Fracture toughness of conventional, resin-modified glass-ionomer and composite luting cements

Zirconia bond strength durability following artificial aging: A systematic review and meta-analysis of in vitro studies

The present study systematically reviewed the literature regarding the bond strength durability of zirconia ceramics to resin-based luting cements after application of different bonding protocols and aging conditions. Electronic searches in PubMed, Scopus, and Web of Science databases were performed for relevant literature published between January 1st 2015 and November 15th 2022. Ninety-three (93) English language in-vitro studies were included. The percentage of the mean bond strength change was recorded prior to and after artificial aging, and the weighted mean values and 95% confidence intervals were calculated. Bonding protocols were classified based on the combination of MDP/non-MDP containing cement/primer and surface pretreatment, as well as the level of artificial aging performed. Alumina sandblasting (SA) was identified as the most frequently used surface pre-treatment while an insufficient number of studies was identified for each category of alternative surface treatments. The combination of MDP cement with tribochemical silica coating (TSC) or SA yielded more durable results after aging, while the application of SA and TSC improved bond durability when a non-MDP cement and a non-MDP primer were used. TSC may lead to increased bond durability compared to SA, whereas MDP cements may act similarly when combined with SA or TSC.

Update on Dental Luting Materials

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

Evaluation of the Mechanical Properties of Three Resin-Modified Glass-Ionomer Materials

This study is aimed at evaluating the flexural strength (FS), fracture toughness (FT), and diametral tensile strength (DTS) of three resin-modified glass-ionomer cements (RMGICs): Ketac Nano, Riva Light Cure, and Fuji II LC. One hundred twenty specimens were prepared from the RMGIC materials ( $n=10$ ). The cements were mixed and inserted into different mould sizes according to the test performed: FS: rectangular Teflon mould ( $32\text{mm}\times 3.15\text{mm}\times 2\text{mm}$ ); FT: notchless triangular prism (NTP) Teflon mould ( $6\text{mm}\times 6\text{mm}\times 6\text{mm}\times 12\text{mm}$ ); and DTS: ring road stainless steel mould ( $6\text{mm}\times 3\text{mm}$ ). Specimens were light cured for 20 seconds on each surface and stored in distilled water at ${37}^{°}\text{C}\pm 2^{°}\text{C}$ for seven days prior to tests. To evaluate the influence of storage in the mechanical properties of the RMGIs, specimens tested for DTS were stored in distilled water at ${37}^{°}\text{C}\pm 2^{°}\text{C}$ for 32 days prior to test. Data were analyzed by ANOVA and Tukey’s test ( $\alpha =0.05$ ). Fuji II LC presented significantly higher values for all tests employed when compared to Ketac Nano and Riva LC RMGIs. There was no significant difference on DTS before and after the 32-day storage for each material. Fuji II LC presented superior mechanical properties when compared to Ketac Nano, and Riva LC storage showed no influence on the mechanical properties of the RMGI materials tested.

Fiber reinforcement of a resin modified glass ionomer cement

OBJECTIVES

Understand how discontinuous short glass fibers and braided long fibers can be effectively used to reinforce a resin modified glass ionomer cement (RMGIC) for carious lesion restorations.

METHODS

Two control groups (powder/liquid kit and capsule) were prepared from a light cured RMGIC. Either discontinuous short glass fibers or braided polyethylene fiber ribbons were used as a reinforcement both with and without pre-impregnation with resin. For the former case, the matrix was the powder/liquid kit RMGIC, and for the latter case the matrix was the capsule form. Flexural strength was evaluated by three-point beam bending and fracture toughness was evaluated by the single-edge V-notch beam method. Compressive strength tests were performed on cylindrical samples. Results were compared by analysis of variances and Tukey's post-hoc test. Flexural strength data were analyzed using Weibull statistical analysis.

RESULTS

The short fiber reinforced RMGIC both with and without pre-impregnation showed a significant increase of ∼50% in the mean flexural strength and 160-220% higher fracture toughness compared with the powder/liquid RMGIC control. Reinforcement with continuous braided fibers gave more than a 150% increase in flexural strength, and pre-impregnation of the braided fibers with resin resulted in a significant flexural strength increase of more than 300% relative to the capsule control. However, for the short fiber reinforced RMGIC there was no significant benefit of resin pre-impregnation of the fibers. The Weibull modulus for the flexural strength approximately doubled for the fiber reinforced groups compared to the control groups. Finally, compressive strength was similar for all the groups tested.

SIGNIFICANCE

By using a RMGIC as a matrix, higher flexural strength was achieved compared to reported values for short fiber reinforced GICs. Additionally, the short fibers provided effective toughening of the RMGIC matrix by a fiber bridging mechanism. Finally, continuous braided polyethylene fibers gave much higher flexural strength than discontinuous glass fibers, and their effectiveness was enhanced by pre-impregnation of the fibers with resin.

Retentive strength of luting cements for stainless steel crowns: A systematic review

BACKGROUND

Stainless steel crowns (SSCs) are unique coronal restorative materials used commonly in the management of primary teeth with extensive caries.

AIM

The aim of this study was to perform a systematic review to evaluate the retentive strength of luting cements for SSCs.

MATERIALS AND METHODS

Two reviewers performed a database search of the studies published from 2004 till date. The inclusion criteria were papers published in the English language andin vitro studies on retentive strength of SSC on primary molars. All potentially relevant studies were identified by the title and the abstract. After the full-text analysis, the selected studies were included in the systematic review.

RESULTS

Sixteen nonduplicated studies were found. However, after reviewing the articles, only seven were included. Risk bias was assessed. Out of seven studies included in the systematic review, five studies presented medium risk of bias and two studies showed high risk of bias.

CONCLUSION

Within the limitations of this study, thein vitro literature seems to suggest that the use of self-adhesive resin cements shows higher retentive strength, followed by resin-modified glass-ionomer cement (RM-GIC) and conventional GIC. However, RM-GIC can be a preferred luting agent due to its clinical advantages over resin cements. Thus, it can be concluded that choice of cement will depend on individual patient needs and clinical situation.

Mechanical and Functional Properties of a Novel Apatite-Ionomer Cement for Prevention and Remineralization of Dental Caries

Especially in pediatric dentistry, prevention by the control of initial lesions prior to cavitation is very important, and application of a pit and fissure sealant is essential to achieve this. Numerous reports have suggested that resin-based sealants are inferior to sealants based on glass-ionomer cement (GIC), because of GIC’s many advantages, such as fluoride ion release properties and its good adhesion to tooth structures. However, the use of GIC is impeded due to its low flexural strength and fracture toughness. In this paper, we developed and characterized an apatite-ionomer cement (AIC) that incorporates hydroxyapatite (HAp) into the GIC; this development was aimed at not only reinforcing the flexural and compressive strength but also improving some functional properties for the creation of the material suitable for sealant. We examined the influence of differences in the compounding conditions of GIC powder, liquid, and HAp on flexural and compressive strengths, fracture toughness, fluoride ion release property, shear bond strength to bovine enamel, surface pH of setting cements, and acid buffer capability. These methods were aimed at elucidating the reaction mechanism of porous spherical-shaped HAp (HApS) in AIC. The following observations were deduced. (1) HAp can improve the mechanical strengths of AIC by strengthening the cement matrix. (2) The functional properties of AIC, such as acid buffer capability, improved by increasing the releasing amounts of various ions including fluoride ions. The novel AIC developed in this study is a clinically effective dental material for prevention and remineralization of tooth and initial carious lesion.

A Review of Dental Cements

This review provides an in-depth comparison of advantages and disadvantages of different types of dental cements as they are used for cementing base metal alloy crowns in dogs.

In vitro Evaluation of Stainless Steel Crowns cemented with Resin-modified Glass Ionomer and Two New Self-adhesive Resin Cements

AIMS

To assess and compare the retentive strength of two dual-polymerized self-adhesive resin cements (RelyX U200, 3M ESPE & SmartCem2, Dentsply Caulk) and a resin-modified glass ionomer cement (RMGIC; RelyX Luting 2, 3M ESPE) on stainless steel crown (SSC).

MATERIALS AND METHODS

Thirty extracted teeth were mounted on cold cured acrylic resin blocks exposing the crown till the cemento-enamel junction. Pretrimmed, precontoured SSC was selected for a particular tooth. Standardized tooth preparation for SSC was performed by single operator. The crowns were then luted with either RelyX U200 or SmartCem2 or RelyX Luting 2 cement. Retentive strength was tested using Instron universal testing machine. The retentive strength values were recorded and calculated by the formula: Load/Area.

STATISTICAL ANALYSIS

One-way analysis of variance was used for multiple comparisons followed by post hoc Tukey's test for groupwise comparisons. Unpaired t-test was used for intergroup comparisons.

RESULTS

RelyX U200 showed significantly higher retentive strength than rest of the two cements (p < 0.001). No significant difference was found between the retentive strength of SmartCem2 and RelyX Luting 2 (p > 0.05).

CONCLUSION

The retentive strength of dual-polymerized self-adhesive resin cements was better than RMGIC, and RelyX U200 significantly improved crown retention when compared with SmartCem2 and RelyX Luting 2.

HOW TO CITE THIS ARTICLE

Pathak S, Shashibhushan KK, Poornima P, Reddy VVS. In vitro Evaluation of Stainless Steel Crowns cemented with Resin-modified Glass Ionomer and Two New Self-adhesive Resin Cements. Int J Clin Pediatr Dent 2016;9(3):197-200.

Selected physical properties of new resin-modified glass ionomer luting cements

STATEMENT OF PROBLEM

Two resin-modified glass ionomer (RMGI)-based luting agents have been recently marketed without independent reports of their physical properties.

PURPOSE

The purpose of this in vitro study was to evaluate selected physical properties of 2 newly marketed RMGI luting agents and compare the findings with traditional materials.

MATERIAL AND METHODS

Specimens (N=12) of Nexus RMGI, UltraCem, GC Fuji Cem 2, and RelyX Luting Plus were fabricated using standardized molds for flexural strength and fracture toughness according to manufacturer recommendations and stored in physiologic phosphate-buffered saline solution at 37°C until testing. Specimens were tested at 1 and 24 hours, 1 week, and 1 month. Mean values for flexural strength, flexural modulus, flexural toughness, and fracture toughness were determined. Additionally, film thickness (N=12) for each material was determined following Amerian National Standards Association/American Dental Association (ANSI/ADA) specifications. Mean results were analyzed with Kruskal-Wallis and Mann-Whitney U tests (α=.05).

RESULTS

All luting agents exhibited a similar film thickness that met ANSI/ADA requirements for aqueous-based luting agents. Nexus RMGI surprisingly demonstrated significantly greater flexural strength and fracture toughness at 1 hour, which decreased significantly at 24 hours, making it similar to the other materials evaluated. All materials had similar flexural strength values at 7 days.

CONCLUSIONS

Physical property performance was material dependent. Nexus RMGI demonstrated greater early physical properties that were significantly less at 24 hours. UltraCem, GC Fuji Cem 2, and RelyX Luting Plus demonstrated the increasing physical property development that is normally associated with polyalkenoate-based systems.

Comparative evaluation of voids present in conventional and capsulated glass ionomer cements using two different conditioners: an in vitro study

This in vitro study evaluated the presence of voids in powder-liquid and capsulated glass ionomer cement. 40 cavities were prepared on root surfaces of maxillary incisors and divided into four groups. Cavities were conditioned with glass ionomer cement liquid (GC Corporation, Tokyo, Japan) in Groups 1 and 3 and with dentin conditioner (GC Corporation, Tokyo, Japan) in Groups 2 and 4. Conventional powder-liquid glass ionomer cement (GC Fuji II, GC Corporation, Tokyo, Japan) was used as a restorative material in Groups 1 and 2. Capsulated glass ionomer cement (GC Fuji II, GC Corporation, Tokyo, Japan) was used in Groups 3 and 4. Samples were sectioned and viewed under stereomicroscope to check for the presence of voids within the cement and at the cement-tooth junction. Data was analyzed using one-way ANOVA and Tukey's post hoc tests. Group 4 showed statistically significant results (P < 0.05) when compared to Groups 1 and 2 for voids within the cement. However, for voids at the margins, the results were statistically insignificant.

Effect of intraoral aging on the setting status of resin composite and glass ionomer orthodontic adhesives

INTRODUCTION

The aim of this study was to assess the effect of intraoral aging on the setting status of a resin composite and a glass ionomer adhesive, relative to control specimens stored in water.

METHODS

Metallic brackets were bonded with resin composite orthodontic adhesive (Transbond XT; 3M Unitek, Monrovia, Calif) or a glass ionomer cement (Fuji I; GC, Tokyo, Japan) to recently extracted premolars and kept in water for 6 months. The same materials were also bonded to the premolars of orthodontic patients. After 6 months, the teeth were carefully extracted, with the brackets intact on their buccal surfaces. All teeth were embedded in epoxy resin and sectioned buccolingually. Fourier transform infrared microscopy and Raman microscopy were used for the estimation of the degree of cure in the composite and the salt yield in the glass ionomer adhesives.

RESULTS

The control samples of the composite showed significantly lower degrees of cure than did the retrieved specimens (52.40% ± 3.21% vs 57.62% ± 1.32% by Fourier transform infrared microscopy, and 61.40% ± 2.61% vs 67.40% ± 3.44% by Raman microscopy). Raman microscopy significantly overestimated the degree of cure and failed to provide reliable information for the salt yield in the glass ionomer cement. Fourier transform infrared microscopy showed increased, but no statistically significant difference in, aluminum-carboxylate salts in the retrieved specimens.

CONCLUSIONS

Enhanced oxidation of residual carbon-carbon bonds in the composite and slightly increased dissolution of the weaker calcium-salt phase in the glass ionomer cement were the main differences in the intraorally aged specimens in comparison with the specimens stored in water.

Effect of metal priming agents on bond strength of resin-modified glass ionomers joined to gold alloy

The aim of this study was to evaluate in vitro the shear bond strength to a gold alloy of RMGICs combined with three metal priming agents. Gold alloy was primed with one of the following materials: Alloy Primer, Metal Primer II, or Metaltite. Non-treated group was considered as the control. Specimens were bonded with one of the following luting agents: Super-Bond C&B, Vitremer Luting Cement, Fuji Lute, or Xeno Cem Plus. Shear bond strength was then determined. The bond strengths of resin-modified glass ionomer cements primed with the metal priming agents were greater than that of non-treated group, except for the Vitremer Luting Cement-Alloy Primer combination. It was thus concluded that the priming agents employed in this study were substantially effective in improving the bonding of resin-modified glass ionomer cements to gold alloy.

Influence of previous provisional cementation on the bond strength between two definitive resin-based luting and dentin bonding agents and human dentin

This study evaluated the effect of two different types of provisional luting agents (RelyX Temp E, eugenol-based; RelyX Temp NE, eugenol-free) on the shear bond strengths between human dentin and two different resin-based luting systems (RelyXARC-Single Bond and Duo Link-One Step) after cementation with two different techniques (dual bonding and conventional technique). One hundred human molars were trimmed parallel to the original long axis, to expose flat dentin surfaces, and were divided into three groups. After related surface treatments for each specimen, the resin-based luting agent was applied in a silicone cylindrical mold (3.5 x 4 mm), placed on the bonding-agent-treated dentin surfaces and polymerized. In the control group (n = 20), the specimens were further divided into two groups (n = 10), and two different resin-based luting systems were immediately applied following the manufacturer's protocols: RelyX ARC-Single Bond (Group I C) and Duo Link-One Step (Group II C). In the provisionalization group (n = 40), the specimens were further divided into four subgroups of 10 specimens each (Group I N, I E and Group II N, II E). In Groups I N and II N, eugenol-free (RelyX NE), and in groups I E and II E, eugenol-based (RelyX E) provisional luting agents (PLA), were applied on the dentin surface. The dentin surfaces were cleaned with a flour-free pumice, and the resin-based luting systems RelyX ARC (Group I N and E) and Duo Link (Group II N and E) were applied. In the Dual bonding groups (n = 40), the specimens were divided into four subgroups of 10 specimens each (Group I ND, ED and Group II ND, ED). The specimens were treated with Single Bond (Groups I ND and ED) or One Step (Groups II ND and ED). After the dentin bonding agent treatment, RelyX Temp NE was applied to Groups I ND and II ND, and RelyX Temp E was applied to Groups I ED and II ED. The dentin surfaces were then cleaned as described in the provisionalization group, and the resin-based luting systems were applied: RelyX ARC-Single Bond (Group I ND and ED) and Duo Link-One Step (Group II ND and ED). After 1,000 thermal cycles between 5 degrees C and 55 degrees C, shear bond testing was conducted at a crosshead speed of 0.5 mm/minutes. One-way ANOVA, followed by a post hoc Tukey test (alpha = 0.05) was done. The dentin-resin-based luting system interfaces were evaluated under a scanning electron microscope. There was a significant reduction in the mean shear bond strength values of groups subjected to the provisionalization compared to the control and dual bonding technique groups (p < 0.05). The composition of provisional luting did not create a significant difference with regard to reducing shear bond strength values (p > 0.05). With regard to resin based luting systems, the shear bond strength values of the double-bond technique groups were not significantly different from the controls (p > 0.05).

Viscoelastic behavior and fracture toughness of six glass-ionomer cements

STATEMENT OF PROBLEM

Viscoelastic behavior can influence the fracture properties of glass ionomers, which is of clinical relevance. Glass-ionomer cements can display viscoelastic behavior, defined as having displacement rate- or strain rate-dependent mechanical properties. Understanding and describing the viscoelastic behavior of glass ionomers is important to understanding their clinical behavior.

PURPOSE

The purpose of this study was to evaluate the viscoelastic behavior of 6 glass-ionomer cements and determine whether there was a correlation to fracture toughness.

MATERIAL AND METHODS

Three conventional glass-ionomer cements (alpha-Silver, alpha-Fil, and Ketac-Molar) and 3 resin-modified glass-ionomer cements (Vitremer, Fuji II LC, and Photac-Fil Quick) were evaluated using measurements of compressive strength (CS), flexural strength (FS), and diametral tensile strength (DTS) at displacement rates of 0.5, 1.0, 1.5, and 2.0 mm/min. The CS and DTS specimens were cured in glass tubes and cut to 4 x 6-mm and 4 x 2-mm disk-shaped specimens, respectively. The FS specimens were cured in bar molds (2 x 2 x 15 mm). The fracture toughness (FT) specimens were cured in a minicompact mold to obtain precracked specimens. The mechanical testing results were compared statistically using generalized linear model/analysis of covariance and the Ryan-Einot-Gabriel-Welsch multiple range test at the alpha=.05 level.

RESULTS

For all 3 mechanical properties, there was a displacement-rate dependence on the mechanical property. However, there were no differences in the displacement-rate dependence based on the type of material-conventional glass ionomer or resin-modified glass ionomer-for any of the mechanical properties. Only for FS test was there a significant difference based on the brand of material. There was no statistical difference in FT among the glass-ionomer cements tested, although the resin-modified glass ionomers tended to display higher FT.

CONCLUSION

A larger sample size and a much wider range of crosshead speeds are necessary to support a correlation between viscoelastic behavior and FT.

Thin-wall ceramic CAD/CAM crown copings: strength and fracture pattern

The strength and fracture pattern of posterior CAD/CAM-generated crown copings with 0.4 mm wall thickness were evaluated in vitro hypothesizing that fracture resistance of YTZP-zirconia copings might be independent of mode of cementation whether resin-bonded or cemented because of the high strength of YTZP-zirconia. Two sets of copings (n = 15) each were fabricated using CEREC inLab CAD/CAM from (i) lithiumdisilicate glass-ceramic, (ii) infiltration ceramic as controls and (iii) YTZP-zirconia. Copings (n = 15) of ceramics (i), (ii) and (iii) each were (a) zinc-phosphate cemented, (b) adhesively seated on resin-based composite dies and loaded until fracture. Load (N) data was analysed using anova and Scheffé tests. Crack pattern was evaluated on additional three sample cross-sections for each group at fracture-start. Radial cracks originated early at the cementation interfaces and cone cracks were observed finally at the loading sites. Mean load (N) values (+/-s.d.) of A-copings at fracture-start/-end (i) 804 +/- 195/862 +/- 162, (ii) 923 +/- 180/975 +/- 147, (iii) 697 +/- 110/1607 +/- 145, were all significantly (P < 0.01) lower when compared with their B-crown coping analogs (i) 1183 +/- 318/1919 +/- 326, (ii) 1621 +/- 165/1820 +/- 211, (iii) 731 +/- 115/1973 +/- 287 except for A3 and B3 at fracture-start. This confirmed our hypothesis at fracture-start (P > 0.05) but rejected it at fracture-end (P < 0.01). The A3 fracture-end data, even if significantly (P < 0.01) lower, came close to the B3 values by 18%. A3 was significantly (P < 0.001) stronger by 86/74% than A1/A2 at fracture-end. The data indicates that YTZP-zirconia copings have the potential to provide support for all-ceramic core crowns, which may be adequate for non-adhesive cementation.

Engineering Properties and Performance of Dental Crowns

Dental crowns are used to replace damaged natural crowns of teeth and are fixed to prepared teeth with luting cements, which should provide an adhesive bond to the tooth structure giving reliable retention and minimal microleakage. Mechanical testing of crowns in vitro gives failure load distributions that are well described by Weibull models, comparing probabilities of survival and reliability. Fatigue testing of crowns is time consuming, but regression analysis to interpolate functions through data points quoting probability limits or applying Weibull analysis is achievable. A complementary approach is to conduct materials tests with appropriate interfacial geometries. Luting cements are used in thin layers of 40–150 um. Contraction during polymerization is restrained by adhesion to substrates, allowing little relaxation of stresses. Conventional and resin-modified glass ionomer cements create thin zones of interaction with dentine and fail cohesively. The chevron notch short rod technique has been used to measure fracture toughness and rank cements. A development of this method, using chevron notch short bar specimens, permitted fracture toughness to be determined for luting cement-dentine substrate interfaces. Representative fracture experiments need to be developed to apply mixed mode conditions. The basic challenge to predict long-term performance from short-term laboratory tests remains.

Strength and fracture pattern of monolithic CAD/CAM-generated posterior crowns

OBJECTIVES

This study evaluated the strength and fracture pattern of monolithic posterior CAD/CAM crowns hypothesizing that zinc-phosphate cemented lithium disilicate crowns might show the same fracture strength as adhesively cemented crowns.

METHODS

Two sets of monolithic posterior crowns each with uniform occlusal and lateral wall thickness of 1.5mm were fabricated from three types of block ceramic (1) lithium disilicate glass, (2) leucite glass and (3) feldspathic ceramic using CEREC 3 CAD/CAM. Crowns (n = 15) of ceramics (1), (2) and (3) each were (A) zinc-phosphate cemented, (B) adhesively cemented on resin-based composite dies and loaded until fracture. Load data was analyzed using ANOVA and Scheffé tests. Crack pattern was evaluated on an additional three sample cross-sections for each group at start of fracture.

RESULTS

Radial cracks originated early at the cementation interfaces and cone cracks were observed finally at the loading sites. Mean load values (SD) of A-crowns at fracture start/end (1) 807 (91) N/2082 (192) N; (2) 915 (193) N/1130 (166) N; (3) 985 (199) N/1270 (301) N were all significantly (P < 0.001) lower when compared to their B-crown analogs (1) 1456 (205) N/2389 (84) N; (2) 1684 (395) N/2469 (171) N; (3) 1548 (304) N/2392 (75) N, rejecting the authors hypothesis. A-1 crowns had significantly (P < 0.001) higher fracture load than A-2 and A-3 crowns. The A-1 crown fracture load data, even if significantly (P < 0.001) lower, came close to the B-1 values.

SIGNIFICANCE

Adhesive cementation balanced the strength of weak ceramics with that of strong ceramic and recommended itself for leucite glass ceramic and feldspathic ceramic crowns. Zinc-phosphate cementation appeared feasible for lithium disilicate crowns.

Fracture toughness of resin-modified glass ionomer restorative materials: effect of powder/liquid ratio and powder particle size reduction on fracture toughness

OBJECTIVES

The objectives of the current investigation were two-fold: (1) to examine the effect of different powder/liquid (P/L) ratios on the fracture toughness of commercial resin-modified glass ionomer cement and conventional glass ionomer cement, and (2) to evaluate the effect of powder size reduction on the fracture toughness of experimental resin-modified glass ionomers in order to improve their physical properties.

METHODS

The P/L ratios of the glass ionomer and resin-modified glass ionomers were varied from the manufacturer's recommended ratio to 2.0 and 1.0 by weight. The powder particle sizes for the experimental resin-modified glass ionomers tested were 2, 5, 10 and 25 micro m in diameter. Fracture toughness was determined on ring-shaped specimens with a fatigued pre-crack.

RESULTS

The fracture toughness of the resin-modified glass ionomers was significantly higher (p<0.005) than that of the glass ionomer and was not greatly influenced by the P/L ratio. For the experimental resin-modified glass ionomers, it was observed that fracture toughness gradually decreased as the powder particle size became finer.

SIGNIFICANCE

The resin components in the liquid play an important role in the improvement of the physical properties of the resin-modified glass ionomer. A reduction in the powder particle size of up to 10 micro m, which resulted in a smoother surface, can maintain high fracture toughness. The high fracture toughness values of the resin-modified glass ionomer may be one of the factors contributing to a favorable clinical outcome in high stress-bearing areas.

An application of nanotechnology in advanced dental materials

BACKGROUND

This article reports the authors' development of nanofillers and a resulting nanocomposite. They measured the nanocomposite's properties in vitro in comparison with those of several existing composites (hybrids, microhybrids and microfill).

METHODS

The authors developed two types of nanofillers: nanomeric particles and nanoclusters. They used optimal combinations of these nanofillers in a proprietary resin matrix to prepare the nanocomposite system with a wide range of shades and opacities. The properties they studied were compressive, diametral tensile and flexural strengths; in vitro three-body wear; fracture resistance; polish retention; and surface morphology after toothbrush abrasion. They performed statistical analysis using analysis of variance/Tukey-Kramer paired analysis at a 95 percent confidence interval.

RESULTS

The compressive and diametral strengths and the fracture resistance of the nanocomposite were equivalent to or higher than those of the other commercial composites tested. The three-body wear results of the nanocomposite system were statistically better than those of all other composites tested. The nanocomposite showed better polish retention than the hybrids and microhybrids tested at the extended brushing periods. After extended toothbrush abrasion, the dentin, body and enamel shades showed polish retention equivalent to that of the microfill tested, while translucent shades showed better polish retention than the microfill.

CONCLUSIONS

The dental nanocomposite system studied showed high translucency, high polish and polish retention similar to those of microfills while maintaining physical properties and wear resistance equivalent to those of several hybrid composites.

CLINICAL IMPLICATIONS

The strength and esthetic properties of the resin-based nanocomposite tested should allow the clinician to use it for both anterior and posterior restorations.

Ceramic Inlays and Onlays: Clinical Procedures for Predictable Results

The use of ceramics as restorative materials has increased substantially in the past two decades. This trend can be attributed to the greater interest of patients and dentists in this esthetic and long-lasting material, and to the ability to effectively bond metal-free ceramic restorations to tooth structure using acid-etch techniques and adhesive cements. The purpose of this article is to review the pertinent literature on ceramic systems, direct internal buildup materials, and adhesive cements. Current clinical procedures for the planning, preparation, impression, and bonding of ceramic inlays and onlays are also briefly reviewed. A representative clinical case is presented, illustrating the technique.

CLINICAL SIGNIFICANCE

When posterior teeth are weakened owing to the need for wide cavity preparations, the success of direct resin-based composites is compromised. In these clinical situations, ceramic inlays/onlays can be used to achieve esthetic, durable, and biologically compatible posterior restorations.

Toughness, bonding and fluoride-release properties of hydroxyapatite-added glass ionomer cement

Improving the mechanical strength of glass ionomer cement while preserving its favorable clinical properties such as fluoride release, bonding to tooth structure and biocompatibility is desirable. In this study, hydroxyapatite was incorporated into chemically setting glass ionomer cement and its effect on the fracture toughness, bonding to dentin and fluoride release was identified. Commercial glass ionomer cement (Fuji IX GP((R)) ) was the control and base material. Eight weight percent of hydroxyapatite was added into the glass ionomer powder. Specimens were fabricated and the fracture toughness, shear bond strength and eluted fluoride ion concentration were measured. Adding hydroxyapatite into the glass ionomer cement led to significantly higher fracture toughness after 15min and 24h from mixing. The hydroxyapatite-added cement also exhibited bond strength to dentin similar to that of the control from 15min to 56 days and consistent fluoride release for 13 weeks. SEM findings showed a cohesive type of fracture in the material for all specimens in both groups. These results indicate that hydroxyapatite-added glass ionomer cement has a potential as a reliable restorative material with improved fracture toughness, long-term bonding to dentin and unimpeded ability of sustained fluoride release.

Effect of different luting materials on the marginal adaptation of Class I ceramic inlay restorations in vitro

OBJECTIVES

The aim of this in vitro study was to assess the marginal adaptation of prefabricated Class I ceramic inlay restorations placed with various luting materials.

METHODS

Forty-two standardized occlusal cavities were prepared in extracted human molars with diamond burs exactly corresponding to the dimensions of prefabricated glass ceramic inlays. The prepared teeth were randomly assigned to seven groups of six teeth each and restored using (1). the composite resin Tetric Ceram in increment technique [Group I] or (2). ceramic inlays (Cerana) luted with: the composite based materials Dual Cement [Gr. II] and Panavia 21 [Gr. III], the compomer material Dyract Cem [Gr. IV], Dyract Cem with additional use of Prime & Bond 2.1 [Gr. V], the silicophosphate cement Trans-Lit [Gr. VI], or the ethylcyanoacrylate Cyano-Veneer [Gr. VII]. Marginal adaptation was evaluated by SEM-analyses before and after thermal cycling (2500 cycles; 5-55 degrees C) and mechanical loading (100N; 500000 cycles) using replica models. Kruskal-Wallis H-test and Mann-Whitney U-test were used for statistical analyses.

RESULTS

Group I (increment technique) as well as Groups II-V (inlay technique) revealed high percentages of perfect marginal adaptation in over 95% of the analyzed margins, both before and after thermo-mechanical loading. Statistical significant differences could not be detected within these groups. All inlays luted with silicophosphate cement (Group VI) and four of six inlays applied with Cyano-Veneer (Group VII) fractured under occlusal load.

SIGNIFICANCE

A stable bonding to the enamel and to the ceramic inlay was achievable with the composite luting resins Dual Cement and Panavia 21 as well as with the compomer based luting material Dyract Cem but not with the use of the silicophosphate cement Trans-Lit or the ethylcyanoacrylate Cyano-Veneer.

A comparative evaluation of dental luting cements by fracture toughness tests and fractography

In recent years there has been a shift from traditional methods of investigating dental materials to a fracture mechanics approach. Fracture toughness (KIC) is an intrinsic material property which can be considered to be a measure of a material's resistance to crack propagation. Glass-ionomer cements are biocompatible and bioactive dental restorative materials, but they suffer from poor fracture toughness and are extremely susceptible to dehydration. The main objective of this study was to evaluate the fracture toughness of three types of commercially available dental cements (polyacid-modified composite resin, resin-modified and conventional glass ionomer) using a short-rod chevron-notch test and to investigate and interpret the results by means of fractography using scanning electron microscopy. Ten specimens of each cement were fabricated according to manufacturers' instructions, coated in varnish, and stored at ambient laboratory humidity, 100 per cent relative humidity, or in water at 37 degrees C for 7 days prior to preparation for testing. Results indicated that significant differences existed between each group of materials and that the fracture toughness ranged from 0.27 to 0.72 MN/m3/2. It was concluded that the resin-modified glass-ionomer cement demonstrated the highest resistance to crack propagation. Fractographs clearly showed areas of stable and unstable crack growth along the fractured surfaces for the three materials examined.