasmart), and a polymer-infiltrated ceramic network block (Vita Enamic). The specimens were randomly divided into two groups: unpolished or polished. The micro-hardness and surface topography of each group were measured before bleaching, after a 60 min bleaching period, and 24-h and one-month post-bleaching. In-office bleaching significantly influenced the Vickers hardness of both the polished and unpolished CAD/CAM composite blocks, with Vita Enamic exhibiting the least hardness stability among all groups. Furthermore, in-office bleaching significantly influenced the surface roughness of unpolished CAD/CAM composite blocks. There was a significant difference in hardness reduction between the polished and unpolished specimens for most of the investigated materials at different time points. The bleaching did not influence the surface roughness of the investigated polished group, except for Vita Enamic and Lava Ultimate. However, it did influence the surface roughness of the investigated materials in the unpolished group.

Clinical Applications and Mechanical Properties of CAD-CAM Materials in Restorative and Prosthetic Dentistry: A Systematic Review

Clinical outcomes of dental restorations depend primarily on the choice of materials used, and nowadays, dental CAD-CAM (Computer-Aided Design Computer-Aided Manufacturing) materials have strongly changed daily clinical practice. The aim of this systematic review is to analyze CAD-CAM dental materials according to their mechanical properties and in relation to their clinical applications. A literature review was performed on PubMed, Scopus, Web of Knowledge, and the Cochrane Library. Articles addressing at least one of the following topics regarding dental materials for CAD-CAM systems: manufacturers, mechanical features, materials' composition, optical properties, clinical indications, and/or outcomes were included in the review. A flowchart was performed as described in the PRISMA guidelines. Among the 564 articles found, 63 were analyzed and evaluated. Within the limitations of this systematic review, it can be concluded that CAD-CAM materials present a wide range of clinical applications due to their improved mechanical properties. Specifically, in addition to materials that have been in use for a long time (such as feldspathic ceramics), resin block composites can also be used for permanent restorations.

Three-Dimensional Printed Resin: Impact of Different Cleaning Protocols on Degree of Conversion and Tensile Bond Strength to a Composite Resin Using Various Adhesive Systems

The present investigation tested the effect of cleaning methods and adhesives on the tensile bond strength (TBS) of a resin-based composite luted to a temporary 3D printed resin. Substrates (n= 360) were printed using a Rapidshape D20II and cleaned with a butyldiglycol-based solution, isopropanol, or by centrifugation. Specimens were air-abraded with Al₂O₃ (mean particle size 50 µm) at 0.1 MPa followed by pretreatment (n = 30/subgroup) with: (1) Clearfil Ceramic Primer (CCP); (2) Clearfil Universal Bond (CUB); (3) Scotchbond Universal Plus (SUP) or 4. Visio.link (VL) and luted to PanaviaV5. TBS (n = 15/subgroup) was measured initially (24 h at 37 °C water) or after thermal cycling (10,000×, 5/55 °C). The degree of conversion (DC) for each cleaning method was determined prior and after air-abrasion. Univariate ANOVA followed by post-hoc Scheffé test was computed (p < 0.05). Using Ciba-Geigy tables and chi-square, failure types were analyzed. The DC values were >85% after all cleaning methods, with centrifugation showing the lowest. CCP pretreatment exhibited the lowest TBS values, with predominantly adhesive failures. The combination of CCP and centrifugation increased the TBS values (p < 0.001) compared to the chemical cleaning. CUB, SUP, and VL, regardless of cleaning, can increase the bond strength between the 3D printed resin and the conventional luting resin.

Improving retention of dental veneers fabricated from an experimental enamel-based biopolymer compared with CAD/CAM hybrid materials

Objectives

CAD/CAM hybrid materials have become increasingly utilized in restorative dentistry. However, their low tensile bond strength (TBS) may lead to the detachment of minimally invasive restorations. When prepared, an experimental enamel-based biopolymer prosthesis provided a honeycomb-like interfacial layer with luting adhesives leading to a higher TBS than Ni-Cr-Be based alloy, lithium disilicate-based ceramic, and cured-resin-composite. This study aimed to compare TBSs of dental veneers fabricated from experimental biopolymer and commercial hybrid materials bonded to enamel using two different luting adhesives.

Methods

Laminate veneers (4 × 4 mm) 1 mm thick were prepared from commercial CAD/CAM blocks: VITA ENAMIC, SHOFU Block HC, KATANA AVENCIA, and an experimental biopolymer. The flat bonding surface of the veneers was ground to 600-grit, followed by 50-μm alumina air-abrading for standardization. Each veneer was fixed on flat ground bovine enamel using either Super-Bond C&B or RelyX™ U200 resin (n = 10). The surface treatment and bonding procedures were treated as recommended by the manufacturers. All bonded specimens were stored in water at 37 °C for 24 h before tensile testing with a universal testing machine at a cross-headed speed of 1.0 mm/min. The fractured surface was examined with a stereomicroscope and scanning electron microscope. TBS data were statistically analyzed using two-way ANOVA and Tukey's HSD test (α = 0.05).

Results

Experimental biopolymer veneers demonstrated the highest mean TBS with cohesive failure in the luting agents. Adhesive failure at the veneer side interface was found in other groups. There was no significant difference between the two luting agents.

Conclusion

The results indicate that the experimental biopolymer veneer bonded to enamel provided the best retention. The TBS at the enamel-resin interface is higher than at the veneer-resin interface for all commercial CAD/CAM hybrid materials.

Clinical significance

An experimental enamel-based biopolymer veneer can provide better retention than CAD/CAM hybrid materials in clinical treatment.

Martens Hardness of CAD/CAM Resin-Based Composites

(1) Background: The properties of CAD/CAM resin-based composites differ due to differences in their composition. Instrumented indentation testing can help to analyze these differences with respect to hardness, as well as energy-converting capabilities due to viscoelastic behavior. (2) Methods: Eleven materials were investigated using instrumented indentation testing. Indentation depth (hr), Martens hardness (HM), indentation hardness (HIT), indentation modulus (EIT), the elastic part of indentation work (ηIT), and indentation creep (CIT) were investigated, and statistical analysis was performed using one-way ANOVA, Bonferroni post-hoc test, and Pearson correlation (α = 0.05). (3) Results: All of the investigated parameters revealed differences between the analyzed materials. Besides the differences in hardness-associated parameters (hr, HM, and HIT), instrumented indentation testing demonstrated differences in energy-converting properties. The subsequent one-way ANOVA revealed significant differences (p < 0.001). A significant (p < 0.01, Pearson correlation >0.576) correlation between the materials and HM, HIT, or EIT was identified. (4) Conclusions: Due to the differences found in the energy-converting properties of the investigated materials, certain CAD/CAM resin-based composites could show superior stress-breaking capabilities than others. The consequential reduction in stress build-up may prove to beneficial, especially for implant-retained restorations or patients suffering from parafunctions.

Wear of Polymer-Infiltrated Ceramic Network Materials against Enamel

Polymer-infiltrated ceramic network materials (PICNs) have high mechanical compatibility with human enamel. However, the wear properties of PICN against natural human enamel have not yet been clarified. We investigated the in vitro two-body wear behaviors of PICNs and an enamel antagonist. Two PICNs were used: Experimental PICN (EXP) prepared via the infiltration of methacrylate-based resin into the porous silica ceramic network and commercial Vita Enamic (ENA). Two commercial dental ceramics, lithium disilicate glass (LDS) and zirconia (ZIR), were also characterized, and their wear performance was compared to PICNs. The samples were subjected to Vickers hardness tests and two-body wear tests that involve the samples being cyclically impacted by enamel antagonists underwater at 37 °C. The results reveal that the Vickers hardness of EXP (301 ± 36) was closest to that of enamel (317 ± 17). The volumetric wear losses of EXP and ENA were similar to those of LDS but higher than that of zirconia. The volumetric wear loss of the enamel antagonist impacted against EXP was moderate among the examined samples. These results suggest that EXP has wear behavior similar to that of enamel. Therefore, PICNs are mechanically comparable to enamel in terms of hardness and wear and are excellent tooth-restoration materials.

A SiO2/pHEMA-Based Polymer-Infiltrated Ceramic Network Composite for Dental Restorative Materials

SiO2-poly(2-hydroxyethyl methacrylate) (pHEMA)-based composites have been widely used as biomaterials owing to their biocompatibility. However, they have not yet been applied as tooth restorative materials because of their poor mechanical properties. In the present paper, we develop a novel SiO2/pHEMA-based composite with a polymer-infiltrated network (PICN) structure for use in dental restorative materials. A mixture of SiO2 nanoparticles and a poly(vinyl alcohol) binder was sintered at 950 °C to fabricate a porous SiO2 block. A monomer mixture containing 70 wt%-HEMA/30 wt%-ethylene glycol dimethacrylate and a benzoyl peroxide initiator was infiltrated into the porous SiO2 block and heat-polymerized to fabricate the SiO2/pHEMA-based composite with a PICN structure. The composite was characterized according to its mechanical properties, surface free energy, and bonding properties with a dental adhesive. The flexural strength was 112.5 ± 18.7 MPa, the flexural modulus was 13.6 ± 3.4 GPa, and the Vickers hardness was 168.2 ± 16.1, which are similar values to human teeth. The surface free energy of the polar component of the composite was 19.6 ± 2.5 mN/m, suggesting that this composite has an active surface for bonding with the adhesive. The composite bonded well to the adhesive, in the presence of a silane coupling agent. The SiO2/pHEMA-based composite was demonstrated to be a potential candidate for dental restorative materials.

Development of Dental Poly(methyl methacrylate)-Based Resin for Stereolithography Additive Manufacturing

Poly(methyl methacrylate) (PMMA) is widely used in dental applications. However, PMMA specialized for stereolithography (SLA) additive manufacturing (3D-printing) has not been developed yet. This study aims to develop a novel PMMA-based resin for SLA 3D-printing by mixing methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and PMMA powder in various mixing ratios. The printability and the viscosity of the PMMA-based resins were examined to determine their suitability for 3D-printing. The mechanical properties (flexural strength and Vickers hardness), shear bond strength, degree of conversion, physicochemical properties (water sorption and solubility), and cytotoxicity for L929 cells of the resulting resins were compared with those of three commercial resins: one self-cured resin and two 3D-print resins. EGDMA and PMMA were found to be essential components for SLA 3D-printing. The viscosity increased with PMMA content, while the mechanical properties improved as EGDMA content increased. The shear bond strength tended to decrease as EGDMA increased. Based on these characteristics, the optimal composition was determined to be 30% PMMA, 56% EGDMA, 14% MMA with flexural strength (84.6 ± 7.1 MPa), Vickers hardness (21.6 ± 1.9), and shear bond strength (10.5 ± 1.8 MPa) which were comparable to or higher than those of commercial resins. The resin’s degree of conversion (71.5 ± 0.7%), water sorption (19.7 ± 0.6 μg/mm³), solubility (below detection limit), and cell viability (80.7 ± 6.2% at day 10) were all acceptable for use in an oral environment. The printable PMMA-based resin is a potential candidate material for dental applications.

The effect of silane and universal adhesives on the micro-shear bond strength of current resin-matrix ceramics

PURPOSE

The aim of this in vitro study was to evaluate the effect of silane and universal adhesive applications on the micro-shear bond strength (µSBS) of different resin-matrix ceramics (RMCs).

MATERIALS AND METHODS

A total of 120 slides (14 × 12 × 1 mm) were produced from 5 different RMC materials (GC Cerasmart [GC]; Brilliant Crios [BC]; Grandio blocs [GB]; Katana Avencia [KA]; and KZR-CAD HR 2 [KZR]) and sandblasted using 50 µm Al₂O₃ particles. Each RMC material was divided into six groups according to the surface conditioning (SC) method as follows: control (G1), silane primer (G2), silane-free universal adhesive (G3), silane-containing universal adhesive (G4), silane primer and silane-free universal adhesive (G5), and silane primer and silane-containing universal adhesive (G6). Three cylindric specimens made from resin cement (Bifix QM) were polymerized over the treated surface of each slide (n = 12). After thermal cycling (10000 cycles, 5 – 55℃), µSBS test was performed and failure types were evaluated using a stereomicroscope. Data were analyzed using 2-way ANOVA and Tukey tests (α = .05).

RESULTS

µSBS values of specimens were significantly affected by the RMC type and SC protocols (P < .001) except the interaction (P = .119). Except for G2, all SC protocols showed a significant increase in µSBS values (P < .05). For all RMCs, the highest µSBS values were obtained in G4 and G6 groups.

CONCLUSION

Only silane application did not affect the µSBS values regardless of the RMC type. Moreover, the application of a separate silane in addition to the universal adhesives did not improve the µSBS values. Silane-containing universal adhesive was found to be the best conditioning method for RMCs.

Effect of sandblasting and/or priming treatment on the shear bond strength of self-adhesive resin cement to CAD/CAM blocks

The aim of this study was to investigate the effect of two different priming agents and/or sandblasting on the shear bond strength of self-adhesive resin cement to the resin composite for core build-up to CAD/CAM blocks. A CAD/CAM ceramic block (GN I CERAMIC BLOCK, GC) and a CAD/CAM resin composite block (CERASMART 270, GC), a self-adhesive resin cement (G-CEM ONE, GC) and two different primers, i.e., a multipurpose primer (MP; G-Multi Primer, GC) and a ceramic primer (CP; Ceramic Primer II, GC), were examined. Five different surface treatments with priming and/or sandblasting and no surface treatment (control) were performed on the block. Disk specimens (6 mm in diameter and 4 mm in thickness) made from core composites were cemented to the blocks after the surface treatments. Then, the 24-h shear bond strength of the resin cement between the block and the resin composite core was determined (n = 15). Sandblasted specimens had greater bond strength than controls for both blocks (p < 0.05). Priming to both blocks significantly increased the bond strength of resin cement compared to that of controls (p < 0.05). Although Weibull moduli were not significantly changed among all surface treatments for both blocks, the strengths with 5% and 95% failure probability of sandblasted and/or primed blocks were estimated to be greater than those of controls. The combination of priming and sandblasting to the CAD/CAM composite and ceramic surface was effective in increasing the bond strength of the resin cement.

The influence of FRC base and bonded CAD/CAM resin composite endocrowns on fatigue behavior of cracked endodontically-treated molars

Cracked endodontically treated molars (ETMs) are commonly treated with full crowns. Less invasive techniques could include fiber-reinforced composite (FRC) base and adhesively bonded endocrowns. The purpose of this study was to assess the fatigue resistance of ETMs restored with CAD/CAM resin composite endocrowns and reinforced with different FRC bases. Cracks were simulated in fifty mandibular molars by cutting the teeth longitudinally and reassembling the two parts. After performing endodontic treatments and preparing cavities, teeth were restored in one of the following methods (n = 10). In Group 1, cavity floors were lined with 0.5 mm of flowable composite (Universal Injectable; GUI, shade A2). In Groups 2 and 3, the cavity floors were covered with one and three layers of FRC-net (ES Net) respectively, whereas in Groups 4 and 5 with 1 mm and 2 mm of flowable FRC-resin (EverX Flow Dentin; EXFD) respectively. Endocrowns (Cerasmart 270; CE, A2 HT) with 5 mm thickness were adhesively luted with preheated composite and all specimens were subjected to cyclic loading in water at 5 Hz, starting with a load of 600 N (5000 cycles), followed by stages of 1000, 1300, 1600, 1900, 2200 and 2500 at a maximum of 20 000 cycles each. Results were analyzed using Kaplan-Meier survival analysis and the Log-Rank test (p = 0.05). The fatigue failure load of ES Net applied in three layers (1617 N ± 371) or in one layer (1499 N ± 306), as well as EXFD applied in 2 mm (1496 N ± 264) or in 1 mm (1434 N ± 372) did not differ significantly (p > 0.05). Control teeth fractured at 1255 N ± 350 (p > 0.05). In the fiber-reinforced groups, restorable fractures were observed in 50%-80%, with only 30% deemed restorable in the control group. The fractures originated mainly at the occlusal contact points and the main crack propagated in the corono-apical direction. No crack origin (primary or secondary) starting from the artificial pre-existing crack was observed in fractured specimens. FRC bases did not improve the fatigue resistance of cracked ETMs, but favorably influenced the failure mode.

Impact of the Microstructure of CAD/CAM Blocks on the Bonding Strength and the Bonded Interface

PURPOSE

To investigate the relationship between the microstructure of CAD/CAM blocks and the quality of adhesion as function of the surface treatment and resin cement type.

MATERIALS AND METHODS

Two nano-ceramic composite resin CAD/CAM blocks, Lava Ultimate (LU) and Cerasmart (CS), and two Leucite-reinforced glass ceramic CAD/CAM IPS blocks, Empress^® CAD (EM) and Initial^TM LRF (IR), received either Hydrofluoric acid (HF) or sandblasting (SB) surface treatments. The blocks were then luted using two dual-cure resin cements, LinkForce (LF) and Multilink Automix (ML) with their corresponding silanes, resulting in 16 study groups. The luted blocks were then thermal-cycling (TC) for 5000 cycles and subjected to a microtensile bond strength (μTBS) test. Scanning electron microscopy (SEM) micrographs of the treated surfaces were analyzed using ImageJ software and XRD analyses were performed for the two ceramic blocks. The data obtained were submitted to Games-Howell post-hoc nonparametric test to compare combinations of groups or treatments and a linear mixed-effects model for the factors surface treatment, block type, and resin cement, together with their first-degree interactions (α = 0.05).

RESULTS

The lowest mean μTBS values were obtained with LU-HF, whereas the highest mean μTBS values were obtained with CS regardless of resin cement type and surface treatment method. IR-HF mean μTBS were significantly higher than IR-SB, EM-SB, and EM-HF. Analysis using ImageJ software demonstrated significant differences in the density and pore size after HF surface treatment.

CONCLUSIONS

The specific microstructure of each block material within the same family group impacted the micromechanical retention and the bonded interface strength.

PICN Nanocomposite as Dental CAD/CAM Block Comparable to Human Tooth in Terms of Hardness and Flexural Modulus

Polymer infiltrated ceramic network (PICN) composites are an increasingly popular dental restorative material that offer mechanical biocompatibility with human enamel. This study aimed to develop a novel PICN composite as a computer-aided design and computer-aided manufacturing (CAD/CAM) block for dental applications. Several PICN composites were prepared under varying conditions via the sintering of a green body prepared from a silica-containing precursor solution, followed by resin infiltration. The flexural strength of the PICN composite block (107.8–153.7 MPa) was similar to a commercial resin-based composite, while the Vickers hardness (204.8–299.2) and flexural modulus (13.0–22.2 GPa) were similar to human enamel and dentin, respectively. The shear bond strength and surface free energy of the composite were higher than those of the commercial resin composites. Scanning electron microscopy and energy dispersive X-ray spectroscopic analysis revealed that the microstructure of the composite consisted of a nanosized silica skeleton and infiltrated resin. The PICN nanocomposite block was successfully used to fabricate a dental crown and core via the CAD/CAM milling process.

Effects of alumina airborne-particle abrasion on the surface properties of CAD/CAM composites and bond strength to resin cement

The purpose of this study is to clarify physical and chemical changes in surfaces of CAD/CAM composites caused by alumina airborne-particle abrasion and its effect on adhesive bonding. Our study involved three dispersed filler (DF)-based and a polymer-infiltrated ceramic network (PICN)-based CAD/CAM composites. Changes in the surface morphologies of the composites were examined, and surface free energy (SFE) analysis was performed based on Owens-Wendt theory. The influence of the abrasion on the bond strengths of CAD/CAM composites to the resin cement was characterized by shear bond strength (SBS) test. The abrasion increased the roughness of the composites. The SFE analysis showed that the abrasion significantly increased the dispersive component but decreased the polar component of the SFE associated with the DF-based composites, while no change occurred for those of the PICN-based composite. The abrasion slightly improved the SBSs for the DF-based composites but not that of the PICN-based composite.

Effect of surface treatment of CAD/CAM resin composites on the shear bond strength of self-adhesive resin cement

This study examined the effects of sandblasting, hydrofluoric acid etching and priming on the shear bond strength of self-adhesive resin cement between seven different CAD/CAM resin composites and a resin composite core material at 24-h after cement mixing. Five surface treatments [control (C), sandblasting (S), priming (P), sandblasting with priming (SP), and 9% HF etching with priming (HFP)] were performed respectively for disc specimens of CAD/CAM blocks. There were no significant differences in bond strength among the C, S, and P, except for one block (p>0.05). SP showed a greater bond strength than S. Weibull moduli were not changed significantly among all treatments for all blocks, whereas the strengths with 5% and 95% failure probability of SP and HFP showed greater values than the others. The bond strengths of HFP were comparable to those of SP. Priming after sandblasting or HF etching could be effective to increase the bond strength of CAD/CAM blocks.