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

Bonding effectiveness of multi-step adhesive resin cements to CAD/CAM blocks: impact of thermal cycling and surface treatment methods

BACKGROUND

To investigate the effects of thermal cycling and surface treatment methods on the bonding effectiveness of multi-step resin cements to CAD/CAM blocks.

METHODS

A total of 198 slices, 66 each from CAD/CAM blocks (feldspathic ceramic: Vitablocs TriLuxe Forte, V; resin matrix ceramics (RMCs): Cerasmart, C; and Shofu Block HC, S), were obtained and randomly divided into two subgroups for etching with hydrofluoric acid (HFA) and sandblasting with Al2O3 (SB). After the surface treatments, one etched and one sandblasted sample of each CAD/CAM block was observed via SEM analysis at 500× magnification. The remaining 32 etched and 32 sandblasted samples of each CAD/CAM block were divided into two subgroups to be cemented with total-etch (TE) and self-etch (SE) resin cements. Then, half of the 16 samples in all the subgroups were subjected to aging (TC) for 5000 cycles (n = 8). The shear bond strength (SBS) of each sample was measured. Four-way analysis of variance (ANOVA) and Tukey tests were used to analyze the data (p < 0.05).

RESULTS

With or without TC, the highest SBS values for V were obtained with the HFA-TE and HFA-SE interactions, respectively. C presented the highest SBS values with HFA-SE and SB-TE interactions, whereas S presented the highest SBS values with SB-TE and HFA-TE interactions. Except the SB-SE interaction, C presented lower SBS values after TC than other materials. HFA created less porosity on the C and S surfaces than V. SB visibly roughened the surfaces of all the materials but caused fractures, cracks, and damage to the surfaces.

CONCLUSION

Similar SBS values can be achieved between feldspathics, RMCs, and multi-step adhesive resins with both HFA and SB treatments. However, the SBS values obtained from the SB-SE interaction may be below the recommended threshold values for all materials after TC. SB can cause distinctive cavities, fissures, and damage, especially on the surfaces of RMCs.

Bond strength of additively manufactured composite resins to dentin and titanium when bonded with dual-polymerizing resin cements

STATEMENT OF PROBLEM

Additively manufactured composite resins for definitive restorations have been recently introduced. The bond strength between these composite resins and different substrates has not been extensively studied.

PURPOSE

The purpose of this in vitro study was to measure the shear bond strength (SBS) between additively manufactured composite resins and dentin and titanium substrates and compare those with the SBS between subtractively manufactured polymer-infiltrated ceramic and the same substrates (dentin and titanium), when different dual-polymerizing resin cements were used.

MATERIAL AND METHODS

One hundred and eighty cylinder-shaped specimens (Ø5×5 mm) were prepared from 3 materials recommended for definitive restorations: an additively manufactured composite resin (Crowntec [CT]); an additively manufactured hybrid composite resin (VarseoSmile Crown Plus [VS]); and a subtractively manufactured polymer-infiltrated ceramic (Enamic [EN]) (n=60). Specimens were randomly divided into six subgroups to be cemented to the two substrates (dentin and titanium; n=30) with 1 of 3 resin cements (RelyX Universal, Panavia V5, and Variolink Esthetic DC) (n=10). The restoration surface to be bonded was treated according to the respective manufacturer's recommendations. Dentin surfaces were treated according to the resin cement (Scotchbond Universal Plus Adhesive for RelyX Universal, Panavia V5 Tooth Primer for Panavia V5, and Adhese Universal for Variolink Esthetic DC), while titanium surfaces were airborne-particle abraded, and only the specimens paired with Panavia V5 were treated with a ceramic primer (Clearfil Ceramic Primer Plus). SBS was measured in a universal testing machine at a crosshead speed of 1 mm/min. Failure modes were analyzed under a microscope at ×12 magnification. Data were analyzed by using 2-way analysis of variance and Tukey honestly significant difference tests (α=.05).

RESULTS

When SBS to dentin was considered, only restorative material, as a main factor, had a significant effect (P<.001); EN had the highest SBS (P<.001), while the difference in SBS values of CT and VS was not significant (P=.145). As for SBS to titanium, the factors restorative material and resin cement and their interaction had a significant effect (P<.001). Within each resin cement, EN had the highest SBS to titanium (P<.001), and within each restorative material, Variolink resulted in the lowest SBS (P≤.010). Overall, EN and RelyX were associated with the highest SBS to titanium (P≤.013). Mixed failures were predominant in most groups.

CONCLUSIONS

Regardless of the substrate or the resin cement used, the subtractively manufactured polymer-infiltrated ceramic had higher shear bond strength than the additively manufactured composite resins. The SBS of the additively manufactured composite resins, whether bonded to dentin or titanium, were not significantly different from each other. Regardless of the restorative material, Variolink DC resulted in the lowest SBS for titanium surfaces.

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.

Fracture resistance of additively or subtractively manufactured resin-based definitive crowns: Effect of restorative material, resin cement, and cyclic loading

OBJECTIVE

To evaluate how restorative material, resin cement, and cyclic loading affect the fracture resistance of resin-based crowns fabricated by using additive or subtractive manufacturing.

METHODS

A right first molar crown standard tessellation language (STL) file was used to fabricate 120 crowns from one subtractively manufactured polymer-infiltrated ceramic network (SM) and two additively manufactured resin composites (AM-B and AM-S) (N = 40). These crowns were randomly divided into 4 groups within each material according to the dual-polymerizing resin cement to be used (RX and PN) and the aging condition (n = 10). After cementation, the crowns without cyclic loading were subjected to fracture testing, while the others were first cyclically loaded (1.7 Hz, 1.2 million cycles, and 49-N load) and then subjected to fracture testing. Data were analyzed with generalized linear model analysis (α = .05).

RESULTS

Fracture resistance of the crowns was affected by material, resin cement, and cyclic loading (P ≤ .030). However, none of the interactions significantly affected fracture resistance of tested crowns (P ≥ .140). Among tested materials, SM had the highest fracture resistance, whereas AM-B had the lowest (P ≤ .025). RX led to higher fracture resistance, and cyclic loading decreased the fracture resistance (P ≤ .026).

SIGNIFICANCE

Tested materials can be considered reliable in terms of fracture resistance in short- or mid-term (5 years of intraoral simulation) when used for single molar crowns with 2 mm occlusal thickness. In the long term, polymer-infiltrated ceramic network crowns cemented with RelyX Universal may provide promising results and be less prone to complications considering higher fracture resistance values obtained.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Repair bond strength of a new self-adhesive composite resin to three different resin-matrix ceramic CAD-CAM materials

This study aimed to evaluate the shear bond strength of two flowable composite resins to resin-matrix ceramic CAD-CAM materials.Fifty-four plates obtained from Lava Ultimate (LU), Cerasmart (CS), and Vita Enamic (VE) CAD-CAM blocks were assigned to nine groups: N0: Nova Compo SF (NCSF), N1: Silane/Single Bond Universal (SBU)/NCSF, N2: SBU/NCSF, N3: Silane/G-Premio Bond (GPB)/NCSF, N4: GPB/NCSF, G1: Silane/SBU/G-aenial Universal Injectable Composite (GUIC), G2: SBU/GUIC, G3: Silane/GPB/GUIC, G4: GPB/GUIC. After the repair procedures, shear bond strength values were analyzed. Silane pre-application decreased bond strength in most LU and CS groups but increased it in VE. NCSF performed better than GUIC in all CAD-CAM's with similar adhesive protocols. SBU in combination with NSCF had the highest bond strength among all repair procedures in LU and CS. Silane-containing universal adhesives in combination with self-adhesive resin composites should be used to repair resin-matrix ceramic materials.

Evaluation of the Mechanical and Adhesion Characteristics of Indirect Restorations Manufactured with Three-Dimensional Printing

The aim of this study was to investigate the marginal fit and bond strength characteristics of onlay restorations manufactured by three-dimensional printing (Varseo XS, Bego GmbH, Bremen, Germany) and CAD/CAM (CAMcube, Montreal, QC, Canada) systems. Class II onlay cavities on sixty mandibular molars were prepared in cavities and restored in three separate groups using different fabrication methods. Digital and conventional impressions were taken to design the restorations in the CAD system (DWOS, Straumann GmbH, Freiburg, Germany). To evaluate the marginal fit and void volumes, all specimens were scanned with microcomputed tomography. A microshear test was performed to compare the bond strength of the restorations to the tooth surface. The marginal fit values measured for the 3D-printed and CAD/CAM onlay restorations were found to be at clinically acceptable levels (<120 µm), and no significant difference could be observed between the three different fabrication methods (p > 0.05). According to the microshear test results, the CAD/CAM group had the highest bond strength values before (34.82 MPa) and after (26.87 MPa) thermal cycling (p < 0.05), while the 3D-printed and conventionally produced onlays had similar results (p < 0.05). 3D printing technology is a promising option for indirect restorations; however, the post-production phase is as crucial as the printing and cementation phases.

The effect of repair protocols and chewing simulation on the microtensile bond strength of two resin matrix ceramics to composite resin

BACKGROUND

To assess the micro tensile bond strength (µTBS) of two resin matrix ceramic (RMC) blocks bonded to composite resin by using different repair protocols with and without chewing simulation (CS).

MATERIALS AND METHODS

Two resin matrix ceramic blocks (Vita Enamic and Lava Ultimate) were divided into 4 groups according to the surface treatments: Bur grinding (control), Bur grinding + silane, 9.5% HF acid etching, and 9.5% HF acid etching + silane. The single bond universal adhesive was applied on all specimens after the surface treatments according to the manufacturer's instructions, it was administered actively on the treated surface for 20 s and then light cured for 10 s, followed by incremental packing of composite resin to the treated surface. Each group was further divided into 2 subgroups (with/without chewing simulation for 500,000 cycles). A micro tensile bond strength test was performed for each group (n = 15). The effect of surface treatments on the materials was examined by using a scanning electron microscope (SEM). The micro tensile bond strength (MPa) data were analyzed with a three-way ANOVA, the independent t-test, and one-way ANOVA followed by the Tukey post-hoc test.

RESULTS

µTBS results were significantly higher for Lava Ultimate than Vita Enamic for all the surface treatment protocols with (p < 0.01). The chewing simulation significantly negatively affected the micro-tensile bond strength (p < 0.001). Bur grinding + saline exhibited the highest bond strength values for Lava Ultimate, both with and without chewing simulation. For Vita Enamic, bur grinding + saline and HF acid + saline showed significantly higher bond strength values compared to other surface treatments, both with and without chewing simulation (p ≤ 0.05).

CONCLUSION

Bur grinding + silane could be recommended as a durable repair protocol for indirect resin matrix ceramics blocks with composite resin material.

Finite element stress analysis of dental cement application on endocrown and onlay restoration

The aim of the study was to evaluate the influence of resin cement material types on tooth with endocrown and onlay restorations. The first molar was scanned using Micro-CT and underwent a modelling process to obtain the 3D model for computational simulation. Eight models were simulated in the current study with two loading conditions (720N vertical load and 200N oblique load), two types of restoration (onlay and endocrown restorations), and two resin cement variants (dual-cure resin cement and light-cure resin cement). The tooth with onlay restoration showed a significant stress reduction (up to 70%) when using light-cure resin cement compared to dual-cure resin cement. In contrast, types of cement did not affect stress distribution in the tooth with endocrown restoration. The current study found that dual-cure resin cement was preferable in Endocrown and Onlay restorations, due to dual-cure resin cement provided better bond strength compared to light-cure resin cement.

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.

Bonding Characteristics of Silane Coupling Agent and MMA-Containing Primer to Various Composite CAD/CAM Blocks

This study evaluated the bonding characteristics of a silane coupling agent (SCA) and a methyl methacrylate (MMA)-containing primer (MCP) for 11 types of commercial composite blocks (CBs) for sandblasted and non-sandblasted surfaces. The shear bond strength (SBS) was measured according to ISO 29022: Notched-edge shear bond strength test. The SBS results demonstrated statistically significant differences between the CBs under all identical conditions. For the non-sandblasted groups, the SBSs of MCP-treated specimens were significantly higher than those of SCA-treated specimens for all but two CBs. Comparing the two treatments in sandblasted groups, the SBS was significantly higher for seven out of 11 MCP-treated RCB specimens, in contrast with three cases for the SCA-treated group. Two-way ANOVA for SBS showed the interaction effect between sandblasting and primer type for specific CBs, indicating that the sandblasting treatment improved SBS more effectively for SCA-treated specimens. Moreover, the effect of the SCA treatment was more material-dependent compared to that of the MCP treatment, which did not achieve a strong bond in all CBs but proved more effective than the SCA treatment, especially for non-sandblasted surfaces.

Effect of Adhesion Conditions on the Shear Bond Strength of 3D Printing Resins after Thermocycling Used for Definitive Prosthesis

Three-dimensional (3D) printing polymers such as urethane dimethacrylate (UDMA) and ethoxylated bisphenol A dimethacrylate (Bis-EMA) are typically used in definitive prosthesis and require surface treatments before bonding. However, surface treatment and adhesion conditions often affect long-term use. Herein, polymers were divided into Groups 1 and 2 for the UDMA and Bis-EMA components, respectively. The shear bond strength (SBS) between two types of 3D printing resins and resin cements was measured using Rely X Ultimate Cement and Rely X U200, according to adhesion conditions such as single bond universal (SBU) and airborne-particle abrasion (APA) treatments. Thermocycling was performed to evaluate the long-term stability. Sample surface changes were observed using a scanning electron microscope and surface roughness measuring instrument. The effect of interaction between the resin material and adhesion conditions on the SBS was analyzed via a two-way analysis of variance. The optimal adhesion condition for Group 1 was achieved when U200 was used after APA and SBU, whereas Group 2 was not significantly affected by the adhesion conditions. After thermocycling, the SBS significantly decreased in Group 1 without APA treatment and in the entire Group 2. Additionally, porosity, along with increased roughness, was observed on both material surfaces after APA.

Clinical Applications for Dentistry and Oral Health

In the last few years, dentistry has expanded the scope of its research and increased its cooperation with other disciplines [...]

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.

Effect of different surface treatments on resin-matrix CAD/CAM ceramics bonding to dentin: in vitro study

BACKGROUND

Evaluating the effect of different surface treatment methods on the micro-tensile bond strength (µTBS) of two different resin-matrix computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics (RMCs).

METHODS

A standardized inlay preparations were performed on 100 intact maxillary premolars. According to the type of the restorative material, the teeth were randomly divided into two equally sized groups (n = 50): (polymer-infiltrated ceramic (Vita Enamic) and resin-based composites (Lava Ultimate)). The inlays were fabricated using CAD/CAM technology. In each group, the specimens were randomly assigned to five subgroups (n = 10) according to the surface treatment method: group 1 used was the control group (no surface treatment); group 2, was treated with air abrasion with 50 μm Al2O3 (A) and universal adhesive (UA); group 3, was treated with air abrasion with 50 μm Al2O3 (A) and silane coupling agent (S); group 4, was treated with hydrofluoric acid (HF) and universal adhesive (UA) and group 5, was treated with Hydrofluoric acid (HF) + silane coupling agent (S). The inlays were then cemented to their respective preparations using dual-cure self-adhesive resin cement (RelyX U200, 3 M ESPE) according to the manufacturer's instructions. The µTBS test was conducted in all groups, and stereomicroscope and scanning electron microscope were used to inspect the failure mode. The data were statistically analyzed using a two-way analysis of variance (ANOVA) and Tukey's post-hoc multiple comparison tests at a significance level of p < 0.05.

RESULTS

Surface treatments significantly increased the µTBS of the materials compared to the control group (p < 0.05). For CAD/CAM RBCs, the µTBS value highest in group 2 whereas, for PICN, the µTBS value was highest in group 3. Cohesive failure of CAD/CAM restorative material was the most predominant mode of failure in all treated groups, whereas adhesive failure at restoration-cement interface was the most predominant failure mode in the control group.

CONCLUSION

Surface treatments increase the µTBS of resin-matrix CAD/CAM ceramics to tooth structure. Air abrasion followed by universal adhesive and hydrofluoric acid followed by silane application appears to be the best strategies for optimizing the bond strength of CAD/CAM RBCs and PICN respectively.

Surface characterization of indirect restorative materials submitted to different etching protocols

OBJECTIVES

This in vitro study aimed to evaluate the effect of different times and concentrations of hydrofluoric acid etching on the surface of indirect restorative materials obtained from blocks used in CAD-CAM technology.

METHODS

Specimens (4 mm × 4 mm × 0.8 mm) were obtained for each indirect restorative material: zirconia-reinforced lithium monosilicate ceramic (Celtra Duo), nanoceramic resin (Lava Ultimate), and polymer-infiltrated ceramic network material (Vita Enamic). The materials were submitted to etching with 5% or 10% hydrofluoric acid for 20, 40, 60, or 90 s. A control group for each material was evaluated without any surface treatment, totaling nine experimental groups for each material (n = 10). The specimens were evaluated for surface roughness (R_a and R_z), confocal optical microscopy, the contact angle (θ), surface free energy (γs), total free interaction energy (∆G) using a goniometer, and microshear bond strength to resin cement. Specimen images were obtained using scanning electron microscopy, confocal optical microscopy, and atomic force microscopy. Data on the surface roughness, the contact angle, surface free energy, total free interaction energy, and bond strength were subjected to two-way ANOVA and Tukey´s test (α=0.05).

RESULTS

In general, Celtra Duo showed better results after etching with 10% hydrofluoric acid for 40 or 60 s. Lava Ultimate showed better performance after etching with 10% hydrofluoric acid for 20 or 40 s, whereas Vita Enamic showed better results after etching with 5% hydrofluoric acid for 90 s.

CONCLUSION

Each material showed different characteristics after etching with hydrofluoric acid. Knowledge of the proper protocol for each material is essential to ensure improvements in the adhesion process and durability of indirect restorations. In general, Celtra Duo presented mechanical properties superior to those of Lava Ultimate and Vita Enamic.

CLINICAL SIGNIFICANCE

Specific etching protocols must be recommended for each indirect material because longer exposure to hydrofluoric acid can jeopardize the surface, thus affecting the mechanical and bond strength properties.

Effect of Bonding Protocols on the Performance of Luting Agents Applied to CAD-CAM Composites

This in vitro study aimed to evaluate the effect of different bonding strategies on the micro-shear bond strength (μSBS) of luting agents to CAD−CAM composites. Surface scanning electron microscopy (SEM) and spectroscopy by energy-dispersive X-ray spectroscopy (EDS) were performed to analyze the surfaces of the composite before and after bonding treatment. Three CAD−CAM composites were evaluated: Lava Ultimate restorative (LU), Brava Blocks (BR), and Vita Enamic (VE). The LU and BR surfaces were sandblasted using aluminum oxide, while the VE surfaces were etched using a 5% hydrofluoric acid gel according to the manufacturers’ recommendations. All surfaces were subjected to the following bonding strategies (n = 15): adhesive with silane and MDP (ScotchBond Universal, 3M Oral Care, St Paul, MI, USA); adhesive with MDP (Ambar Universal, FGM, Joinville, Brazil); adhesive without silane or MDP (Prime&Bond Elect, Dentsply Sirona, Charlotte, NC, USA), pure silane without MDP (Angelus, Londrina, Brazil), and pure silane with MDP (Monobond N, Ivoclar Vivadent, Schaan, Liechtenstei). Afterwards, tygons were filled with RelyX Ultimate (3M Oral Care), AllCem (FGM), or Enforce (Dentsply Sirona), which were light-cured and subjected to the μSBS test. Data were analyzed using two-way ANOVA and Bonferroni’s post hoc test (α = 0.05). Additional blocks (n = 15) were subjected to scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) before and after the surface treatment. The μSBS values on VE surfaces were higher than those observed on LU and BR surfaces (p < 0.001). Silane without MDP (Allcem) promoted the highest μSBS values, while silane with MDP (RelyX Ultimate) provided the highest values among all bonding strategies (p < 0.001). Enforce promoted no significant difference in μSBS values. SEM and EDS analyses detected noticeable changes to the surface morphology and composition after the surface treatment. The effectiveness of the bonding strategy may vary according not only to the CAD−CAM composite but also to resin cement/bonding agent/silane used.

Effect of the thickness of CAD-CAM materials on the shear bond strength of light-polymerized resin cement

This study aimed to investigate the effect of the thickness of computer aided design-computer aided manufacturing (CAD-CAM) restorative materials on the bond strength of light-polymerized resin cement. Ninety specimens were prepared from three different CAD-CAM materials (a leucite-based glass-ceramic [Empress CAD], a polymer-infiltrated ceramic network [Vita Enamic], and a zirconia-reinforced lithium silicate glass-ceramic [Vita Suprinity]) in different thicknesses (1, 2, and 3 mm). One surface of each specimen was treated by using a single-step self-etching ceramic primer (Monobond Etch & Prime). Light-polymerized resin cement was bonded to treated surfaces by exposure to a light-emitting diode curing unit from the untreated side of the samples. Shear bond strength (SBS) between the ceramic and the resin cement was measured by using a universal testing machine. The leucite-based glass-ceramic had higher SBS values than the other materials at each thickness. For each material, 1 mm-thick specimens had the highest SBS values. The difference between the SBS values of 2 mm- and 3 mm-thick polymer-infiltrated ceramic network was nonsignificant, whereas the SBS values of 2 mm-thick leucite-based glass-ceramic and the zirconia-reinforced lithium silicate glass-ceramic were significantly higher than those of the corresponding 3 mm-thick specimens. The choice of the material and its thickness may be highly important for clinical success when light-polymerized resin cements are used for cementation.

Shear Bond Strength of a Direct Resin Composite to CAD-CAM Composite Blocks: Relative Contribution of Micromechanical and Chemical Block Surface Treatment

This study aims to compare the shear bond strength (SBS) of a direct resin composite to CAD-CAM resin composite blocks treated with different surface treatments: micromechanical, chemical or a combination of both. Eight CAD-CAM resin composite blocks, namely Brilliant Crios, Cerasmart 270, Vita Enamic, Grandio block, Katana Avencia, Lava Ultimate, Tetric CAD and Shofu Block HC were chosen. The micromechanical surface treatment protocols tested were hydrofluoric acid, polyacrylic acid or sandblasting, and the chemical one was a universal primer. These treated CAD-CAM blocks were tested to determine the SBS of a light-curing composite resin Z100 bonded to their surface. Two-way ANOVA followed by Tukey’s post hoc test was used to investigate the difference in SBS. Failures were analyzed by Fisher’s exact test. Bonding interfaces were examined by scanning electron microscopy. The micromechanical surface treatments give the highest SBS values: sandblasting appears to be the most efficient procedure for dispersed filler composite blocks, while hydrofluoric acid etching is preferable for polymer-infiltrated ceramic network (PICN) blocks. The use of universal primer does not improve SBS values on dispersed filler composite blocks. For PICN blocks, the use of universal primer significantly increases SBS values when combined with hydrofluoric acid etching.

Influence of mechanical and chemical pre-treatments on the repair of a hybrid ceramic

OBJECTIVES

This study aimed to investigate the influence of the respective mechanical and chemical pre-treatments on the composite repair of a CAD/CAM hybrid ceramic using a microtensile bond strength test (μTBS).

METHODS

15 CAD/CAM Blocks of Vita Enamic (VE) were randomly sectioned into three mechanical pre-treatments: (1.) Diamond bur (D), (2.) Airborne abrasion (A), (3.) Tribochemical silica coating (T) and subsequently five chemical pre-treatments: (1.) Clearfil SE Bond Bond (B; negative control), (2.) ESPE Sil (S), (3.) Clearfil Ceramic Primer Plus (CPP), (4.) Clearfil Repair (CR) and (5.) Scotchbond Universal (SCB). Per block, n = 20 specimens were sawn. Half of the specimens were randomly selected and subjected to an immediate bond strength test, while the other half was subjected to artificial aging for 6 months 180 days at 37 °C and subsequent thermocycling of 5000 cycles. A μTBS was performed and data (MPa) were compared in one-way and two-way ANOVA and Tukey's HSD. Paired-t-test was used for artificial aging (α = 0.05). Debonded specimens were analyzed of for failure modes with a stereomicroscope (SEM).

RESULTS

The results of one-way ANOVA for the fifteen fastening procedures after aging indicated significant differences according to SCB-A and CPP-T. Two-way ANOVA after aging observed inferior bond strength for SCB. No differences were observed for mechanical pre-treatments. Artificial aging showed a significant reduction in bond strength on most of the fastening procedures.

SIGNIFICANCE

SCB showed the lowest bond strength values besides B, S, CPP, and CR. MDP and silane are both suitable for the repair of VE.

Evaluation of Micro-Shear Bond Strength of Four Different CAD-CAM Polymer-Infiltrated Ceramic Materials after Thermocycling

PURPOSE

To evaluate the bond strength of three monolithic hybrid ceramics/resin nanoceramics and a zirconia-reinforced lithium silicate to resin cement after thermocycling.

MATERIALS AND METHODS

Using four materials, including Vita Enamic (VITA Zahnfabrik), Lava Ultimate (3M ESPE), Crystal Ultra (Digital Dental), and Vita Suprinity (VITA Zahnfabrik), 64 specimens were prepared with dimensions of 4mm×3mm×1.5mm. Vita Suprinity samples were sintered at 840°C for 8 min. After polishing and cleaning all the samples in each group (n = 16), they were subjected to their recommended surface treatment: 10% hydrofluoric acid for Vita Enamic (60s) and Vita Suprinity (20s); air abrasion of Lava Ultimate and Crystal Ultra with 50μ Al₂ O₃ particles. Then, tygon tubes were filled with dual cure resin cement (Panavia F2.0), cured and then subjected to thermal cycling (2000 cycles; 5-55°C). The micro-shear bond strength was measured using micro-tensile testing machine. The data were analyzed using Welch and Games-Howell tests (α = 0.05). The mode of failure was also evaluated using a stereomicroscope.

RESULTS

The highest and the lowest mean micro-shear bond strength belonged to the Crystal Ultra (7.71 ±1.54 MPa) and Vita Suprinity (4.73 ±1.87 MPa) groups, respectively. The differences between groups were significant and Crystal Ultra had higher bond strength in comparison to all three materials (p<.05).

CONCLUSION

Hybrid ceramics showed higher bond strength to resin cements in comparison to resin nanoceramics and zirconia-reinforced lithium silicate materials. This article is protected by copyright. All rights reserved.

Bonding ability of resin cements to different types of CAD/CAM composite blocks

This study investigated the bonding performance of two different types of resin cements to computer-aided design/computer-aided manufacturing (CAD/CAM) composite blocks based on the shear bond strength (SBS) test. A silane-containing self-adhesive resin cement (Panavia SA Cement Universal) and resin luting cement (Block HC Cem) with a primer, were used. Specimens were fabricated from three different types of CAD/CAM composite blocks, and their surfaces were blasted with alumina. Resin cements were bonded to the specimens, and their SBSs were measured after 15 min, 24 h, and after being subjected to thermal cycling for 10,000 and 30,000 cycles. Three-way ANOVA for bond strength revealed that CAD/CAM composite block, resin cement and storage time significantly influenced the SBS values, and the three-way interactions between the evaluated factors, and all the interactions were significant. It was concluded that the bonding performance of resin cements to CAD/CAM composite blocks were material and storage period dependent.

Retention of different CAD/CAM endocrowns bonded to severely damaged endodontically treated teeth: An in vitro study

Aim:

Assess the retention of endocrowns fabricated of different CAD/CAM materials.

Settings and Design:

In vitro - comparative study.

Material and Methods:

Root canal treated mandibular first molars were prepared in a standardized method. Standardized endocrowns were manufactured using four CAD-CAM blocks: resin infiltrated ceramic (Vita Enamic), partially stabilized tetragonal zirconia (Katana), lithium disilicate ceramic (IPS e.max CAD), and polyether-ether-keton (PEEK, BioHPP). After proper surface treatment, the restorations were cemented using a resin cement (Panavia F2.0) and were connected to a special attachment unit and secured to a universal testing machine. The amount of axial load required to dislodge the restoration from the tooth structure was measured (n = 12, α = 0.05). Failures were classified as adhesive debonding from the tooth structure without damaging the supporting tooth structure and cohesive fracture of the supporting tooth structure

Statistical Analysis Used:

One-way analysis of variance,Tukey's post hoc test.

Results:

The retention of Vita Enamic (61 ± 11 N) and IPS e.max CAD (58 ± 9 N) was significantly higher (F = 123, P < 0.01) than Katana (33 ± 13) and Peek restorations (23 ± 11). Vita Enamic and IPS e.max CAD were associated with fractured tooth segments during debonding while Katana and PEEK specimens were adhesively debonded from the remaining tooth structure.

Conclusions:

Within the limitations of this study, using lithium disilicate ceramics and resin infiltrated ceramics as restorative materials to fabricate endocrowns to restore severely damaged endodontically treated teeth, recorded significantly higher retention values. Meanwhile, using yttrium partially stabilized zirconia and polyether ether ketones for the same purpose recorded a favorable mode failure which avoided the possibility of tooth fracture.

Shear-bond strength and optical properties of short fiber-reinforced CAD/CAM composite blocks

The aim of this study was to assess the shear-bond strength (SBS) of resin-luting cement to experimental short fiber-reinforced CAD/CAM composite (SFRC) compared to conventional CAD/CAM (Cerasmart 270), 3D printed (GC TEMP PRINT, Pro3dure GR-17), and laboratory (Gradia Plus) composites. Moreover, translucency parameter values and light transmission were evaluated. For each of the five types of composites, discs were prepared (n = 16/group) and divided into subgroups (n = 8/group) according to surface treatment protocol (hydrofluoric acid or air-particle abrasion). SBS test was performed using universal testing machine until failure, and failure modes were visually analyzed. Translucency parameter and curing-light transmission values through 1, 2, and 3 mm thickness were quantified using spectrophotometry and the MARC resin calibrator, respectively. Scanning electron microscopy (SEM) was used to examine the CAD/CAM composites after surface treatment. Composite type and surface treatment had a significant effect on SBS. Laboratory composite showed the highest SBS value (22.4 MPa). Cerasmart 270 exhibited higher translucency parameter values (19.8, 11.0, 5.0) than SFRC (14.5, 5.2, 1.6) at the three composite thicknesses tested. Air-particle abrasion was more effective in enhancing SBS than acid etching. Experimental SFRC CAD/CAM composite showed higher SBS values than Cerasmart 270. For all composites, translucency parameter values and light transmission decreased as thickness increased.

A 3-dimensional finite element and in vitro analysis of endocrown restorations fabricated with different preparation designs and various restorative materials

STATEMENT OF PROBLEM

The preparation design and fabrication materials directly affect the clinical success of endocrown restorations, and yet, knowledge is lacking about the biomechanical impact of specific designs or materials on endocrown restorations.

PURPOSE

The purpose of this in vitro and finite element analysis study was to evaluate the biomechanical behavior of endocrown restorations.

MATERIAL AND METHODS

A total of 36 freshly extracted mandibular first molars were collected. The teeth were prepared as per 2 different preparation geometries: with the buccal wall intact (Class 2) and without the buccal wall (Class 3). Teeth were restored with endocrowns made from 3 different fabricating materials, Vita Enamic, GC Cerasmart, and Lava Ultimate. To analyze the in vitro fracture strength, cemented endocrowns were loaded in a universal test machine with a 200-N oblique force until the restoration fractured. Finite element analysis was used to evaluate the stress distribution on both the dentin tissue and the restorative materials. The data were analyzed with a 2-way ANOVA test and the Tukey post hoc test (α=.05).

RESULTS

No significant differences were found between the different preparation designs (Class 2 and Class 3) on fracture strength (P>.05). The highest mean ±standard deviation fracture strength values were found in the Lava Ultimate material (Class 2, 606.20 ±293; Class 3, 659.40 ±226 N) (P>.05), but the lowest fracture strength test values were obtained in the Vita Enamic material (Class 2, 439.60 ±136; Class 3, 340 ±98 N) (P>.05) for both preparation design test groups.

CONCLUSIONS

A statistically significant difference was not found between the 2 tooth preparation classifications. However, significant differences were observed among the test groups in the Class 2 preparation specimens. The Class 2 preparation design exhibited a higher number of irreparable failures.

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.

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.

Effect of thermocycling on the surface properties of resin-matrix CAD-CAM ceramics after different surface treatments

PURPOSE

To evaluate the effect of thermocycling on the water contact angle (WCA), surface roughness (SR), and microhardness (MH) of resin-matrix computer-assisted design and computer-assisted manufacturing (CAD-CAM) ceramics after different surface treatments (conventional polishing or 2 different surface sealants).

MATERIAL AND METHODS

Two different types of resin-matrix CAD-CAM ceramics; a nanoparticle-filled resin (CeraSmart; CS) and a resin nanoceramic (Lava Ultimate; LU) were tested. Rectangular-shaped plates (1 mm-thick) were divided into 3 groups (n = 8) in terms of surface treatment methods applied: conventional polishing (control) or 2 surface sealants (Optiglaze (OG) and Palaseal (PS)). Scanning electron microscope images ( × 1000 and × 700 magnifications) of each material were taken from 2 additional specimens before surface treatments. After surface treatments, WCAs of deionized water, SR, and MH values of specimens were measured. All specimens were subjected to 5000 thermocycling and measurements were repeated. SR, WCA, and MH data before and after thermocycling were compared by using a 2-way ANOVA (α=.05).

RESULTS

A significant interaction was found between the surface treatment and the material for WCA after thermocycling (P < .001), for SR before thermocycling (P = .014), and for MH both before and after thermocycling (P < .001). SEM images before surface treatments revealed that the surface of CS was mechanically rougher with a more microretentive topography compared with the surface of LU. No significant correlation was found between SR and WCA (P > 0.05).

CONCLUSIONS

Thermocycling affected the SR, MH, and WCA of all resin-matrix CAD-CAM ceramics.

Influence of Low-Pressure Plasma on the Surface Properties of CAD-CAM Leucite-Reinforced Feldspar and Resin Matrix Ceramics

The introduction of new ceramic materials for dental restorations is currently a reality; however, little information is available on their surface treatment for the bonding process. Furthermore, surface treatment with plasma on ceramic materials has been recently introduced, although not many studies are available. The aim of this study was to evaluate the surface properties of a leucite-reinforced feldspar ceramic (LIC) and resin matrix ceramic (RMC) after low-pressure plasma treatment. From each material, 48 discs were prepared and subject to surface treatment. The LIC group was treated by hydrofluoric acid (HF) (LIC-HF), plasma with oxygen (LIC-O2), and plasma with argon (LIC-Ar). The RMC group was treated by sandblasting with alumina (RMC-SB), plasma with oxygen (RMC-O2), and plasma with argon (RMC-Ar). The groups whose surfaces were not subjected to treatment were considered as the control group. Surface wettability and roughness was analyzed. The results showed significant differences among the treatments for both ceramics regarding wettability and roughness. Plasma treatments increased the wettability and had a very low effect on the roughness. Plasma treatments achieved similar values for both surface properties in each ceramic group with no differences between both treatments. Plasma treatment seems to be a promising alternative for ceramic surface treatments since it increased the surface energy of the ceramics analyzed and hardly affects the roughness. Further studies are necessary to evaluate the effect of plasma treatment on the bond strength of ceramics.

Repair bond strength and surface topography of resin-ceramic and ceramic restorative blocks treated by laser and conventional surface treatments

This study intended to compare the repair bond strength of computer-aided design/computer-aided manufacturing (CAD/CAM) blocks consisting of resin and feldspathic ceramics following different surface treatments using the microtensile bond strength (μTBS) test. Ten specimens were prepared with 4 mm height for Vita Enamic (VE), Lava Ultimate (LU), Vita Mark II (VM), and thermocycled (10,000 cycle, 5-55°C). Each material was categorized into one of five subgroups according to following surface treatments: (a) bur grinding (BG), (b) hydrofluoric acid etching (HF), (c) neodymium-doped yttrium aluminum garnet (Nd:YAG or NY), (d) erbium-doped yttrium aluminum garnet (Er:YAG or EY), and (e) erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG or ECY) laser conditioning. After surface treatment procedures, specimens were properly restored to 4 mm high with a micro-hybrid composite resin. Bar specimens (1 × 1 × 8 mm) were obtained using a low-speed cutting machine and then thermocycled (10,000 cycle, 5-55°C). The μTBS was tested at 1 mm/min crosshead speed, and failure modes were evaluated. Data were analyzed with two-way ANOVA and post hoc Tukey tests. LU-BG showed significantly higher μTBS (32.94 ± 5.80 MPa) compared to LU-laser groups (p < .05). VE-BG showed significantly higher μTBS (22.06 ± 4.26 MPa) compared to other VE groups (p < .05). Among the laser groups, the NY laser produced the lowest (p < .05) μTBS for LU (13.42 ± 3.44 MPa) and VE (2.27 ± 0.85 MPa), while EY showed the highest (p < .05). Laser-treated VM groups were all prefailured. VM-HF produced a higher μTBS (18.73 ± 3.75 MPa) than VM-BG (5.05 ± 1.76 MPa) (p < .05).

Effect of etching with low concentration hydrofluoric acid on the bond strength of CAD/CAM resin block

The effect of etching for 90 s with low concentrations (0.5, 1.0, 2.0, 3.0, 3.5, and 4.0%) of hydrofluoric acid (HF) on the adhesiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) resin blocks [CERASMART (CS), SHOFU BLOCK HC (HC), KATANA AVENCIA Block(KA), and VITA ENAMIC (EN)] was investigated. Energy dispersive spectroscopy revealed that the silicon content of HC, KA, and EN groups remained almost constant with HF etching of ≤4%. HF etching increased the surface roughness of all blocks. The HF concentration resulting in the highest shear bond strength in each group was as follows: CS (2.0%), HC (3.0%), KA (3.5%) and EN (0.5%). Scanning electron microscopy revealed that the bonding interface of etched surfaces differed significantly from that of airborne-particle abrasion surfaces. Thus, low concentration HF etching is effective for surface treatment of CAD/CAM resin blocks. The etching effect and optimum HF concentration differ with the block composition and structure.

Effect of prolonged application of single-step self-etching primer and hydrofluoric acid on the surface roughness and shear bond strength of CAD/CAM materials

This in vitro study aimed to assess the influence of different concentrations and durations of hydrofluoric acid (HF) and Monobond Etch & Prime (MEP) etching on the surface roughness (R_a ) of different CAD/CAM materials and on the shear bond strength (SBS) of a self-adhesive resin bonded to the materials. Seventy specimens of hybrid ceramic, leucite-based glass-ceramic, lithium disilicate glass-ceramic, and zirconia-reinforced lithium silicate glass-ceramic were prepared and divided into seven groups according to the surface treatments: Control (C); MEP etching for 60 (MEP₆₀ ) and 120 (MEP₁₂₀ ) s; 5% HF etching for 60 (HF-5%₆₀ ) and 120 (HF-5%₁₂₀ ) s; 9.5% HF etching for 60 (HF-9.5%₆₀ ) and 120 (HF-9.5%₁₂₀ ) s. The R_a was measured using a 3D profilometer. All groups were treated with a universal primer except for the C, MEP₆₀ , and MEP₁₂₀ groups. A self-adhesive resin cement was bonded to all specimens, and the bond strengths were measured using a universal testing machine. All surface treatments increased both R_a and SBS values compared to the control in each material. Neither the duration of surface treatments nor the HF acid concentrations had a statistically significant effect on SBS. Within the limitations of this experimental study, it can be concluded that Monobond Etch & Prime may be a preferable method to achieve high bond strength values.

Effect of color of the cement and the composite resin foundation on the resultant color of resin-matrix ceramics

STATEMENT OF PROBLEM

An improper restoration color match to the adjacent natural teeth can jeopardize esthetic success. The type of resin-matrix ceramic (RMC), the shade of the underlying foundation, and the shade of cement may affect the optical behavior of RMC materials, but studies on this issue are lacking.

PURPOSE

The purpose of this in vitro study was to assess the cumulative effect of different shades of composite resin foundation (CRF) and cement on the optical behaviors of 3 different RMCs.

MATERIAL AND METHODS

Forty-five rectangular RMC specimens (14×12×1 mm, shade A2) were prepared from 3 different blocks, including a polymer-infiltrated ceramic network (Vita Enamic [VE]), a resin nanoceramic (Lava Ultimate [LU]), and a flexible nanoparticle-filled resin (GC Cerasmart [GC]) (n=15 per RMC block). CRFs (14×12×4 mm) were fabricated in white and dentin shades (n=1 per composite resin shade). Cement specimens (G-CEM LinkForce) were prepared from 3 shades (A2, opaque [OP], and translucent [TR]) (n=15 per shade). For control groups, 3 rectangular RMC foundations (14×12×4 mm) were also milled from RMC blocks (n=1 per block). Color coordinates were recorded by using a digital spectrophotometer. The coordinates of 4-mm-thick RMC foundations served as the control groups. The coordinates of RMC specimens on each combination of CRF and cement served as test groups. The CIEDE2000 (ΔE₀₀) formula was used to assess color differences. Data were subjected to 3-way ANOVA and Tukey honestly significant difference (HSD) tests (α=.05).

RESULTS

ΔE₀₀ values of specimens were influenced by the CRF shade, cement shade, RMC type, as well as the interaction terms of the 3 variables (P<.001). Color differences in groups VE-A2-dentin, VE-OP-dentin, LU-OP-dentin, and GC-OP-dentin showed perceptible but clinically acceptable values (0.8<ΔE₀₀≤1.8). The highest and lowest ΔE₀₀ values were observed in the white-OP-LU (5.32 ±0.34) and dentin-OP-VE (0.94 ±0.31) groups.

CONCLUSIONS

Opaque cement on the white foundation led to the highest ΔE₀₀ values in the resultant colors of all RMC groups. When used with the same shade on the dentin foundation, this cement produced clinically acceptable results.

Bonding performance of dispersed filler resin composite CAD/CAM blocks with different surface treatment protocols

The effect of various pretreatments on the bonding of a resin cement to resin-composite CAD/CAM blocks (RCBs) was examined. The surface of dispersed-filler RCBs (DF-RCBs) and a polymer infiltrated ceramic network RCB (PICN-RCB) was roughened using hydrofluoric acid etching (HF) or sandblasting, and followed by silanization and/or universal adhesive (UA) application. Microtensile bond strength (µTBS), surface roughness parameters (arithmetical mean height (Sa); developed interfacial area ratio (Sdr)), and critical surface energy (γ_c) were determined. For most DF-RCBs, the highest µTBS was obtained using HF+UA. UA application to DF-RCBs resulted in similar or higher µTBS compared to silanization, which indicates that silane treatment is not crucial for DF-RCBs, especially after HF. In contrast, the highest µTBS to PICN-RCB was obtained with silanization. Both roughening pretreatments significantly increased the surface roughness parameters and the γ_c of all RCBs. The γ_c was positively correlated with Sa (r=0.756, p<0.001) and Sdr (r=0.837, p<0.001).

Effect of the amount of light energy transmitted through CAD/CAM resin block on bonding performance of four types of resin cement adhesive systems

Resin-ceramic hybrid materials for computer-aided design/computer-aided manufacturing (CAD/CAM resins) have been developed. In this study, the effects of the amount of light energy transmitted through the four types of 1.5-mm-thick CAD/CAM resin blocks on the bond performance of corresponding resin cement adhesive systems consisting of an adhesive and a dual-curable resin cement were examined. The bond strengths of the four types of resin cement adhesive systems decreased with decreasing the amount of light energy transmitted through CAD/CAM resin block, due to a decrease in the light-curable ability of dual-curable resin cements. However, the degradation behavior of the bond strengths was strongly affected by the types of adhesives and initiator systems utilized. The adhesive consisting of a dimethacrylate monomer and redox-initiators enhanced the bonding performance of the dual-curable resin cement more effectively than the adhesive, which consists of a dimethacrylate monomer and photo-initiators or a γ-me thacryloxypropyltrimethoxysilane and a 10-methacryloyloxydecyl dihydrogen phosphate.

Evaluation of shade correspondence between current monolithic CAD/CAM blocks and target shade tab by considering the influence of cement shade and restorative material thickness

It was aimed to evaluate shade matching between novel CAD/CAM blocks and the A2 target shade tab by considering the influence of cement shade and restorative material thickness on the chromatic background. A total number of 120 rectangular-shaped specimens were subtracted from four different prefabricated CAD/CAM blocks [Vita Enamic (VE), Lava Ultimate (LU), GC Cerasmart (GC), and Vita Mark II (VMII)]. These specimens had thicknesses of 0.5 mm and 1.0 mm. Three different shades (A2, opaque, and translucent) of dual-polymerized resin cement were chosen. The dentin shade (A3.5) restorative composite foundation was incrementally fabricated in a silicon mold. For control group, the A2 shade tab of the Vitapan classical shade guide was used. Different restorative material-cement-foundation assemblies were generated with optic gel. Color readings were performed by using a clinical spectrophotometer, and CIEDE2000 (ΔE₀₀) formula was used to assess color differences. Data were statistically analyzed (α = 0.05). With increasing thickness, color difference values decreased. Higher mean ΔE₀₀ units were observed in all restorative material sub-groups for 0.5 mm thickness. In TR shade, no statistically significant difference was detected among the mean ΔE₀₀ values of 0.5 mm-thick restorative materials. Color differences in groups 1.0 mm-opaque-LU and 1.0 mm-opaque-GC indicated perceptible but clinically acceptable values (0.8˂ΔE₀₀ ≤ 1.8). The highest and lowest ΔE₀₀ units were observed in the 0.5 mm-A2-VE group (ΔE₀₀ = 7.07) and 1 mm-opaque-GC group (ΔE₀₀ = 1.46), respectively. Luting cement shade, restorative material type, and thickness significantly influenced the resultant color of restoration. Opaque cement on dentin foundation exhibited lower color differences.

A potential application of materials based on a polymer and CAD/CAM composite resins in prosthetic dentistry

PURPOSE

A bioactive high performance polymer (BioHPP) and computer-aided design/computer-aided manufacturing (CAD/CAM) composite resin materials are a relatively new class of dental biomaterials, that are biocompatible and have good aesthetic features. In this review paper, we will summarize literature and publication data on the characteristics of the mentioned materials, as well as their potential application in the dental prosthetics.

STUDY SELECTION

Available studies and literature reviews from PubMed, SCIndex, Scopus and Google Scholar corresponding to polyetheretherketone (PEEK), high-performance polymers, reinforced composite materials, composite materials, resins, glass-fiber reinforced materials, CAD/CAM materials, dental implants, removable and fixed dental were reviewed.

RESULTS

To avoid many disadvantages of metals and their alloys in dental practice, such as inadequate color, high density, thermal conductivity and possible allergic reactions, materials based on polymers (such as BioHPP), and CAD/CAM composite resins are being developed. These materials have significantly better aesthetics and physical-mechanical properties. They are biocompatible materials that are lightweight, resistant, durable, exhibit high bending and compression resistance.

CONCLUSIONS

The use of CAD/CAM composite resin materials and BioHPP in dentistry has begun recently, so the data about their potential clinical use are limited. Most of their features have been demonstrated through laboratory testing, while clinical studies are relatively scarce, so the need for further clinical trials is emphasized.

Effect of various surface treatments on the bond strength of resin luting agent and the surface roughness and surface energy of CAD/CAM materials

The aim of this study was to examine the effect of various surface treatments on the bond strength of a resin luting agent and the surface roughness and surface energy of computer-aided design and computer-aided manufacturing (CAD/CAM) materials. Four types of CAD/CAM blocks (Shofu Block HC: BHC; GC Cerasmart: CER; VITA Enamic: ENA; and Lava Ultimate: LAV) were used. All blocks were randomly divided into eight groups based on the surface treatment as follows: no surface treatment (C), airborne-particle abrasion (AA), hydrofluoric acid etching (HA), silane coupling agent application (SL), AA/SL, HA/SL, AA/HA, and AA/HA/SL. The microtensile bond strength (µTBS), surface roughness and surface energy were measured. Three-way ANOVA revealed that all surface treatments significantly influenced the µTBS between the resin luting agent and all types of CAD/CAM materials; however, the effect of each surface treatment on surface roughness and energy was dependent on the CAD/CAM materials.

Effect of storage conditions on mechanical properties of resin composite blanks for CAD/CAM crowns

The objective of this study was to examine the effects of storage conditions on the flexural strengths of resin composite materials for CAD/CAM restorations. Seven commercially available resin composite CAD/CAM blanks were examined. Rectangular specimens (4.0×1.2×4.0 mm) of each material were trimmed from the blanks and subjected to thermal cycling between 5°C and 55°C in deionized water at 10,000 cycles or stored in 37°C deionized water for one week or air for one day (n=10 for each condition). The difference in storage condition between water immersion and thermal cycling did not affect the flexural strengths of resin composite materials for CAD/CAM examined in this study. The resin composite block CS300 made from Bis-MEPP and UDMA showed the greatest flexural strength under all storage conditions and less deterioration of strength by thermal cycling and water immersion among the resin composite blocks tested.

Evaluation of the Surface Characteristics of Dental CAD/CAM Materials after Different Surface Treatments

Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was developed to ensure the sufficient strength of tooth restorations, to improve esthetic restorations with a natural appearance and to make the techniques easier, faster and more accurate. In the view of the limited research on the surface treatments of the CAD/CAM materials and the need to evaluate the ideal surface characteristics of a material to achieve the best adhesion to tooth tissues, this study aimed to investigate the surface roughness and morphology of four different CAD/CAM materials using four different surface treatments. The CAD/CAM materials used in this study were three composites (Shofu Block HC, Lava Ultimate and Brilliant Crios) and a hybrid ceramic (Enamic). The surface of the specimens of each material received one of the following treatments: no surface treatment, sandblasting with 29 μm Al₂O₃ particles, 9% hydrofluoric acid etching and silane application, and the tribochemical method using CoJet System. Surface roughness was evaluated using optical profilometry, and surface morphology was observed by means of scanning electron microscopy. All surface treatments resulted in higher surface roughness values compared to the control group. Different treatments affected the surface properties of the materials, presumably due to discrepancies in their composition and structure.

Bonding to industrial indirect composite blocks: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis was to evaluate the effect of surface conditioning methods on the bond strength of industrial indirect composite blocks (ICs).

METHODS

Based on the PICOS strategy, the Medline via PubMed, Embase and Web of Science (ISI - Web of Knowledge) electronic databases were searched for peer-reviewed articles in both English and Chinese, with no publication year limit. In vitro studies evaluating the effects of surface conditioning on the bond strength of ICs were selected. The meta-analysis was conducted to calculate the mean difference between surface-conditioned ICs and unconditioned controls. Subgroup analysis was performed to evaluate the different surface conditioning methods, separately for polymer-infiltrated ceramic network (PICN) material and the ICs with dispersed fillers (ICDFs). Meta-analyses were performed with a random-effects model at a significance level of 0.05.

RESULTS AND SIGNIFICANCE

From 802 relevant studies, 25 were selected for full-text analysis. Nineteen studies were eligible for inclusion in this systematic review, whereas 9 studies were included in the meta-analysis. A manual search of the principal periodicals specific to the area resulted in no additional articles. The meta-analysis indicated a significant difference in bond strength between the surface-conditioned ICs and controls under both non-aged and aged conditions. The combination of mechanical and chemical conditioning yielded the highest bond strength of ICs. This meta-analysis suggests that chemical etching followed by a universal primer and alumina air abrasion followed by a silane coupling agent could be considered the best strategy for optimizing the bond strength of PICN materials and ICDFs under aged conditions, respectively.

Comparison of Bond Strength of Monolithic CAD-CAM Materials to Resin Cement Using Different Surface Treatment Methods

Objective:

To compare the bond strength of monolithic CAD-CAM materials to resin cement using different surface treatment methods.

Materials and Methods:

Lithium disilicate glass ceramic (IPS e-max CAD), zirconia-reinforced lithium silicate ceramic (Vita Suprinity), resin nanoceramic (Lava Ultimate), and hybrid ceramic (Vita Enamic) were used. Five groups of CAD-CAM blocks were treated as follows: control (C), HF etching (HF), HF etching + silanization (HF + S), sandblasting (SB), and sandblasting + silanization (SB + S). After surface treatments, SEM analyses were conducted. Specimens were cemented with self-adhesive resin cement (Theracem) and stored in distilled water at 37°C for 24 h. Shear bond strength (SBS) was measured, and failure types were categorized. Results were analyzed using two-way ANOVA and the post-hoc Tukey test.

Results:

Statistical analysis revealed significant differences between SBS values obtained for different surface treatments and CAD-CAM block types ( P < .001). Among the CAD-CAM materials, the highest SBS was reported in the HF + S group for Vita Enamic. Although IPS e.max CAD, Vita Suprinity, and Vita Enamic showed higher bond strength when treated with HF + S, Lava Ultimate has the highest bond strength value when treated with SB + S.

Conclusions:

The bond strength of CAD-CAM materials was influenced by surface treatment. Additionally, silanization significantly improved the bond strength of all materials except Lava Ultimate.

Hydroxyapatite coating effect on the bond strength between CAD/CAM materials and a resin cement

The purpose of this study was to evaluate the bond strength between CAD/CAM materials and a resin cement using hydroxyapatite coating as a surface treatment method. Different surface treatments (Control, no treatment-C; Sandblasting-SB; Hydrofluoric acid etching-HF; applying tooth desensitizer-TeM; applying topical crème-ToM, HAp coating with Pulse Laser Deposition technique-PLD) were applied to three different CAD/CAM materials (LAVA Ultimate, VITA Enamic, and Cerec Blocs). After surface treatments, a universal adhesive (Single Bond Universal, 3M ESPE) was applied and adhesive resin (Rely X Ultimate, 3M ESPE) were cemented on each material surface using plastic tubes (4 mm in diameter). The shear bond strength values were measured using a universal testing machine. Scanning electron microscope analysis were performed to evaluate failure modes and effects of surface treatments. Obtained data were statistically analyzed using two-way ANOVA and Tukey's post hoc test (p = 0.05). The bond strength of PLD groups were significantly higher than other groups in resin-ceramics (p < 0.05). In Cerec Blocs, HF resulted significantly higher bond strength than other groups (p < 0.05). SEM analysis of surface treatment methods (except TeM and ToM) revealed an increase in surface alterations compared to control groups. Failure modes were dominantly adhesive in groups C, TeM, and ToM, whereas mostly mix or cohesive failures were observed in PLD, HF, and SB. Hydroxyapatite coating with PLD technique exhibited promising bond strength results for CAD/CAM resin-ceramics. HAp coating can be used as a replacement for hydrofluoric acid etching and sandblasting in CAD/CAM resin-ceramic materials to obtain better bond strength values.

Bonding effectiveness of tooth-colored materials to resin cement provided by self-etching silane primer after short- and long-term storage

STATEMENT OF PROBLEM

Glass-ceramic materials are typically treated with hydrofluoric acid (HF) and silane to improve their bond to composite resin; however, HF may be harmful to human tissues and the integrity of the material, and its application is a technique-sensitive procedure. A novel self-etching ceramic primer has been introduced with the claim that it can solve those problems. However, independent scientific evidence regarding its performance is scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of self-etching silane primer on glass-ceramic surface roughness and on long-term bonding between glass-ceramic and composite resin cement.

MATERIAL AND METHODS

Plates of 3 materials (n=10), lithium disilicate glass-ceramic (LDC) (IPS e.max CAD), leucite-based glass-ceramic (LEU) (IPS Empress CAD), and resin-modified ceramic (PIC) (VITA ENAMIC), were treated in the following ways: no treatment (C), HF (5%) applied during the recommended time for each material (HF), and self-etching ceramic primer (Monobond Etch & Prime [MBEP]). Surface roughness (Sa) was analyzed with a laser 3D profiler. Ceramic sticks were subjected to (n=20) no treatment (C); treatment with hydrofluoric acid plus silane (HF+S); and treatment with self-etching ceramic primer (MBEP) bonded to prepolymerized composite resin sticks with composite resin cement (Variolink II) and stored for 24 hours and 1 year (n=10). The assemblies were submitted to microtensile bond strength testing (μTBS). Data were analyzed using ANOVA and the Tukey pairwise, post hoc test (α=.05). Failure pattern and surface and interface morphology were assessed using scanning electron microscopy.

RESULTS

Only individual factors resulted in statistically significant differences for both variables (material: P<.001; surface treatment: P=.020), interaction (P=.570). HF group (0.49 ±0.11 μm) showed statistically higher roughness values (P≤.05) than control groups (0.44 ±0.97 μm), while MBEP (0.48 ±0.11 μm) was comparable with both. HF produced greater surface alterations than MBEP and C. PIC (0.60 ±0.051 μm) exhibited significantly higher roughness values (P≤.05) than LDC (0.37 ±0.07 μm) and LEU (0.45 ±0.04). Regarding μTBS, the general mean of PIC (24.6 ±10.1 MPa) was higher (P≤.05) than LEUs (14.7 ±6.7 MPa) and LDCs (13.1 ±4.8 MPa), while treatment groups HF+S (17.9 ±10.0 MPa) and MBEP (20.5 ±9.7 MPa) produced higher μTBS values than control groups (14.2 ±5.5 MPa). Adhesive failure was associated with low μTBS values and aged specimens, while cohesive failure within the composite resin-cement layer and mixed failures were associated with higher μTBS values. Interface debonding was detected in C groups for LDC and LEU. PIC exhibited better interface stability.

CONCLUSIONS

MBEP produced smoother surfaces than HF. HF+S and MBEP significantly improved ceramic and composite resin cement bonding.