The effect of different ceramic surface treatments on the repair bond strength of resin composite to lithium disilicate ceramic

Effect of brushing simulation on the wear behavior of repaired CAD-CAM restorations

OBJECTIVE

The aim of the present study was to evaluate the influence of multidirectional brushing on the surface roughness, morphology, and bonding interface of resin-repaired CAD-CAM ceramic and composite restorations.

MATERIALS AND METHODS

Twelve (N = 12) blocks (4 mm × 4 mm × 2 mm for parallel axis; 5 mm × 4 mm × 2 mm for perpendicular axis) of lithium disilicate glass-ceramic (IPS e.max CAD, Ivoclar AG) and CAD-CAM resin composite (Tetric CAD, Ivoclar AG) were obtained and repaired with direct resin composite (Clearfil AP-X, Kuraray). An abrasive slurry was prepared and the brushing was performed according to each restorative material and axis of brushing (n = 6; perpendicular to repair interface and parallel to repair interface) during 3,650 cycles (240 strokes per minute) to simulate 3 years of brushing. The surface roughness (Ra) and the profile variation for each material (restoration and direct repair resin composite) were measured at the baseline condition and after brushing, and the mean roughness and presence of steps at the repair interface were evaluated through factorial analysis of Variance (ANOVA). Scanning Electron Microscopy (SEM) images were taken to evaluate the surface topography of the repaired materials after brushing.

RESULTS

The mean roughness of the repaired CAD-CAM restorations was affected by the brushing (P < .05), mainly when evaluating the repair material and the interface (P < .05), while the restorative CAD-CAM materials presented more stable values. The profile evaluation showed higher steps at the interface when repairing lithium disilicate than for CAD-CAM resin composite.

CONCLUSION

Repaired CAD-CAM restorations were susceptible to wear after brushing simulation. The surface roughness of the direct resin composite was the most affected leading to step development at the interface, particularly in the repaired lithium disilicate samples. Cinical maintenance recalls and polishing protocols must be considered to enhance the longevity of such restorations.

Repair protocols for indirect monolithic restorations: a literature review

Despite the advancements in indirect monolithic restorations, technical complications may occur during function. To overcome this issues, intraoral repair using resin composite is a practical and low-cost procedure, being able to increase the restoration's longevity. This review aimed to evaluate the need for repair and suggest a standardized repair protocol to the main indirect restorative materials. For this, studies were surveyed from PubMed with no language or date restriction, to investigate the scientific evidence of indirect monolithic restoration repair with direct resin composite. A classification to guide clinical decisions was made based on the FDI World Dental Federation criteria about defective indirect restorations considering esthetic and functional standards, along with the patient's view, to decide when polishing, repairing or replacing a defective restoration. Based on 38 surveyed studies, different resin composite intraoral repair protocols, that included mechanical and chemical aspects, were defined depending on the substrate considering resin-based, glass-ceramic or zirconia restorations. The presented criteria and protocols were developed to guide the clinician's decision-making process regarding defective indirect monolithic restorations, prolonging longevity and increasing clinical success.

Adhesive Performance of Resin Cement to Glass-Ceramic and Polymer-Based Ceramic CAD/CAM Materials after Applying Self-Etching Ceramic Primer or Different Surface Treatments

Ensuring optimum bond strength during cementation is vital for restoration success, with the practicality of the process being crucial in clinical practice. This study analyzed the effect of a single-step self-etching ceramic primer (MEP) and various surface treatments on the microshear bond strength (µSBS) between resin cement and glass-ceramic or polymer-based ceramic CAD/CAM materials. Specimens were fabricated from leucite-based glass-ceramic (LEU), lithium disilicate glass-ceramic (LDC), resin nanoceramic (RNC), and polymer infiltrated ceramic network (PICN) (n = 160). They were then classified based on the surface treatments (n = 10): control (no treatment); sandblasting with Al2O3 (AL); etching with hydrofluoric acid (HF); and MEP application. Scanning electron microscopy was used to evaluate the surface topography. µSBS was measured after cementation and thermocycling procedures. Failure modes were examined with a stereomicroscope. Statistical analysis involved two-way analysis of variance and Tukey HSD tests with a significance level of 0.05. µSBS was significantly influenced by both surface treatment and CAD/CAM material type. The most enhanced µSBS values for each material, regarding the surface treatment, were: LEU and LDC, HF; RNC, AL; PICN, AL or HF. MEP significantly increased the µSBS values of CAD/CAM materials except RNC, yet it did not yield the highest µSBS values for any of them.

Do different protocols affect the success rate or bond strength of glass-ceramics repaired with composite resin? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Intraoral repair techniques prevent unnecessary replacement of ceramic restorations, thereby increasing the survival rate. However, adhesion between ceramics and the composite resin is challenging and how different protocols influence adhesion is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to analyze the influence of different protocols on repairing glass-ceramic surfaces with composite resins.

MATERIAL AND METHODS

PubMed, Scopus, ISI Web of Science, and Embase electronic databases were searched to select studies comparing bond strength values or survival rates of glass-ceramic repaired with composite resins using different surface treatment protocols. No publication year or language restriction was applied. Data sets were extracted from all included studies, and the mean differences calculated. A 95% confidence interval was calculated by using the random effect model (Rev Man 5.4).

RESULTS

The search identified 5037 studies, and 165 were assessed for eligibility. Finally, 123 in vitro studies were included in the systematic review and 48 in the meta-analysis. Considering different glass-ceramics, bond strength tests, and aged or not aged specimens, 37 meta-analyses found the effect of repair protocols: only adhesive, silane plus adhesive alone or preceded by hydrofluoric (HF) acid, airborne-particle abrasion (APA) with Al2O3 particles, silica-coated APA (SCAPA), diamond rotary instrument (DRI), and laser irradiation (LI).

CONCLUSIONS

For feldspathic porcelain, HF acid, APA, SCAPA, or DRI improved the repair micromechanical retention; applying silane is essential to HF-conditioned surfaces but the use of adhesive is optional when silane is applied. Results for leucite and lithium disilicate were inconclusive in terms of suggesting a treatment other than HF acid plus silane and adhesive applications.

Shear Bond Strength of Resin Luting Materials to Lithium Disilicate Ceramic: Correlation between Flexural Strength and Modulus of Elasticity

This study investigates the effect of the curing mode (dual-cure vs. self-cure) of resin cements (four self-adhesive and seven conventional cements) on their flexural strength and flexural modulus of elasticity, alongside their shear bond strength to lithium disilicate ceramics (LDS). The study aims to determine the relationship between the bond strength and LDS, and the flexural strength and flexural modulus of elasticity of resin cements. Twelve conventional or adhesive and self-adhesive resin cements were tested. The manufacturer's recommended pretreating agents were used where indicated. The shear bond strengths to LDS and the flexural strength and flexural modulus of elasticity of the cement were measured immediately after setting, after one day of storage in distilled water at 37 °C, and after 20,000 thermocycles (TC 20k). The relationship between the bond strength to LDS, flexural strength, and flexural modulus of elasticity of resin cements was investigated using a multiple linear regression analysis. For all resin cements, the shear bond strength, flexural strength, and flexural modulus of elasticity were lowest immediately after setting. A clear and significant difference between dual-curing and self-curing modes was observed in all resin cements immediately after setting, except for ResiCem EX. Regardless of the difference of the core-mode condition of all resin cements, flexural strengths were correlated with the LDS surface upon shear bond strengths (R² = 0.24, n = 69, p < 0.001) and the flexural modulus of elasticity was correlated with them (R² = 0.14, n = 69, p < 0.001). Multiple linear regression analyses revealed that the shear bond strength was 17.877 + 0.166, the flexural strength was 0.643, and the flexural modulus was (R² = 0.51, n = 69, p < 0.001). The flexural strength or flexural modulus of elasticity may be used to predict the bond strength of resin cements to LDS.