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Lackington WA, Bellon B, Guimond S, Schweizer P, Cancellieri C, Ambeza A, Chopard-Lallier AL, Pippenger B, Armutlulu A, Maeder X, Schmutz P, Rottmar M. Bio-Inspired Micro- and Nano-Scale Surface Features Produced by Femtosecond Laser-Texturing Enhance TiZr-Implant Osseointegration. Adv Healthc Mater 2024:e2400810. [PMID: 38857489 DOI: 10.1002/adhm.202400810] [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: 03/01/2024] [Revised: 05/13/2024] [Indexed: 06/12/2024]
Abstract
Surface design plays a critical role in determining the integration of dental implants with bone tissue. Femtosecond laser-texturing has emerged as a breakthrough technology offering excellent uniformity and reproducibility in implant surface features. However, when compared to state-of-the-art sandblasted and acid-etched surfaces, laser-textured surface designs typically underperform in terms of osseointegration. This study investigates the capacity of a bio-inspired femtosecond laser-textured surface design to enhance osseointegration compared to state-of-the-art sandblasted & acid-etched surfaces. Laser-texturing facilitates the production of an organized trabeculae-like microarchitecture with superimposed nano-scale laser-induced periodic surface structures on both 2D and 3D samples of titanium-zirconium-alloy. Following a boiling treatment to modify the surface chemistry, improving wettability to a contact angle of 10°, laser-textured surfaces enhance fibrin network formation when in contact with human whole blood, comparable to state-of-the-art surfaces. In vitro experiments demonstrate that laser-textured surfaces significantly outperform state-of-the-art surfaces with a 2.5-fold higher level of mineralization by bone progenitor cells after 28 days of culture. Furthermore, in vivo evaluations reveal superior biomechanical integration of laser-textured surfaces after 28 days of implantation. Notably, during abiological pull-out tests, laser-textured surfaces exhibit comparable performance, suggesting that the observed enhanced osseointegration is primarily driven by the biological response to the surface.
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Affiliation(s)
- William Arthur Lackington
- Biointerfaces Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, 9014, Switzerland
| | - Benjamin Bellon
- Institut Straumann AG, Basel, 4052, Switzerland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, 33720, Finland
| | - Stefanie Guimond
- Biointerfaces Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, 9014, Switzerland
| | - Peter Schweizer
- Mechanics of Materials & Nanostructures Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, Thun, 3603, Switzerland
| | - Claudia Cancellieri
- Joining Technologies & Corrosion Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, 8600, Switzerland
| | - Antoine Ambeza
- Laser TSE, GF Machining Solutions SA, Geneva, 1242, Switzerland
| | | | - Benjamin Pippenger
- Institut Straumann AG, Basel, 4052, Switzerland
- Department of Periodontology, University of Bern, Bern, 3010, Switzerland
| | | | - Xavier Maeder
- Mechanics of Materials & Nanostructures Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, Thun, 3603, Switzerland
| | - Patrik Schmutz
- Joining Technologies & Corrosion Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, 8600, Switzerland
| | - Markus Rottmar
- Biointerfaces Lab, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, 9014, Switzerland
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Kemaloglu H, Cay O, Devrimci EE, Pamir T. Repair bond strength of a new self-adhesive composite resin to three different resin-matrix ceramic CAD-CAM materials. Dent Mater J 2024; 43:137-145. [PMID: 38233189 DOI: 10.4012/dmj.2023-165] [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: 01/19/2024]
Abstract
This study aimed to evaluate the shear bond strength of two flowable composite resins to resin-matrix ceramic CAD-CAM materials.Fifty-four plates obtained from Lava Ultimate (LU), Cerasmart (CS), and Vita Enamic (VE) CAD-CAM blocks were assigned to nine groups: N0: Nova Compo SF (NCSF), N1: Silane/Single Bond Universal (SBU)/NCSF, N2: SBU/NCSF, N3: Silane/G-Premio Bond (GPB)/NCSF, N4: GPB/NCSF, G1: Silane/SBU/G-aenial Universal Injectable Composite (GUIC), G2: SBU/GUIC, G3: Silane/GPB/GUIC, G4: GPB/GUIC. After the repair procedures, shear bond strength values were analyzed. Silane pre-application decreased bond strength in most LU and CS groups but increased it in VE. NCSF performed better than GUIC in all CAD-CAM's with similar adhesive protocols. SBU in combination with NSCF had the highest bond strength among all repair procedures in LU and CS. Silane-containing universal adhesives in combination with self-adhesive resin composites should be used to repair resin-matrix ceramic materials.
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Affiliation(s)
- Hande Kemaloglu
- Department of Restorative Dentistry, Faculty of Dentistry, Ege University
| | - Ozge Cay
- Department of Restorative Dentistry, Faculty of Dentistry, Ege University
| | | | - Tijen Pamir
- Department of Restorative Dentistry, Faculty of Dentistry, Ege University
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Porto TS, Medeiros da Silva IG, de Freitas Vallerini B, Fernando de Goes M. Different surface treatment strategies on etchable CAD-CAM materials: Part 1-Effect on the surface morphology. J Prosthet Dent 2023; 130:761-769. [PMID: 35094771 DOI: 10.1016/j.prosdent.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials have either a high content of ceramic filler particles or a ceramic network structure. Proper etching of these materials is challenging. Therefore, it is relevant to assess different surface etching strategies and morphological alterations as a result of these techniques. PURPOSE The purpose of this 2-part in vitro study was to evaluate different etching strategies on the surface roughness and its relationship to the surface contact angle with a subsequent morphological characterization of different CAD-CAM materials. MATERIAL AND METHODS Two CAD-CAM polymer-based materials and 1 CAD-CAM ceramic material were selected for this study. The materials were treated with different strategies, including a combination of airborne-particle abrasion and an application of 9% hydrofluoric acid etching. After the surface treatment, roughness measurements (Sa) were assessed by using an optical profilometer on an area of 1.47 mm2. Subsequently, the contact angle on the surface was examined by means of the sessile drop technique and an optical contact angle meter. The data were analyzed by using a 2-way analysis of variance, the post hoc Tukey test (α=.05), and the Pearson correlation coefficient. RESULTS The 3 materials tested showed an increase in surface roughness when treated with surface airborne-particle abrasion. However, the materials with polymer in their composition concomitantly increased the contact angle. More hydrophilic surfaces were observed when hydrofluoric acid was applied, regardless of the composition of the materials. The surface roughness presented a strong positive linear tendency in the surface treatments used. CONCLUSIONS The application of airborne-particle abrasion on the surface of the polymer-based CAD-CAM materials increased the roughness and contact angle. However, the application of acid etching after the airborne-particle abrasion decreased the contact angle for polymer-based CAD-CAM materials, resulting in considerable enhancement of the surface quality for proper bonding.
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Affiliation(s)
- Thiago Soares Porto
- Assistant Professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.
| | - Italo Guimaraes Medeiros da Silva
- Researcher, Department of Macromolecular Science and Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Bruna de Freitas Vallerini
- PhD Candidate, Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Sao Paulo State University, UNESP, Sao Paulo, Brazil
| | - Mario Fernando de Goes
- Professor, Department of Restorative Dentistry (Dental Materials Area), Piracicaba Dental School, University of Campinas, UNICAMP, Sao Paulo, Brazil
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Porto TS, Medeiros da Silva IG, de Freitas Vallerini B, Fernando de Goes M. Different surface treatment strategies on etchable CAD-CAM materials: Part II-Effect on the bond strength. J Prosthet Dent 2023; 130:770-779. [PMID: 35101273 DOI: 10.1016/j.prosdent.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
STATEMENT OF PROBLEM Bonding to recently launched polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials has been challenging. Evidence regarding etching strategies for dual-phase CAD-CAM materials is sparse, but adequate bonding is crucial for the clinical success and longevity of a restoration. PURPOSE The purpose of this 2-part in vitro study was to evaluate and compare the effect of surface treatment strategies on the microshear bond strength and work of adhesion of polymer-based and ceramic materials. In addition, chemical elements present on the surface and the interface morphology after using those strategies were also assessed. MATERIALS AND METHODS Two CAD-CAM polymer and 1 CAD-CAM ceramic materials were selected for this in vitro study. The materials were subjected to different surface treatment strategies, including airborne-particle abrasion and the application of 9% hydrofluoric acid. Specimens were submitted to microshear bond strength before and after thermocycling, and the failure mode was classified. The work of adhesion was calculated based on the water-to-air surface tension of 72.8 mN.m-1 and the Young- Dupré equation. The surfaces were submitted to energy-dispersive X-ray spectroscopy, and the interfaces were analyzed using a scanning electron microscope. Data were subjected to 2-way ANOVA and the Tukey post hoc test (α=.05). RESULTS The highest microshear bond strength means were observed for the polymer-based materials when hydrofluoric acid or airborne-particle abrasion was applied. The 3 materials tested showed a decrease in microshear bond strength after thermocycling, except for applying airborne-particle abrasion to 1 of the polymer-based material tested. The ceramic material tested showed a high microshear bond strength with the application of airborne-particle abrasion and hydrofluoric acid combined. The work of adhesion varied across the materials and presented high means when hydrofluoric acid was used. CONCLUSIONS A combination of airborne-particle abrasion plus hydrofluoric acid should be considered for polymer-based or feldspathic ceramic CAD-CAM materials. In this in vitro study, both etching procedures combined produced higher bonding values for all materials tested.
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Affiliation(s)
- Thiago Soares Porto
- Assistant Professor, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.
| | - Italo Guimaraes Medeiros da Silva
- Researcher, Department of Macromolecular Science and Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Bruna de Freitas Vallerini
- PhD Candidate, Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Mario Fernando de Goes
- Professor, Department of Restorative Dentistry (Dental Materials Area), Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Yiğit E, Güngör Erdoğan H, Eyüboğlu TF, Özcan M. Effect of Various Beverages on Adhesion of Repaired CAD/CAM Restorative Materials. J Funct Biomater 2023; 14:380. [PMID: 37504875 PMCID: PMC10381350 DOI: 10.3390/jfb14070380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
(1) Background: The purpose of this study was to determine the effect of commonly consumed beverages on the bond strength of three different computer-aided design-computer-aided manufacturing (CAD/CAM) resin-ceramic hybrid materials repaired with resin-based composite (RBC) materials. (2) Materials and Methods: Rectangular prism specimens (N = 138) measuring 6 mm × 5 mm × 2 mm were obtained from GC Cerasmart (GC), Lava Ultimate (LU), and Vita Enamic (VE) blocks. These blocks were polished and then subjected to thermal cycling (10,000 cycles, 5 °C to 55 °C). After the surface treatment was applied, the average surface roughness value was measured. All the surfaces were repaired with RBC. Thermal cycling was performed for the second time. Each group was then distributed into three subgroups according to the beverage used: tea (t), cola (c), and distilled water (0) (n = 15). The specimens were stored in these solutions for 28 days and then subjected to the shear bond strength (SBS) test. Statistical analysis was performed using a two-way ANOVA test with Bonferroni adjustment. (3) Results: The surface roughness of the materials presented no significant difference after different surface treatments (p > 0.05). No significant difference was observed among the materials (p > 0.05). Tea and cola presented similar SBS values (p > 0.05). Both were significantly lower than distilled water (p < 0.001, p < 0.001, respectively). (4) Conclusions: Consumption of beverages reduces the bond strength in surfaces repaired with RBC to CAD/CAM resin-ceramic hybrid materials. (5) Clinical Significance: Repairing damaged resin matrix dental restorations with RBC is advantageous in terms of time and cost by achieving adequate bond strengths. Frequently consumed beverages reduce the bond strength of repaired CAD/CAM resin-ceramic hybrid materials.
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Affiliation(s)
- Elif Yiğit
- Department of Prosthodontics, Faculty of Dentistry, University of Karabük, Karabük 78050, Türkiye
| | - Hamiyet Güngör Erdoğan
- Department of Prosthodontics, Faculty of Dentistry, Lokman Hekim University, Ankara 06510, Türkiye
| | - Tan Fırat Eyüboğlu
- Department of Endodontics, Faculty of Dentistry, Istanbul Medipol University, Istanbul 34083, Türkiye
| | - Mutlu Özcan
- Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland
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Alghamdi WS, Labban N, Maawadh A, Alsayed HD, Alshehri H, Alrahlah A, Alnafaiy SM. Influence of Acidic Environment on the Hardness, Surface Roughness and Wear Ability of CAD/CAM Resin-Matrix Ceramics. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15176146. [PMID: 36079529 PMCID: PMC9457874 DOI: 10.3390/ma15176146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/02/2023]
Abstract
This study aimed to measure the effect of storage environment on the hardness, surface roughness and wear ability of CAD/CAM resin-matrix ceramics. A total of 200 rectangular-shaped specimens were obtained by sectioning 5 CAD/CAM blocks; Crystal Ultra (CU), Vita Enamic (VE), Lava Ultimate (LU), Cerasmart (CS) and Vita blocks Mark II (MII). Microhardness and surface roughness were measured at baseline and after 7 days of immersion either in saliva or cola (n = 10). The wear ability of the CAD/CAM materials against steatite-ceramics antagonist was determined using a chewing simulator. The data were statistically analyzed using factorial ANOVA followed by post hoc Bonferroni multiple comparison tests (p < 0.05). The independent factors significantly influenced the microhardness and surface roughness (p < 0.05). The highest VHN was observed in MII at baseline (586.97 ± 13.95), while CU showed the lowest VHN after 7 days of immersion in cola (68.3 ± 1.89). On the contrary, the highest Ra was observed after 120,000 chewing cycles for the VE specimens (1.09 ± 0.43 µm) immersed in cola, while LU showed the lowest Ra at baseline (0.07 ± 0.01 µm). The highest % mass loss of the antagonist was observed with MII immersed in cola (1.801%), while CS demonstrated the lowest % mass loss of 0.004% and 0.007% in AS and cola, respectively. This study confirms that the surface properties of tested CAD/CAM materials are susceptible to degradation in an acidic environment except for hardness and wear of CS material.
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Affiliation(s)
- Wejdan S. Alghamdi
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Nawaf Labban
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Ahmed Maawadh
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Hussain D. Alsayed
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Huda Alshehri
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Ali Alrahlah
- Department of Restorative Dental Sciences, Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Sarah M. Alnafaiy
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
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Önöral Ö, Ongun S, Günal B. Evaluation of surface characterization and mechanical features of resin-matrix ceramics before and after different surface treatments. J Prosthet Dent 2022; 127:928.e1-928.e8. [PMID: 35568526 DOI: 10.1016/j.prosdent.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Surface treatments (STs) required for micromechanical interlocking can lead to alterations in the surface characterization and mechanical features of the resin-matrix ceramics (RMCs), which may jeopardize the long-term outcome of an indirect restoration. However, evidence on this issue is lacking. PURPOSE The purpose of this in vitro study was to assess the influence of different STs on the surface roughness (SR), water contact angle (WCA), and flexural strength (FS) of RMCs. MATERIAL AND METHODS Two hundred rectangular plates (12×14×1 mm) were prepared from 5 different RMC ingots, including a polymer-infiltrated ceramic network (Vita Enamic [VE]), 2 resin nanoceramics (Lava Ultimate [LU], Grandio Blocks [GB]), a flexible nanoparticle-filled resin (GC Cerasmart [GC]), and a reinforced composite resin (Brilliant Crios [BC]). Plates of each RMC group were further divided into 4 subgroups according to the ST applied: Control, no treatment (C); airborne-particle abrasion with aluminum oxide particles (APA); 2W- and 3W-Er,Cr:YSGG laser irradiations (LI2W, LI3W) (n=10 per ST). The SR (Ra) of each plate was recorded with a contact profilometer. WCAs (θ) of distilled water on the plates were determined by using the sessile-drop method. The FS (MPa) of each plate was measured with a universal testing machine. Data acquired for SR, WCA, and FS were statistically analyzed (α=.05). Weibull statistics were also conducted to determine the reliability of each material. RESULTS The 2-way ANOVA showed that SR, WCA, and FS values were significantly influenced not only by all tested variables but also by their interaction terms (P<.001). All STs significantly increased the SR values (P<.05). Maximum and minimum SR values were recorded in GC-LI3W (7.06 ±0.16) and GC-C (0.07 ±0.02) groups. After STs, WCA values significantly diminished (P<.05). Maximum and minimum WCA values were recorded in LU-C (61.74 ±2.45) and VE-APA (40.38 ±1.56) groups. All STs significantly reduced the FS values (P<.05). The upper and lower FS bounds were 140.7 ±17.07 and 60.66 ±6.31, respectively, set by VG-C and GC-APA. Weibull distribution indicated that the untreated groups presented the highest m values. Among the treated groups, BC-LI3W demonstrated superior reliability (m=14.04). CONCLUSIONS APA for LU, LI2W for VG and BC, and LI3W for GC and VE can be preferred. Although APA increased the SR and provided more wettable surfaces, it caused considerable loss of FS. Therefore, LI can be recommended as a safer ST for RMCs.
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Affiliation(s)
- Özay Önöral
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin, Turkey.
| | - Salim Ongun
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin, Turkey
| | - Burcu Günal
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin, Turkey
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Beyabanaki E, Ashtiani RE, Feizy M, Zandinejad A. Evaluation of Micro-Shear Bond Strength of Four Different CAD-CAM Polymer-Infiltrated Ceramic Materials after Thermocycling. J Prosthodont 2021; 31:623-628. [PMID: 34890485 DOI: 10.1111/jopr.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the bond strength of three monolithic hybrid ceramics/resin nanoceramics and a zirconia-reinforced lithium silicate to resin cement after thermocycling. MATERIALS AND METHODS Using four materials, including Vita Enamic (VITA Zahnfabrik), Lava Ultimate (3M ESPE), Crystal Ultra (Digital Dental), and Vita Suprinity (VITA Zahnfabrik), 64 specimens were prepared with dimensions of 4mm×3mm×1.5mm. Vita Suprinity samples were sintered at 840°C for 8 min. After polishing and cleaning all the samples in each group (n = 16), they were subjected to their recommended surface treatment: 10% hydrofluoric acid for Vita Enamic (60s) and Vita Suprinity (20s); air abrasion of Lava Ultimate and Crystal Ultra with 50μ Al2 O3 particles. Then, tygon tubes were filled with dual cure resin cement (Panavia F2.0), cured and then subjected to thermal cycling (2000 cycles; 5-55°C). The micro-shear bond strength was measured using micro-tensile testing machine. The data were analyzed using Welch and Games-Howell tests (α = 0.05). The mode of failure was also evaluated using a stereomicroscope. RESULTS The highest and the lowest mean micro-shear bond strength belonged to the Crystal Ultra (7.71 ±1.54 MPa) and Vita Suprinity (4.73 ±1.87 MPa) groups, respectively. The differences between groups were significant and Crystal Ultra had higher bond strength in comparison to all three materials (p<.05). CONCLUSION Hybrid ceramics showed higher bond strength to resin cements in comparison to resin nanoceramics and zirconia-reinforced lithium silicate materials. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elaheh Beyabanaki
- Assistant Professor, Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Eftekhar Ashtiani
- Assistant Professor, Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirali Zandinejad
- Associate Professor and Program Director AEGD Residency, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, TX
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Sarahneh O, Günal-Abduljalil B. The effect of silane and universal adhesives on the micro-shear bond strength of current resin-matrix ceramics. J Adv Prosthodont 2021; 13:292-303. [PMID: 34777719 PMCID: PMC8558573 DOI: 10.4047/jap.2021.13.5.292] [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] [Received: 06/01/2021] [Revised: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this in vitro study was to evaluate the effect of silane and universal adhesive applications on the micro-shear bond strength (µSBS) of different resin-matrix ceramics (RMCs). MATERIALS AND METHODS A total of 120 slides (14 × 12 × 1 mm) were produced from 5 different RMC materials (GC Cerasmart [GC]; Brilliant Crios [BC]; Grandio blocs [GB]; Katana Avencia [KA]; and KZR-CAD HR 2 [KZR]) and sandblasted using 50 µm Al2O3 particles. Each RMC material was divided into six groups according to the surface conditioning (SC) method as follows: control (G1), silane primer (G2), silane-free universal adhesive (G3), silane-containing universal adhesive (G4), silane primer and silane-free universal adhesive (G5), and silane primer and silane-containing universal adhesive (G6). Three cylindric specimens made from resin cement (Bifix QM) were polymerized over the treated surface of each slide (n = 12). After thermal cycling (10000 cycles, 5 – 55℃), µSBS test was performed and failure types were evaluated using a stereomicroscope. Data were analyzed using 2-way ANOVA and Tukey tests (α = .05). RESULTS µSBS values of specimens were significantly affected by the RMC type and SC protocols (P < .001) except the interaction (P = .119). Except for G2, all SC protocols showed a significant increase in µSBS values (P < .05). For all RMCs, the highest µSBS values were obtained in G4 and G6 groups. CONCLUSION Only silane application did not affect the µSBS values regardless of the RMC type. Moreover, the application of a separate silane in addition to the universal adhesives did not improve the µSBS values. Silane-containing universal adhesive was found to be the best conditioning method for RMCs.
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Affiliation(s)
- Omar Sarahneh
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Turkey
| | - Burcu Günal-Abduljalil
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Turkey
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Günal-Abduljalil B, Önöral Ö, Ongun S. Micro-shear bond strengths of resin-matrix ceramics subjected to different surface conditioning strategies with or without coupling agent application. J Adv Prosthodont 2021; 13:180-190. [PMID: 34234928 PMCID: PMC8250191 DOI: 10.4047/jap.2021.13.3.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study aimed to assess the influence of various micromechanical surface conditioning (MSC) strategies with or without coupling agent (silane) application on the micro-shear bond strength (µSBS) of resin- matrix ceramics (RMCs). MATERIALS AND METHODS GC Cerasmart (GC), Lava Ultimate (LU), Vita Enamic (VE), Voco Grandio (VG), and Brilliant Crios (BC) were cut into 1.0-mm-thick slices (n = 32 per RMC) and separated into four groups according to the MSC strategy applied: control-no conditioning (C), air-borne particle abrasion with aluminum oxide particles (APA), 2W- and 3W-Er,Cr:YSGG group coding is missing. The specimens in each group were further separated into silane-applied and silane-free subgroups. Each specimen received two resin cement microtubules (n = 8 per subgroup). A shear force was applied to the adhesive interface through a universal test machine and µSBS values were measured. Data were statistically analyzed by using 3-way ANOVA and Tukey HSD test. Failure patterns were scrutinized under stereomicroscope. RESULTS RMC material type, MSC strategy, and silanization influenced the µSBS values (P<.05). In comparison to the control group, µSBS values increased after all other MSC strategies (P<.05) while the differences among these strategies were insignificant (P>.05). For control and APA, there were insignificant differences between RMCs (P>.05). The silanization decreased µSBS values of RMCs except for VE. Considerable declines were observed in GC and BC (P<.05). CONCLUSION MSC strategies can enhance bond strength values at the RMC - cement interface. However, the choice of MSC strategy is dependent on RMC material type and each RMC can require a dedicated way of conditioning.
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Affiliation(s)
- Burcu Günal-Abduljalil
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Özay Önöral
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
| | - Salim Ongun
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Mersin, Turkey
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Donmez MB, Okutan Y, Yucel MT. Effect of prolonged application of single-step self-etching primer and hydrofluoric acid on the surface roughness and shear bond strength of CAD/CAM materials. Eur J Oral Sci 2020; 128:542-549. [PMID: 33247878 DOI: 10.1111/eos.12747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
This in vitro study aimed to assess the influence of different concentrations and durations of hydrofluoric acid (HF) and Monobond Etch & Prime (MEP) etching on the surface roughness (Ra ) of different CAD/CAM materials and on the shear bond strength (SBS) of a self-adhesive resin bonded to the materials. Seventy specimens of hybrid ceramic, leucite-based glass-ceramic, lithium disilicate glass-ceramic, and zirconia-reinforced lithium silicate glass-ceramic were prepared and divided into seven groups according to the surface treatments: Control (C); MEP etching for 60 (MEP60 ) and 120 (MEP120 ) s; 5% HF etching for 60 (HF-5%60 ) and 120 (HF-5%120 ) s; 9.5% HF etching for 60 (HF-9.5%60 ) and 120 (HF-9.5%120 ) s. The Ra was measured using a 3D profilometer. All groups were treated with a universal primer except for the C, MEP60 , and MEP120 groups. A self-adhesive resin cement was bonded to all specimens, and the bond strengths were measured using a universal testing machine. All surface treatments increased both Ra and SBS values compared to the control in each material. Neither the duration of surface treatments nor the HF acid concentrations had a statistically significant effect on SBS. Within the limitations of this experimental study, it can be concluded that Monobond Etch & Prime may be a preferable method to achieve high bond strength values.
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Affiliation(s)
- Mustafa B Donmez
- Department of Prosthodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Yener Okutan
- Department of Prosthodontics, Faculty of Dentistry, Aydin Adnan Menderes University, Aydın, Turkey
| | - Munir T Yucel
- Department of Prosthodontics, Faculty of Dentistry, Selcuk University, Konya, Turkey
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12
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Tokunaga E, Nagaoka N, Maruo Y, Yoshihara K, Nishigawa G, Minagi S. Phosphate group adsorption capacity of inorganic elements affects bond strength between CAD/CAM composite block and luting agent. Dent Mater J 2020; 40:288-296. [PMID: 33028787 DOI: 10.4012/dmj.2020-029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate whether inorganic elements of polymer-infiltrated ceramic (PIC) and microfilled resin (MFR) for CAD/CAM would affect initial bond strength to luting agent. Inorganic elements of PIC and MFR were different with shape and ingredient observed by SEM, STEM and EDS. Microtensile bond strengths (µTBS) value of PIC was increased by 10-methacryloyloxydecyl dihydrogen phosphate (MDP) and acetic acid (AA)- or MDP-activated silane treatment, and further increased by succeeding heat treatment (HT). The µTBS of MFR was increased by MDP and MDP-activated silane, but decreased by AA-activated silane without HT. The HT improved the µTBS of MFR with AA-activated silane, but conversely for MDP-activated silane. Only in MFR, phosphoric acid (PA) application before each surface treatment dramatically decreased the µTBS of AA-activated silane. FTIR peaks in MFR shifted according to phosphate group's peak. MFR would possess high phosphate group adsorption capacity, with MDP effectively improving its bonding capability.
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Affiliation(s)
- Eri Tokunaga
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Noriyuki Nagaoka
- Advanced Research Center for Oral and Craniofacial Science, Okayama University
| | - Yukinori Maruo
- Department of Occlusion and Removable Prosthodontics, Okayama University
| | - Kumiko Yoshihara
- Health Research Institute, National Institute of Advanced Industrial Science and Technology
| | - Goro Nishigawa
- Department of Occlusion and Removable Prosthodontics, Okayama University
| | - Shogo Minagi
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
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13
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Günal Abduljalil B, Ongun S, Önöral Ö. How will surface conditioning methods influence the translucency and color properties of CAD-CAM resin-matrix ceramics with different thicknesses? J ESTHET RESTOR DENT 2020; 33:925-934. [PMID: 33006276 DOI: 10.1111/jerd.12667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE It was aimed to evaluate the effect of various surface-conditioning methods on the translucency and color properties of resin-matrix ceramics (RMCs) with different types and thicknesses. MATERIALS AND METHODS Rectangle-shaped RMCs were prepared from Voco Grandio, Brilliant Crios, Lava Ultimate, GC Cerasmart, and Vita Enamic blocks at 0.5 and 1.0 mm thicknesses. Specimens were divided into four groups: control, airborne-particle abrasion (APA), 2 and 3 W Er, Cr:YSGG laser irradiations (L2W , L3W ) (n = 15). The color values of specimens were recorded before and after surface-conditioning using a spectrophotometer. The translucency parameter (RTP00 ) and color difference (ΔE00 ) values were calculated. Data were statistically analyzed using three-way ANOVA and Tukey post hoc tests. RESULTS The translucencies of RMCs decreased after all surface-conditioning procedures. L caused more decline in translucency of materials than APA. All ΔE00 values were under the acceptability threshold except for APA-applied Voco Grandio at 0.5 mm. Differences in ΔE00 values between APA and L3W groups were significant (P˂0.05); while differences between L2W and L3W groups were insignificant (P > .05). In all experimental groups, ΔE00 values decreased with increasing thickness of RMCs. CONCLUSIONS L and APA significantly affected the translucency and color properties of RMCs. APA was found more favorable than L. CLINICAL SIGNIFICANCE Clinicians should carefully use surface conditioning methods, considering their impact on the optical characteristics of RMCs, especially when the restoration is thin.
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Affiliation(s)
- Burcu Günal Abduljalil
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Turkey
| | - Salim Ongun
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Turkey
| | - Özay Önöral
- Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Turkey
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14
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Biggemann J, Müller P, Köllner D, Simon S, Hoffmann P, Heik P, Lee JH, Fey T. Hierarchical Surface Texturing of Hydroxyapatite Ceramics: Influence on the Adhesive Bonding Strength of Polymeric Polycaprolactone. J Funct Biomater 2020; 11:jfb11040073. [PMID: 33023048 PMCID: PMC7712268 DOI: 10.3390/jfb11040073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
The tailored manipulation of ceramic surfaces gained recent interest to optimize the performance and lifetime of composite materials used as implants. In this work, a hierarchical surface texturing of hydroxyapatite (HAp) ceramics was developed to improve the poor adhesive bonding strength in hydroxyapatite and polycaprolactone (HAp/PCL) composites. Four different types of periodic surface morphologies (grooves, cylindric pits, linear waves and Gaussian hills) were realized by a ceramic micro-transfer molding technique in the submillimeter range. A subsequent surface roughening and functionalization on a micron to nanometer scale was obtained by two different etchings with hydrochloric and tartaric acid. An ensuing silane coupling with 3-aminopropyltriethoxysilane (APTES) enhanced the chemical adhesion between the HAp surface and PCL on the nanometer scale by the formation of dipole-dipole interactions and covalent bonds. The adhesive bonding strengths of the individual and combined surface texturings were investigated by performing single-lap compressive shear tests. All individual texturing types (macro, micro and nano) showed significantly improved HAp/PCL interface strengths compared to the non-textured HAp reference, based on an enhanced mechanical, physical and chemical adhesion. The independent effect mechanisms allow the deliberately hierarchical combination of all texturing types without negative influences. The hierarchical surface-textured HAp showed a 6.5 times higher adhesive bonding strength (7.7 ± 1.5 MPa) than the non-textured reference, proving that surface texturing is an attractive method to optimize the component adhesion in composites for potential medical implants.
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Affiliation(s)
- Jonas Biggemann
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
- Correspondence: (J.B.); (T.F.); Tel.: +49-9131-8527561 (J.B.); +49-9131-8527546 (T.F.)
| | - Philipp Müller
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
| | - David Köllner
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
| | - Swantje Simon
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
| | - Patrizia Hoffmann
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
| | - Paula Heik
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
| | - Jung Heon Lee
- School of Advanced Materials Science & Engineering, Sungkyunkwan University (SKKU), Suwon 16149, Korea;
| | - Tobias Fey
- Department of Materials Science (Institute of Glass and Ceramics), University of Erlangen-Nuernberg, Martensstr. 5, D-91058 Erlangen, Germany; (P.M.); (D.K.); (S.S.); (P.H.); (P.H.)
- Frontier Research Institute for Materials Science, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466-8555, Japan
- Correspondence: (J.B.); (T.F.); Tel.: +49-9131-8527561 (J.B.); +49-9131-8527546 (T.F.)
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15
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Chuenjit P, Suzuki M, Shinkai K. Effect of various surface treatments on the bond strength of resin luting agent and the surface roughness and surface energy of CAD/CAM materials. Dent Mater J 2020; 40:16-25. [PMID: 32779607 DOI: 10.4012/dmj.2019-359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to examine the effect of various surface treatments on the bond strength of a resin luting agent and the surface roughness and surface energy of computer-aided design and computer-aided manufacturing (CAD/CAM) materials. Four types of CAD/CAM blocks (Shofu Block HC: BHC; GC Cerasmart: CER; VITA Enamic: ENA; and Lava Ultimate: LAV) were used. All blocks were randomly divided into eight groups based on the surface treatment as follows: no surface treatment (C), airborne-particle abrasion (AA), hydrofluoric acid etching (HA), silane coupling agent application (SL), AA/SL, HA/SL, AA/HA, and AA/HA/SL. The microtensile bond strength (µTBS), surface roughness and surface energy were measured. Three-way ANOVA revealed that all surface treatments significantly influenced the µTBS between the resin luting agent and all types of CAD/CAM materials; however, the effect of each surface treatment on surface roughness and energy was dependent on the CAD/CAM materials.
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Affiliation(s)
- Pakorn Chuenjit
- Advanced Operative Dentistry and Endodontics, The Nippon Dental University Graduate School of Life Dentistry at Niigata
| | - Masaya Suzuki
- Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata
| | - Koichi Shinkai
- Advanced Operative Dentistry and Endodontics, The Nippon Dental University Graduate School of Life Dentistry at Niigata.,Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata
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Bahadır HS, Bayraktar Y. Evaluation of the repair capacities and color stabilities of a resin nanoceramic and hybrid CAD/CAM blocks. J Adv Prosthodont 2020; 12:140-149. [PMID: 32601533 PMCID: PMC7314625 DOI: 10.4047/jap.2020.12.3.140] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/02/2020] [Accepted: 04/28/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study evaluated the color stabilities of two computer-aided design and computer-aided manufacturing (CAD/CAM) blocks and a nanofill composite resin and the microtensile bond strength (µTBS) between the materials. MATERIALS AND METHODS Twelve specimens of 4 mm height were prepared for both Lava Ultimate (L) and Vita Enamic (E) CAD/CAM blocks. Half of the specimens were thermocycled (10,000 cycle, 5° to 55℃) for each material. Both thermocycled and non-thermocycled specimens were surface treated with one of the three different methods (Er,Cr:YSGG laser, bur, or control). For each surface treatment group, one of the thermocycled and one of non-thermocycled specimens were restored using silane (Ceramic Primer II), universal adhesive (Single Bond Universal), and nanofill composite resin of 4-mm height (Filtek Ultimate). The other specimens were restored with the same procedure without using silane. For each group, 1 × 1 × 8 mm bar specimens were prepared using a microcutting device. Bar specimens were thermocycled (10,000 cycle, 5° to 55℃) and microtensile tests were performed. Staining of the materials in coffee solution was also compared using a spectrophotometer. Data were analyzed using one-way ANOVA, t-test and post-hoc Scheffe tests. RESULTS µTBS were found similar between the thermocycled and non-thermocycled groups (P>.05). The highest µTBS (20.818 MPa) was found in the non-thermocycled, bur-ground, silane-applied E group. Silane increased µTBS at some E groups (P<.05). Composite resin specimens showed more staining than CAD/CAM blocks (P<.05). CONCLUSION CAD/CAM blocks can be repaired with composite resins after proper surface treatments. Using silane is recommended in repair process. Color differences may be shown between CAD/CAM blocks and the nanofill composite after a certain time period.
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Affiliation(s)
- Hasibe Sevilay Bahadır
- Department of Restorative Dentistry, Faculty of Dentistry, Yıldırım Beyazıt University, Ankara, Turkey
| | - Yusuf Bayraktar
- Department of Restorative Dentistry, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
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17
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Ayres APA, Hirata R, Fronza BM, Lopes BB, Ambrosano GMB, Giannini M. Effect of Argon Plasma Surface Treatment on Bond Strength of Resin Composite Repair. Oper Dent 2019; 44:E75-E82. [DOI: 10.2341/18-050-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Objectives:
This study evaluated the effect of argon plasma treatment (PLA) and its combination with sandblasting (SAN), silanization (SIL), and hydrophobic bonding resin (HBR) application on the micro-shear bond strength of water-aged restorative resin composite to a newly placed composite, simulating restoration repair.
Methods and Materials:
Forty-five light-cured composite plates (20-mm long × 20-mm wide × 4-mm thick) were fabricated using a hybrid composite and stored at 37°C in distilled water for six months. The aged composite surfaces were treated according to the following experimental groups, varying both treatment and order of application: 1) SAN + SIL + HBR (control), 2) SAN + PLA for 30 seconds + SIL + HBR, 3) SAN + SIL + PLA + HBR, 4) PLA + SIL + HBR, 5) PLA + SIL, 6) PLA + HBR, 7) SIL + PLA + HBR, 8) SIL + PLA, and 9) PLA. After the surface treatments, four fresh resin composite cylinders (1.5-mm high × 1.5-mm diameter) of the same composite were built on each aged composite surface using a silicone mold. After water storage for 24 hours or one year, the specimens were submitted to shear bond strength testing. Data were statistically analyzed by two-way analysis of variance and Tukey's test (5%).
Results:
Groups 1, 2, and 4 presented significantly higher bond strength means at 24 hours, although group 4 did not differ from group 7. Groups 5, 8, and 9 demonstrated significantly lower means than the other groups. Even though groups 1 and 2 had a significant bond strength reduction after 1 year, they still demonstrated higher bond strength at one year of storage.
Conclusions:
While PLA application combined with surface treatment methods demonstrated high bond strength results, this treatment alone was not as beneficial as other methods that included SAN, SIL and HBR.
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Affiliation(s)
- APA Ayres
- Ana Paula Almeida Ayres, DDS, MSc, PhD, assistant professor, Clinical Restorative Dentistry, University of Uberaba, Uberaba, MG, Brazil
| | - R Hirata
- Ronaldo Hirata, DDS, MSc, PhD, clinical assistant professor, Department of Biomaterials and Biomimetics, College of Dentistry, New York University, New York, NY
| | - BM Fronza
- Bruna Marin Fronza, DDS, MSc, PhD student, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - BB Lopes
- Bruno Bellotti Lopes, MSc, PhD, Surface-Engineering and Plasma Solution LTDA, Campinas, SP, Brazil
| | - GMB Ambrosano
- Gláucia Mari Bovi Ambrosano, MSc, PhD, professor, Department of Social Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - M Giannini
- Marcelo Giannini, DDS, MSc, PhD, associate professor, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas. Piracicaba, SP, Brazil
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