HF etching of CAD/CAM materials: influence of HF concentration and etching time on shear bond strength

Effect of hydrofluoric acid and self-etch ceramic primers on the flexural strength and fatigue resistance of glass ceramics: A systematic review and meta-analysis of in vitro studies

This systematic review evaluated the effect of different hydrofluoric acid (HF) etching regimens and a self-etch ceramic primer (SECP) on the flexural strength (FS) and fatigue failure load (FFL) of glass-ceramic materials.The identification of relevant studies was conducted by two authors in five databases: PubMED, Scopus, Web Of Science, LILACS and Virtual Health Library (BVS) until July 2022 with no year limit. The analysis was conducted in RevMan 5.4.1 Software (Cochrane Collaboration) using Random effect model at 5 %. The risk of bias of the included studies were assessed. From the 5349 articles identified, 34 were included for quantitative analysis. Meta-analysis showed that for predominantly glassy ceramics, etching with HF 5 % had no significant impact on FS, however, HF acid etching with concentrations greater than 5 % negatively impacted FS. For lithium disilicate glass-ceramics (LDGC) HF acid etching, negatively influenced FS, while increasing the FFL. HF etching negatively affected FS of hybrid ceramics. The self-etch ceramic primer and HF acid etching showed a similar impact on FFL and FS. This meta-analysis indicates that the impact of SECP and HF acid etching on the mechanical behavior of glass ceramics is material-dependent.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Light transmittance through resin-matrix composite onlays adhered to resin-matrix cements or flowable composites

OBJECTIVE

The aim of this study was to evaluate the influence of the thickness of resin-matrix composite blocks manufactured by CAD-CAM on the light transmittance towards different resin-matrix cements or flowable composites.

METHODS

Sixty specimens of resin-matrix composite CAD-CAM blocks reinforced with 89 wt% inorganic fillers were cross-sectioned with 2 or 3 mm thicknesses. The specimens were conditioned with adhesive system and divided in groups according to the luting material, namely: two dual-cured resin-matrix cements, two traditional flowable resin-matrix composites, and one thermal-induced flowable resin-matrix composite. Specimens were light-cured at 900 mW/cm2 for 40s. Light transmittance assays were preformed using a spectrophotometer with an integrated monochromator before and after light-curing. Microstructural analysis was performed by optical and scanning electron microscopy (SEM). Nanoindentation tests were performed to evaluate mechanical properties for indirect evaluation of degree of monomers conversion.

RESULTS

Optical and SEM images revealed low thickness values for the cementation interfaces for the traditional flowable resin-matrix composite. The cement thickness increased with the size and content of inorganic fillers. The highest light transmittance was recorded for the onlay blocks cemented with the traditional flowable resin-matrix composites while a group cemented with the dual-cured resin-matrix cement revealed the lowest light transmittance. The elastic modulus and hardness increased for specimens with high content of inorganic fillers as well as it increased in function of the light transmittance.

CONCLUSIONS

The light transmittance of flowable resin-matrix composites was higher than that for resin-matrix cement after cementation to resin-matrix composites blocks. The type, size, and content of inorganic fillers of the luting material affected the thickness of the cement layer and light transmittance through the materials.

CLINICAL RELEVANCE

On chair-side light curing, the transmission of visible light can be interfered by the chemical composition and viscosity of the luting materials. The increase in size and content of inorganic fillers of resin-matrix composites and luting materials can decrease the light transmittance leading to inefficient polymerization.

Influence of surface treatments and adhesive protocols on repair bond strength of glass-matrix and resin-matrix CAD/CAM ceramics

OBJECTIVE

To specify the effects of self-etching ceramic primer, Monobond Etch and Prime (MEP), and universal adhesive (UA) on repair bond strength between CAD/CAM blocks and resin composite.

MATERIALS AND METHODS

Vita Mark II (VM), IPS e.max CAD (EMAX), Shofu Block HC (SHC), and Tetric CAD (TET) blocks were sliced and thermocycled. They were divided into four groups according to surface treatments (n = 24): control, sandblasting (AL), hydrofluoric acid etching (HF), and MEP application. SEM analysis assessed surface topography. Subdivided, specimens followed distinct adhesive protocols (n = 12): control (silane + adhesive [SA] or adhesive [A] only for MEP group) and UA. Microshear bond strength (μSBS) was measured following resin composite repair. Data were analyzed using two-way ANOVA and Tukey tests (p < 0.05).

RESULTS

The μSBS of CAD/CAM blocks was significantly influenced by surface treatment type and adhesive protocol. The highest μSBS values for each block, considering surface treatment + adhesive protocol, were VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA.

CONCLUSIONS

Except for EMAX, it was not the adhesive protocol that made the significant difference in bond strength for each CAD/CAM block, but the surface treatment. MEP + UA application on glass ceramics lowered μSBS values significantly, so it is not recommended in clinical conditions.

CLINICAL SIGNIFICANCE

Repair is an essential therapeutic option, particularly in esthetic restorations, to swiftly repair the impaired esthetics caused by fracture. Repair protocol is dependent on the restorative material, and to have a reliable repair bond strength, the following surface treatment and adhesive protocol combinations are recommended for each CAD/CAM block: VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA.

Influence of different surface treatment on bonding of metal and ceramic Orthodontic Brackets to CAD-CAM all ceramic materials

BACKGROUND

Developing efficient bonding techniques for orthodontic brackets and all-ceramic materials continues to pose a clinical difficulty. This study aimed to evaluate the shear bond strengths (SBS) of metal and ceramic brackets to various all-ceramic CAD-CAM materials, such as lithium disilicate CAD (LDS-CAD), polymer-infiltrated ceramic (PIC), zirconia-reinforced lithium silicate glass ceramic (ZLS), and 5YTZP zirconia after different surface treatments and thermal cycling.

MATERIALS AND METHODS

The samples were divided into two groups to be bonded with ceramic and metal lower incisor brackets. Each group was subdivided into a control group devoid of any surface treatment, 10% HF acid (HFA) etching, ceramic etch & prime (MEP), Al2O3 air abrasion, and medium grit diamond bur roughening. After surface treatment, brackets were bonded with composite resin cement, thermal cycled, and tested for shear bond strength. The failed surfaces were evaluated with a digital microscope to analyse the type of failure. The data were statistically analysed using a one-way ANOVA and Tukey HSD tests at p < 0.05.

RESULTS

The highest mean bond strengths were found with HFA etching in LDS-CAD (13.17 ± 0.26 MPa) and ZLS (12.85 0.52 MPa). Diamond bur recorded the lowest mean bond strength roughening across all the ceramic groups. There were significant differences in mean shear bond values per surface treatment (p < 0.001) and ceramic materials.

CONCLUSION

Among the surface treatment protocols evaluated, HFA etching and MEP surface treatment resulted in enhanced bond strength of both ceramic and metal brackets to CAD-CAM all ceramic materials.

Influence of dental prophylaxis procedures on the tooth veneer interface in resin-based composite and polymer-infiltrated ceramic veneer restorations: an in vitro study

OBJECTIVES

The aim of this study was to investigate the influence of dental prophylaxis cleaning procedures and artificial aging on veneers in human teeth. The external marginal and internal tooth veneer as well as the restoration surfaces were examined.

MATERIAL AND METHODS

Thirty-two extracted premolars were restored with resin-based composite (RBC) and polymer-infiltrated ceramic network (PICN) veneers. Artificial aging by alternating thermocycling and subsequent prophylaxis procedure (glycine-based powder air polishing or ultrasonic scaling) was conducted for five consecutive cycles. The external marginal interface was examined by height profile measurements and the internal interface was investigated using micro X-ray computed tomography. In addition, the surface texture of the veneer surface was analyzed using confocal laser scanning microscopy.

RESULTS

The application of both prophylaxis procedures resulted in a deepening of the marginal interface (10 µm ± 8 µm) for materials. Furthermore, the internal interface of PICN restorations showed marginal gaps after both treatments and artificial aging (16 µm ± 3 µm). In contrast to the RBC specimens, a significant increase in surface roughness was identified for PICN veneers after ultrasonic scaling.

CONCLUSIONS

The marginal and internal interface regions in veneers fabricated from PICN and RBC were affected by prophylaxis procedures. Furthermore, it may result in increased veneer surface roughness, especially in PICN and after ultrasonic scaling, which might affect bioadhesion and longevity.

CLINICAL RELEVANCE

After dental prophylaxis procedures, examination of the marginal and the internal interface as well as the veneer surface provides a precise insight into damage mechanisms and offers an assessment of longevity.

Microshear bond strength of resin cement to a zirconia-reinforced lithium silicate glass ceramic using different surface treatments

Background

The purpose of this study was to evaluate the effect of different surface treatments on the microshear bond strength (μSBS) of resin cement to zirconia-reinforced lithium silicate ceramic and to compare it with lithium disilicate ceramic.

Materials and Methods

In this in vitro study, 80 specimens containing two glass ceramics of IPS e.max press and VITA SUPRINITY were prepared and categorized into four groups according to the surface treatments (n = 10) as Group 1 (C): no treatment (control); Group 2 (HF): etching with 9% hydrofluoric acid (HF) for 90 s followed by silane application; Group 3 (SPH): sandblasting with Al₂O₃ particles (50 μm), etching with 35% phosphoric acid for 40 s followed by application of silane and adhesive (Clearfil liner bond F); and Group 4 (SB): sandblasting with Al₂O₃ followed by silanization. Then, a resin cement (Panavia F2) was applied to the prepared ceramic surfaces. All samples were subjected to thermal aging (5000 cycles, 5-55). The μSBS test was evaluated and failure modes were recorded. Data were analyzed using the Shapiro-Wilk, two-way analysis of variance and Tukey's Honest Significant Difference post hoc tests (P < 0.05).

Results

IPS e.max press samples revealed significantly higher μSBS values compared to VITA SUPRINITY (P < 0.001), in whole surface treatments. The HF group showed the highest μSBS value, followed by the SPH and SB groups, respectively (P < 0.001). Adhesive failure was recorded as a predominant failure mode.

Conclusion

The adhesion performance of IPS e.max press was significantly higher than VITA SUPRINITY. The common surface treatment protocol including HF application followed by silanization was the most effective surface treatment for both glass ceramics.

Influence of the Application Time of Silane for the Bonding Performance between Feldspar or Lithium Disilicate Ceramics and Luting Resin Composites

A correct silanization time is essential for successful surface functionalization and sufficient bonding to dental ceramics. The shear bond strength (SBS) of lithium disilicate (LDS) and feldspar (FSC) ceramics and luting resin composite was investigated with respect to different silanization times, taking into account the physical properties of the individual surfaces. The SBS test was performed with a universal testing machine, and the fracture surfaces were evaluated by stereomicroscopy. The surface roughness of the prepared specimens was analyzed after etching. Changes in surface properties due to surface functionalization were evaluated by surface free energy (SFE) via contact angle measurement. Fourier transform infrared spectroscopy (FTIR) was used to determine the chemical binding. The roughness and SBS of the control group (no silane, etched) were higher for FSC than for LDS. Regarding the SFE, the dispersive fraction increased and the polar fraction decreased after silanization. FTIR confirmed the presence of silane on the surfaces. The SBS of LDS showed a significant increase from 5 to 15 s, depending on the silane and luting resin composite. For FSC, cohesive failure was observed for all samples. For LDS specimens, a silane application time of 15 to 60 s is recommended. Based on clinical conditions, no difference between the silanization times was observed for FSC specimens, indicating that etching alone produces sufficient bonding.

Effect of ceramic primers with different chemical contents on the shear bond strength of CAD/CAM ceramics with resin cement after thermal ageing

BACKGROUND

This study evaluated the effect of ceramic primers containing 10-methacryloyloxydecyl phosphate (10-MDP) and γ-methacryloxypropyl trimethoxysilane (γ-MPTS) agents on the shear bond strength (SBS) of CAD/CAM ceramics with different chemical structures and resin cement.

METHODS

A total of 640 CAD/CAM ceramic specimens were obtained from Vita Mark II (VM), IPS E.max CAD (EM), Vita Suprinity (VS) and Vita Enamic (VE). The specimens were divided into two groups: etched with hydrofluoric acid (HF) and unetched. Each group was treated with a different ceramic primer (Clearfil Ceramic Primer Plus, G-Multi Primer and Monobond S), except for an untreated group (n = 10). After ceramic primers and resin cement were applied to each ceramic surface, half of the specimens were thermally aged at 10,000 cycles, 5-55 ± 1 °C, with a dwell time of 30 s. The SBS was tested with a universal testing machine at a 0.5 mm/min crosshead speed. Data were analysed by using statistical software (SPSS 20). Normal data distribution was checked with the Shapiro‒Wilk test. Three-way ANOVA was used to analyse the difference between the numeric data of the HF etched and thermally aged groups. A post hoc Tukey test was applied in the paired comparison of significant difference. The statistical significance level was accepted as p < 0.05.

RESULTS

The highest SBS values were obtained in the HF etched G-Multi primer applied nonaged EM group (28.3 ± 2.62 MPa), while the lowest values were obtained in the nonetched and thermally aged EM group that received no treatment (2.86 ± 0.04 Mpa). The SBS significantly increased in all specimens on which the ceramic primer was applied (p < 0.001). Thermal ageing had a significant negative effect on the SBS values in all groups (p < 0.001).

CONCLUSION

The positive combined effects of the 10-MDP and γ-MPTS agents resulted in a significant increase in the bonding strength of the resin cement to the CAD/CAM ceramics. In addition, the increase in the amount of inorganic filler provided a favourable effect on durable adhesion.

Comparison of the Micro-Shear Bond Strength of Resin Cements to CAD/CAM Glass Ceramics with Various Surface Treatments

This study aimed to compare the effect of acid etching, sandblasting, or silica coating on the micro-shear bond strength of dual-cured resin cements to computer-aided design and computer-aided manufacturing (CAD/CAM) glass ceramic materials. Feldspathic, lithium disilicate, and zirconia-reinforced CAD/CAM ceramics were divided into four groups: control group (C), no surface treatment; hydrofluoric (HF) group, 5% HF acid-etched; sandblasting (SB) group, abraded with 50 µm aluminum oxide (Al₂O₃) particles; silica-coated (CJ) group, abraded with 30 µm silica-modified Al₂O₃ particles. Roughness values were obtained by using a profilometer. The cements were condensed on the surface-treated specimens and a micro-shear bond test was conducted. The ceramic material (p < 0.001) and surface treatment type (p < 0.001) significantly affected the micro-shear bond strength values. HF acid etching can be recommended for the surface pretreatment of feldspathic, lithium disilicate, and zirconia-reinforced CAD/CAM ceramics. Better bond strengths can be obtained with HF acid etching than with sandblasting and silica coating.

In Vitro Investigation of Material Combinations for Meso- and Suprastructures in a Biomimetic Approach to Restore One-Piece Zirconia Implants

The aim of this study was to find a suitable material combination to avoid cement excess in the marginal region of one-piece zirconia implant-supported restorations by means of a hybrid crown consisting of a meso- and a suprastructure. One-piece zirconia implants (n = 120) were embedded in epoxy resin. Microfilled resin composite mesostructures (n = 60), designed as caps, were bonded on the implant abutment with a primer only. A molar crown was constructed and cemented with a resin cement on top of the mesostructure as a suprastructure out of feldspar ceramic (n = 12), lithium-disilicate (n = 24), or zirconia (n = 24). Fracture load (n = 6) and retention force (n = 6) were measured immediately after storage in distilled water at 37 °C for 24 h, as well as after an additional exposure to artificial aging in a chewing simulator and simultaneous thermal cycling. For the measurement of the fracture load, monolithic crowns made of the employed restorative materials and identical in shape to the hybrid crowns served as controls (n = 6 each). Fracture load values for feldspar ceramic and lithium-disilicate hybrid crowns were slightly higher than those for the respective monolithic crowns at baseline and after aging, which was statistically significant only for feldspar crowns after aging. In contrast, fracture load values for zirconia monolithic crowns were higher than those for zirconia hybrid crowns, which was only statistically significant after aging. Artificial aging reduced the fracture load of feldspar and lithium-disilicate crowns both for hybrid and monolithic crowns. The effect was only statistically significant for lithium disilicate hybrid crowns. The fracture load for hybrid and monolithic zirconia crowns was increased by artificial aging without reaching statistical significance. The retention force of lithium-disilicate and zirconia hybrid crowns was not affected by artificial aging. Taking into account retention force and fracture load, lithium-disilicate hybrid crowns showed promising results.

Surface characterization of indirect restorative materials submitted to different etching protocols

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Effect of Different Etching Times with Hydrofluoric Acid on the Bond Strength of CAD/CAM Ceramic Material

The objective of this study was to evaluate the influence of hydrofluoric acid (HF) and conditioning time on the micro-shear bond strength (µSBS) between dual-cure resin cement and glass-ceramic materials, such as lithium disilicate ceramic (IPS e.max CAD, Ivoclar Vivadent) (EX) and leucite-reinforced ceramic (IPS Empress CAD, Ivoclar Vivadent) (EP), and also a hybrid ceramic (Vita Enamic, Vita Zahnfabrik) (VE). Eighteen sections with 1 mm thickness were cut from each CAD/CAM material and randomly divided into three groups, according to the surface etching time (30 s, 60 s, 90 s). The surface treatment was performed using 9.5% HF acid gel, then resin cement was applied on the prepared ceramic plates and light cured. µSBS values between resin cement and the ceramic material were measured with a universal testing machine at a crosshead speed of 0.5 mm/min until the failure occurred. The fractured surfaces of specimens were microscopically evaluated, and failure modes were classified as: adhesive between resin cement and ceramic, cohesive within ceramic or cement and mixed failure. Surface roughness of etched samples was examined using a scanning electron microscope. Obtained data were statistically analysed using one-way analysis of variance (ANOVA) and Bonferroni post hoc test with a level of significance α = 0.05. The results of the statistical methods applied indicate that µSBS mean difference for leucite-reinforced ceramic (EP) was statistically significant (p < 0.05). However, µSBS values for hybrid ceramic (VE) and lithium disilicate ceramic (EX) were not affected, from a statistical point of view, by the conditioning time (p > 0.05).

Current Protocols for Resin-Bonded Dental Ceramics

Resin-bonded ceramic restorations are common treatment options. Clinical longevity of resin-bonded ceramic restorations depends on the quality and durability of the resin-ceramic bond. The type and composition of the specific ceramic determines the selection of the most effective bonding protocol. Such protocol typically includes a surface pretreatment step followed by application of a priming agent. Understanding of fundamental ceramic properties and chemical compositions enables the clinician to make proper material selection decisions for clinically successful and long-lasting restorations. Based on research accrued over the past decades, this article reviews and discusses current resin-bonding protocols to most commonly used dental ceramics.

HASTABAŞI CAD-CAM BLOKLARIN EROZE DENTİNE MAKASLAMA BAĞLANMA DAYANIMI

Amaç: Bu çalışmada hastabaşı bilgisayar destekli tasarım-bilgisayar destekli üretim (CAD-CAM) bloklarının self-etch ve self-adeziv rezin simanlar kullanılarak gastrik erozyona uğratılmış dentine olan makaslama bağlanma dayanımlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Yüz seksen dentin örneği sağlam dentin ve eroze dentin olmak üzere iki gruba ayrılmıştır. Eroze dentin grubunda örnekler HCI (0,01 M, pH 2, 2 dk) ile erozyona uğratılmış ve 60 dk yapay tükrükte bekletilmiş, sonrasında, elektrikli diş fırçası kullanılarak (2N, 15 s) fırçalanmıştır. Bu döngü üç kere tekrar edilmiştir. Lava Ultimate (LU), Vita Enamic (VE) ve Vita Suprinity (VS) CAD-CAM blokları (3x3x3 mm3, n=15/grup) self-etch Multilink N (MN) ve self-adeziv RelyX U200 Automix (RU) rezin simanları kullanılarak sağlam ve eroze dentin örneklerine simante edilmiştir. Makaslama bağlanma dayanımı 24 saat sonra ölçülmüştür. Başarısızlık tipi stereomikroskop kullanılarak değerlendirilmiştir. Veriler üç-yönlü ANOVA ve Bonferroni düzeltmesi kullanılarak analiz edilmiştir (p˂0,05). Bulgular: Makaslama bağlanma dayanımı ana faktörlerden önemli ölçüde etkilenmiştir: diş yapısı (p=0,011), rezin simanlar (p˂0,001) ve CAD-CAM bloklar (p=0,001). LU sağlam dentine RU ile simante edildiğinde, eroze dentinle karşılaştırıldığında daha yüksek bağlanma dayanımı elde edilmiştir (p=0,001). MN kullanıldığında, RU’dan daha yüksek bağlanma dayanımı değerleri elde edilmiştir (p

Anterior Incisal Onlay—A Minimally Invasive Non-Surgical Approach to Correct an Esthetic Complication of an Implant Supported Crown in the Anterior Zone

The growing demand for re-treatment of existing implant supported restorations in the anterior area due to esthetic complications poses a clinical challenge. One-piece implant supported restoration adds to the clinical complexity. Single implant crown restorations appear short as a result of expected cranio-facial changes. In the presented clinical case, a minimally invasive approach is offered as a solution for such an esthetic difficulty. The clinical old crown was prepared to receive an anterior incisal onlay (AIO) made from lithium disilicate and felspathic porcelain. The manufactured addition was adhesively cemented, presenting a simple prosthetic solution for an esthetic complaint, with no need for surgical procedure, while not challenging the one-piece implant body. As the variety of materials and methods for predictable adhesion increases, non-surgical and non-invasive treatment options will receive high priority. When correctly diagnosed and meticulously performed, the presented solution will meet the patient expectations and provide a satisfying result.

Resin Cement Residue Removal Techniques: In Vitro Analysis of Marginal Defects and Discoloration Intensity Using Micro-CT and Stereomicroscopy

The objective was to compare marginal defects and evaluate discoloration for adhesively cemented veneers in vitro when using two cement removal techniques. Twenty premolars were prepared with chamfer and borders in enamel. IPS e.max CAD veneers were cemented using Panavia V5 and divided in two groups (n = 10): cement excess removed with a probe after tack-curing for 3–5 s, or cement excess removed with a brush, then completely polymerized. All teeth were stored in alginate gel until micro-CT examination. Scanning was performed twice: directly after cementation and after thermocycling (5000 cycles, between 5 and 55 °C). To analyze discoloration, teeth were colored using 0.5% basic fuchsine and examined under a stereomicroscope. Depth of dye infiltration was scored 0 (no discoloration) to 5 (discoloration along the entire margin). Statistically significant differences of cement defects before thermocycling were reported, where brushing showed more defects than probing (p = 0.0161). After thermocycling, the defects increased for both groups. Extensive discoloration was the most common (55.56%) when removing excess by probing; by brushing, 90% of the specimens exhibited slight discoloration (p = 0.008). Regression analysis showed no relationship between type of defect and degree of discoloration. Removing cement with a brush causes more marginal defects, however less discoloration after thermocycling.

A comprehensive in vitro study on the performance of two different strategies to simplify adhesive bonding

Objective

The purpose of this study is to compare the bonding performance and mechanical properties of two different resin composite cements using simplified adhesive bonding strategies.

Materials and methods

Shear bond strength of two resin composite cements (an adhesive cement: Panavia V5 [PV5] and a self‐adhesive cement: RelyX Universal [RUV]) to human enamel, dentin, and a variety of restorative materials (microfilled composite, composite, polymer‐infiltrated ceramic, feldspar ceramic, lithium disilicate and zirconia) was measured. Thermocycle aging was performed with selected material combinations.

Results

For both cements, the highest shear bond strength to dentin was achieved when using a primer (PV5: 18.0 ± 4.2 MPa, RUV: 18.2 ± 3.3 MPa). Additional etching of dentin reduced bond strength for RUV (12.5 ± 4.9 MPa). On enamel, PV5 achieved the highest bond strength when the primer was used (18.0 ± 3.1 MPa), while for RUV etching of enamel and priming provided best results (21.2 ± 6.6 MPa). Shear bond strength of RUV to restorative materials was superior to PV5. Bonding to resin‐based materials was predominantly observed for RUV.

Conclusions

While use of RUV with the selective‐etch technique is slightly more labor intensive than PV5, RUV (with its universal primer) displayed a high‐bonding potential to all tested restorative materials, especially to resin.

Clinical significance

For a strong adhesion to the tooth substrate, PV5 (with its tooth primer) is to be preferred because etching with phosphoric acid is not required. However, when using a wide range of varying restorative materials, RUV with its universal primer seems to be an adequate option.

Influence of the foundation substrate on the fatigue behavior of bonded glass, zirconia polycrystals, and polymer infiltrated ceramic simplified CAD-CAM restorations

This study evaluated the influence of distinct substrates on the mechanical fatigue behavior of adhesively cemented simplified restorations made of glass, polycrystalline or polymer infiltrated-ceramics. CAD/CAM ceramic blocks (feldspathic - FEL; lithium disilicate - LD; yttria-stabilized zirconia - YZ; and polymer-infiltrated ceramic network - PICN) were shaped into discs (n = 15, Ø = 10 mm; thickness = 1.0 mm), mimicking a simplified monolithic restoration. After, they were adhesively cemented onto different foundation substrates (epoxy resin - ER; or Ni-Cr metal alloy - MA) of the same shape (Ø = 10 mm; thickness = 2.0 mm). The assemblies were subjected to fatigue testing using a step-stress approach (200N-2800 N; step-size of 200 N; 10,000 cycles per step; 20 Hz) upon the occurrence of a radial crack or fracture. The data was submitted to two-way ANOVA (α = 0.05) to analyze differences considering 'ceramic material' and 'type of substrate' as factors. In addition, a survival analysis (Kaplan Meier with Mantel-Cox log-rank post-hoc tests; α = 0.05) was conducted to obtain the survival probability during the steps in the fatigue test. Fractographic and finite element (FEA) analyzes were also conducted. The factors 'ceramic material', 'type of substrate' and the interaction between both were verified to be statistically significant (p < .001). All evaluated ceramics presented higher fatigue failure load (FFL), cycles for failure (CFF) and survival probabilities when cemented to the metallic alloy substrate. Among the restorative materials, YZ and LD restorations presented the best fatigue behavior when adhesively cemented onto the metallic alloy substrate, while FEL obtained the lowest FFL and CFF for both substrates. The LD, PICN and YZ restorations showed similar fatigue performance considering the epoxy resin substrate. A more rigid foundation substrate improves the fatigue performance of adhesively cemented glass, polycrystalline and polymer infiltrated-ceramic simplified restorations.

Load capacity of occlusal veneers of different restorative CAD/CAM materials under lateral static loading

OBJECTIVE

The aim of this in vitro study was to analyze the failure of occlusal veneers made of three different restorative CAD/CAM materials under lateral static loading.

MATERIALS AND METHODS

Sixty standardized semi-anatomical occlusal veneers were fabricated on natural lower molars from three different CAD/CAM materials: hybrid ceramic (Vita Enamic), lithium disilicate (IPS e. max CAD) and translucent zirconia (Bruxzir). The specimens were mechanically loaded by a custom-made device attached to a universal testing machine (MTS 858 Mini Bionix II, MN, USA). Static lateral loading was applied on the buccal cusp of the occlusal veneer until failure. Failure loads were recorded, and the types of failure noted for each group. 3D finite element (FE) models simulating the actual test set-up were further employed to evaluate the stresses within the tooth-restoration complex to help interpret the experimental results.

RESULTS

Occlusal veneers made from zirconia recorded a significantly higher mean failure load (843.1 ± 141.5 N) than specimens of the other two materials (p < 0.05). There was no statistically significant difference between the lithium disilicate (493.21 ± 102.24 N) and the hybrid ceramic (499.6 ± 123.1 N) groups (p = 0.863). 74% of the hybrid ceramic and 84% of the lithium disilicate specimens showed veneer fracture, whereas 78% of the zirconia veneers showed debonding. Comparison of the FE-predicted stresses with the different failure strengths corroborated with the experimental results.

CONCLUSION

Lateral loading caused failure of occlusal veneers at loads significantly lower than those reported for axial loading. Among the materials tested, zirconia veneers showed the highest resistance to failure, with the main failure mode being debonding under lateral loading. The other two material groups failed mainly by veneer fracture at lower loads.

HIGHLIGHTS

- A novel device was used for testing occlusal veneers under lateral static loading. - 3D-FE analysis explained and corroborated the experimental results. - The relationship between vertical and horizontal forces acting on teeth has been described. - The study highlights the harm of excursive contacts on ceramic restorations.

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

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

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

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

Comparison of lithium disilicate-reinforced glass ceramic surface treatment with hydrofluoric acid, Nd:YAG, and CO2 lasers on shear bond strength of metal brackets

OBJECTIVES

To evaluate and compare the effects of different surface conditioning methods of lithium disilicate-reinforced ceramic on shear bond strength (SBS) of metallic brackets.

MATERIALS AND METHODS

Thirty-six lithium disilicate ceramic blocks mounted in acrylic resin blocks were assigned to 3 groups (n = 12): 9.6% hydrofluoric acid (HF); neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; and carbon dioxide (CO₂) laser. The glass ceramic surfaces were primed with a silane, and the brackets were bonded using a light-cured composite resin. SBS test was carried out in a universal testing machine at 0.5 mm/min crosshead speed until the brackets were debonded. The remaining adhesive was evaluated under a stereomicroscope in terms of the adhesive remnant index (ARI). The surface hardness was determined with a 100-gr force using a microhardness tester. Glass ceramic surface changes were evaluated using the scanning electron microscope. One-way ANOVA and post hoc Tamhane tests were used to compare microhardness values, and Kruskal-Wallis and Mann-Whitney U tests were used to analyze SBS values and ARI.

RESULTS

The median and interquartile range of SBS values in 3 groups were 6.48 (1.56-15.18), 1.26 (0.83-1.67), and 0.99 MPa (0.70-2.10), respectively. Microhardness analysis revealed significant differences between the CO₂ laser and intact porcelain groups (P = 0.003), without significant differences between the other groups. Group 1 exhibited the highest ARI.

CONCLUSION

Neither CO₂ nor Nd:YAG lasers resulted in adequate surface changes for bonding of brackets on ceramics compared with the samples conditioned with HF. CO₂ laser decreased the microhardness of ceramics.

CLINICAL RELEVANCE

Surface conditioning with HF resulted in clinically acceptable SBS values.