1
|
Alkhudhairy F. Experimental and Chitosan-Infused Adhesive with Dentin Pretreated with Femtosecond Laser, Methylene Blue-Activated Low-Level Laser, and Phosphoric Acid. Photobiomodul Photomed Laser Surg 2024; 42:634-642. [PMID: 39069884 DOI: 10.1089/pho.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Aim: To prepare experimental adhesive (EA) with 1% and without chitosan nanoparticles on dentin conditioned with a conventional technique phosphoric acid (PA) compared with two different contemporary techniques: photodynamic therapy (PDT) and femtosecond laser (FSL). Method: The methodology consisted of synthesis of EA and 1% chitosan-modified adhesive (CMA). Scanning electron microscopy, dentin adhesive interface assessment, energy-dispersive spectroscopy, shear bond strength (SBS), degree of conversion (DC), and bond failure were assessed. Teeth were selected, disinfected, and mounted in acrylic up to the cementoenamel junction. Occlusal enamel was removed and teeth were randomly allocated into groups and conditioned. These included Group 1: samples treated with PA; Group 2: specimens conditioned with methylene blue photosensitizer (MBP) activated by PDT; and Group 3: samples conditioned with FSL. Following different conditioning regimes, specimens were bonded using 1% CMA and EA. The composite buildup was followed by SBS testing and a bond failure assessment. DC was assessed for both EA and CMA. Analysis of variance and Tukey's post hoc test were used to compare the mean and standard deviation of SBS and DC in different experimental groups, with a significance level of p < 0.05. Results: Dentin pretreated with etch and rinse demonstrated the highest bond strength with 1% CMA. Dentin conditioned with MBP activated by PDT and bonded to EA showed the lowest bond scores. Overall SBS values of 1% CMA were better than EA irrespective of the conditioning regime of dentin. The DC was higher in EA adhesive. This was followed by DC in 1% CMA. DC in EA was found to be comparable with 1% CMA. Conclusions: PA remains the gold standard for dentin conditioning. The incorporation of 1% chitosan in adhesive improves SBS and results in no change in DC. The use of FSL in dentin conditioning can be used as an alternative approach as it results in SBS within acceptable limits. The study was approved by the ethical board of King Saud University.
Collapse
Affiliation(s)
- Fahad Alkhudhairy
- Restorative Dental Sciences Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Okutan Y, Gundogdu Y, Donmez MB, Seker H, Kilic HS. Effect of femtosecond laser induced surface patterns on the flexural strength of monolithic zirconia. J Biomed Mater Res B Appl Biomater 2024; 112:e35432. [PMID: 38817034 DOI: 10.1002/jbm.b.35432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 06/01/2024]
Abstract
To investigate how patterns generated by femtosecond (fs) laser and femtosecond laser power affect the surface roughness (Ra) and biaxial flexural strength (BFS) of monolithic zirconia. Eighty disk-shaped zirconia specimens were divided into eight subgroups (n = 10): Control (C), airborne-particle abrasion (APA), 400 mW fs laser (spiral [SP(400)], square [SQ(400)], circular [CI(400)]), and 700 mW fs laser ([SP(700)], [SQ(700)], [CI(700)]). Ra values were calculated by using a surface profilometer. One additional specimen per group was analyzed with scanning electron microscopy and x-ray diffractometry. BFS values were obtained by using the piston-on-3-ball test. One-way ANOVA and either Tukey's HSD (BFS) or Tamhane's T2 (Ra) tests were used to evaluate data (α = 0.05). Regardless of the pattern and power, fs laser groups had higher Ra than C and APA, while SP groups had lower Ra than CI and SQ groups (p ≤ 0.004). For each pattern, Ra increased with higher laser power (p < 0.001), while the laser power did not affect the BFS (p ≥ 0.793). CI and SQ groups had lower BFS than the other groups (p ≤ 0.040), whereas SP groups had similar BFS to C and APA (p ≥ 0.430). Fs laser microstructuring with spiral surface pattern increased the Ra without jeopardizing the BFS of zirconia. Thus, this treatment might be an option to roughen tested zirconia.
Collapse
Affiliation(s)
- Yener Okutan
- Aydın Adnan Menderes University, Faculty of Dentistry, Department of Prosthodontics, Aydın, Turkey
| | - Yasemin Gundogdu
- Selcuk University, Kadınhanı Faik İçil Vocational High School, Department of Computer Technologies, Konya, Turkey
| | - Mustafa Borga Donmez
- Istinye University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
- University of Bern, School of Dental Medicine, Department of Reconstructive Dentistry and Gerodontology, Bern, Switzerland
| | - Huseyin Seker
- Aydın Adnan Menderes University, Faculty of Dentistry, Department of Prosthodontics, Aydın, Turkey
| | - Hamdi Sukur Kilic
- Selcuk University, Faculty of Science, Department of Physics, Konya, Turkey
| |
Collapse
|
3
|
Mosaddad SA, Abduo J, Zakizade M, Tebyaniyan H, Hussain A. The Effect of Various Lasers on the Bond Strength Between Orthodontic Brackets and Dental Ceramics: A Systematic Review and Meta-Analysis. Photobiomodul Photomed Laser Surg 2024; 42:20-48. [PMID: 37862260 DOI: 10.1089/photob.2023.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Background/objective: This systematic review and meta-analysis aimed to assess how laser conditioning affected brackets bonded to dental ceramics' shear bond strength (SBS). Materials and methods: The study was conducted by searching Pubmed/Medline, Scopus, Embase, Web of Science, the Cochrane Library, and Google Scholar up to September 14, 2022. In addition, the reference lists of the relevant articles were checked manually. Articles that compared SBS of laser-treated feldspathic, lithium disilicate, or zirconia surfaces with other standard techniques for bonding metal or ceramic orthodontic brackets were considered. Using a random-effects model, data pooling was carried out as the weighted mean difference (WMD). Results: This study initially contained 1717 reports, and following review, 32 articles were deemed suitable for our meta-analysis. The pooling results showed that the treatments with lasers such as "Er:YAG" [WMD = -1.12 MPa; 95% confidence interval (CI): -1.93 to -0.31], "Er:YAG + Silane" (WMD = -3.08 MPa; 95% CI: -4.77 to -1.40), and "Nd: YAG + Silane" (WMD = -2.58 MPa; 95% CI: -3.76 to -1.40) had statistically significant lower adhesion values compared with controls. Contrarily, "Ti:Sapphire femtosecond" demonstrated significantly higher bonding values (WMD = 0.94 MPa; 95% CI: 0.29-1.60). In contrast, other interventions obtained no statistically significant difference in SBS. Conclusions: Most of the laser groups showed results comparable with those of conventional approaches. Although more research is necessary for definitive conclusions, laser treatment may be an effective option for treating the surfaces of ceramic materials.
Collapse
Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jaafar Abduo
- Department of Prosthodontics, Melbourne Dental School, Melbourne University, Melbourne, Victoria, Australia
| | - Mehrnaz Zakizade
- Department of Orthodontics, School of Dentistry, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran
| | - Ahmed Hussain
- School of Dentistry, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Alsarani MM, Alsadon O, Alageel O, Alfrisany N, Almutairi Z, Al-Gawati MA, Almozainy M. The Effect of Femtosecond Laser Surface Patterns on the Effectiveness of Resin Composite to Zirconia Bonding. J Funct Biomater 2023; 14:508. [PMID: 37888173 PMCID: PMC10607183 DOI: 10.3390/jfb14100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
This laboratory study aimed to evaluate the effect of different surface patterns using femtosecond laser treatment on the enclosed mold shear bond strength (EM-SBS) of resin composite to zirconia (ZrO2) surfaces and to contrast it with the widely used tribochemical silica coating (TBC) surface conditioning method. A set of fifteen rectangular ZrO2 blocks were randomly divided into five groups according to surface pretreatment: Control G0-no treatment; G1-TBC with silane application; G2-femtosecond laser irradiation with horizontal lines 30 µm apart; G3-femtosecond laser irradiation with horizontal lines 15 µm apart; and G4-femtosecond laser irradiation with cross lines 30 µm apart. The pretreated surfaces were characterized by a surface profilometer, tensiometer and scanning electron microscope. The EM-SBS of resin composite stubs to ZrO2 was measured followed by fractographic analysis. The surface roughness and water contact angle were observed to be statistically higher among the femtosecond laser groups compared to the TBC and control groups. The G4 group exhibited the highest EM-SBS among all the groups, irrespective of the ageing conditions used. At the end of 5000 thermocycles, G4 exhibited EM-SBS of 14.05 ± 4.21 MPa compared to 13.80 ± 3.01 MPa in G1 and 5.47 ± 0.97 MPa in G0. The two-way ANOVA revealed a significant effect of both study groups and ageing conditions on the EM-SBS (p < 0.001). Utilization of femtosecond laser technology holds promise as a potential and alternative mechanical retention approach for enhancing the bonding strength of the resin composite to ZrO2.
Collapse
Affiliation(s)
- Majed M Alsarani
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Omar Alsadon
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Omar Alageel
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Najm Alfrisany
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Zeyad Almutairi
- Department of Mechanical Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
| | - Mahmoud A Al-Gawati
- Department of Physics and Astronomy, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mayyadah Almozainy
- Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh 12371, Saudi Arabia
| |
Collapse
|
5
|
Piulachs I, Giner-Tarrida L, España-Tost A, Arnabat-Dominguez J, Florian C. In vitro comparative study between adhesion forces obtained on zirconia ceramic micromechanically treated with femtosecond laser (1027 nm), carbon dioxide laser (10,600 nm), and aluminum-oxide particles. Lasers Med Sci 2023; 38:194. [PMID: 37626207 DOI: 10.1007/s10103-023-03859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Conventional surface roughening treatments used for silica-based ceramics in order to improve subsequent adhesion become unreliable for zirconia ceramics. Laser conditioning can be a good alternative. The purpose of this in vitro study was to compare conventional (macro) shear bond strength (SBS) values obtained between resin composite and zirconium oxide ceramic samples grouped according to different micromechanical treatments received, and examine differences in surface roughness. One-hundred and fifty disks of sintered zirconia were randomly divided into 5 groups and roughened as follows: (1) Group NOT, no surface treatment; (2) Group APA, abraded with 50-μm aluminum-oxide (Al2O3) particles; (3) Group TBS, abraded with 30-μm aluminum-oxide particles covered with silica; (4) Group CO2, irradiated with a CO2 laser which emitted in continuous wave mode at 3 W of power; and (5) Group FEM, irradiated with a pulsed femtosecond laser, with an incident energy of 10 μJ, a frequency of 1000 Hz, and a fluence of 1.3 kJ/cm2. All surfaces were treated with a MDP-containing adhesive/silane coupling agent mixture upon which were prepared and light polymerized composite resin cylinders. Shear bond strength was measured and samples were observed by scanning electron microscopy (SEM). Statistically significant differences (p < 0.05) were found among all groups, except between CO2 and FEM, which showed the highest adhesion values (15.12 ± 2.35 MPa and 16.03 ± 2.73 MPa). SEM revealed differences in surface patterns. CO2 laser irradiation can be an alternative to sandblasting, although it could also weaken the ceramic. Suitable surface patterns on zirconia ceramics can be obtained with ultrashort pulsed radiation emitted by a pulsed femtosecond laser.
Collapse
Affiliation(s)
- Ignasi Piulachs
- Department of Prosthetic Dentistry, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Luis Giner-Tarrida
- Department of Prosthetic Dentistry, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Antoni España-Tost
- Department of Oral Surgery, Universitat de Barcelona (UB), Barcelona, Spain
| | | | - Camilo Florian
- Department of Applied Physics, Universitat de Barcelona (UB), Barcelona, Spain
- Instituto de Óptica Daza de Valdés, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| |
Collapse
|
6
|
Sahoo N, Carvalho O, Özcan M, Silva F, Souza JCM, Lasagni AF, Henriques B. Ultrashort pulse laser patterning of zirconia (3Y-TZP) for enhanced adhesion to resin-matrix cements used in dentistry: An integrative review. J Mech Behav Biomed Mater 2023; 143:105943. [PMID: 37276650 DOI: 10.1016/j.jmbbm.2023.105943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
Surface modification of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) using lasers for adhesion enhancement with resin-matrix cement has been increasingly explored. However, Y-TZP is chemically inert and non-reactive, demanding surface modification using alternative approaches to enhance its bond strength to resin-matrix cements. The main aim of this study was to conduct an integrative review on the influence of ultrashort pulse laser patterning of zirconia (3Y-TZP) for enhanced bonding to resin-matrix cements. An electronic search was performed on web of science, SCOPUS, Pubmed/Medline, Google Scholar and EMBASE using a combination of the following search items: zirconia, 3Y-TZP, surface modification, laser surface treatment, AND laser, ultrashortpulse laser, bonding, adhesion, and resin cement. Articles published in the English language, up to January 2022, were included regarding the influence of surface patterning on bond strength of Y-TZP to resin-matrix cements. Out of the 12 studies selected for the present review 10 studies assessed femtosecond lasers while 2 studies assessed picosecond lasers. Ultrashort pulsed laser surface patterning successfully produced different surface morphological aspects without damaging the bulk properties of zirconia. Contrarily, defects such as micro-cracks occurs after surface modification using traditional methods such as grit-blasting or long-pulsed laser patterning. Ultrashort pulsed laser surface patterning increase bond strength of zirconia to resin-matrix cements and therefore such alternative physical method should be considered in dentistry. Also, surface defects were avoided using ultrashort pulsed laser surface patterning, which become the major advantage when compared with traditional physical methods or long pulse laser patterning.
Collapse
Affiliation(s)
- Narayan Sahoo
- Centre Microelectromechanical Systems (CMEMS-UMinho), University of Minho, Campus Azurém, Guimarães, 4800-058, Portugal; LABBELS Associate Laboratory, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Oscar Carvalho
- Centre Microelectromechanical Systems (CMEMS-UMinho), University of Minho, Campus Azurém, Guimarães, 4800-058, Portugal; LABBELS Associate Laboratory, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Mutlu Özcan
- Division of Dental Materials, Center for Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Zurich, 8032, Switzerland
| | - Filipe Silva
- Centre Microelectromechanical Systems (CMEMS-UMinho), University of Minho, Campus Azurém, Guimarães, 4800-058, Portugal; LABBELS Associate Laboratory, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Júlio C M Souza
- Centre Microelectromechanical Systems (CMEMS-UMinho), University of Minho, Campus Azurém, Guimarães, 4800-058, Portugal; LABBELS Associate Laboratory, University of Minho, Guimarães, 4710-057, Braga, Portugal; Department of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, Gandra, PRD, 4585-116, Portugal
| | - Andrés-Fabian Lasagni
- Institute for Manufacturing Technology, Technische Universität Dresden, 01062, Dresden, Germany
| | - Bruno Henriques
- Centre Microelectromechanical Systems (CMEMS-UMinho), University of Minho, Campus Azurém, Guimarães, 4800-058, Portugal; LABBELS Associate Laboratory, University of Minho, Guimarães, 4710-057, Braga, Portugal; Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, Florianópolis, SC, 88040-900, Brazil.
| |
Collapse
|
7
|
Li Q, Li C, Wang Y. Effect of femtosecond laser ablate ultra-fine microgrooves on surface properties of dental zirconia materials. J Mech Behav Biomed Mater 2022; 134:105361. [DOI: 10.1016/j.jmbbm.2022.105361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
|
8
|
Inokoshi M, Yoshihara K, Kakehata M, Yashiro H, Nagaoka N, Tonprasong W, Xu K, Minakuchi S. Preliminary Study on the Optimization of Femtosecond Laser Treatment on the Surface Morphology of Lithium Disilicate Glass-Ceramics and Highly Translucent Zirconia Ceramics. MATERIALS 2022; 15:ma15103614. [PMID: 35629640 PMCID: PMC9143866 DOI: 10.3390/ma15103614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022]
Abstract
All-ceramic restorations have become increasingly popular in dentistry. Toward ensuring that these restorations adhere to the tooth structure, this study determines the optimal femtosecond laser (FL) treatment parameters for lithium disilicate glass-ceramics and highly translucent zirconia ceramics with respect to surface morphology. For both the ceramics, the following surface conditions were investigated: (1) as-sintered; (2) Al2O3 sandblasted; (3) FL treatment (dot pattern with line distances of 14, 20, and 40 µm); (4) FL treatment (crossed-line pattern with a line distance of 20 and 40 µm). Surface roughness parameters were estimated using a 3D confocal laser microscope; microstructures were analyzed using a scanning electron microscope. Peak fluence (Fpeak) values of 4 and 8 J/cm2 and irradiation numbers (N) of 20 and 10 shots were selected to create dot patterns in highly translucent zirconia and lithium disilicate glass-ceramics, respectively. Furthermore, Fpeak = 8 J/cm2 and N = 20 shots were chosen to obtain crossed-line patterns in both ceramics. Our results show that lithium disilicate glass-ceramics and highly translucent zirconia exhibit a similar surface morphology under each of the surface treatment conditions. Therefore, FL irradiation of dot or crossed-line patterns (at a distance of 20 and 40 µm) are potential candidates for future investigations.
Collapse
Affiliation(s)
- Masanao Inokoshi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (W.T.); (K.X.); (S.M.)
- Correspondence:
| | - Kumiko Yoshihara
- National Institute of Advanced Industrial Science and Technology (AIST), Health and Medical Research Institute, Takamatsu 761-0395, Japan;
- Department of Pathology & Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Masayuki Kakehata
- National Institute of Advanced Industrial Science and Technology (AIST), Research Institute for Advanced Electronics and Photonics, Tsukuba 305-8568, Japan; (M.K.); (H.Y.)
| | - Hidehiko Yashiro
- National Institute of Advanced Industrial Science and Technology (AIST), Research Institute for Advanced Electronics and Photonics, Tsukuba 305-8568, Japan; (M.K.); (H.Y.)
| | - Noriyuki Nagaoka
- Advanced Research Center for Oral and Craniofacial Sciences, Okayama University Dental School, Okayama 700-8558, Japan;
| | - Watcharapong Tonprasong
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (W.T.); (K.X.); (S.M.)
| | - Kaiqi Xu
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (W.T.); (K.X.); (S.M.)
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (W.T.); (K.X.); (S.M.)
| |
Collapse
|
9
|
Sun L, Hong G. Surface Modifications for Zirconia Dental Implants: A Review. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.733242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Zirconia-based bioceramic is a potential material for dental implants developed and introduced in dentistry 30 years ago. However, some limitations still exist for zirconia implants caused by several factors, such as manufacturing difficulties, low-temperature degradation (LTD), long-term stability, and clinical experience. Several studies validated that some subtle changes on the zirconia surface might significantly impact its mechanical properties and osseointegration. Thus, attention was paid to the effect of surface modification of zirconia implants. This review generally summarizes the surface modifications of zirconia implants to date classified as physical treatment, chemical treatment, and surface coating, aiming to give an overall perspective based on the current situation. In conclusion, surface modification is an effective and essential method for zirconia implant application. However, before clinical use, we need more knowledge about these modification methods.
Collapse
|
10
|
Bitencourt SB, Ferreira LC, Mazza LC, Dos Santos DM, Pesqueira AA, Theodoro LH. Effect of laser irradiation on bond strength between zirconia and resin cement or veneer ceramic: A systematic review and meta-analysis. J Indian Prosthodont Soc 2021; 21:125-137. [PMID: 33938862 PMCID: PMC8262443 DOI: 10.4103/jips.jips_590_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: This systematic review with meta-analysis aimed to evaluate the effect of the laser treatment on bond strength between Y-TZP and the resin cement or with the veneering ceramic, and the effect on the alteration of the Y-TZP surface roughness. Settings and Design: Systematic review and meta analysis following PROSPERO guidelines. Materials and Methods: A comprehensive review was performed up to September 2020 on four databases (PubMed/MEDLINE, Embase, Scopus, and Cochrane Library), using the combination of keywords: “laser AND zirconia AND surface treatment AND bond strength”. Statistical Analysis Used: The meta-analysis was based on the Mantel–Haenszel and inverse variance methods. The continuous outcome was evaluated by mean difference and the corresponding 95% confidence intervals. Results: A total of 37 studies were identified for the inclusion of data, with only in vitro studies. The types of laser reported in the studies were: Er:YAG, Nd:YAG, Er,Cr:YSGG, CO2, Femtosecond, and Yb lasers. A random-effect model found statistically significant differences between lasers and control groups of Y-TZP (P < 0.00001; MD: 3.08; 95% CI: 2.58 to 3.58). Only the bond strength with the Er:YAG laser did not present statistical difference (P = 0.51; MD: 0.22; 95% CI: −0.44–0.88). In another analysis, a random-effect model found a statistically significant difference between the laser and control groups on surface roughness (P < 0.00001; MD: 0.96; 95% CI: 0.86 to 1.06). Conclusions: Laser irradiation is capable to improve the Y-TZP surface roughness and the bond strength of zirconia with resin cement and veneering ceramics. However, there is a lack of laser protocol for the zirconia surface, a fact that makes a simple and direct comparison difficult.
Collapse
Affiliation(s)
- Sandro Basso Bitencourt
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Letícia Chaves Ferreira
- Department of Surgery and Integrated Clinic, Division of Periodontics, Group for the Research and Study of Laser in Dentistry, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Leticia Cerri Mazza
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Daniela Micheline Dos Santos
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Aldieris Alves Pesqueira
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Leticia Helena Theodoro
- Department of Surgery and Integrated Clinic, Division of Periodontics, Group for the Research and Study of Laser in Dentistry, Aracatuba Dental School, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| |
Collapse
|
11
|
Changes in Crystal Phase, Morphology, and Flexural Strength of As-Sintered Translucent Monolithic Zirconia Ceramic Modified by Femtosecond Laser. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Conventional bonding technology suitable for silica-based ceramics is not applicable to zirconia, due to its polycrystalline phase composition, chemical stability, and acid corrosion resistance. The development of an effective treatment to improve its surface roughness and mechanical properties remains an unresolved problem. Therefore, to solve this problem, this in vitro study evaluated the changes in surface morphology and flexural strength of translucent monolithic zirconia surfaces treated with femtosecond laser technology. As-sintered translucent zirconia specimens were subjected to airborne particle abrasion and femtosecond laser treatments, while control group specimens received no treatment. After treatment, the roughness and morphology of the treated zirconia surfaces were examined. The flexural strength and X-ray diffraction of the treated specimens were measured and analyzed. Statistical inferential analysis included one-way analysis of variance at a set significance level of 5%. The surface roughness after femtosecond laser treatment was significantly improved when compared with the control group and the group that received the airborne particle abrasion treatment (p < 0.05). In comparison with the airborne particle abrasion group, the flexural strength of the group that received the femtosecond laser treatment was significantly improved (p < 0.05). The femtosecond laser approach using appropriate parameters enhanced the roughness of the zirconia without reducing its flexural strength; therefore, this approach offers potential for the treatment of zirconia surfaces.
Collapse
|
12
|
Han J, Zhang F, Van Meerbeek B, Vleugels J, Braem A, Castagne S. Laser surface texturing of zirconia-based ceramics for dental applications: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:112034. [PMID: 33812647 DOI: 10.1016/j.msec.2021.112034] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Laser surface texturing is widely explored for modifying the surface topography of various materials and thereby tuning their optical, tribological, biological, and other surface properties. In dentistry, improved osseointegration has been observed with laser textured titanium dental implants in clinical trials. Due to several limitations of titanium materials, dental implants made of zirconia-based ceramics are now considered as one of the best alternatives. Laser surface texturing of zirconia dental implants is therefore attracting increasing attention. However, due to the brittle nature of zirconia, as well as the metastable tetragonal ZrO2 phase, laser texturing in the case of zirconia is more challenging than in the case of titanium. Understanding these challenges requires different fields of expertise, including laser engineering, materials science, and dentistry. Even though much progress was made within each field of expertise, a comprehensive analysis of all the related factors is still missing. This review paper provides thus an overview of the common challenges and current status on the use of lasers for surface texturing of zirconia-based ceramics for dental applications, including texturing of zirconia implants for improving osseointegration, texturing of zirconia abutments for reducing peri-implant inflammation, and texturing of zirconia restorations for improving restoration retention by bonding.
Collapse
Affiliation(s)
- Jide Han
- KU Leuven, Department of Mechanical Engineering and Flanders Make@KU Leuven-MaPS, Celestijnenlaan 300, 3001 Leuven, Belgium
| | - Fei Zhang
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium; KU Leuven, Department of Oral Health Sciences, BIOMAT, Kapucijnenvoer 7 Block A, 3000 Leuven, Belgium
| | - Bart Van Meerbeek
- KU Leuven, Department of Oral Health Sciences, BIOMAT, Kapucijnenvoer 7 Block A, 3000 Leuven, Belgium
| | - Jozef Vleugels
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Annabel Braem
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001 Leuven, Belgium
| | - Sylvie Castagne
- KU Leuven, Department of Mechanical Engineering and Flanders Make@KU Leuven-MaPS, Celestijnenlaan 300, 3001 Leuven, Belgium.
| |
Collapse
|
13
|
Novel Femto Laser Patterning of High Translucent Zirconia as an Alternative to Conventional Particle Abrasion. Dent J (Basel) 2021; 9:dj9020020. [PMID: 33567579 PMCID: PMC7915195 DOI: 10.3390/dj9020020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: currently applied surface treatments for zirconia bonding may create undesired microcracks and surface flaws. The aim of the present study was to evaluate the efficacy of alternative surface treatments on the shear bond strength of high translucency zirconia to 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin-based cement. Methods: fifty disk-shaped specimens (10 mm × 5 mm) were fabricated from a commercial yttria-stabilized zirconia with 5 mole% yttrium oxide tetragonal zirconia polycrystal (5Y-TZP), and underwent air-abrasion with alumina particles (50 μm-AL50 and 90 μm-AL90), glass beads (GB 10–60 μm), and ablation with femtosecond laser (FEMTO). Shear bond strength was evaluated with a universal testing machine under a crosshead speed of 0.5 mm/min until fracture. Fracture type was evaluated with an optical stereomicroscope. Differences among groups were evaluated by one-way ANOVA and Bonferroni pairwise comparison tests (p < 0.05). Results: the highest shear bond strength values were presented by the laser treated group (23.97 ± 3.7 MPa). No statistically significant differences were found among the Cl, Al50, Al90 and FEMTO groups. The lowest mean value was presented by the glass-beads treated group (11.93 ± 2.88 MPa) which was significantly lower compared to all other groups (p < 0.001). Conclusions: under the limitations of this in vitro study, femtosecond laser treatment of High-translucent monolithic zirconia (HTZ) ceramics is a promising alternative method for the mechanical retention of resin cements.
Collapse
|
14
|
Okutan Y, Kandemir B, Gundogdu Y, Kilic HS, Yucel MT. Combined application of femtosecond laser and air-abrasion protocols to monolithic zirconia at different sintering stages: Effects on surface roughness and resin bond strength. J Biomed Mater Res B Appl Biomater 2020; 109:596-605. [PMID: 33073447 DOI: 10.1002/jbm.b.34741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/06/2022]
Abstract
This study aimed to investigate the effects of femtosecond laser (Fs) and/or air-abrasion protocols on surface roughness (Ra) of zirconia and resin bond strength. Eighty zirconia samples were randomly divided into eight subgroups according to surface treatment protocols: Control (C), Air-abrasion before sintering (ABS), Air-abrasion after sintering (AAS), Air-abrasion before and after sintering (ABS + AAS), Fs laser before sintering (FBS), Fs laser before sintering + air-abrasion after sintering (FBS + AAS), Fs laser after sintering (FAS), and Fs laser after sintering + air-abrasion after sintering (FAS + AAS). Measurements of Ra values were obtained using a surface profilometer. Surface morphological properties were evaluated with scanning electron microscopy (SEM), and crystallographic changes were examined by X-Ray diffractometry (XRD). Self-adhesive resin cement was bonded to zirconia samples, and shear bond strength (SBS) tests were performed. The data were statistically analyzed by one-way ANOVA, followed by Tamhane tests. The control group displayed the lowest Ra and SBS values among all groups. The highest Ra and SBS values were found in the FBS and FBS + AAS groups. Air-abrasion applied before sintering significantly increased the Ra of specimens. FAS, FAS + AAS, and ABS + AAS groups exhibited higher SBS values than AAS and ABS (p < .05). Air-abrasion applied after Fs laser did not produce any significant change in the Ra and SBS compared to Fs laser alone (p > .05). Femtosecond laser application may be a promising method to enhance the surface roughness of zirconia and improve resin bond strength. Air-abrasion at pre- and post-sintered stages may also be a viable surface treatment option.
Collapse
Affiliation(s)
- Yener Okutan
- Faculty of Dentistry, Department of Prosthodontics, Aydın Adnan Menderes University, Aydın, Turkey
| | - Banucicek Kandemir
- Faculty of Dentistry, Department of Prosthodontics, Selcuk University, Konya, Turkey
| | - Yasemin Gundogdu
- Department of Electric and Energy, Selcuk University, Kadınhanı Faik İçil Vocational High School, Konya, Turkey
| | - Hamdi Sukur Kilic
- Faculty of Science, Department of Physics, Selcuk University, Konya, Turkey
| | - Munir Tolga Yucel
- Faculty of Dentistry, Department of Prosthodontics, Selcuk University, Konya, Turkey
| |
Collapse
|
15
|
Abu Ruja M, De Souza GM, Finer Y. Ultrashort-pulse laser as a surface treatment for bonding between zirconia and resin cement. Dent Mater 2019; 35:1545-1556. [DOI: 10.1016/j.dental.2019.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
|
16
|
Comparison of Shear Strength of Metal and Ceramic Orthodontic Brackets Cemented to Zirconia Depending on Surface Treatment: An In Vitro Study. Eur J Dent 2019; 13:150-155. [PMID: 31450247 PMCID: PMC6777170 DOI: 10.1055/s-0039-1694304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives
Due to the high demand for all-ceramic restorations, monolithic zirconia restorations are nowadays frequently used. With the demand for adult orthodontic treatments, orthodontists need to be mindful of the quality of their brackets bonding to this type of material, as it requires special conditioning. This study aimed to compare different surface treatments of zirconia when bonding metal or ceramic orthodontic brackets. The objectives are to compare the shear bond strength; the amount of adhesive remaining on the surface of the material; the incidence of adhesive, cohesive, and mixed failures; and the occurrence of zirconia fractures.
Materials and Methods
Forty monolithic blocks of zirconia of a diameter of 10 mm and a length of 10 mm were prepared and randomly divided into two groups (
n
= 20): metallic or ceramic brackets. Each group was subsequently divided into two subgroups (
n
= 10) depending on the surface preparation (laser treatment or airborne particle abrasion): SMB (airborne particle abrasion, metal bracket), SCB (airborne particle abrasion, ceramic bracket), LMB (laser; metal bracket), and LCB (laser, ceramic bracket). The samples were tested for shear bond strength using a universal testing machine. The adhesive remnant index and the occurrence of zirconia fractures and different types of failures were assessed by optical and electron microscopy.
Statistical Analysis
Results were analyzed using analysis of variance.
Results
The differences were significant between the metallic (SMB, LMB) and ceramic (SCB, LCB) bracket groups with regard to shear bond strength, with respectively 23.29 ± 5.34 MPa, 21.59 ± 4.03 MPa, 20.06 ± 4.05 MPa, and 17.55 ± 3.88 MPa. In terms of surface treatment, no statistical differences were found between the different groups.
Conclusion
Metal brackets have a greater bond strength than ceramic brackets when cemented to zirconia. The surface treatment of zirconia surface has no influence on the shear bond strength.
Collapse
|
17
|
García-Sanz V, Paredes-Gallardo V, Bellot-Arcís C, Martínez-León L, Torres-Mendieta R, Montero J, Albaladejo A. Femtosecond laser settings for optimal bracket bonding to zirconia. Lasers Med Sci 2018; 34:297-304. [DOI: 10.1007/s10103-018-2589-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
|
18
|
García-Sanz V, Paredes-Gallardo V, Mendoza-Yero O, Carbonell-Leal M, Albaladejo A, Montiel-Company JM, Bellot-Arcís C. The effects of lasers on bond strength to ceramic materials: A systematic review and meta-analysis. PLoS One 2018; 13:e0190736. [PMID: 29293633 PMCID: PMC5749860 DOI: 10.1371/journal.pone.0190736] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022] Open
Abstract
Lasers have recently been introduced as an alternative means of conditioning dental ceramic surfaces in order to enhance their adhesive strength to cements and other materials. The present systematic review and meta-analysis aimed to review and quantitatively analyze the available literature in order to determine which bond protocols and laser types are the most effective. A search was conducted in the Pubmed, Embase and Scopus databases for papers published up to April 2017. PRISMA guidelines for systematic review and meta-analysis were followed. Fifty-two papers were eligible for inclusion in the review. Twenty-five studies were synthesized quantitatively. Lasers were found to increase bond strength of ceramic surfaces to resin cements and composites when compared with control specimens (p-value < 0.01), whereas no significant differences were found in comparison with air-particle abraded surfaces. High variability can be observed in adhesion values between different analyses, pointing to a need to standardize study protocols and to determine the optimal parameters for each laser type.
Collapse
Affiliation(s)
- Verónica García-Sanz
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Omel Mendoza-Yero
- GROC•UJI, Institute of New Imaging Technologies, Universitat Jaume I, Castellón, Spain
| | - Miguel Carbonell-Leal
- GROC•UJI, Institute of New Imaging Technologies, Universitat Jaume I, Castellón, Spain
| | - Alberto Albaladejo
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | | | - Carlos Bellot-Arcís
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| |
Collapse
|
19
|
Tabatabaei MH, Chiniforush N, Namdar SF. Effects of different ceramic primers and surface treatments on the shear bond strength of restorative composite resin to zirconium. Laser Ther 2018; 27:111-117. [PMID: 30087530 DOI: 10.5978/islsm.18-or-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 04/20/2018] [Indexed: 11/06/2022]
Abstract
Background and aims Data are limited about the effect of ceramic primers on the bond of zirconia to restorative resin composite. The aim of this study was to assess the effect of different surface treatments and two ceramic primers on shear bond strength (SBS) of zirconia to restorative resin composite. Materials and methods 100 samples of zirconium ceramic blocks were randomly divided into 5 groups (n = 20) and received the following surface treatments: a)Control groupb)AL2O3 abrasionc)Nd:YAG laserd)Er:YAG lasere)Bur preparation.Next, each group was divided into two subgroups of 20. In ten out of 20 specimens in each group, monobond plus and Tetric ceram composite resin were applied on the surface. ZPrime Plus and Elite composite were applied on the surfaces of the remaining 10 specimens in each group. Samples were then subjected to shear bond strength test in a universal testing machine until fracture. The mean SBS were calculated and statistically analyzed by two-way ANOVA and T-Test. P < 0.05 was considered statistically significant. Results In ZPrime plus subgroups, diamond bur yielded the highest bond strength. Laser groups showed no significant difference with the control group. In monobond plus subgroups, SBS of air abrasion and diamond bur subgroups was highest and Nd:YAG laser showed the lowest SBS. The lowest bond strength belonged to the Nd:YAG laser subgroup of monobond plus group. Conclusions Type of surface preparation significantly affected the bond strength.
Collapse
Affiliation(s)
- Masoumeh Hasani Tabatabaei
- Associate Professor of Restorative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Chiniforush
- PhD candidate of laser dentistry, Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fatemeh Namdar
- Assistant Professor of Operative dentistry, Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
20
|
García-Sanz V, Paredes-Gallardo V, Bellot-Arcís C, Mendoza-Yero O, Doñate-Buendía C, Montero J, Albaladejo A. Effects of femtosecond laser and other surface treatments on the bond strength of metallic and ceramic orthodontic brackets to zirconia. PLoS One 2017; 12:e0186796. [PMID: 29049418 PMCID: PMC5648233 DOI: 10.1371/journal.pone.0186796] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/07/2017] [Indexed: 11/19/2022] Open
Abstract
Femtosecond laser has been proposed as a method for conditioning zirconia surfaces to boost bond strength. However, metallic or ceramic bracket bonding to femtosecond laser-treated zirconia surfaces has not been tested. This study compared the effects of four conditioning techniques, including femtosecond laser irradiation, on shear bond strength (SBS) of metallic and ceramic brackets to zirconia.Three hundred zirconia plates were divided into five groups: 1) control (C); 2) sandblasting (APA); 3) silica coating and silane (SC); 4) femtosecond laser (FS); 5) sandblasting followed by femtosecond laser (APA+SC). A thermal imaging camera measured temperature changes in the zirconia during irradiation. Each group was divided into 2 subgroups (metallic vs ceramic brackets). SBS was evaluated using a universal testing machine. The adhesive remnant index (ARI) was registered and surfaces were observed under SEM. Surface treatment and bracket type significantly affected the bracket-zirconia bond strength. SBS was significantly higher (p<0.001) for ceramic brackets in all groups (APA+FS > APA > FS > SC > control) than metallic brackets (APA+FS > FS > SC > APA > control). For metallic brackets, groups SC (5.99 ± 1.86 MPa), FS (6.72 ± 2.30 MPa) and APA+FS (7.22 ± 2.73 MPa) reported significantly higher bond strengths than other groups (p < 0.05). For ceramic brackets, the highest bond strength values were obtained in groups APA (25.01 ± 4.45 MPa), FS (23.18 ± 6.51 MPa) and APA+FS (29.22 ± 8.20 MPa).Femtosecond laser enhances bond strength of ceramic and metallic brackets to zirconia. Ceramic brackets provide significantly stronger adhesion than metallic brackets regardless of the surface treatment method.
Collapse
Affiliation(s)
- Verónica García-Sanz
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia. Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia. Valencia, Spain
| | - Carlos Bellot-Arcís
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia. Valencia, Spain
| | - Omel Mendoza-Yero
- GROC•UJI, Institute of New Imaging Technologies, Universitat Jaume I, Castellón, Spain
| | - Carlos Doñate-Buendía
- GROC•UJI, Institute of New Imaging Technologies, Universitat Jaume I, Castellón, Spain
| | - Javier Montero
- Orthodontics Teaching Unit, Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Alberto Albaladejo
- Orthodontics Teaching Unit, Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| |
Collapse
|