Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations

Comparison of the clinical outcomes of resin-modified glass ionomer and self-adhesive resin cementations for full-coverage zirconia restorations

OBJECTIVES

Both resin-modified glass ionomer cement (RMGIC) and self-adhesive resin cement (SAC) may be suitable for cementation of full-coverage zirconia restorations. This retrospective study aimed to investigate the clinical outcomes of zirconia-based restorations cemented with RMGIC and compare them with those cemented with SAC.

METHODS

Cases of full-coverage zirconia-based restorations cemented with either RMGIC or SAC between March 2016 and February 2019 were evaluated in this study. The clinical outcomes of the restorations were analyzed according to the type of cement used. In addition, cumulative success and survival rates were evaluated according to the cement and abutment types. Non-inferiority, Kaplan-Meier, and Cox hazard tests were conducted (α=.05).

RESULTS

A total of 288 full-coverage zirconia-based restorations (natural teeth, 157; implant restorations, 131) were analyzed. Loss of retention occurred in only one case; a single-unit implant crown cemented with RMGIC, which decemented 4.25 years post-restoration. RMGIC was non-inferior to SAC in terms of loss of retention (<5%). For single-unit natural tooth restorations, the four-year success rates in the RMGIC and SAC groups were 100% and 95.65%, respectively (p=.122). For single-unit implant restorations, the four-year success rates in the RMGIC and SAC groups were 95.66% and 100%, respectively (p=.365). The hazard ratios of all the predictor variables, including cement type, were not significant (p>.05).

CONCLUSIONS

Cementation of full-coverage zirconia restorations of both natural teeth and implants using RMGIC and SAC yields satisfactory clinical outcomes. Furthermore, RMGIC is non-inferior to SAC in terms of cementation success.

CLINICAL SIGNIFICANCE

Cementation with RMGIC or SAC for full-coverage zirconia restorations has favorable clinical outcomes in both natural teeth and implants. Both RMGIC and SAC have advantages in the cementation of full-coverage zirconia restorations to abutments with favorable geometries.

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

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

Effect of the thickness of CAD-CAM materials on the shear bond strength of light-polymerized resin cement

This study aimed to investigate the effect of the thickness of computer aided design-computer aided manufacturing (CAD-CAM) restorative materials on the bond strength of light-polymerized resin cement. Ninety specimens were prepared from three different CAD-CAM materials (a leucite-based glass-ceramic [Empress CAD], a polymer-infiltrated ceramic network [Vita Enamic], and a zirconia-reinforced lithium silicate glass-ceramic [Vita Suprinity]) in different thicknesses (1, 2, and 3 mm). One surface of each specimen was treated by using a single-step self-etching ceramic primer (Monobond Etch & Prime). Light-polymerized resin cement was bonded to treated surfaces by exposure to a light-emitting diode curing unit from the untreated side of the samples. Shear bond strength (SBS) between the ceramic and the resin cement was measured by using a universal testing machine. The leucite-based glass-ceramic had higher SBS values than the other materials at each thickness. For each material, 1 mm-thick specimens had the highest SBS values. The difference between the SBS values of 2 mm- and 3 mm-thick polymer-infiltrated ceramic network was nonsignificant, whereas the SBS values of 2 mm-thick leucite-based glass-ceramic and the zirconia-reinforced lithium silicate glass-ceramic were significantly higher than those of the corresponding 3 mm-thick specimens. The choice of the material and its thickness may be highly important for clinical success when light-polymerized resin cements are used for cementation.

Impact of Immediate and Delayed Photo-activation of Self-adhesive Resin Cements on Bonding Efficacy and Water Uptake Under Simulated Pulpal Pressure

This study investigated the effect of immediate versus delayed photo-activation on the bonding performance and water uptake of self-adhesive (SA) resin cements under simulated pulpal pressure (SPP). The occlusal dentin surface was exposed in 66 extracted third molars. Resin composite cylinders were cemented to dentin under SPP, with either RelyX Unicem 2 (RU) (3M Oral Care, St Paul, MN, USA) or Maxcem Elite (MC) (Kerr, Orange, CA, USA). Each cement group was equally divided into three groups (n=8 each) according to the time elapsed between placement and photo-activation: immediate activation (IM), 30-second delayed activation (D30), or 120-second delayed activation (D120). Shear bond strength (SBS) was measured, and the type of failure was determined using a stereomicroscope. Three additional samples from each experimental subgroup were used for confocal laser scanning microscopy (CLSM) analysis. A fluorescent dye solution was added to the pulpal fluid reservoir, then a CLSM was used to detect the dye distribution within the tooth-restoration interface. Two-way analysis of variance (ANOVA) and the Tukey post-hoc test were used to analyze the SBS results (α=0.05). D30 resulted in a significantly higher mean SBS in the two cement groups than IM and D120 (p<0.05). RU showed significantly higher SBS values than MC regardless of the time of light activation (p<0.05). RU showed less dye uptake confined to the cement-dentin interface compared to the MC groups, which showed dye uptake throughout the entire thickness of the cement layer and gap formation at the interface, especially in the D120 group. The 30-second photo-activation delay group significantly improved the bond strength of SA cements. Delaying the photo-activation to 120 seconds increased pulpal fluid uptake by SA cements and compromised the integrity of the bonded interfaces.

Physical-chemical characterization and bond strength to zirconia of dental adhesives with different monomer mixtures and photoinitiator systems light-activated with poly and monowave devices

Introduction: Bonding to crystalline zirconia is currently a challenge. Properly cured adhesives are crucial to optimize this bond, and that in turn is influenced by the initial mobility of the system, as well as by the reactivity of the initiators. Aim: This study aimed to characterize adhesives containing monomer mixtures of different viscosities and double and triple photoinitiator systems; and to evaluate the bonding to Y-TZP zirconia, when adhesives were light-activated with monowave or polywave light-curing units (LCU). Materials and methods: Adhesives were formulated at a 1:1 weight proportion of Bis-GMA/TEGDMA or Bis-GMA/Bis-EMA. To these mixtures 0.5 wt% of CQ, 0.5–1.0 wt% of DABE, 0.5–1.0 wt% of DPIHP, or 0.5–1.0 wt% of TAS-Sb were added and used as photoinitiator systems. A total of ten adhesives were prepared. Resin composite cylinders were cemented on zirconia slices and 6000 thermal cycles were performed. Degree of conversion (DC), sorption (SO) and solubility (SL) after 7 days of water storage, and microshear bond strength (µSBS) were evaluated. Data were analyzed with three-way ANOVA and Tukey’s HSD (α = 0.05). Results: Bis-GMA/Bis-EMA combined with either CQ/DABE or CQ/DABE/TAS-Sb presented the highest DC, and no significant differences were observed for LCUs (p = .298). CQ/DABE < CQ/DABE/TAS-Sb ≈ CQ/DABE/DPIHP and the polywave LCU showed smaller overall SO (p < .05). Bis-GMA/TEGDMA with CQ/DABE cured with the polywave LCU presented the lowest SO. SL varied as follows: CQ/DABE/TAS-Sb < CQ/DABE/DPIHP < CQ/DABE (p < .001). For µSBS, only the factor photoinitiator system was significant (p = .045). All mean values were above 30 MPa, with higher values being observed for BIS-GMA/TEGDMA and CQ/DABE. Conclusion: It can be concluded that the adhesive containing CQ/DABE/TAS-Sb as coinitiator of Bis-GMA/Bis-EMA mixtures produced a material with higher DC and lower SL, while bond strength values were similar to the ones obtained by CQ/DABE.

Effect of different surface treatments on optical, colorimetric, and surface characteristics of a lithium disilicate glass-ceramic

OBJECTIVE

To evaluate the effect of surface treatments on optical, colorimetric, and surface characteristics of lithium disilicate glass-ceramic.

MATERIALS AND METHODS

Specimens (n = 5, IPS e.max CAD) were randomly allocated to the following treatments: mirror-polished: SiC papers; as-cut: mimicking CAD-CAM milling; ground: 90-120 μm-grit diamond bur; ground polished: ground, finished (46-30 μm-grit diamond bur), polished (diamond cups, brush and diamond paste); ground glazed: ground, glazed; ground polished glazed: association of methods. CIELAB color coordinates were obtained by a spectrophotometer. CIEDE2000 color differences (ΔE₀₀ ) and the translucency parameter (TP₀₀ ) were calculated. Light transmittance was assessed with a colorimeter. Surface characteristics (topography and roughness) were analyzed. Statistical differences for each condition and outcome were detected using one-way ANOVA with Tukey's post-hoc test (α = 0.05).

RESULTS

TP₀₀ data show statistical reduction after grinding (p < 0.05), which was only restored with polishing (solely or with glazing). ΔE₀₀ shows that grinding results in perceptible variations in color (above 0.81), which were restored after all post-processing protocols (exception to only glaze application in contact with a black background). Light transmittance data corroborated such performance. Polishing and glazing reduced roughness and improved surface topography.

CONCLUSION

Grinding statistically increased roughness, reduced translucency, light transmittance through the ceramic, and resulted on color differences. On contrary, polishing (followed or not by glazing) reduced roughness and enhanced ceramic translucency and light transmittance. Glaze also reduced roughness, but it still presented reduced translucency. The positioning (facing up or down) of the ceramic treated surface influenced the considered outcomes.

CLINICAL SIGNIFICANCE

Grinding with diamond burs results in a deleterious impact to the optical, colorimetric and surface characteristics of lithium disilicate ceramic. Thus, polishing (followed or not by glazing) is recommended for optical and topographical enhancements when lithium disilicate monolithic restorations require occlusal adjustments.

The influence of zirconia veneer thickness on the degree of conversion of resin-matrix cements: an integrative review

OBJECTIVE

The main aim of this study was to conduct an integrative review on the influence of the zirconia veneer thickness on the degree of conversion of resin-matrix cements.

MATERIALS AND METHOD

An electronic search was performed on PubMed using a combination of the following search items: zirconia, thickness, veneer, degree of conversion, resin cement, light curing, and polymerization. Articles published in the English language, up to July 2020, were included regarding the influence of ceramic veneer thickness on the degree of conversion of resin-matrix cements. Randomized controlled trials and prospective cohort studies were also evaluated.

RESULTS

Of the 21 selected studies, 9 investigated the light-curing effect, while five other articles evaluated the ceramic translucency. Three studies evaluated the degree of conversion of the resin-matrix cement while four articles assessed the veneer thickness. Results revealed a significant decrease of light transmission through the zirconia with a thickness ranging from 0.1 up to 1.5 mm. However, the ultra-thin thickness around 0.1 and 0.3 mm allowed a full polymerization of the dual-curing resin-matrix cement resulting in the integrity of the interface properties. The light-curing process of resin-matrix cements is also affected by the shade, chemical composition, and microstructure of zirconia and resin cement. Optimal conditions of light-curing are required to reach the threshold intensity of light and energy for polymerization of resin-matrix cements.

CONCLUSIONS

The increase in zirconia veneer thickness negatively affects the degree of conversion of resin-matrix cements. Also, shade and microstructure are key factor to improve the light curing of resin cements.

CLINICAL RELEVANCE

Clinicians should consider the zirconia thickness on resin-based cementation since a higher veneer thickness can negatively affect the light irradiation intensity towards the dual-curing resin-matrix cement. Thus, the degree of conversion of the resin-matrix cement can decrease leading to a low chemical stability (e.g., color instability) and poor mechanical properties.

Initial curing characteristics of composite cements under ceramic restorations

PURPOSE

To assess the degree of conversion (DC) of dual-curing composite cements when cured through ceramic-veneered zirconia disks.

METHODS

Portions of mixed cement, either G-CEM LinkForce (GC), Panavia V5 (Kuraray Noritake) or ResiCEM (Shofu), were placed on the ATR crystal of a Fourier Transform Infrared Spectroscope (FTIR; iS50, Thermo Scientific) and squeezed to a 100-µm film thickness using a microscopy cover glass. DC (%) of the composite cements applied in self-curing mode was measured in the dark at 37°C. Following the dual-curing mode, the cements were light-cured directly (positive control) or through a ceramic-veneered zirconia disk (0.5-mm thick zirconia with a 1.0-mm thick veneering ceramic) for 40 sec using two light-curing units (G-Light Prima 2, GC; PenCure, Morita). Per experimental group, 5 tests were conducted to measure DC in self-cure and dual-cure mode (n=5). FTIR spectra of the composite cement films were acquired to determine DC every min up to 30 min. DC of the composite cements was statistically compared using two-way repeated-measures ANOVA (α=0.05).

RESULTS

For all cements investigated, the self-curing mode resulted in significantly lower DC at 10, 20 and 30 min than the light-curing mode. When the composite cements were light-cured through the zirconia disk, DC at 30 min dropped significantly for ResiCem (Shofu), while not for Panavia V5 (Kuraray Noritake) and G-CEM LinkForce (GC).

CONCLUSIONS

Self-curing slows down polymerization but does not reach for all composite cements the highest (light-cured) DC. Ceramic-veneered zirconia-based restorations may affect DC of some composite cements.

Niobium silicate as a filler for an experimental photopolymerizable luting agent

PURPOSE

To synthesize niobium silicate particles (SiNb) and incorporate into resin-based luting agents.

METHODS

SiNb particles were synthesized and characterized by x-ray diffraction, FTIR spectroscopy, particle size, and specific surface area. Luting agents were formulated with 50 wt% BisGMA, 30 wt% TEGDMA and 20 wt% UDMA. BAPO was used as a photoinitiator in 1mol%. The SiNb particles were incorporated into the agents at concentrations of 50 wt% (SiNb50%) or 65% wt% (SiNb65%). Barium glass particles at the same concentrations were used as controls (SiBa50% and SiBa65%). Refractive index, degree of conversion (DC), polymerization kinetics, softening in solvent, radiopacity, film thickness, color stability, flexural strength (FS) and micro shear bond strength (µSBS) were evaluated.

RESULTS

SiNb particles were successfully synthesized with an adequate structure to be applied as inorganic fillers. SiNb groups had higher DC, lower %ΔKHN, greater film thickness and greater radiopacity than the SiBa groups. Color stability was greater for SiNb50% and SiNb65% after six months of storage, as demonstrated by ΔE00. ΔWID values were lower for the SiBa groups. FS results decreased over time, and lower values were found for SiNb. In µSBS, the values of SiNb65% were higher at 24 h (45.22 MPa) and at six months (36.83 MPa), with statistically differences from values for the SiBa groups.

CONCLUSIONS

SiNb particles were successfully synthesized using the sol-gel method, and their incorporation into luting agents at a concentration of up to 65% improved the physicomechanical characteristics and color stability of these agents.