Influence of Pre-Heating Regular Resin Composites and Flowable Composites on Luting Ceramic Veneers with Different Thicknesses

The effect of photoinitiator type and filler load on physicochemical and mechanical properties of experimental light-cured resin cements through lithium disilicate ceramics of different shades and thicknesses

OBJECTIVE

This study investigated the influence of photoinitiator types on degree of conversion (DC), rate of polymerization (RP), flexural strength (FS), flexural modulus (FM), and light transmittance (LT) of filled and unfilled light-curable resin cements through different thicknesses and shades of lithium disilicate ceramics.

METHODS

Lithium disilicate ceramic discs (IPS Emax Press, background [0.0], 0.5, 1.0, 2.0, 3.0, and 4.0 mm, shades A1 and BL3) were prepared. Experimental resin-based cements [TEGDMA/BisGMA (50/50 mass%)] were prepared using either camphorquinone (CQ)/amine (0.44/1.85 mol%) or TPO (0.44 mol%)], and a micro and nanofiller loads of nil (unfilled); 40/10 mass%; and 50/10 mass%). Resin cements (0.2 mm thick) were placed on the lower surface of the ceramic specimens and light-activated for 30 s from the upper surface using a Bluephase Style curing light (exitance at tip: 1236 mW/cm2 ± 1.20). LT and distribution of irradiance through the ceramics were measured using a UV-vis spectrometer and a beam profile camera, respectively (n = 3). The DC and RP were measured in real-time using mid infrared spectroscopy in attenuated total reflectance (ATR) mode (n = 3). FS and FM were measured using a universal testing machine (n = 5). Statistical analyses were performed on LT, DC, RP, FS, and FM data using a general linear model, and supplementary ANOVA and post hoc Tukey multiple comparison test were also performed (α = .05).

RESULTS

Thicknesses, shades, photoinitiator type, and fillers load significantly influenced the optical and mechanical characteristics of the resin-based materials (p < 0.05). The BL3 shade ceramic provided higher values of DC, RP, FS, FM, and LT compared with the A1 shade (p < 0.05). Increasing ceramic thickness decreased the properties of the resin-based materials (p < 0.05). Generally, TPO improved mechanical properties of the resin cement compared with CQ (p < 0.05).

SIGNIFICANCE

The luting process of indirect restorations may be improved by using high molar absorptivity, more reactive, and more efficient photoinitiators such as TPO, as opposed to conventional CQ. The use of such initiator may allow the placement of thicker and more opaque indirect restorations.

Application of Bulk-Fill Composite to Simplify the Cementation of Indirect Restorations: The COMBO Technique

This article proposes a technique to simplify the cementation of indirect restorations by exploiting the advantageous properties of bulk-fill composites (BFCs). The proposed technique consists of using a thin layer of a high-viscosity (HV) BFC in the interproximal margins of the preparation and applying low-viscosity (LV) resin luting agents (RLAs) to the rest of the prepared surface. The application of the HV BFC limits the extrusion of the LV RLAs in the interproximal area, deviating the excesses of LV RLAs only on the vestibular and lingual side. This deviation allows the management and control of the excess material in complicated interproximal spaces, simplifying the cementation procedure of indirect restorations and achieving a reliable final result in terms of removing excess in a safe and repeatable way. This technical report provides an alternative clinical approach for cementing indirect restorations using the consistency and viscosity of different RLAs.

The impact of inorganic fillers, organic content, and polymerization mode on the degree of conversion of monomers in resin-matrix cements for restorative dentistry: a scoping review

PURPOSE

The main aim of the present study was to carry out a scoping review on the differences in degree of conversion of monomers regarding several types resin cements, indirect restorative materials, and light-curing procedures used in dentistry.

METHOD

A bibliographic review was performed on PubMed using the following search items: "degree of conversion" OR "filler" AND "resin cement" OR "inorganic cement" AND "organic" OR "radiopacity" OR "refractive" OR "transmittance" OR "type" AND "resin composite." The search involved articles published in English language within the last thirteen years. A research question has been formulated following the PICO approach as follow: "How different is the degree of conversion of monomers comparing several types of resin-matrix cements?".

RESULTS

Within the 15 selected studies, 8 studies reported a high degree of conversion (DC) of the organic matrix ranging from 70 up to 90% while 7 studies showed lower DC values. Dual-cured resin-matrix cements revealed the highest mean values of DC, flexural strength, and hardness when compared with light- and self-polymerized ones. DC mean values of resin-matrix cements light-cured through a ceramic veneer with 0.4 mm thickness were higher (~ 83%) than those recorded for resin-matrix cements light-cured through a thicker ceramic layer of 1.5 mm (~ 77%).

CONCLUSIONS

The highest percentage of degree of conversion of monomers was reported for dual-cured resin-matrix cements and therefore both chemical and light-induced pathways promoted an enhanced polymerization of the material. Similar degree of conversion of the same resin-matrix cement were recorded when the prosthetic structure showed a low thickness. On thick prosthetic structures, translucent materials are required to allow the light transmission achieving the resin-matrix cement.

CLINICAL RELEVANCE

The chemical composition of resin-matrix cements and the light-curing mode can affect the polymerization of the organic matrix. Thus, physical properties of the materials can vary leading to early clinical failures at restorative interfaces. Thus, the analysis of the polymerization pathways of resin-matrix cements is significantly beneficial for the clinical performance of the restorative interfaces.

Effects of pre-heating on physical-mechanical-chemical properties of contemporary resin composites

This research assessed the effects of pre-heating on the physical-mechanical-chemical properties of different resin composites. For this, resin composites were evaluated in 6 levels: Admira/ADM, Vitra/VIT, Filtek Supreme/FS, Filtek Supreme Flowable/FSF, Filtek One/FO, and Filtek Bulk Fill Flowable/FBF; temperature was evaluated in 4 levels using a composite heater: room temperature/22 ºC, 37 ºC, 54 ºC, and 68 ºC. Response variables were: degree of conversion/DC, flexural strength/FS and color stability/ΔE (immediately after light curing/LC, after 7 days of dark-dry-storage, and after 24 h and 3 days of artificial aging in water at 60 ºC). Data were subjected to 2-way ANOVA (DC and FR) and 3-way repeated measurements ANOVA (ΔE), all followed by Tukey's test (α = 5%). DC were similar (FBF, FS, and FSF) or increased (ADM, FO, and VIT) as the temperature increased. Results of FR were unchanged or increased for all composites except VIT and ADM. High-viscosity composites (VIT and FS) showed higher FR values than low-viscosity composite (FSF). For bulk-fill composites, FBF and FO showed similar results, but lower than high-viscosity composites. Results of color stability showed acceptable values up to 3 days aging except for ADM and FSF. ΔE was not influenced by pre-heating and, overall, ΔE: FS < VIT < FO < FSF < ADM < FBF. Only VIT and FS showed ΔE ≤ 3.3 (clinical threshold). Therefore, the effects of pre-heating depend on the material. The tested materials generally showed similar or enhanced properties after pre-heating (except ADM and VIT).

Effect of preheating and ultrasound application of resin-based luting agents on the failure load of a lithium disilicate glass-ceramic

PURPOSE

To assess the effect of preheating resin-based materials and ultrasound application on the failure load of a lithium disilicate glass-ceramic.

MATERIALS AND METHODS

Ninety ceramic specimens were produced (14×12×1.0 mm) and divided into 9 groups (n = 10) to be bonded to a dentin analog (Nema G10) with light-cured luting agent (LC), flowable resin composite (FL), and supra-nano filled resin composite (SN), as follows: LC/R - LC at room temperature; LC/P - preheated LC; LC/P/U - preheated LC and Ultrasound; FL/R - FL at room temperature; FL/P - preheated FL; FL/P/U - preheated FL and Ultrasound; SN/R - SN at room temperature; SN/P - preheated SN; SN/P/U - preheated SN and Ultrasound. The failure load test was performed in a universal testing machine with the aid of acoustic detection. The data was analyzed with two-way ANOVA (for failure load) and Weibull statistics (Weibull modulus - m and characteristic strength, based on 95% confidence intervals - CI).

RESULTS

The analyses of failure load revealed no statistically significant difference among groups considering the type of luting agent (P = 0.075; F = 2,673), the application method (P = 0.772; F = 2,259), and the interaction between them (P = 0.297; F = 1,248). The characteristic strength did not show differences among groups (95% CI). The m, which indicates structural reliability, showed lower values for SN/P/U and SN/P, with a difference from other selected groups (95% CI).

CONCLUSION

Preheating of resin-based materials and ultrasound application did not affect the failure load of lithium disilicate glass-ceramic. Lower reliability was observed with supra-nano filled resin composite.

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.

Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques

OBJECTIVES

To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface.

MATERIALS AND METHODS

Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1 min and 40 s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1 s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5 s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1 min and 40 s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin.

RESULTS

According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups.

CONCLUSIONS

Tack-curing for 1 s or 5 s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin.

CLINICAL RELEVANCE

The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1 s or 5 s is recommended to mitigate the excess resin cement.

A comprehensive review of resin luting agents: Bonding mechanisms and polymerisation reactions

The field of dentistry is constantly evolving and increasingly embracing minimally invasive approaches. One such approach, which is bonding to the tooth structure, particularly enamel, has been shown to offer the most predictable outcomes. However, there are instances where significant tooth loss may limit treatment options for a restorative dentist. In these scenarios, indirect restoration might be the preferred treatment option. This literature review provides a comprehensive examination of the currently available resin luting agents and their bonding requirements. It provides valuable insights for dental professionals seeking an in-depth understanding of the current state of the field and the future prospects of dental adhesion.

Comparative Evaluation of Microtensile Bond Strength in Three Different Dentin Luting Agents: An In vitro Study

Aim

Long-term clinical success on indirect restorations is largely determined by bonding efficiency of the luting agent, with adhesion to dentin being the main challenge. Therefore, aim of this study was to assess the microtensile bond strength when using flowable resin composite, preheated resin composite and dual self-adhesive resin cement as dentin luting agents.

Materials and Methods

Occlusal thirds of molar teeth were cut and randomly divided into 3 groups to be cemented: RelyX™U200, Filtek™ Z250 XT- preheated to 70° and Filtek Flow™ Z350XT. They were then thermocycled 5000 times between 5+/-2°C and 55+/-2°C. Subsequently, 10 microbars per group were prepared. The 30 samples were placed in saline solution for 24 hours at room temperature prior to microtensile test. This was performed with a digital universal testing machine at a crosshead speed of 0.5 mm/min. The bond strength values obtained were analyzed in Megapascals (MPa). Measures of central tendency such mean and measures of dispersion such standard deviation were used. In addition, the Kruskall Wallis non-parametric test with Bonferroni post hoc test was applied, considering a significance value of 5% (P < 0.05), with type I error.

Results

The dentin microtensile bond strengths of preheated resin composite, flowable resin composite and dual self-adhesive cement were 6.08 ± 0.66 Mpa, 5.25 ± 2.60Mpa and 2.82 ± 1.26Mpa, respectively. In addition, the preheated resin composite exhibited significantly higher microtensile bond strength compared to the dual self-adhesive cement (P < 0.001). While the flowable resin composite showed no significant difference with the dual self-adhesive cement (P = 0.054) and the preheated resin composite (P = 0.329).

Conclusions

The microtensile bond strength in dentin was significantly higher when using a preheated resin composite at 70°C as a luting agent compared to dual self-adhesive cement. However, the preheated resin composite showed similar microtensile bond strength compared to the flowable resin composite.

Luting laminate veneers: Do resin-composites produce less polymerization stress than resin cements?

OBJECTIVES

Regular composites could produce less polymerization stress than resin cements when luting laminate veneers but there is no proper evidence to support this theory. The current study aimed to determine the degree of conversion, volumetric shrinkage, polymerization stress and the resultant elastic moduli of materials currently used for adhesive cementation and to determine possible correlations.

METHODS

The study considered (i) regular resin composites (Admira Fusion, Gradia, Grandioso, Palfique, Sirius Z, Viscalor and Z100) at room and pre-warmed (PW) at 69ºC, (ii) flowable composites (Sigma Flow and Grandioso Flow); (iii) solely light-activated cements (AllCem Veneer, Variolink Esthetic and RelyX Veneer); and (iv) one dual-activated resin cement (SpeedCEM). Degree of conversion (DC, n = 3) was accessed with FTIR 1 h after irradiation. Bonded-disk and Bioman II instruments were used to access polymerization shrinkage strain and shrinkage stress, respectively, for 60 min at 23 ± 1◦C (n = 3). The elastic modulus was determined by 3-point bending flexural test (n = 6). The results were submitted to analyse s of variance, Tukey's, and correlation tests.

RESULTS

For regular composites, the pre-warming did not affect DC, shrinkage and modulus but significantly increased the stress magnitude. Correlation tests indicated a significant relationship only between stress and polymerization shrinkage (r = 0.811343).

SIGNIFICANCE

Regular composites can produce less polymerization stress than resin cements when luting laminate veneers. Polymerization stress was dependent on the shrinkage magnitude, but not on the degree of conversion nor the elastic modulus.

The influence of pre-heating the restoration and luting agent on the flexural strength of indirect ceramic and composite restorations

Background

This study investigated the impact of luting procedure and restoration thicknesses on the flexural strength of CAD/CAM restorations. Traditional luting agents have been questioned in favor of pre-heated resin composites or flowable composites.

Materials and Methods

400 disc-shaped restorations (lithium disilicate [IPS e.max CAD] or resin composite [Tetric CAD, Ivoclar]) were cemented onto dentin analog discs using different procedures (n = 20): dual-curing resin cement (Panavia V5), light-curing resin cement (Panavia Veneer LC), pre-heated resin composite (Clearfil™ AP-X) with or without pre-heated restoration, and high-filled flowable composite (Clearfil Majesty™ Flow). The biaxial flexural strength was calculated.

Results

There were significant effects of material, thickness, and luting procedure on flexural strength (p < 0.001). Resin composite specimens exhibited lower flexural strength (90 MPa) compared to lithium disilicate specimens (571 MPa), with thicker restorations (338 MPa) being stronger than thinner ones (323 MPa). Light-curing cement showed the highest strength (408.8 MPa)A, followed by dual-curing cement (362 MPa)B, pre-heated cement with pre-heated composite (318 MPa)C, pre-heated composite (304 MPa)C, and flowable resin composite (259 MPa)D. The light-curing cement yielded similar results to the pre-heated resin composite associated or not with the pre-heated crown for the thicker lithium disilicate specimens, whereas for the thinner lithium disilicate specimens all luting procedures performed similarly. Thin resin composite discs showed higher flexural strength when luted with light-curing cement, whereas the luting procedure had less influence for the thicker restorations.

Conclusion

Luting procedures impact the flexural strength of CAD/CAM lithium disilicate and resin composite restorations. Pre-heated resin composite, with or without pre-heated restoration, can replace dual-curing cement. Nevertheless, light-curing cement is superior for resin composite and 1.5 mm lithium disilicate restorations.

Comparison between a bulk-fill resin-based composite and three luting materials on the cementation of fiberglass-reinforced posts

Objectives

This study verified the possibility of cementing fiberglass-reinforced posts using a flowable bulk-fill composite (BF), comparing its push-out bond strength and microhardness with these properties of 3 luting materials.

Materials and Methods

Sixty endodontically treated bovine roots were used. Posts were cemented using conventional dual-cured cement (CC); self-adhesive cement (SA); dual-cured composite (RC); and BF. Push-out bond strength (n = 10) and microhardness (n = 5) tests were performed after 1 week and 4 months of storage. Two-way repeated measures analysis of variance (ANOVA), 1-way ANOVA, t-test, and Tukey post-hoc tests were applied for the push-out bond strength and microhardness results; and Pearson correlation test was applied to verify the correlation between push-out bond strength and microhardness results (α = 0.05).

Results

BF presented higher push-out bond strength than CC and SA in the cervical third before aging (p < 0.01). No differences were found between push-out bond strength before and after aging for all the luting materials (p = 0.84). Regarding hardness, only SA presented higher values measured before than after aging (p < 0.01). RC and BF did not present 80% of the maximum hardness at the apical regions. A strong positive correlation was found between the luting materials' push-out bond strength and microhardness (p < 0.01, R2 = 0.7912).

Conclusions

The BF presented comparable or higher push-out bond strength and microhardness than the luting materials, which indicates that it could be used for cementing resin posts in situations where adequate light curing is possible.

Various ways of pre-heating a bulk-fill thermoviscous composite in restoration in non-carious cervical lesions: 12-month randomized clinical trial

OBJECTIVE

The objective of the study is to evaluate through a randomized clinical trial the best method to preheat a composite resin, if using a Caps dispenser device associated with Caps Warmer (CD) or with a VisCalor Caps dispenser/warmer (VD) for restorations in non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

One hundred and twenty restorations were distributed to two groups (n = 60) according to the pre-heating way of thermoviscous bulk-fill composite resin. For the CD group, pre-heating was carried at 68 °C using a heating bench for 3 min. For the VD group, pre-heating was performed at 68 °C using a heating gun for 30 s. After that, pre-heated bulk-fill composites were directly inserted in the NCCLs. The total working time was recorded. The restorations were evaluated after 6 and 12 months of clinical performance according to the FDI criteria. Statistical analysis was performed using the Student's t test for unpaired samples for working time, and the Chi-square test for restoration clinical performance (α = 0.05).

RESULTS

Working time was shorter for VD with a statistically significant difference compared to CD (p = 0.01). Few restorations were lost or fractured after 12 months of clinical evaluation (p > 0.05). The retention rates were 96.7% (CI 95 %: 88.6-99.1%) for CD and 98.3% (CI 95 %: 91.1-99.7%) for VD. The other FDI parameters were considered clinically acceptable.

CONCLUSIONS

The different pre-heating ways did not influence the clinical performance of thermoviscous bulk-fill composite restorations in NCCLs after 12 months.

CLINICAL RELEVANCE

Regardless of the bulk-fill thermoviscous composite resin pre-heating ways, the restorations are clinically acceptable after 12 months.

Surface Analysis of a Universal Resin Composite and Effect of Preheating on its Physicochemical Properties

This study was aimed at analyzing the surface properties of a universal resin composite and evaluating the effect of preheating on its physicochemical properties. Two commercial resin composites were used under two conditions: Filtek Universal Restorative (UR); UR preheated (URH); Filtek Supreme (FS) and FS preheated (FSH). The film thickness (FT) test (n = 10) was done using two glass slabs under compression. Flexural strength (FLS) and modulus (FLM) were evaluated using a three-point flexion test (n = 10). Polymerization shrinkage stress (PSS) was evaluated in a universal testing machine (n = 5). Gap width (GW) between composite and mold was measured in internally polished metallic molds (n = 10). The degree of conversion (DC) was evaluated by Fourier Transform Infrared spectroscopy (n = 3). The morphology of the filler particles was checked by scanning electron microscope (SEM) and EDX analysis. Surface gloss (SG) and surface roughness (SR) were evaluated before and after mechanical brushing (n = 10). The outcomes were submitted to 2-way ANOVA and Tukey's test (α = 0.05). Lower mean values of FT were observed for the preheated groups when compared to the non-preheated groups. URH and FSH showed higher mean values of FLS and FLM when compared with UR and FS. No differences were observed between groups in the PSS test. The GW was higher for the UR and FS groups when compared with URH and FSH. The DC was higher for preheated resin composites when compared to the non-preheated groups. The SR of the UR composite was higher than the FS after mechanical brushing, while the SG was higher for the FS groups. In conclusion, the universal resin composite tested generally presented similar physicochemical properties compared with the nanofilled resin composite and either similar or slightly inferior surface properties. The preheating improved or maintained all properties evaluated.

Effect of preheating on mechanical properties of a resin-based composite containing elastomeric urethane monomer

This study investigated the effect of preheating an elastomeric urethane monomer (Exothane-24) experimental resin composite on its physicochemical properties. Two resin matrices were formulated: (a) 50 wt% Bisphenol-glycidyl methacrylate (Bis-GMA) and 50 wt% triethylene glycol dimethacrylate (TEGDMA); and (b) 20 wt% Exothane-24, 40 wt% Bis-GMA and 40 wt% TEGDMA. A photoinitiator system (0.25 wt% camphorquinone and 0.50 wt% ethyl-4-dimethylamino benzoate) and 65 wt% of the inorganic filler (20 wt% 0.05 μm silica and 80 wt% 0.7 μm BaBSiO₂ glass) were added to both matrices. These formulations were then assigned to four groups: Exothane-24 (E); Exothane-24 plus preheating (EH); no Exothane-24 (NE); and no Exothane-24 plus preheating (NEH). NEH and EH were preheated at 69 °C. The dependent variables were as follows: film thickness (FT); polymerization shrinkage stress (PSS); gap width (GW); maximum rate of polymerization (Rp_max); and degree of conversion (DC). Data were statistically analyzed by two-way ANOVA and Tukey's test (α = 0.05). Preheating reduced FT for both composites. PSS and GW were significantly lower for EH, when compared with E. The DC for EH and NEH and the Rp_max for EH increased significantly. Preheating improved most of the physicochemical properties (FT, PSS, GW, and DC) of the experimental resin composite containing Exothane-24.

Effect of thickness of CAD/CAM materials on light transmission and resin cement polymerization using a blue light-emitting diode light-curing unit

OBJECTIVE

Evaluate the effect of thickness of high-translucency (HT) CAD/CAM materials on irradiance and beam profile from a blue light-emitting diode light-curing unit (LCU) and on the degree of conversion (DC) and maximum polymerization rate (Rp_max ) of a light-cured resin cement (LCC).

MATERIAL AND METHODS

The direct output from the LCU, the light transmission and irradiance ratio (IR) through one conventional composite and nine HT CAD/CAM materials (0.5, 1.0, 1.5, or 2.0-mm thick; n = 5) were measured with a integrating sphere coupled to a spectrometer. The light beam was assessed with a beam profiler camera. The DC at 600 s and the Rp_max of one LCC was determined using a Fourier transform infrared spectrometer (n = 5). Data were analyzed by ANOVA followed by Tukey's tests, and Dunnett's test was also used for irradiance data (α = 0.05).

RESULTS

A significant decrease in irradiance through all materials occurred as thickness increased. Thin CAD/CAM materials improved light homogeneity, which decreased with the increase in thickness. The DC of the LCC directly exposed to light was the same as when exposed to 45%, 25%, 15%, or 5% IRs. Rp_max decreased with the decrease in IR.

CONCLUSIONS

Although the HT CAD/CAM materials reduced the irradiance from the LCU, minor effects were observed in the LCC's DC.

CLINICAL SIGNIFICANCE

Despite the light attenuation of blue light through different CAD/CAM materials that were up to 2-mm thick, the degree of conversion of one brand of light-cured resin cement was clinically acceptable when the LCU was used for 30 s.

Color Assessment of Feldspathic Ceramic with Two Different Thicknesses, Using Multiple Polymeric Cements

The purpose of this study was to evaluate the color changes of feldspathic ceramics CEREC Blocs (Dentsply Sirona, Milford, DE, USA) when cemented with different luting agents, while varying the ceramic thickness. Seventy ceramic discs of feldspathic ceramic (A2 shade) were obtained with 0.5 and 0.8 mm thicknesses. Seventy composite discs (A3 shade) 1 mm in thickness were used as substrates. After being polished and conditioned, the ceramic and composite discs were cemented with different resin cements and a flowable composite: Variolink^® Esthetic Light, Neutral and Warm (Ivoclar Vivadent, Schaan, Liechtenstein); RelyX^TM Veneer B0.5, Translucent and A3 Opaque/yellow shades (3M Oral Care, St. Paul, MN, USA); G-aenial^® Universal Flow A2 (GC Europe, Leuven, Belgium). Color difference (ΔE) was determined using a spectrophotometer. A two-way ANOVA and multiple comparisons were performed using the Bonferroni method with a 95% confidence interval. Variolink^® Neutral showed the highest ΔE (15.12 ± 0.71) and RelyX^TM Veneer A3 the lowest value (1.59 ± 0.33). There are no statistically significant differences between the two ceramic thicknesses for Variolink^® Light (p = 0.230) and RelyX^TM Veneer B0.5 (p = 0.318) cements. The feldspathic ceramic final color is influenced by the cement used and the ceramic thickness. The use of different cements in a thin ceramic has a clinically significant impact on the final esthetic result.

Effect of preheating on the physicochemical properties and bond strength of composite resins utilized as dental cements: An in vitro study

STATEMENT OF PROBLEM

Little is known regarding the use of preheated composite resins to bond indirect restorations and its impact on mechanical properties when compared with resin cements.

PURPOSE

The purpose of this in vitro study was to compare the chemical and physical properties and bond strength to enamel and ceramics of preheated composite resins and resin cements.

MATERIAL AND METHODS

Two composite resins, the microhybrid Filtek Z250XT and the nanoparticulate Z350XT were tested, and 2 commercially available resin cements, the dual-polymerized Rely-X ARC and the light-polymerized Rely-X Veneer were used as controls. A device (HotSet) was used to preheat the composite resins to 69 °C before light-polymerization. The following properties were tested: flexural strength, modulus of elasticity, fracture toughness, microshear bond strength to enamel and ceramics, degree of conversion, flow, sorption and solubility, and color stability. Statistical analysis was done with ANOVA and Holm-Sidak for multiple comparisons (α=.05).

RESULTS

Preheating had no significant effect on the degree of conversion, flexural strength, fracture toughness, solubility, or microshear bond strength to the enamel of the tested composite resins (P>.05). However, preheating increased the sorption and reduced the microshear bond strength to the ceramic (P<.05). The flowability of the composite resins increased with heating but showed lower values when compared with both resin cements (P<.05). Color stability was more affected in the preheated composite resins than in the resin cements.

CONCLUSIONS

The preheating process resulted in little to no benefit in the evaluated properties for the composite resins. Resin cements appear to be the best option for cementing indirect restorations.

Operator versus material influence on film thickness using adhesive resin cement or pre‐heated resin composite

OBJECTIVE

There is a growing interest in using pre-heated composites instead of dual-cured cements when luting indirect restorations. This study evaluated the film thickness obtained from two pre-heated composites and two resin cements, by two different operators. The influence of the materials and the level of expertise of the operator were analyzed.

MATERIALS AND METHODS

Forty specimens of human dentin and composite discs were prepared and divided into four groups depending on the luting process. Each group was randomly equally divided to be handled by two operators with different levels of experience. Two of the initial four groups were luted using dual-cured cements and the two remaining groups using light-cured pre-heated composites. Specimen discs were cut after luting, and film thickness was measured using a Digital microscope. Data were analyzed using a 2-way ANOVA with the Holm-Sidak pairwise multiple comparison procedure (p < 0.05).

RESULTS

Mean film thickness ranged from 156.16 ± 4.7 to 33.82 ± 0.7 μm. Significant differences (p < 0.001) were noticed between expert and novice results with pre-heated composites.

CONCLUSION

Within the limits of this study, using pre-heated composites as a luting cement requires a better level of expertise to achieve a clinically acceptable film thickness.

CLINICAL SIGNIFICANCE

Using pre-heated composites as luting agent for indirect restorations requires an experimented skill level to achieve a clinically recommended film 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.

Comparison of Mechanical Properties of a Self-Adhesive Composite Cement and a Heated Composite Material

(1) Background: Due to the limitations of composite cements, the authors carried out tests to compare such materials with preheated composite materials because the latter may be an alternative to cements in the adhesive cementation procedure. (2) Methods: The materials used in the adhesive cementation procedure, i.e., Enamel Plus Hri (Micerium, Avegno, Italy), a heated composite material, and RelyX U200 Automix (3M, Maplewood, MN, USA), a dual composite cement, were tested for microhardness, compressive strength, flexural strength, diametral compressive strength, and elastic modulus. Composite material was heated to the temperature of 50 degrees Celsius before polymerisation. (3) Results: Higher values of microhardness (by 67.36%), compressive strength (by 41.84%), elastic modulus (by 17.75%), flexural strength (by 36.03%), and diametral compressive strength (by 45.52%) were obtained using the Enamel Plus Hri composite material compared to the RelyX U200 self-adhesive cement. The survey results revealed statistically significant differences. (4) Conclusions: Due to its better mechanical properties, the heated composite material (Enamel Plus Hri) is a beneficial alternative to composite cements in the indirect restoration placement procedure. As the strength parameters of the heated composite material increase, a higher resistance to the compressive and bending forces present in the oral cavity, and hence a greater durability of the created prosthetic reconstructions can be expected.

Surface roughness and oxygen inhibited layer control in bulk-fill and conventional nanohybrid resin composites with and without polishing: in vitro study

Background

It has been demonstrated that dental restorations with rough surfaces can have several disadvantages such as pigment retention or plaque accumulation, which can facilitate caries formation, color variation, loss of brightness, degradation of restoration, among others. The present study aimed to assess surface roughness in bulk fill and conventional nanohybrid resins with and without polishing, controlling the oxygen inhibited layer.

Methods

This in vitro and longitudinal experimental study consisted of 120 resin blocks of 6 mm diameter and 4 mm depth, divided into two groups: Bulk Fill (Tetric^® N-Ceram Bulk-fill, Opus Bulk Fill APS, Filtek™ Bulk Fill) and conventional nanohybrid (Tetric^® N-Ceram, Opallis EA2, Filtek™ Z250 XT). Each resin group was divided into two equal parts, placing glycerin only on one of them, in order to control the oxygen inhibited layer. Subsequently, the surface roughness was measured before and after the polishing procedure with Sof-Lex discs. The data were analyzed with the T-test for related measures, and for comparison between groups before and after polishing, the non-parametric Kruskal Wallis test with the Bonferroni post hoc was used, considering a significance level of p < 0.05.

Results

Before polishing, the resin composites with the lowest surface roughness were Opus Bulk Fill APS (0.383 ± 0.186 µm) and Opallis EA2 (0.430 ± 0. 177 µm) with and without oxygen inhibited layer control, respectively; while after polishing, those with the lowest surface roughness were Opus Bulk Fill APS (0.213 ± 0.214 µm) and Tetric N-Ceram (0.097 ± 0.099 µm), with and without oxygen inhibited layer control, respectively. Furthermore, before and after polishing, all resins significantly decreased their surface roughness (p < 0.05) except Opus Bulk Fill APS resin with oxygen inhibited layer control (p = 0.125). However, when comparing this decrease among all groups, no significant differences were observed (p < 0.05).

Conclusion

The Opus Bulk Fill APS resin with oxygen inhibited layer control presented lower surface roughness both before and after polishing, being these values similar at both times. However, after polishing the other bulk fill and conventional nanohybrid resins with and without oxygen inhibited layer control, the surface roughness decreased significantly in all groups, being this decrease similar in all of them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02297-w.

Luting indirect restorations with resin cements versus composite resins: Effects of preheating and ultrasound energy on film thickness

OBJECTIVE

This study aims to evaluate and compare the film thickness obtained with a resin cement and two composite resins, preheated and/or ultrasonically vibrated, as luting agents.

MATERIALS AND METHODS

One hundred and twenty-six (126) pairs of resin discs were randomly assigned to six experimental groups (n = 21) according to luting agent (Variolink Esthetic LC, IPS Empress Direct or Estelite Omega) and cementation technique (preheating at 68°C and/or ultrasonic vibration). Specimens were luted by applying a controlled force. Following sectioning and film thickness measurement through field emission gun scanning electron microscopy, statistical analysis was carried out considering a 5% significance level.

RESULTS

Statistically significant lower film thickness was observed in Variolink Esthetic LC group when compared to all composite resin groups (p < 0.001), except IPS Empress Direct preheated and ultrasonically vibrated group (p = 0.073). IPS Empress Direct with ultrasonic vibration yielded statistically lower film thickness values than Estelite Omega groups, regardless of luting technique (p < 0.05). Ultrasonically vibrated Estelite Omega groups showed statistically lower film thickness values than solely preheated groups (p < 0.05).

CONCLUSIONS

Both Variolink Esthetic LC and IPS Empress Direct preheated and ultrasonically vibrated provided the lowest film thickness. The addition of ultrasonic vibration during cementation proved to be effective in reducing film thickness of both tested composite resins.

CLINICAL SIGNIFICANCE

The cementation technique will have variable results depending on the luting material. Adhesive cementation protocols with composite resins should mainly consider ultrasonic vibration, but also preheating, as strategies for reducing film thickness. The tested resin cement, alongside with IPS Empress Direct composite resin preheated and ultrasonically vibrated, provided the lowest film thickness among the tested materials and techniques.

A Comparison of Microtensile Bond Strength, Film Thickness, and Microhardness of Photo-Polymerized Luting Composites

The aim of this study was to evaluate the effect of CAD/CAM composite thickness on micro-tensile bond strength (µTBS), microhardness (HV), and film thickness (FT) of different luting composites. Composite blocks (6.8 mm × 6.8 mm) were divided into 12 groups according to: CAD/CAM thickness and luting composite. For each group, 21 rods (1 mm × 1 mm) were tested in tension at crosshead speed of 1 mm/min. Fracture modes were categorized as adhesive, mixed, and cohesive. Microhardness (n = 5/group) was assessed using microhardness tester. Film thickness (12-rods/group) was evaluated using a stereomicroscope (×40). Data were analyzed using the two-way ANOVA/Tukey’s HSD test (p = 0.05). Parameters “thickness”, “cement”, and “thickness x cement” showed significant difference on µTBS and HV (p < 0.05). At 2 mm, heated x-tra fil composite showed the highest µTBS (45.0 ± 8.5 MPa), while at 4 mm thickness, Grandio Flow revealed the lowest µTBS (33.3 ± 6.3 MPa). Adhesive, mixed, and cohesive failures were reported. The HV of all composites decreased when photo-polymerized through 4 mm thickness (p < 0.05). Regardless of CAD/CAM thickness, photo-polymerized composites can be successfully used for luting CAD/CAM composite.

Final esthetic result of ceramic restorations cemented with different colors of cement

OBJECTIVE

The purpose of this study is to evaluate the color changes of lithium disilicate ceramics when cemented with different brands of cement by varying the thickness of the ceramic.

MATERIALS AND METHODS

Forty ceramic discs, shade A2, were fabricated with 0.5 and 0.8 mm thickness. Forty composite resin discs, shade A3, were also produced. The ceramic samples were cemented to the composite resin discs, with two colors of resin cement, Neutral and Warm. A spectrophotometer evaluation was made. Translucency and color change analysis was performed by calculating the ΔE. A two-way analysis of variance test and multiple comparisons were performed using the Bonferroni method with a 95% confidence interval.

RESULTS

There are statistically significant differences between the two ceramic thicknesses with different brands of cement (p < .001). In addition, using the translucency analysis it was found that there are statistically significant differences between the two ceramic thicknesses in both types of cement (p < .001).

CONCLUSIONS

The use of different cementation materials on lithium disilicate ceramics appears to have little visible influence at the clinical level. Different ceramic thicknesses have a clinically visible influence on the final restoration color.

Bonding Effectiveness of Contemporary Materials in Luting Glass-Ceramic to Dentine: An In Vitro Study

Aim:

To evaluate the shear bond strength (SBS) of resin cements, flowable composites, and a preheated composite in luting glass-ceramic to dentin.

Materials and Methods:

In total, 108 noncaries human third molar teeth embedded in acrylic blocks, grinded from the occlusal surfaces until dentin was exposed, and divided into 9 randomized groups ( n = 12). In total, 108 ceramic samples prepared in disc shape (3mm × 3mm) from IPS e. max CAD (Ivoclar Vivadent) blocks. Four adhesive resin cements: Variolink Esthetic DC (Ivoclar Vivadent), G-CEM LinkForce (GC), Panavia V5 (Kuraray Noritake), Maxcem Elite Chroma (Kerr), and three flowable composites: G-ænial Universal Flo (GC), Herculite XRV Ultra Flow (Kerr), Vertise Flow (Kerr), and one preheated composite: Enamel Plus HRI (Micerium) luted to the prepared occlusal surfaces of the teeth with total-etch, self-etch, and self-adhesive protocols. Then samples were thermocyled (5,000 cycles, 5–55°C, dwell time 20 s). SBS test was performed in a universal testing machine (at 0.5 mm/min). Failure modes were examined under a stereomicroscope at ×25 magnification. Data were analyzed using Kruskal–Wallis and Dunn–Bonferroni tests ( α = 0.05).

Results:

There were statistically significant differences among material types ( P < .05). Highest SBS values found in G-ænial Universal Flo (15.43 ± 5.67), and the lowest values obtained in Maxcem Elite Choroma (SA) (1.25 ± 1.47). There were no significant differences between self-etch (Panavia V5, Maxcem Elite Choroma [SE]) and self-adhesive (Maxcem Elite Choroma [SA], Vertise Flow) protocols ( P > .05).

Conclusion:

Flowable composites can be alternatives to resin cements when bonded with total-etch procedures. Bond strength of self-etch and self-adhesive applications is still to be developed.