Flexural Strength, Elastic Modulus, and pH Profile of Self-etch Resin Luting Cements

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

Stress distribution in pediatric zirconia crowns depending on different tooth preparation and cement type: a finite element analysis

BACKGROUND

In clinical settings, tooth preparation for prefabricated zirconia crowns (PZCs) in the primary dentition varies widely. However, knowledge about the biomechanical behavior of PZCs in various clinical settings is limited. This study was conducted to evaluate the biomechanical behavior of PZCs in different clinical settings using 3-dimensional finite element analysis.

METHODS

3-dimensional models of the PZC, cement, and tooth with six different conditions were simulated in primary molar teeth, incorporating cement thickness (100, 500, and 1000 μm) and cement type (resin-modified glass ionomer cement and resin cement). A total of 200 N of occlusal force was applied to the models, both vertically and obliquely as representative cases. A general linear model univariate analysis with partial eta-squared (ηp²) was performed to evaluate the relative effects of the variables.

RESULTS

The overall stress of tooth was increased as the cement space increases under oblique loading. The von Mises stress values of the resin cements were significantly higher than those of the resin-modified glass ionomer cements for all cement thicknesses (p < .05). The effect size of the cement type (η_p² = .519) was more dominant than the cement thickness (η_p² = .132) in the cement layer.

CONCLUSIONS

Within the limits of this study, cement type has a greater influence on the biomechanical behavior of PZCs than cement thickness.

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.

Post-Cure Development of the Degree of Conversion and Mechanical Properties of Dual-Curing Resin Cements

This study investigated the effect of different curing conditions on the degree of conversion and mechanical properties of contemporary dual-curing resin cements. The material specimens were either light-cured directly, light-cured through a 1-mm lithium disilicate glass-ceramic layer, or self-cured. The degree of conversion was measured in 0.1-mm films using Fourier-transform infrared spectroscopy 1 day, 7 days, and 28 days post-cure. Specimens used to study the flexural strength and modulus were prepared according to the ISO 4049 protocol, stored for 28 days post-cure, and subjected to accelerated aging by absolute ethanol immersion. The degree of conversion values ranged between 44.3–77.8%. Flexural strength varied between 11.4–111.1 MPa, while flexural modulus amounted to 0.7–5.5 GPa. The degree of conversion was significantly affected by material type, curing conditions, and post-cure time; however, variations in curing conditions were the least influential factor. A statistically significant effect of curing conditions on the degree of conversion was identified for only one of the five materials tested, whereas the flexural strength and modulus of all tested materials were significantly reduced in the experimental groups that were light-cured through a ceramic layer or self-cured. The effect size analysis showed that mechanical properties were most affected by the material type, while the differences in curing conditions were less influential. A comparison of the degree of conversion and mechanical properties indicated that different curing conditions may lead to significantly different flexural strength and modulus, which are not necessarily accompanied by identifiable variations in the degree of conversion.

Cement Choice and the Fatigue Performance of Monolithic Zirconia Restorations

This study investigated the fatigue failure load of simplified monolithic yttria partially stabilized zirconia polycrystal restorations cemented to a dentin-like substrate using different luting systems. Disc-shaped ceramic (Zenostar T, 10 mm Ø × 0.7 mm thick) and dentin-like substrate (10 mm Ø × 2.8 mm thick) were produced and randomly allocated into eight groups, without or with thermocycling (TC=5-55°C/12,000×): "cement" (RelyX Luting 2 - glass ionomer cement [Ion], [Ion/TC]; RelyX U200 - self-adhesive resin cement [Self], [Self/TC]; Single Bond Universal+RelyX Ultimate - MDP-containing adhesive + resin cement [MDPAD + RC], [MDP-AD + RC/TC]; ED Primer II+Panavia F 2.0 - Primer + MDP-containing resin cement [PR + MDP-RC], [PR + MDP-RC/TC])). Each luting system was used as recommended by the manufacturer. Staircase methodology (20 Hz; 250,000 cycles) was applied for obtaining the fatigue failure loads. Fractographic characteristics were also assessed. At baseline, the Ion group presented the lowest fatigue load, although it was statistically similar to the Self group. The resin-based cement systems presented the highest fatigue performance, with the Ion group being only statistically equal to the Self group. Thermocycling influenced the groups differently. After aging, the MDP-AD + RC presented the highest mean, followed by the PR + MDP-RC and Self groups, while the Ion group had the lowest mean. Fractographic analysis depicted all failures as radial cracks starting at the zirconia intaglio surface. The luting system with MDP-containing adhesive applied prior to the resin cement presented the highest fatigue failure load after aging, presenting the best predictability of stable performance. Despite this, monolithic zirconia presents high load-bearing capability regardless of the luting agent.

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

OBJECTIVES

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

METHODS AND MATERIALS

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

CONCLUSIONS

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

Physical, Mechanical, and Adhesive Properties of Novel Self-Adhesive Resin Cement

Objective

To evaluate a newly developed self-adhesive resin cement on physical, mechanical, and adhesive properties and compare it with other commercial self-adhesive resin cements.

Materials and Methods

Experimental self-adhesive resin cement (SARC) was formulated by our proprietary adhesive resin and filler technology. Maxcem Elite, RelyX Unicem 2, SpeedCem Plus, SmartCEM 2, and Calibra Universal 2 were selected for comparison. Working and setting times, film thickness, water sorption and solubility, flexural strength, and modulus were measured in accordance with ISO-4049. Consistency was tested according to modified ISO 4823. Shear bond strengths were conducted according to ISO 29022. The data were analyzed by one-way ANOVA and post hoc Tukey's tests (p ≤ 0.05).

Results

All cements showed about 2–4 min working time and about 3–6 min setting time except that RelyX Unicem 2 has a longer working time (9'58”) and setting time (10'18”). All cements meet ISO standards for film thickness (≤50 µm), water sorption (≤40 µg/mm³) except Maxcem Elite (46.19 µg/mm³), and water solubility (≤7.5 µg/mm³) except SmartCEM 2 (11.35 µg/mm³) and Calibra Universal (9.87 µg/mm³). Experimental SARC showed significantly higher flexural strength and modulus than other cements (p < 0.001). For self-curing, Experimental SARC has statistically higher bond strength than other cements (p < 0.001) except statistically the same as RelyX Unicem 2 (p > 0.05). For light-curing, Experimental SARC showed significantly higher bond strength than other cements (p < 0.001) except statistically the same as Maxcem Elite and RelyX Unicem 2 (p > 0.05). For dual-curing, the bond strength of Experimental SARC is significantly higher than that of other cements (p < 0.001).

Conclusion

The newly developed self-adhesive resin cement exhibited favorable bonding capability and physical and mechanical properties compared to other commercial self-adhesive resin cements and is a good option for cementation of indirect restorations with potential long-term clinical success.

Finite element analysis and nanomechanical properties of composite and ceramic dental onlays

The aim is to evaluate the mechanical properties of the composite and ceramic based indirect restorative materials used in dental treatments with scanning nanoindentation test (NT). Finite element analysis (FEA) was applied to investigate the stress distribution. Four hybrid composite materials; Indirect resin composite (IRC), Resin nanoceramic (RNC), Polymer infiltrated ceramic (PIC) and Zirconia-reinforced lithium-di-silicate (ZRC) were divided into two subgroups for NT (n = 20) and fracture test (n = 40). Statistical analyses were performed with independent t-test, ANOVA and post-hoc Tukey tests (p ≤ 0.05). The highest hardness, elasticity and fracture toughness were observed in ZRC (p = 0.001). Frequency of vertical root fractures in RNC and IRC were statistically lower than ZRC (p = 0.032). Reinforced CAD-CAM ceramics revealed higher mechanical properties compared with IRC materials. The FEA model for fracture mechanism of RNC demonstrated lowest stress values and uniform stress distribution amongst all groups, while ZRC and PIC presented the highest fracture toughness.

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

Objectives

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

Materials and Methods

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

Results

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

Conclusions

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

Evaluation of the Water Sorption and Solubility Behavior of Different Polymeric Luting Materials

Objective: The study evaluated the water sorption (WSP) and water solubility (WSL) characteristics of different luting agents over a 180-day water storage period. Materials and Methods: Nine luting materials, i.e., conventional resin cement: Panavia F (PF), Rely X ARC (RA), self-adhesive resin cement: Rely X Unicem (RU), Breez (BZ), Maxcem Elite (MX), BisCem (BC) and resin-modified glass ionomer cement: FujiCem (FC), FujiPlus (FP) Rely X luting plus (RL) were assessed and fifty-two-disc specimens of each material were fabricated. All specimens were desiccated until a constant weight (W0) was reached. Thirteen specimens for each luting material were then randomly assigned to one of the four water immersion periods (7, 30, 90, and 180 days). After each period, the specimens were removed from the water and weighed to get W1. The samples were again desiccated for a second time and W₂ was measured. Both WSP and WSL were determined by the following equations: WSP (%) = (W₁ − W₂) × 100/W₀ and WSL (%) = (W₀ − W₂) × 100/W₀. Assessments were performed following ISO standards. ANOVA was used to assess the effect of luting agent and time period on water sorption and solubility. Pair-wise comparisons were adjusted using Tukey’s multiple comparison procedure. A significance level of 0.05 was used for all statistical tests. Results: The highest mean WSP and WSL (WSP/WSL) were demonstrated by resin-modified glass-ionomers (RL 18.32/3.25, FC 17.08/4.83, and FP 14.14/1.99), while resin luting agents showed lower WSP and WSL results (PF 1.6/0.67 and RA 1.76/0.46), respectively. The self-adhesive agents exhibited a wide range of WSP and WSL values (RU 1.86/0.13, BZ 4.66/0.93, and MX 3.68/1.11). Self-adhesive cement showed lower WSP and WSL compared with the resin-modified glass-ionomers (p < 0.05). All the materials reached equilibrium after 90-days. Conclusions: Resin-based luting materials have the lowest sorption and solubility. Rely X Unicem self-adhesive luting materials were comparable to resin luting materials for WSL and WSP. Resin-modified glass-ionomer showed the highest water sorption and solubility compared with both resin and self-adhesive materials.

Three-dimensional finite element analysis of buccally cantilevered implant-supported prostheses in a severely resorbed mandible

PURPOSE

The aim of the study was to compare the lingualized implant placement creating a buccal cantilever with prosthetic-driven implant placement exhibiting excessive crown-to-implant ratio.

MATERIALS AND METHODS

Based on patient's CT scan data, two finite element models were created. Both models were composed of the severely resorbed posterior mandible with first premolar and second molar and missing second premolar and first molar, a two-unit prosthesis supported by two implants. The differences were in implants position and crown-to-implant ratio; lingualized implants creating lingually overcontoured prosthesis (Model CP2) and prosthetic-driven implants creatingan excessive crown-to-implant ratio (Model PD2). A screw preload of 466.4 N and a buccal occlusal load of 262 N were applied. The contacts between the implant components were set to a frictional contact with a friction coefficient of 0.3. The maximum von Mises stress and strain and maximum equivalent plastic strain were analyzed and compared, as well as volumes of the materials under specified stress and strain ranges.

RESULTS

The results revealed that the highest maximum von Mises stress in each model was 1091 MPa for CP2 and 1085 MPa for PD2. In the cortical bone, CP2 showed a lower peak stress and a similar peak strain. Besides, volume calculation confirmed that CP2 presented lower volumes undergoing stress and strain. The stresses in implant components were slightly lower in value in PD2. However, CP2 exhibited a noticeably higher plastic strain.

CONCLUSION

Prosthetic-driven implant placement might biomechanically be more advantageous than bone quantity-based implant placement that creates a buccal cantilever.

Resistance to fracture of intraradicular posts made of biological materials

Background

The aim was to analyze the fracture resistance of human teeth treated endodontically and restored with posts made of bovine dentin, human dentin, or glass fiber, and to evaluate the fracture pattern.

Methods

Cylindrical posts of 1.5 mm in diameter cemented to the roots of human maxillary canines presented a length of 15 mm, cervical diameter of 5–5.5 mm in the mesiodistal direction, and 7–7.5 mm in the vestibule-palatal direction. The groups studied were: Group I—10 glass fiber posts; Group II—10 human dentin posts; Group III—10 bovine dentin posts (self-adhesive resin cement); and Group IV—10 bovine dentin posts (resin-modified glass-ionomer cements). The coronal part of tooth was restored with a standardized core build-up using composite. All of the groups were submitted to a compression force test and the resistance to fracture was verified using a universal testing machine. The fracture pattern was likewise evaluated.

Results

The values of resistance to fracture were: 723.3N in group I, 561.5N in group II, 556.6N in group III, and, 613.27N in group IV. However, no statistically significant difference was observed among the groups. The fractures in groups I and II were most commonly found in the middle/apical third and were considered irreparable. For restored teeth in group III, half of the fractures appeared in the cervical third and were reparable. In group IV, all of the fractures were reparable, with the majority in the cervical thirds.

Conclusion

Bovine dentin can be used as intraradicular post to substitute human dentin and glass fiber posts. The greater the malleability of the post, the greater the chances of survival of the teeth when subjected to fracture testing.

Time-dependent Microhardness Gradients of Self-adhesive Resin Cements Under Dual- and Self-curing Modes

CLINICAL RELEVANCE

Acid-functional monomers in self-adhesive resin cements may decrease their self-curing polymerization ability. Light irradiation optimizes polymerization performance.

SUMMARY

Purpose: The aim of this study was to investigate Knoop microhardness of self-adhesive resin cements under dual- and self-curing modes in simulated canals for describing the polymerization behavior.Methods and Materials: Slots in lightproof silicone cylinders with one open end were filled with the following eight materials: a traditional resin cement (Duolink), a core build-up resin material (MultiCore Flow), and six self-adhesive resin cements (RelyX Unicem 2, G-Cem Automix, Maxcem, Biscem, Multilink Speed, and PermaCem 2.0). The resins were exposed to light through the open end and then stored in a lightproof box. The Knoop hardness gradient for each resin was measured after 1 hour and 120 hours. Surface readings were obtained at 1-mm intervals from 1 mm to 10 mm away from the open ends. The data were analyzed by two-way analysis of variance and the Student-Newman-Keuls test (α=0.05).Results: All the resin materials had stable Knoop hardness numbers (KHNs) at a certain depth; their KHNs in the self-curing mode did not change (p>0.05). The region above this certain depth was regarded as having undergone the dual-curing mode, and the KHN decreased gradually with depth (p<0.05). Between 1 and 120 hours postexposure, the ratio of the KHN at a 5-mm depth (self-cured) to that at a 1-mm depth (dual-cured) increased in Duolink and MultiCore Flow. However, the ratios of the six adhesive resin cements varied.Conclusion: Without light, most self-adhesive resin cements differed from traditional dual-cured resin materials in terms of Knoop micro-hardness, and they had a lesser capacity for chemical-induced curing.

Dual-curing resin cement with colour indicator for adhesively cemented restorations to dental tissues: Change of colour by curing and some physical properties

The study was aimed to investigate a color indicator containing dual curing resin composite luting cement and to plot the color change to the time of solidification of the cement. In addition some physical properties were studied. Specimens were made of a dual-cure resin cement (Maxcem Elite™ Chroma, Kerr, Orange, CA, USA) and polymerized by autopolymerization only, or with light initiated polymerization. A spectrophotometer was used to quantify the color change of the cement as plotted with the curing time. The efficacy of the curing process was studied by measuring water sorption and the ultimate flexural properties of the cement. The results showed that the flexural strength of cement after autopolymerization was 27.3 MPa and after light initiated polymerization 48.1 MPa. Young’s modulus of bending was 2089.3 MPa and 3781.5 MPa respectively for the same cement samples. Water sorption after two weeks for the autopolymerization cement samples was −1.12 wt% and for the light initiated polymerization samples 0.56 wt%. Non-parametric Spearman’s correlation was measured for autopolymerized cement samples between variables for color and solidification load (N), which showed a strong correlation between curing process and color change (p < 0.05). There was a correlation between the color change and degree of monomer conversion of the dual curing resin composite luting cement which contained a color indicator system for polymerization reaction. The study also suggested that autopolymerization only resulted in suboptimal polymerization of the cement. By additional light curing considerably higher flexural properties were obtained.

Effects of Polymerization Mode and Interaction with Hydroxyapatite on the Rate of pH Neutralization, Mechanical Properties, and Depth of Cure in Self-Adhesive Cements

Objective The aim of the study was to evaluate the physicochemical properties of self-adhesive resin cements associated with hydroxyapatite (HAp) according to the polymerization activation.

Materials and Methods Specimens of cements (PermaCem 2.0 [DMG]; MaxCem Elite [Kerr], and RelyX U200 [3M ESPE]) were distributed into three groups: activation mode; self-cured and dual-cured modes; and association or not with HAp powder mode. The pH neutralization was evaluated as a function of time. Flexural strength and elastic modulus were also tested (0.5 mm/min.). The depth of cure was also analyzed using the scraping test (ISO 4049). Infrared spectroscopy was also used to collect the spectra of specimens to evaluate the chemical bonds. Statistical comparisons were conducted at 5% of significance.

Results The aggressiveness of the self-adhesive resin cements evaluated varied among the materials with a tendency for neutralization. Self-cure groups exhibited lower pH throughout the entire evaluation when compared with that of the dual-cure ones, irrespective of the addition of HAp. MaxCem Elite when photoactivated was the only cement influenced by the addition of the HAp in terms of mechanical properties. The self-adhesive cements tested presented equivalent depth of cure based on the ISO 4049 requirements, regardless of the evaluated factors.

Conclusions Based on the parameters evaluated, the results demonstrated that most of the self-adhesive cements remained unaltered or improved when mixed with HAp, regardless of the activation mode.

Effect of Surface Treatment and Cement on Fracture Load of Traditional Zirconia (3Y), Translucent Zirconia (5Y), and Lithium Disilicate Crowns

PURPOSE

To determine if surface treatment and cement selection for traditional 3 mol% yttria partially stabilized zirconia (3Y-PSZ), "translucent" 5 mol% yttria-stabilized zirconia (5Y-Z), or lithium disilicate crowns affected their fracture load.

MATERIALS AND METHODS

Crowns with 0.8 mm uniform thickness (96, n = 8/group) were milled of 3Y-PSZ (Lava Plus), 5Y-Z (Lava Esthetic), or lithium disilicate (e.max CAD) and sintered/crystallized. Half the crowns were either particle-abraded with 30 µm alumina (zirconias) or etched with 5% hydrofluoric acid (lithium disilicate), and the other half received no surface treatment. Half the crowns from each group were luted with resin-modified glass ionomer (RMGI, RelyX Luting Plus) and half were luted with a resin cement (RelyX Unicem 2) to resin composite dies. Crowns were load cycled (100,000 cycles, 100 N force, 24°C water) and then loaded with a steel indenter until failure. A three-way ANOVA examined the effects of material, cement, and surface treatment on fracture load. Post-hoc comparisons were performed with the Tukey-Krammer method.

RESULTS

Fracture load was signficiantly different for materials and cements (p < 0.0001) but not surface treatments (p = 0.77). All lithium disilicate crowns luted with RMGI failed in fatigue loading cycling; 3Y-PSZ and 5Y-Z crowns luted with resin showed a higher fracture load compared with RMGI (p < 0.001). With resin cement, there was no signficant difference in fracture load between 5Y-Z and lithium disiliciate (p = 1) whereas 3Y-PSZ had a higher fracture load (p < 0.0001).

CONCLUSIONS

Cement type affected fracture load of crowns but surface treatment did not. The 0.8 mm uniform thick crowns tested benefited from using resin cement regardless of type of ceramic material. Crowns fabricated from 5Y-Z may be particle-abraded if luted with resin cement.

In Vivo Measurement of Root Canal Wall Temperature at Different Stages Prior to Fiber Post Cementation

Objective This study measured the in vivo temperature of prepared root canal walls during various stages of treatment prior to endodontic postcementation.

Materials and Methods One tooth each from five patients requiring endodontic treatment received conventional gutta-percha obturation. The coronal 4 mm of gutta-percha was removed by drilling and the canal wall temperature was measured. A sterile, saline rinse was applied, and another temperature value was recorded. Paper points were placed, and the wall temperature was recorded. A standardized period of 1.5 minute passed, simulating time needed to mix and place the resin cement and post (no resin was placed), after which the final wall temperature was obtained. The tooth was temporized and scheduled for prosthetic reconstruction. A one-way repeated measure analysis of variance (with Tukey's post hoc test) was performed among mean temperature values for each treatment stage (preset α 0.05).

Results Significant temperature differences were found among the treatment stages. Canal space drilling yielded the highest temperature (35.5 ± 0.8°C), while the lowest was obtained after saline rinsing (34.0 ± 0.9°C). The temperature of prepared root canal wall prior to postplacement (34.9 ± 1.2°C) and following paper point drying (34.8 ± 1.1°C) presented intermediate results, with no statistical difference between them.

Conclusions This study suggested that root canal wall temperature varied during various stages of preparation prior to endodontic post.

Effect of Different Adhesive Strategies and Time on Microtensile Bond Strength of a CAD/CAM Composite to Dentin

PURPOSE

The aim of this study was to evaluate the effect of adhesive strategy and time on the microtensile bond strength of a computer-aided design/computer-aided manufacturing (CAD/CAM) composite to dentin.

METHODS AND MATERIALS

Sixty CAD/CAM composite blocks were bonded to human dentin with simplified bonding agents using etch-and-rinse and self-etching approaches and amine-based and amine-free resin cements, with and without the application of a dual-cure activator (DCA; n=10): SBP-ARC (Adper Single Bond Plus + RelyX ARC), SBP-RXU (Adper Single Bond Plus + RelyX Ultimate), SBP-DCA-RXU (Adper Single Bond Plus + DCA + RelyX Ultimate), SBU-ARC (Scotchbond Universal + RelyX ARC), SBU-RXU (Scotchbond Universal + RelyX Ultimate), and SBU-DCA-ARC (Scotchbond Universal + DCA + RelyX ARC). Each specimen was light cured for 40 seconds under load and stored in distilled water at 37°C for seven days. Stick-shaped specimens (1.0 mm²) were obtained. Half of the specimens underwent microtensile bond strength testing, and the other half were subjected to the same tests after six months of storage. Failure mode was determined using an optical microscope (40×). The data were analyzed by a two-way analysis of variance followed by the Games-Howell test and Student t-test (preset alpha of 0.05).

RESULTS

After seven days, SBU-RXU presented the highest mean bond strength, statistically different from only SBU-ARC (p<0.05). Most of the groups exhibited a statistically significant reduction in bond strength after 6 months (p<0.05), except SBP-RXU and SBU-ARC (p>0.05).

CONCLUSION

The adhesive strategy, with different associations between adhesive systems and resin cements, as well as the use of a DCA, affected the bond strength of both amine-free and amine-based resin cements to a CAD/CAM composite.

Does a Self-etching Ceramic Primer Improve Bonding to Lithium Disilicate Ceramics? Bond Strengths and FESEM Analyses

OBJECTIVE:

To compare the effect of hydrofluoric acid (HF) vs self-etching ceramic primer on resin cement microshear bond strength (μSBS) and ultramorphology of lithium disilicate (LD) ceramic.

METHODS AND MATERIALS:

LD (IPS e.max CAD, Ivoclar Vivadent) blocks (14×4×2 mm³) were polished to 1200 grit and assigned to nine groups (n=5): CON: control, no LD surface treatment; IVO: 5.0% HF (IPS Ceramic Etching Gel, Ivoclar Vivadent); VIT: 5.0% HF (Vita Ceramics Etch, VITA Zahnfabrik); FGM: 5.0% HF (Condac Porcelana, FGM); ULT: 9.0% HF (Porcelain Etch, Ultradent); PRM: 9.6% HF (Premier Porcelain Etch Gel, Premier); BIS: 9.5% HF (Porcelain Etchant, Bisco Inc); DEN: 10.0% HF (Condicionador de Porcelanas, Dentsply Brazil); and MEP: self-etching ceramic primer (Monobond Etch & Prime, Ivoclar Vivadent). For all HF groups and control, an MDP-containing silane solution (MB⁺, Monobond Plus, Ivoclar Vivadent) was applied on rinsing the HF gel and air drying. Three transparent matrices for each specimen were filled with light-cured resin cement (Variolink Veneer, Ivoclar Vivadent). After storage in water for 48 hours at 37°C, specimens were tested in shear mode to measure μSBS. Mode of failure was analyzed at 50×. Statistical analysis included one-way analysis of variance and the Duncan post hoc test (α=0.05). Thirty-six additional LD specimens were assigned to the same experimental groups (n=4) and observed under a field-emission scanning electron microscope (FESEM) at magnifications ranging from 10,000× to 100,000×.

RESULTS:

IVO resulted in statistically higher mean μSBS than all the other groups. MEP resulted in statistically lower μSBS than all HF groups. The failure mode for MEP was predominantly adhesive. The most frequent failure mode for the HF groups was mixed. CON resulted in 100% pretesting failures. For FESEM, no retentive pattern was observed for CON specimens. MEP resulted in the least pronounced etching pattern, few areas around crystals exhibited a slight increase in retention pattern compared to the control group. All HF gels created microporosities on the LD surface with distinct etching patterns. VIT and DEN resulted in an LD ultramorphology that suggested overetching.

CONCLUSIONS:

HF etching followed by a silane solution resulted in higher bond strengths than a self-etching ceramic primer. Some HF gels may cause overetching of the LD intaglio surface.

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

Self-adhesive resin cements combine easy application of conventional luting materials with improved mechanical properties and bonding capability of resin cements. The presence of functional acidic monomers, dual cure setting mechanism, and fillers capable of neutralizing the initial low pH of the cement are essential elements of the material and should be understood when selecting the ideal luting material for each clinical situation. This article addresses the most relevant aspects of self-adhesive resin cements and their potential impact on clinical performance. Although few clinical studies are available to establish solid clinical evidence, the information presented provides clinical guidance in the dynamic environment of material development.

Longevity of bond strength of resin cements to root dentine after radiation therapy

AIM

To evaluate the bond strength and adhesive interface between several resin cements and root dentine immediately and 6 months after radiotherapy.

METHODOLOGY

Sixty maxillary canines were selected and randomly assigned to two groups (n = 30): one group was not irradiated and the other one was subjected to a cumulative radiation dose of 60 Gy. The teeth were sectioned to obtain roots 16 mm long and the canals were prepared with the Reciproc system (R50) and filled using a lateral condensation technique with an epoxy resin sealer. Each group was divided into three subgroups (n = 10) according to the resin cement used for fibreglass fibre post cementation: RelyX-U200, Panavia-F2.0 and RelyX ARC. The posts were cemented in accordance with the manufacturer's recommendations. Three 1-mm-thick dentine slices were then obtained from each root third. The first two slices in the crown-apex direction of each third were selected for the push-out test. The failure mode after debonding was determined with a stereo microscope. The third slice from each root third was selected for scanning electron microscopy (SEM) analyses to examine the resin cement-dentine interface with 100, 1000, 2000 and 4000× magnification. Bond strength data were analysed by anova and Tukey's test (α = 0.05).

RESULTS

Significantly lower bond strength (P < 0.0001) was obtained after irradiation compared to nonirradiated teeth. RelyX-U200 cemented fibre posts had the higher bond strength (15.17 ± 5.89) compared with RelyX ARC (P < 0.001) and Panavia-F2.0 (P < 0.001). The evaluation after 6 months revealed lower bond strength values compared to the immediate values (P < 0.001) for irradiated and nonirradiated teeth. Cohesive failures occurred in the irradiated dentine. SEM revealed fractures, microfractures and fewer collagen fibres in irradiated root dentine. RelyX-U200 and Panavia-F2.0 were associated with a juxtaposed interface of the cement with the radicular dentine in irradiated and nonirradiated teeth, and for RelyX ARC, hybrid layer formation and tags were observed in both irradiated and nonirradiated teeth.

CONCLUSION

Radiation was associated with a decrease in the push-out bond strength and with lower resin cement/root dentine interface adaptation. Self-adhesive resin cement was a better alternative for fibre post cementation in teeth subjected to radiation therapy. The bond strength decreased after 6 months.

Hygroscopic expansion of self-adhesive resin cements and the integrity of all-ceramic crowns

OBJECTIVE

Low pH neutralization and subsequent remnant hydrophilicity can lead to hygroscopic expansion of self-adhesive resin cements (SARCs) after water storage. The aim of this in vitro study was to investigate the effects of hygroscopic expansion of SARCs, used as luting and partial core build-up material, on integrity and cement gap thickness increase of all-ceramic CAD/CAM crowns.

METHODS

Human third molars (n=48) were prepared and anatomical all-ceramic CAD/CAM crowns were manufactured (VITABLOCS Mark II, VITA Zahnfabrik). Crowns internal surfaces were HF etched and silanized. The prepared teeth with their respective crowns were divided into 6 groups (n=8). In groups 1, 3 and 5 the coronal dentin was removed to simulate a partial core build-up. Groups 1 and 2 were luted with iCEM (Heraeus Kulzer), 3 and 4 with RelyX Unicem 2 Automix (3M), 5 and 6 with Variolink Esthetic DC (Ivoclar Vivadent). All specimens were dual cured and stored in distilled water at 37°C. Crown integrity was controlled at baseline and in regular intervals until 180 days. Cement gap thickness was measured using an optical 3D scanner (ATOS Triple scan, GOM) at baseline and after 180 days. Crown integrity was statistically analysed using Kaplan-Meier survival analysis and cement gap thickness increase using two-way ANOVA (α=0.05).

RESULTS

After 180 days storage, crack formation was observed in all specimens of group 1 (mean survival time of 85.5 days), in one specimen of group 2 and in two specimens of group 4. Two-way ANOVA analysis revealed a statistically significant interaction between material type and build-up on cement gap size increase for iCEM.

SIGNIFICANCE

Within the limits of this study, the application of SARCs with low pH neutralization as partial build-up material under CAD/CAM crowns is not recommended for clinical use.

Stress generation in mandibular anterior teeth restored with different types of post-and-core at various levels of ferrule

STATEMENT OF PROBLEM

Pertinent evidence regarding the mechanical integrity of mandibular anterior teeth restored with a post-and-core is limited.

PURPOSE

The purpose of this finite element analysis study was to compare the impact of the post type (glass fiber post-and-resin core or cast post-and-core) along with the ferrule effect on the stress fields generated in endodontically treated mandibular lateral incisors and canines.

MATERIAL AND METHODS

Three-dimensional models of the segmented mandible were developed. Mandibular incisors and canines with or without a 2-mm circular ferrule and restored with a cast post-and-core or glass fiber post-and-resin core were simulated and subjected to linear elastic static analysis. The principal stress values were calculated. von Mises equivalent stresses were used to evaluate the stress.

RESULTS

Maximum principal stresses in dentin were highest in incisors, with a ferrule. Stress parameters in composite resin core in both incisors and canines were critically close to the tensile failure limit of the core material. Cast post-and-cores cemented in incisors without a ferrule accumulated the highest stresses, exceeding the tensile failure limit of resin-modified glass ionomer cement.

CONCLUSIONS

Tooth preparation with a ferrule led to a remarkable rise in stress in the dentin of mandibular incisors but favored the mechanical integrity of the restoration.

Comparison of the shear bond strength of self-adhesive resin cements to enamel and dentin with different protocol of application

AIM

The aim of the present study was to determine the shear bond strength of self-adhesive resin cements to enamel and dentin with and without surface treatments, and compare them with conventional resin cement as the control group.

METHODS

In this experimental study, buccal and lingual surface of the thirty sound human premolars were polished in order to obtain a flat surface of enamel (E) in buccal, and dentin (D) in lingual. Sixty feldspathic ceramic blocks (2×3×3 mm) were prepared and randomly divided into six groups (n=10). Each block was cemented to the prepared surface (30 enamel and 30 dentin surface) according to different protocol: E1 and D1; RelyX ARC as control group, E2, D2; RelyX Unicem, E3, D3; acid etching +RelyX Unicem. The specimens were termocycled and subjected to shear forces by a universal testing machine at a cross head speed of 0.5 mm/min. The mode of fracture were evaluated by stereomicroscope. Data were analyzed with descriptive statistical methods using SPSS version 15. One-way ANOVA, and post hoc Tukey tests were used to compare bond strengths between the groups with different adhesives at α=0.05.

RESULTS

Statistical analysis showed no significant differences within the enamel subgroups, but there were significant differences within the dentinal subgroups, and statistically significant differences were found between the groups D1and D3 (p=0.02). Comparison between similar enamel and dentinal subgroups showed that there was a significant difference just between the subgroups E3 and D3 (p=0.01).

CONCLUSION

Elective etching of enamel did not lead to significant increase in the shear bond strength of RelyX Unicem in comparison to RelyX ARC. On the other hand, elective etching of dentin reduces the bond strength of RelyX Unicem with the dentin.

Effects of the application techniques of self-adhesive resin cements on the interfacial integrity and bond strength of fiber posts to dentin

Objective:

To evaluate the influence of an application technique of a glass-fiber post using self-adhesive resin cements on the push-out bond strength and the presence of bubbles in the root thirds. The cements were either applied according to the manufacturer's instruction or using a commercial delivering system (Centrix), at which the cement pastes were collected and applied after manipulation.

Material and Methods:

Self-adhesive resin cements (RelyX U200/3M ESPE-U200; Maxcem Elite/Kerr-MAX; Clearfil SA Cement/Kuraray-CSA) and a conventional cement (RelyX ARC/3M ESPE-ARC) were used to cement a post and applied either based on the manufacturer's instructions or using a Centrix syringe to deliver the cements directly onto the post of choice, or directly into canal. The roots were scanned with a micro-computed tomography (μCT) and then sectioned into nine 1-mm thick slices for a push-out bond strength test. The μCT images showed the percentage of bubbles in the root thirds (cervical, medium, and apical). Data were analyzed with three-way ANOVA/Tukey (α=0.05).

Results:

Triple interaction was not significant (p>0.05). The interaction “material” vs “root third” was not significant. A significant interaction was observed between “material” vs “application technique” (p<0.05). For ARC, U200, and MAX, significantly lower percentages of bubbles were observed when the Centrix syringe delivered the cements. Equivalent percentages of voids were observed for CSA, irrespective of the application technique (p>0.05). Significantly higher bond strength was observed when the self-adhesive resin cements were applied using the Centrix delivery system, in comparison with the manufacturer's instructions (p<0.05). Bond strength varied with the root third: cervical>medium>apical (p<0.05). No correlations were found between the bond strength and voids.

Conclusions:

Bond strength and voids are negatively influenced by the conventional application technique for luting fiber posts. The delivery system (Centrix) seems to produce better results when cementing fiber posts.

Correlation between flexural and indirect tensile strength of resin composite cements

Background

To evaluate a potential correlation between flexural strength and indirect tensile strength in assessing the mechanical strength of resin composite cements.

Methods

Flexural strength (n = 5) and indirect tensile strength (n = 5) of 7 resin composite cements (RelyX Unicem 2 Automix [RXU], Panavia SA [PSA], Clearfil SA [CSA], Panavia F2.0 [PF2], Multilink Implant [MLI], DuoCem [DCM], Panavia 21 [P21]) were determined. Specimens were either auto-polymerized or dual-cured (except P21) and stored in water at 37 °C for 1 day prior to measurement. Flexural and indirect tensile strength of 4 cements (RXU, PSA, PF2, MLI) was additionally measured directly after curing and after 96 h water storage at 37 °C.

Results

Except for PF2, dual-cured specimens achieved higher flexural strength than auto-polymerized specimens. In the indirect tensile strength test differences in auto-polymerized and dual-cured specimens were only detected for RXU and DCM. A general non-linear correlation was found between flexural and indirect tensile strength values. However, strength values of auto-polymerized and dual-cured specimens did not generally correlate.

Conclusions

Flexural strength and indirect tensile strength of resin composite cements are correlated. At high strength values the indirect tensile test is less sensitive than the flexural test. The results suggest that the indirect tensile test may only be recommended as a screening test especially for low or medium strength resin composite cements.

Relined Fiberglass Post: Effect of Luting Length, Resin Cement, and Cyclic Loading on the Bond to Weakened Root Dentin

This study evaluated the effects of luting length of the post, the resin cement, and cyclic loading on pull-out bond strength of fiberglass posts relined with composite resin in weakened roots. The canals of 80 bovine incisors were endodontically treated and weakened with diamond burs. The teeth were randomly divided into eight groups (n=10) according to the luting procedures of the relined fiberglass post (RFP): In groups 1, 2, 3, and 4, the RFPs were luted with RelyX ARC, and in groups 5, 6, 7, and 8 they were luted with RelyX U200. In groups 1, 3, 5, and 7, the RFPs were luted at a length of 5 mm, and in groups 2, 4, 6, and 8 they were luted at a length of 10 mm. Specimens from groups 3, 4, 7, and 8 were submitted to cyclic loading. Specimens were subjected to a pull-out bond strength test in a universal testing machine. The results (MPa) were analyzed by three-way analysis of variance and the Tukey post hoc test (α=0.05). Six human upper anterior teeth were used to analyze the bond interface by confocal laser scanning microscopy (CLSM). The pull-out bond strength of RFPs luted with RelyX U200 was statistically higher than that of RelyX ARC. Cyclic loading influenced the bond strength only for the luting length of 5 mm. CLSM analysis revealed the formation of resin cement tags for both materials. Luting length is an important factor in retaining RFPs in weakened roots when they are subjected to cyclic loading, and RelyX U200 resulted in greater bond strengths to the root canal in comparison with RelyX ARC.

Self-adhesive resin cements: pH-neutralization, hydrophilicity, and hygroscopic expansion stress

OBJECTIVES

The objective of the study was to investigate the relationship between pH-neutralization, hydrophilicity, and free hygroscopic expansion stress of self-adhesive resin cements (SARCs) after storage in artificial saliva.

MATERIALS AND METHODS

The SARCs RelyX Unicem Automix 2 (RX2, 3 M ESPE), iCEM (iCEM, Heraeus) and Maxcem Elite (MCE, Kerr) were under investigation in this study. Cylinders (height × diameter, 6 × 4mm) were prepared from each material and stored in artificial saliva (7d at 37 °C). Cylinder height was measured at baseline and after 7 days. After storage, the compression modulus was measured to calculate the free hygroscopic expansion stress. For pH-neutralization and hydrophilicity assessment, disks (height × diameter, 1 × 1.5 mm) were prepared, covered with electrolyte, and monitored over 24 h at 37 °C. Hydrophilicity was assessed using the static sessile drop technique at baseline and at different time intervals up to 24 h. Data were analyzed using one-way ANOVA and post hoc Student-Newman-Keuls test (S-N-K, α = 0.05).

RESULTS

After 24 h, RX2 (pH_24h 4.68) had a significantly higher (p < 0.05) pH-value than MCE (pH_24h 4.2) and iCEM (pH_24h 3.23). iCEM showed the significantly highest hydrophilicity (p < 0.05) after 24 h (θ_24h 85.02°), while MCE resulted lower (θ_24h 113.01°) in comparison with RX2 (θ_24h 108.11°). The resulting hygroscopic expansion stress of iCEM (29.15 MPa) was significantly higher (p < 0.05) compared to RX2 (14.5 MPa) and MCE (21.02 MPa).

CONCLUSIONS

The material with lowest pH-neutralization capacity displayed higher hydrophilicity after 24 h and higher hygroscopic expansion stress after 7 days compared to those with high pH-neutralization.

CLINICAL SIGNIFICANCE

Remnant hydrophilicity due to low pH-neutralization of SARCs could lead to cement interface stress build-up and long-term failure of silicate ceramic restorations.

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.

Mechanical Properties and Sliding-impact Wear Resistance of Self-adhesive Resin Cements

The present study determined the mechanical properties and impact-sliding wear characteristics of self-adhesive resin cements. Five self-adhesive resin cements were used: G-CEM LinkAce, BeautiCem SA, Maxcem Elite, Clearfil SA Automix, and RelyX Unicem 2. Clearfil Esthetic Cement was employed as a control material. Six specimens for each resin cement were used to determine flexural strength, elastic modulus, and resilience according to ISO specification #4049. Ten specimens for each resin cement were used to determine the wear characteristics using an impact-sliding wear testing apparatus. Wear was generated using a stainless-steel ball bearing mounted inside a collet assembly. The maximum facet depth and volume loss were determined using a noncontact profilometer in combination with confocal laser scanning microscopy. Data were evaluated using analysis of variance followed by the Tukey honestly significantly different test (α=0.05). The flexural strength of the resin cements ranged from 68.4 to 144.2 MPa; the elastic modulus ranged from 4.4 to 10.6 GPa; and the resilience ranged from 4.5 to 12.0 MJ/m3. The results for the maximum facet depth ranged from 25.2 to 235.9 μm, and volume loss ranged from 0.0107 to 0.5258 mm3. The flexural properties and wear resistance were found to vary depending upon the self-adhesive resin cement tested. The self-adhesive cements tended to have lower mechanical properties than the conventional resin cement. All self-adhesive resin cements, apart from G-CEM LinkAce, demonstrated significantly poorer wear resistance than did the conventional resin cement.

Inclusion of the periodontal ligament in studies on the biomechanical behavior of fiber post-retained restorations: An in vitro study and three-dimensional finite element analysis

Endodontically treated teeth are known to have reduced structural strength. Periodontal ligament may influence fracture resistance. The purpose of this study was to assess the influence of including the periodontal ligament in biomechanical studies about endodontically treated and restored teeth. Forty human maxillary central incisors were treated endodontically and randomly divided into four groups: non-crowned (with and without an artificial ligament) and crowned (with and without an artificial ligament) with glass-ceramic crowns. All groups received prefabricated glass-fiber posts and a composite resin core. Specimens were tested, under a flexural-compressive load, until failure occurred. The failure mode was registered for all specimens. The failure loads were recorded and analyzed using an analysis of variance test (p < 0.05). These results were compared with those predicted by a finite element model. The analysis of variance did not show significant differences between the use of crown on the failure load (p = 0.331) and the use of periodontal ligament (p = 0.185). A cohesive mode in crown appeared in crowned teeth and in core in non-crowned groups. For non-crowned teeth, adhesive failure occurred along the cement-enamel junction with a slight tendency in specimens without periodontal ligament. Furthermore, an unfavorable failure mode affects partially the root with no differences regarding non-crown specimens. In crowned teeth, the tendency was an adhesive failure along the cement-enamel junction. The model predicted a distribution of the safety factor consistent with these results. This study showed that inclusion of periodontal ligament is not particularly important on biomechanical behavior of post-retained restorations. However, we recommend its inclusion in fatigue studies.

Bond strength of self-adhesive resin cements to tooth structure

OBJECTIVES

The aim of this study was to evaluate the strength of the bond between newly introduced self-adhesive resin cements and tooth structures (i.e., enamel and dentin).

METHODS

Three self-adhesive cements (SmartCem2, RelyX Unicem, seT SDI) were tested. Cylindrical-shaped cement specimens (diameter, 3 mm; height, 3 mm) were bonded to enamel and dentin. Test specimens were incubated at 37 °C for 24 h. The shear bond strength (SBS) was tested in a Zwick Roll testing machine. Results were analyzed by one-way ANOVA and t-test. Statistically significant differences were defined at the α = 0.05 level. Bond failures were categorized as adhesive, cohesive, or mixed.

RESULTS

The SBS values ranged from 3.76 to 6.81 MPa for cements bonded to enamel and from 4.48 to 5.94 MPa for cements bonded to dentin (p > 0.05 between surfaces). There were no statistically significant differences between the SBS values to enamel versus dentin for any given cement type. All cements exhibited adhesive failure at the resin/tooth interface.

CONCLUSIONS

Regardless of their clinical simplicity, the self-adhesive resin cements examined in this study exhibit limited bond performance to tooth structures; therefore, these cements must be used with caution.

A castor oil-containing dental luting agent: effects of cyclic loading and storage time on flexural strength

Favorable results in the use of castor oil polyurethane (COP) as pulp capping, membrane material, sealer, mouthwash and in bone repair, associated with the fact that Ricinus communis is not derived from petroleum and it is abundant in Brazil, encourage researches in the development of luting agents.

Influence of different drying methods on microtensile bond strength of self-adhesive resin cements to dentin

OBJECTIVE

This study investigated the effect of different drying methods of dentin surface on the bonding efficacy of self-adhesive resin cements (SRCs).

MATERIALS AND METHODS

Three SRCs (RelyX U200, RU; Maxcem Elite, ME; and BisCem, BC) and one resin-modified glass ionomer cement (RelyX Luting 2, RL) were used. The characteristics of the materials were evaluated using thermogravimetric analysis and surface roughness and contact angle measurements. Human dentin surfaces were finished with 600-grit silicon carbide paper and assigned to three groups according to these drying methods: ethanol dehydration, drying by waiting for 10 s after blot-drying and blot-drying. The four cements were used for luting composite overlays to the dried dentin. After 24 h storage at 37°C and 100% relative humidity, stick-shaped specimens with a cross-sectional area of 0.8 mm(2) were prepared and stressed to failure in tension at a crosshead speed of 0.5 mm/min (n = 27). Failure modes of fractured specimens were assessed by optical and scanning electron microscopy.

RESULTS

RL was the most hydrophilic, followed by BC and ME and then RU. All the luting cements luted to ethanol-dehydrated dentin showed zero bond strengths. For the three SRCs, drying by waiting produced higher microtensile bond strengths than blot-drying. RU showed the best bonding performance in the above two dentin conditions. RL showed significantly higher bond strength in blot-drying condition than in drying-by-waiting (p < 0.001).

CONCLUSIONS

This study suggests that dentin surface moisture has a crucial effect on the bond strength of SRCs.

Damage of lithium-disilicate all-ceramic restorations by an experimental self-adhesive resin cement used as core build-ups

OBJECTIVES

This in vitro study aimed to predict the potential of fracture initiation after long-term incubation (LTI) of lithium-disilicate restorations due to a hygroscopic expansion of self-adhesive resin cement (SARC) used as core build-up material.

METHODS

Human maxillary central incisors were divided into four groups (n = 10). Teeth were endodontically treated and decoronated. Specimens were restored in a one-stage post-and-core procedure using experimental dual-curing SARC. Three application protocols to build up the core were compared as follows: I, auto-polymerisation; II, dual curing including 40 s light-initiated polymerisation; and III, an open matrix technique in a dual-curing mode. In group IV, a chemical-curing composite core build-up material served as control. For all specimens, a 2-mm ferrule design was ensured. Full anatomic lithium-disilicate crowns were adhesively luted. One-year LTI in 0.5 % chloramine solution at 37 °C was performed. Restorations were examined after 3, 6, 9 and 12 month of storage. Survival rates were calculated using log-rank statistics (p = 0.05).

RESULTS

Fifty per cent of lithium-disilicate crowns of groups I and II showed visible crack propagation after 9 months of incubation, while one crown failed in group III. No failure was observed in group IV. The survival rates differed significantly (p = 0.017).

CONCLUSION

SARC used to build up the core of severely damaged endodontically treated teeth does have the potential to cause fracture of lithium-disilicate crown restorations.

CLINICAL RELEVANCE

Hygroscopic expansion of self-adhesive resin cements used as a core build-up material might have an adverse impact on longevity of glass-ceramic crowns.

Fracture resistance of endodontically treated premolars restored with lithium disilicate CAD/CAM crowns or onlays and luted with two luting agents

The purpose of the present study is to evaluate the fracture resistance of endodontically treated maxillary premolars restored using CAD/CAM onlays or crowns and luted with two types of resin cement. Forty all-ceramic crowns and twenty onlays were fabricated on maxillary premolars using the Cerec 3 system (n=10). The abutments were randomly subjected to two different procedures: Endodontic treatment was performed on forty teeth restored through a mesio-occlusal-distal (MOD) cavity preparation with composite resin fillings; twenty teeth without endodontic treatment served as control. In endodontically treated teeth restored using IPS e.max CAD crowns or onlays, the fracture loads were lower than those of the control. Endodontic treatment of teeth restored using CAD/CAM crowns does not impair the fracture load but shows more severe fractures than teeth restored using CAD/CAM onlays. This suggests that a CAD/CAM onlay might be an effective method for the restoration of endodontically treated premolars with MOD cavity defect.

Self-adhesive resin cements: a new perspective in luting technology

Many materials are available for the fabrication of indirect restorations such as, metal alloys, resin-based composites and ceramics. Resin cements have long been valued as luting agents for indirect restorations because of their high retentive strength, resistance to wear, and low solubility. However, one of the common discouraging factors regarding their chairside use is the need of multiple-steps (etching, drying, priming and luting) for bonding. Thus the current impetus is towards the use of self-adhesive cements that require no etching, priming or bonding agents to bond to the tooth surface. Their increased popularity can be judged by the commercial availability of more than a dozen self-adhesive resin products/brands, in a short span of time. This article reviews the composition, physical and biological properties, adhesion characteristics and clinical performance of self-adhesive (resin) cements.

CLINICAL RELEVANCE

Self-adhesive resin cements are dual-cured and adhere to tooth structure without the requirement of a separate etching step and application of an adhesive/bonding agent.

Effects of differing thickness and mechanical properties of cement on the stress levels and distributions in a three-unit zirconia fixed prosthesis by FEA

PURPOSE

This study analyzed the impact of cement layer thickness (CLT) and Young's modulus of the cement on the stress distribution in a three-unit zirconia fixed dental prosthesis (FDP) and in the bonding interfaces by means of finite element method.

MATERIALS AND METHODS

A 3D finite element model was created from a stylized three-unit FDP-cement-tooth/socket system. The pulp and the periodontal ligament were not modeled. Two CLTs (50 and 150 μm) and two values of Young's modulus of the cement (4.9 for simulation of resin cement, 20.1 GPa for glass ionomer cement) were evaluated. A 500 N static vertical load was applied at the central fossa of the pontic to calculate maximum displacement in the framework and maximum principal stresses in both framework and bonding interfaces.

RESULTS

The simulated results showed that the Young's modulus affected stress occurrence only in the cement interface. Lower moduli were associated with less stress. The thickness of the cement layer influenced the maximum principal stress in both the FDP and in the cement layer itself. Thicker cement layers led to higher stresses in the framework but lower stresses in the cement layer. Maximum displacement was less dependent of the investigated variables. During all trials, the location of the maximum principal stress did not change. Maximum stress concentrations were observed at the lower embrasures of the connector areas and in the bonding layer at the cervical margin of the preparation.

CONCLUSIONS

Choosing cements with a preferably low Young's modulus in combination with a CLT as small as possible might increase the clinical survival rate.

Shear bond strength of self-adhesive resin cements to base metal alloy

STATEMENT OF PROBLEM

Many self-adhesive cements have been introduced in the past few years, with little or no data regarding their clinical performance. This study investigated the shear bond strength of some recently introduced self-adhesive resin cements.

PURPOSE

The purpose of this study was to evaluate the shear bond strength of self-adhesive and conventional resin-based cements to a base metal alloy.

MATERIAL AND METHODS

Four groups (10-12 each) that comprised 3 self-adhesive cements (SmartCem2; RelyX Unicem; seT SDI) and a conventional resin-based cement (RelyX ARC) were tested. Cylindrical cement specimens (diameter, 3 mm; height, 3 mm) were applied to nickel-free base metal alloy (Sheradent) disks with a diameter of 12 mm, and the surface was treated with airborne-particle abrasion of 50 μm aluminum oxide. The metal disks were fixed in brass molds specifically designed for the shear bond test device. Test specimens were incubated at 37°C for 24 hours and then the shear bond was tested with a Zwick Roll testing machine at a 0.8 mm/min cross-head speed. In addition, bond failures were investigated and categorized as adhesive, cohesive, or mixed. Shear bond strengths were calculated by dividing the maximum debonding force over the cross-sectional area of each specimen. One-way ANOVA and the Tukey (honestly significant difference) post hoc test were used to test statistical significant differences among the groups (α=.05).

RESULTS

Statistical analysis showed significant differences among different resin cements (F=14.34, P<.001). The highest mean shear bond strength was observed for SmartCem2 (14.18 MPa), and the lowest was reported for seT (3.52 MPa). The observed failure mode in all the materials was adhesive in nature, which occurred at the resin-metal interface.

CONCLUSIONS

The early bond strength of self-adhesive resin cements varied significantly among the tested materials. SmartCem2 showed the highest bond strength, which was 4 times the strength observed for seT SDI.

Bonding of Y-TZP to dentin: effects of Y-TZP surface conditioning, resin cement type, and aging

PURPOSE

To evaluate the effects of two surface treatments, aging, and two resin cements on shear bond strength between dentin and yttrium-stabilized tetragonal zirconia polycrystal ceramic (Y-TZP).

MATERIALS AND METHODS

Eighty human molars were embedded in acrylic resin and sectioned 3 mm below the occlusal plane. These teeth and 80 cylindrical Y-TZP specimens (height, 4 mm; diameter, 3.4 mm) were divided into eight groups (n=10) using the following factors: Y-TZP surface treatment (Vi: low-fusing porcelain [vitrification] + hydrofluoric acid etching + silanization or Si: tribochemical silicatization); cementation strategies (PF: Panavia or CC: Clearfil); and storage (nonaging or aging). Bonding surfaces of 40 Y-TZP specimens received Vi treatment, and the rest received Si treatment. Half of the ceramic-tooth assemblies were cemented with Panavia, the rest with Clearfil. Shear tests were executed using 0.4-mm-thick wire at 0.5 mm/min. Data were analyzed by three-way analysis of variance and Tukey test (α=0.05). Fractures were analyzed.

RESULTS

Y-TZP surface treatments did not affect bond strength (p=0.762, Vi = Si), while resin cements (p<0.001, Panavia > Clearfil) and aging (p=0.006, nonaging > aging) showed a significant effect. Most failures were in adhesive at dentin-cement interfaces; no failure occurred between zirconia and cement.

CONCLUSION

When Y-TZP ceramic is bonded to dentin, the weakest interface is that between dentin and resin cement. The resin cement/Y-TZP interface was less susceptible to failures, owing to Y-TZP surface treatments.

Effect of the crown design and interface lute parameters on the stress-state of a machined crown-tooth system: a finite element analysis

The effect of preparation design and the physical properties of the interface lute on the restored machined ceramic crown-tooth complex are poorly understood. The aim of this work was to determine, by means of three-dimensional finite element analysis (3D FEA) the effect of the tooth preparation design and the elastic modulus of the cement on the stress state of the cemented machined ceramic crown-tooth complex. The three-dimensional structure of human premolar teeth, restored with adhesively cemented machined ceramic crowns, was digitized with a micro-CT scanner. An accurate, high resolution, digital replica model of a restored tooth was created. Two preparation designs, with different occlusal morphologies, were modeled with cements of 3 different elastic moduli. Interactive medical image processing software (mimics and professional CAD modeling software) was used to create sophisticated digital models that included the supporting structures; periodontal ligament and alveolar bone. The generated models were imported into an FEA software program (hypermesh version 10.0, Altair Engineering Inc.) with all degrees of freedom constrained at the outer surface of the supporting cortical bone of the crown-tooth complex. Five different elastic moduli values were given to the adhesive cement interface 1.8GPa, 4GPa, 8GPa, 18.3GPa and 40GPa; the four lower values are representative of currently used cementing lutes and 40GPa is set as an extreme high value. The stress distribution under simulated applied loads was determined. The preparation design demonstrated an effect on the stress state of the restored tooth system. The cement elastic modulus affected the stress state in the cement and dentin structures but not in the crown, the pulp, the periodontal ligament or the cancellous and cortical bone. The results of this study suggest that both the choice of the preparation design and the cement elastic modulus can affect the stress state within the restored crown-tooth complex.