Ceramic inlays (Cerec) cemented with either a dual-cured or a chemically cured composite resin luting agent. A 2-year clinical study

Influence of curing mode and time on degree of conversion of one conventional and two self-adhesive resin cements

This study evaluated the effect of curing mode (auto- and dual-polymerizing mode) and time interval (5, 10 and 15 minutes) on the degree of conversion of resin cements. One conventional dual-cured resin cement (Panavia F 2.0 [Kuraray Medical Inc]) and two self-adhesive cements (RelyX Unicem [3M ESPE] and BisCem [BISCO, Inc]) were evaluated. The products (n = 5) were manipulated according to the manufacturer's instructions and applied to the surface of a horizontal attenuated reflectance unit attached to an infrared spectrometer. The materials were either light-cured for 40 seconds (dual-polymerizing mode) or allowed to auto-polymerize. The degree of conversion was calculated according to changes in the aliphatic-to-aromatic peak ratios prior to and 5, 10 and 15 minutes after light-activation or after mixing when the specimens were allowed to auto-polymerize. Data (%) were analyzed by two-way repeated measure ANOVA (curing mode and time interval) and Tukey's post-hoc test (alpha = 0.05%). The light-activating mode led to a higher degree of conversion values than the self-curing mode in self-adhesive cements (RelyX Unicem and BisCem), while there was no difference in the degree of conversion between the self- and light-cured groups of Panavia F 2.0 resin cement. All products showed a higher degree of conversion at 15 minutes postcuring than any other evaluation interval. The self-adhesive cements provide a higher degree of conversion values when light-activated. After 15 minutes of polymerization initiation, the degree of conversion was higher in all resin cements, regardless of the curing mode.

An effect of immediate dentin sealing on the shear bond strength of resin cement to porcelain restoration

PURPOSE

The aim of this study was to determine differences in shear bond strength to human dentin using immediate dentin sealing (IDS) technique compared to delayed dentin sealing (DDS).

MATERIALS AND METHODS

Forty extracted human molars were divided into 4 groups with 10 teeth each. The control group was light-cured after application of dentin bonding agent (Excite® DSC) and cemented with Variolink® II resin cement. IDS/SE (immediate dentin sealing, Clearfil™ SE Bond) and IDS/SB (immediate dentin sealing, AdapterTM Single Bond 2) were light-cured after application of dentin bonding agent (Clearfil™ SE Bond and Adapter™ Sing Bond 2, respectively), whereas DDS specimens were not treated with any dentin bonding agent. Specimens were cemented with Variolink® II resin cement. Dentin bonding agent (Excite® DSC) was left unpolymerized until the application of porcelain restoration. Shear strength was measured using a universal testing machine at a speed of 5 mm/min and evaluated of fracture using an optical microscope.

RESULTS

The mean shear bond strengths of control group and IDS/SE group were not statistically different from another at 14.86 and 11.18 MPa. Bond strength of IDS/SE group had a significantly higher mean than DDS group (3.14 MPa) (P < .05). There were no significance in the mean shear bond strength between IDS/SB (4.11 MPa) and DDS group. Evaluation of failure patterns indicates that most failures in the control group and IDS/SE groups were mixed, whereas failures in the DDS were interfacial.

CONCLUSION

When preparing teeth for indirect ceramic restoration, IDS with Clearfil™ SE Bond results in improved shear bond strength compared with DDS.

The Influence of Luting Systems on the Microtensile Bond Strength of Dentin to Indirect Resin-based Composite and Ceramic Restorations

Compared to self-etch and self-adhesive luting systems, the two etch-and-rinse luting agents evaluated in the current study provided more reliable bonding when used to bond indirect resin-based composite restorations to sound dentin. On the contrary, the self-adhesive luting system showed the highest mean bond strength for the cementation of glass ceramic restorations.

The Effect of the Presence and Presentation Mode of Co-Initiators on the Microtensile Bond Strength of Dual-Cured Adhesive Systems Used in Indirect Restorations

The presentation mode of co-initiators added to bonding agents may affect the bond strength of indirect composite restorations to dentin.

Effect of curing mode on microtensile bond strength to dentin of two dual-cured adhesive systems in combination with resin luting cements for indirect restorations

This study evaluated the microtensile bond strength (microTBS) of dual-cured adhesive systems when the different components were either light activated or left in the uncured state prior to cementation of an indirect composite restoration. Occlusal dentin surfaces of 40 human third molars were flattened. The teeth were randomly assigned to 8 groups (n = 5) according to the dual-cured systems (bonding agents/resin cements) and curing modes: All Bond 2/Duolink (AB2-BISCO Inc) and Optibond Solo Plus Dual Cure/Nexus 2 (SOLO-Kerr). Resin cements were applied to pre-cured resin composite discs (2 mm thick/Z-250/3M ESPE), which were fixed to dentin surfaces containing adhesive resin in either cured (LP) or uncured states (SP). The restored teeth were light activated according to the manufacturers' instructions (LRC-XL3000/3M ESPE) or allowed to self-cure (SRC). The restored teeth were water-stored at 37 degrees C for 24 hours. They were then both mesial-distally and buccal-lingually sectioned to obtain bonded specimens (1.2 mm2). Each specimen was tested in tension at a crosshead speed of 0.6 mm/minute until failure. Data (MPa (SD)) were analyzed by two-way ANOVA and Tukey's post-hoc test (p < .05). AB2/SP exhibited higher microTBS than AB2/LP (p = .00001); however, no significant differences were noted between SOLO/LP and SOLO/SP. Results suggested that dual-cured adhesive systems were as strong or even stronger when they were left in the uncured state prior to indirect resin composite cementation.

Microtensile bond strength of dual-polymerizing cementing systems to dentin using different polymerizing modes

STATEMENT OF THE PROBLEM

The effectiveness of bond strength using dual-polymerizing cementing systems ([DCSs] defined as the combination of dual-polymerizing bonding agents and resin cements) used with indirect restorations has not been evaluated when used solely with the autopolymerizing mode.

PURPOSE

This study evaluated the in vitro microtensile bond strength (MTBS) of fourth- and fifth-generation DCSs with indirect composite restorations either light polymerized or autopolymerized.

MATERIAL AND METHODS

Occlusal dentin surfaces of 48 human third molars were exposed and flattened. Teeth were assigned to 8 groups (n=6) according to the DCS and polymerizing modes: All-Bond2/Duolink (AB2), Optibond/Nexus2 (OPT), Bond1/Lute-it (B1), and Optibond Solo Dual Cure/Nexus2 (SOLO). Bonding agents were applied to dentin surfaces and left in the unpolymerized state. Resin cements were applied to prepolymerized resin discs (2 mm thick/Z250), which were subsequently bonded to the dentin surfaces. The restored teeth were light polymerized according to manufacturers' instructions (PP/XL 3000) or allowed to autopolymerize (AP). Restored teeth were stored in water at 37 degrees C for 24 hours and were both mesio-distally and bucco-lingually sectioned to obtain multiple bonded beams (1.2 mm2 of cross-sectional area). Each specimen was tested in tension at a crosshead speed of 0.6 mm/min until failure. Data (MPa) were analyzed by 2-way analysis of variance and the Tukey post hoc test (alpha=.05). Failure patterns of tested specimens were analyzed using scanning electron microscopy.

RESULTS

The mean (SD) MTBS values (MPa) were: AB2/PP: 36.9 (6.5); AB2/AP: 32.7 (7.3); B1/PP: 38.2 (7.0); B1/AP: 13.0 (4.2); SOLO/PP: 33.2 (7.2); SOLO/AP: 23.4 (3.4); OPT/PP: 30.8 (7.5); OPT/AP: 13.1 (5.8). The AP groups showed significantly lower MTBS than the PP groups (P<.0001), except for AB2, which showed no difference between polymerization modes (P=.2608).

CONCLUSION

The autopolymerizing mode of some dual-polymerizing cement systems may not be effective in promoting bond strength.

Systematic review of ceramic inlays

The purpose of the present study was to conduct a systematic review of ceramic inlays, assess the quality of published clinical studies, and determine the clinical effectiveness of ceramic inlays compared to other forms of posterior restorations. Prospective clinical trials of ceramic inlays published from 1990 to 2001 were retrieved by electronic and hand searching. The methodological quality of each study was assessed by two calibrated reviewers using a standardised checklist. The clinical effectiveness of ceramic inlays was evaluated in terms of failure rate, postoperative pain, and aesthetics. The results were compared to those of other forms of posterior restorations by means of an odds ratio. Among 46 articles selected for quality assessment, only five (10.6%) reported randomised controlled trials and 15 (32.6%) presented controlled clinical trials. The remaining 26 papers (56.5%) were longitudinal clinical trials lacking control groups. Only three papers fulfilled the requirement for statistical analysis to evaluate the clinical effectiveness of ceramic inlays. The results indicate no significant differences in longevity or postoperative sensitivity between ceramic and other posterior restorations over assessment periods of up to 1 year. It is concluded that no strong evidence is available to confirm the clinical effectiveness of ceramic inlays in comparison to other posterior restorations. Greater attention is required to the design and reporting of studies to improve the quality of clinical trials of ceramic inlays.

Dentin bond strengths of two ceramic inlay systems after cementation with three different techniques and one bonding system

STATEMENT OF PROBLEM

Cementation of inlay restoration is critical. Because of its high organic content, dentin is a less favorable substrate for bonding than enamel. Therefore it is important to improve dentin adhesion when placing ceramic inlay restorations.

PURPOSE

The purpose of this study was to compare the dentin bond strengths of 2 different ceramic inlay systems after cementation with 3 different techniques and 1 bonding system.

MATERIAL AND METHODS

One hundred twenty freshly extracted caries- and restoration-free molar teeth used in this study were stored in saline solution at room temperature. Standardized Class I preparations were made in all teeth. Each preparation had a length of 6 mm, a width of 3 mm, a depth of 2 mm, and 6-degree convergence of the walls. Teeth were randomly assigned to 2 groups of 60 each to evaluate the bonding of 2 ceramic systems, Ceramco II (Group I) and IPS Empress 2 (Group II), to dentin. Each of the 2 groups were further divided into 3 cementation technique groups of 20 each (Group I A, B, and C and Group II A, B, and C). Groups I A and B and Groups II A and B used dentin bonding agent (DBA) Clearfil Liner Bond 2V, and resin cement (Panavia F). Groups I C and II C served as control groups and used Panavia F without the dentin-bonding agent. In Groups I A and II A, the DBA was applied immediately after the completion of the preparations (D-DBA). Impressions were then made, and the ceramic inlays were fabricated according to the manufacturers' guidelines. In Groups I B and II B the DBA was applied just before luting the inlay restorations (I-DBA). In Groups I C and II C, no bonding agent was used before the cementation of the inlay restorations (No DBA). Cementation procedures followed a standard protocol. After cementation, specimens were stored in distilled water at 37 degrees C for 24 hours. The teeth were sectioned both mesial-distally and buccal-lingually along their long axis into three 1.2 x 1.2 mm wide |-shaped sections. The specimens were then subjected to microtensile testing at a crosshead speed of 1 mm/min, and the maximum load at fracture (in kilograms) was recorded. Two-way analysis of variance and Tukey honestly significant difference tests were used to evaluate the results (P<.05). Scanning electron microscopy analysis was used to examine the details of the bonding interface. The fractured surfaces were observed with a stereomicroscope at original magnification x22 to identify the mode of fracture.

RESULTS

Although no significant difference was found among the 2 ceramic systems with regard to dentin bond strengths (P>.05), the difference between the cementation techniques was found to be significant (P<.001). Comparison among techniques showed that the dentin bond strength in the D-DBA technique had a significantly higher mean (40.27 +/- 8.55 Kg) than the I-DBA (30.20 +/- 6.78 Kg) and No DBA techniques (32.43 +/- 8.58 Kg). As a result of scanning electron microscopy analysis, a distinct and thicker hybrid zone with more, and longer resin tags were found in specimens treated with the D-DBA technique than with the other 2 techniques. Most failures (353 of 360) were adhesive in nature at the bonding resin/dentin interface. Only 7 specimens showed cohesive failure within the bonding resin.

CONCLUSION

Within the limitations of this in vitro study, the cementation of the ceramic inlays tested with the D-DBA technique used resulted in higher bond strengths to dentin.

Margin gap size of ceramic inlays using second-generation CAD/CAM equipment

OBJECTIVE

The goal of this study was to determine if the fit of second-generation computer-assisted design/computer-assisted manufacturing (CAD/CAM) (CEREC 2, Sirona Dental Systems, Bensheim, Germany) inlays within Class II cavity preparations were within the range of 50 to 100 microns and were equal or better to CEREC 1 inlays.

MATERIALS AND METHODS

Extracted human molars free of surface defects and caries were prepared with standard mesio-occlusodistal cavity preparations. Ceramic inlays were fabricated with CEREC 2 CAD/CAM equipment and seated into cavity preparations. Digital images were captured at 100 times magnification. Marginal gaps were measured with an image analysis program. For each restoration, gaps were measured at 12 locations along interproximal margins and 10 locations along occlusal margins.

RESULTS

No difficulty occurred in seating any of the milled inlays. Average marginal gaps for occlusal (59 +/- 35 microns) and interproximal (97 +/- 66 microns) margins were statistically different (t-test, p < or = .01). Average marginal gap for all sites combined was 80 +/- 57 microns. Marginal gap widths were smaller than those obtained from a similar study done earlier with the CEREC 1 unit for occlusal (89 +/- 65 microns) and interproximal (105 +/- 81 microns) margins. Ease of seating with CEREC 2 inlays was much better than with CEREC 1.

CLINICAL SIGNIFICANCE

Improvements in software and hardware allow the CEREC 2 to adapt well to standard inlay cavity preparations. The ability of the device to create inlays that seat without interference is remarkable. The improved fit and ability to create the occlusal surface in a variety of ways make CEREC 2 an attractive restorative option for all-ceramic restorations.

IPS Empress inlays and onlays after four years--a clinical study

OBJECTIVE

Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined.

MATERIALS AND METHODS

Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear.

RESULTS

Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p < 0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations.

CONCLUSION

After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

Clinical performance of CEREC ceramic inlays: a systematic review

OBJECTIVE

This systematic review of clinical trials seeks to identify the clinical performance of intra-coronal CEREC restorations luted with an adhesive composite technique. The focus of the review is to establish the survival rate of these restorations and to identify the factors that may cause them to fail.

METHOD

A comprehensive literature search was undertaken, spanning from the year of introduction of the technology--1986 to 1997. This review identifies universal indicators of the clinical performance of intra-coronal CEREC restorations luted with an adhesive composite technique. Throughout the critical appraisal, each individual study was analysed identifying the aims, the methodology and materials used and the results obtained.

RESULTS

29 clinical reports were identified in the search. The systematic analysis reduced the focus of review to 15 studies. The data available establishes ceramic intra-coronal restorations machined by the CEREC system as a clinically successful restorative method with a mean survival rate of 97.4% over a period of 4.2 years. The review also highlights the reasons and the rates of failure for this type of restoration. The predominant reasons for failures are fracture of the ceramic, fracture of the supporting tooth, postoperative hypersensitivity and wear of the interface lute.

SIGNIFICANCE

Machinable ceramics, as used by the CEREC system provide a useful restoration with a high success rate. These restorations are color stable and wear at a clinically acceptable rate. Wear of the luting composite on occlusal surfaces leads to the phenomenon of submargination. Ceramic fracture, wear at the interface and post-operative hypersensitivity remain a problem which require further investigation.

A 5-year clinical evaluation of ceramic inlays (Cerec) cemented with a dual-cured or chemically cured resin composite luting agent

Sixty-six class-II CAD/CAM-manufactured ceramic inlays (Cerec) were placed in 27 patients. Each patient received at least one inlay luted with a dual-cured resin composite and one inlay luted with a chemically cured resin composite. The inlays were examined 5 years after luting using the California Dental Association (CDA) criteria. Eighty-nine percent of the 66 inlays were rated 'satisfactory'. During the follow-up period replacement was required for 3 inlays because of inlay fractures (4.5%) and 1 inlay because of fracture of the tooth substance (1.5%). All those inlays were luted with the dual-cured resin composite luting agent. Of the remaining 62 inlays the CDA rating 'excellent' was given to 84% for color, 97% for surface, and 81% for anatomic form. 'Excellent' margin integrity was seen in 52% of the dual-cured resin composite luted inlays and in 61% of the chemically cured resin composite luted inlays. No statistically significant (P> 0.05) difference was observed between the two luting agents.

Fired ceramic inlays: a 6-year follow up

OBJECTIVES

The aim of this study was to evaluate feldspathic ceramic inlays luted with dual-cured resin composite or glass polyalkenoate (ionomer) cement (GIC) during a 6-year follow-up.

METHODS

One-hundred and eighteen Class II fired feldspathic ceramic inlays were placed in 50 patients. In each patient half of the inlays were luted with a dual-cured resin composite and the other half with a conventional glass ionomer cement. The inlays were evaluated clinically, according to modified USPHS criteria, at baseline, after 6 months and then annually over a 6-year period.

RESULTS

Of the 115 inlays evaluated at 6 years, 12% in the resin composite group and 26% in the GIC group were assessed as having failed. The main reason for failure in both groups was partial fracture or total loss of the inlays. Secondary caries was found to be associated with three inlays in one high caries risk patient. One inlay was replaced because of postoperative sensitivity.

CONCLUSION

A relatively high and increasing failure rate was observed over the 6-year period of the study. The failure rate was more pronounced in the GIC group.

Filler content and gap width after luting of ceramic inlays, using the ultrasonic insertion technique and composite resin cements. An in vitro study

The effect of ultrasonic insertion on the filler content and the gap width for two brands of composite resin luting agents, intended for luting with the ultrasonic insertion technique, were studied after MOD ceramic inlays (Cerec) had been placed. In addition, the internal and marginal gap widths were determined after MOD ceramic inlays (Celay) bad been luted on extracted premolars with this technique. No statistically significant differences (P > 0.05) were observed for either brand between the filler content obtained from the internal surfaces, from the excess luting agent, or from the luting agent as delivered. There were no statistically significant differences (P > 0.05) between the final internal and marginal gap widths when the two brands of luting agent were compared with each other. Except for the final occlusal and internal gap widths obtained for the inlays luted with the Sono-Cem luting agent, no statistically significant differences (P > 0.05) were observed between the gap widths at the different locations determined. Thus, the ultrasonic insertion technique used did not significantly influence the filler ratio of the hybrid luting agents studied. Judged by the findings in this study, the properties of luting agents seem to greatly influence the final marginal and internal gap widths.

Review of dental materials citations: Part B, July to December 1995

OBJECTIVE

A lag of many months occurs between journal issue publication and updates to electronic databases. The objective of this literature analysis was to identify and categorize all of the dental materials citations in biomedical journals that were published from July 1995 through December 1995.

METHODS

Seventeen primary and 51 secondary journals were searched using their tables of contents to detect and record dental materials publications from July to December of 1995. Those journals that were typically rich in dental materials articles were classified as primary ones. Citations were categorized into 17 topics and divided into subsections. The review excluded case reports, most literature related primarily to dental implants, and most articles on biomedical materials used outside of the field of general dentistry.

RESULTS

The greatest number of citations was related to topics of dentin bonding and resin-based restorative filling materials (composites and glass ionomers). There was no major change in the number of dental materials publications per year reported from 1993 (n = 786) to 1995 (n = 751).

SIGNIFICANCE

This citation list provides a comprehensive resource for use by academicians and researchers to bridge the gap between initial publication and access to electronic searching methods for major databases.