Effect of Various Surface Treatments of Zirconia on its Adhesive Properties to Dentin: An In Vitro Study

AIM

To assess the effectiveness of various surface treatments and adhesives on the bond strength of zirconia-based ceramic to dentin.

MATERIALS AND METHODS

Eighty samples of zirconia were subjected to the four-surface treatment protocols (sandblasting, 48% hydrofluoric acid (HF), 48% hydrofluoric acid + 70% nitric acid (HNO3) and no treatment (control) following which the samples from each group were subdivided into two subgroups (n = 10) based on the resin cement employed for cementation (RelyX U200 and G-Cem Linkforce). The bonded specimens were subjected to shear stress to measure the bond strength using Universal testing machine. To test the difference in bond strength among the eight study groups, the Kruskal-Wallis ANOVA test was applied and for comparison between cements in each group, Mann-Whitney U test was applied.

RESULTS

The highest bond strength values were observed for 48% HF group cemented with G-Cem Linkforce resin cement (16.220 ± 1.574) and lowest for control group-RelyX (4.954 ± 0.972). G-Cem cement showed higher bond strength than RelyX for all surface treatments except 48% HF + 70% nitric acid.

CONCLUSION

It can be inferred that 48% HF can etch zirconia and generate a porous structure that proves to be beneficial for bonding.

CLINICAL SIGNIFICANCE

The increasing demand for esthetics has led to the replacement of metal-ceramic materials with zirconia-based ceramics. However, the chemical inertness of zirconia to various conventional surface treating agents has continuously challenged researchers to discover a new surface treatment protocol that could enhance the bond strength of zirconia. How to cite this article: Yenamandra MS, Joseph A, Singh P, et al. Effect of Various Surface Treatments of Zirconia on its Adhesive Properties to Dentin: An In Vitro Study. J Contemp Dent Pract 2024;25(3):226-230.

Light transmittance through resin-matrix composite onlays adhered to resin-matrix cements or flowable composites

OBJECTIVE

The aim of this study was to evaluate the influence of the thickness of resin-matrix composite blocks manufactured by CAD-CAM on the light transmittance towards different resin-matrix cements or flowable composites.

METHODS

Sixty specimens of resin-matrix composite CAD-CAM blocks reinforced with 89 wt% inorganic fillers were cross-sectioned with 2 or 3 mm thicknesses. The specimens were conditioned with adhesive system and divided in groups according to the luting material, namely: two dual-cured resin-matrix cements, two traditional flowable resin-matrix composites, and one thermal-induced flowable resin-matrix composite. Specimens were light-cured at 900 mW/cm2 for 40s. Light transmittance assays were preformed using a spectrophotometer with an integrated monochromator before and after light-curing. Microstructural analysis was performed by optical and scanning electron microscopy (SEM). Nanoindentation tests were performed to evaluate mechanical properties for indirect evaluation of degree of monomers conversion.

RESULTS

Optical and SEM images revealed low thickness values for the cementation interfaces for the traditional flowable resin-matrix composite. The cement thickness increased with the size and content of inorganic fillers. The highest light transmittance was recorded for the onlay blocks cemented with the traditional flowable resin-matrix composites while a group cemented with the dual-cured resin-matrix cement revealed the lowest light transmittance. The elastic modulus and hardness increased for specimens with high content of inorganic fillers as well as it increased in function of the light transmittance.

CONCLUSIONS

The light transmittance of flowable resin-matrix composites was higher than that for resin-matrix cement after cementation to resin-matrix composites blocks. The type, size, and content of inorganic fillers of the luting material affected the thickness of the cement layer and light transmittance through the materials.

CLINICAL RELEVANCE

On chair-side light curing, the transmission of visible light can be interfered by the chemical composition and viscosity of the luting materials. The increase in size and content of inorganic fillers of resin-matrix composites and luting materials can decrease the light transmittance leading to inefficient polymerization.

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

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

Effect of glass-ceramic coating versus alumina air-abrasion on the bond strength and residual stress of zirconia

OBJECTIVES

To assess the effect of glass-ceramic coated zirconia versus alumina air-abraded zirconia on the shear bond strength (SBS) of resin cement and investigate the residual stresses present on both mechanically pre-treated surfaces.

MATERIALS AND METHODS

A total of 180 zirconia disks, with diameters of 10 mm and 5 mm, were divided into two groups: DCMhotbond glass-ceramic coated, followed by hydrofluoric acid etching (DCM), and alumina air-abraded (AB). All mechanically pre-treated disks were conditioned with G-Multi Primer and bonded using G-Cem Linkforce Cement. Ninety specimens were immersed in distilled water for 24 h and subsequently allocated into three groups based on aging conditions (n = 15/subgroups): immediate testing, 5000 thermal cycles, and 10,000 thermal cycles. Then, the shear bond strength was assessed, and the obtained data were subjected to analysis using a two-way ANOVA, followed by a one-way ANOVA and Tukey's HSD post hoc test (α = 0.05). The residual stresses present on both mechanically pre-treated surfaces were examined using X-ray diffraction analysis.

RESULTS

The mean SBS values of the DCM and AB groups showed no significant difference under each aging condition. The SBS of DCM groups was not affected by thermal cycles, whereas the SBS of AB groups exhibited a significant decrease following thermal cycles. Glass-ceramic coated surfaces exhibited higher compressive stresses than alumina air-abrasion.

CONCLUSIONS

The DCMhotbond glass-ceramic coated zirconia showed comparable bond strength to the alumina air-abrasion technique.

CLINICAL RELEVANCE

The DCMhotbond glass-ceramic coating technique is a promising alternative for zirconia surface pre-treatment. However, further investigations are needed before suggesting its clinical use.

Assessment of physical/mechanical properties and cytotoxicity of dual-cured resin cements containing Sr-bioactive glass nanoparticles and calcium phosphate

The aim was to develop dual-cured resin cements containing Sr-bioactive glass nanoparticles (Sr-BGNPs; 5 or 10 wt%) and monocalcium phosphate monohydrate (MCPM; 3 or 6 wt%). Effects of additives on degree of monomer conversion (DC), biaxial flexural strength/modulus, shear bond strength (SBS), mass/volume change, color stability, ion release, and cytotoxicity were examined. Controls included material without reactive fillers and Panavia SA Plus (PV). Experimental cements showed higher DC than PV regardless of light activation (p<0.05). Mean SBS and color stability were comparable between experimental cements and PV. Cell viability upon the exposure to sample extracts of experimental cements was 80%-92%. High additive concentrations led to lower strength and modulus than PV (p<0.05). The additives increased mass change, reduced color stability, and promoted ion release. The experimental resin cements demonstrated acceptable mechanical/chemical properties and cytotoxicity. The additives reduced the strength but provided ion release, a desirable action to prevent recurrent caries.

The load capacity of maxillary central incisor with simulated flared root canal restored with different fiber-reinforced composite post and cementation protocols

Background

This study aimed to evaluate the load capacity of maxillary central incisors with simulated flared root canal restored with different fiber-reinforced composite (FRC) post cemented with either self-adhesive or self-etch resin cement and its mode of fracture.

Methods

Sixty-five extracted maxillary incisors were decoronated, its canal was artificially flared and randomly categorized into group tFRC (tapered FRC post) (n = 22), mFRC (multi-FRC post) (n = 21), and DIS-FRC (direct individually shaped-FRC (DIS-FRC) post) (n = 22), which were further subdivided based on cementation resin. The posts were cemented and a standardized resin core was constructed. After thermocycling, the samples were loaded statically and the maximum load was recorded.

Results

The load capacity of the maxillary central incisor was influenced by the different FRC post system and not the resin cement (p = 0.289), and no significant interaction was found between them. Group mFRC (522.9N) yielded a significantly higher load capacity compared to DIS-FRC (421.1N). Overall, a 55% favorable fracture pattern was observed, and this was not statistically significant.

Conclusion

Within the limitation of the study, it can be concluded that prefabricated FRC posts outperform DIS-FRC posts in terms of the load capacity of a maxillary central incisor with a simulated flared root canal. The cementation methods whether a self-adhesive or self-etch resin cement, was not demonstrated to influence the load capacity of a maxillary central incisor with a flared root canal. There were no significant differences between the favorable and non-favorable fracture when FRC post systems were used to restored a maxillary central incisor with a flared root canal.

Fracture resistance of monolithic translucent zirconia crown bonded with different self-adhesive resin cement: influence of MDP-containing zirconia primer after aging

OBJECTIVES

Successful ceramic restorations depend on the strong bonding with resin cement and even stress distribution. The aim of this study was to evaluate the impact of adding MDP-containing zirconia primer before self-adhesive resin cements with different functional acidic monomers on fracture resistance of monolithic zirconia crown.

MATERIALS AND METHODS

Eighty defect-free human maxillary premolars were divided according to the cement type and application of MDP-containing zirconia primer into eight groups (n = 10): Calibra Universal (C), Calibra Universal combined with zirconia primer (CZ), RelyX U200 (R), RelyXU200 combined with zirconia primer (RZ), Panavia SA Cement Plus (P), Panavia SA Cement Plus combined with zirconia primer (PZ), Multilink Speed (M), and Multilink Speed combined with zirconia primer (MZ). After teeth preparation and fabrication of zirconia crowns, each crown was bonded to its corresponding tooth. All specimens were subjected to 10,000 thermocycles between 5 and 55°C, followed by cyclic load (50 N) for 240,000 cycles. Each specimen was subjected to a static axial load until fracture using universal testing machine and the fracture load was recorded. The fracture mode studied and recorded. The fracture load results were analyzed using two-way ANOVA test (α = 0.05).

RESULTS

A significant interaction (P = 0.038) of combining MDP-containing zirconia primer and cement type on fracture resistance of monolithic zirconia crown was detected. The mean fracture load values of zirconia crown were significantly influenced by the combined application of the MDP-containing zirconia primer with Calibra Universal (P = 0.01), RelyX U200 (P < 0.001), and Multilink Speed (P = 0.038), while there was no significant difference with Panavia SA Cement Plus (P = 0.660). There was significant difference (F = 20.69, P < 0.001) between the mean fracture loads of groups with self-adhesive cements (C, R, P, and M groups). The highest fracture load was recorded with RZ group (2446.90 ± 126.72 N) while the lowest fracture load was recorded with C group (1623.18 ± 149.86 N).

CONCLUSIONS

The self-adhesive resin cement with different acidic functional monomer affects the fracture resistance of monolithic zirconia crown. Application of MDP-containing primer could improve the fracture resistance of monolithic zirconia crown with most self-adhesive cements. The application of an MDP-containing primer had no impact on the fracture resistance of monolithic translucent zirconia crown bonded by MDP-containing self-adhesive resin cement.

Analysis of the effect of thermocycling on bonding cements to zirconia

Objective

The aim of this study was to evaluate the effect of thermocycling on shear bond strength (SBS) of several resin cement materials to different types of zirconia dental ceramics.

Materials and Methods

120 square shaped disc specimens were fabricated using two types of zirconia blocks (Sagemax and Sirona). Each zirconia group was divided into three sub-groups based on the resin cement bonded to the specimens. Three different self-adhesive resin cements were used (Calibra, Breeze and RelyX). The specimens were further grouped into experimental and control groups (n = 10). The experimental specimens were exposed to a thermo-cycling protocol of 1500 cycles in water bath at 5c and 55c. Specimens were then stored at 37c for 24 h then all specimens underwent SBS test with an Instron machine. Mode of failure was inspected visually and microscopically. Data were statistically analyzed using multivariate analysis of variance followed by one-way analysis of variance, Tukey's multiple comparison test, student's t-test for independent samples were used to compare the mean values of SBS in relation to the categorical study variables.

Results

The mean SBS values of experimental groups were significantly lower than control groups for all the 6 combinations of Zirconia and cement types (p < 0.0001). The higher mean difference (14.29 MPa) was observed in the combination of Sagemax and Rely-X. Rely-X displayed the highest SBS among all the cements while no significant difference was found in mean SBS values of Calibra and Breez cements in all groups. The mean SBS values of Sagemax zirconia were significantly higher than the Sirona with all three types of cements (p < 0.0001) within control groups. Microscopic and visual analysis demonstrated a majority of adhesive mode of failure.

Conclusion

Thermocycling significantly reduced the SBS between the zirconia materials and self-adhesive resin cements tested. The amount of reduction varies according to cement and zirconia types.

Effect of apical root resection, orthodontic extrusion, and surgical crown lengthening on load capability

OBJECTIVES

This study aims to investigate the load-to-fracture of procedures changing crown-to-root ratio (RCRR) aimed to restore severely damaged upper central incisors to avoid tooth extraction compared to implant placement. There is no evidence on load capability after apical root resection (AR), orthodontic extrusion (OE), and surgical crown lengthening (SCL) in respect to RCRR, respectively.

MATERIAL AND METHODS

Human maxillary central incisors were endodontically treated, decoronated, and divided into 4 groups (n = 48). The following specimen preparation was performed: (I) adhesive core-and-post build-up (control), (II) as (I) and 2 mm apical root resection (AR), (III) before adhesive core-and-post build-up teeth were shortened 2 mm coronally (OE) (IV) as (I), but specimens were embedded 4 mm instead of 2 mm below the CEJ (SCL), group (V) implant-borne restoration with individual all-ceramic abutments (n = 12; ∅4.1/l = 12 mm) (IBR). All specimens received all-ceramic crowns, thermo-mechanical (TML), and subsequent linear loading (LL) until failure. RCRR were calculated and log-rank, Kruskal-Wallis, Mann-Whitney U, ANOVA, and chi-square tests applied (p = 0.05).

RESULTS

Fracture loads after subsequent LL differed significantly (p = 0.001) between groups, while implants showed the highest values. Fmax median (min/max) were as follows: (I) 252 (204/542), (II) 293 (243/443), (III) 253 (183/371), (IV) 195 (140/274), and (V) 446 (370/539). Pair-wise comparison showed significant differences (p = 0.001) between group I/IV and group V, I, and IV (p = 0.045), II and IV (p = 0.001), and III compared to IV (p = 0.033), respectively. RCRR below 1 significantly increased load capability compared to RCRR = 1.

CONCLUSIONS

OE appears to preferably ensure biomechanical stability of teeth that are endodontically treated and receive core-and-post and crown placement compared to SCL. AR has no adverse biomechanical impact. RCRR < 1 is biomechanically beneficial.

CLINICAL RELEVANCE

For endodontically treated and restored teeth, orthodontic extrusion should be preferred compared to surgical crown lengthening prior single-crown restoration. As orthodontic extrusion, apical root resection has no adverse effect on load capability. Single-crown implant-borne restorations are most load capable.

In vitro study on how photodynamic therapy and calcium hydroxide medication influence adhesive interface properties of glass-fiber posts to intraradicular dentin

PURPOSE

This in vitro study evaluated the influence of antimicrobial photodynamic therapy (aPDT), using methylene blue (MB) as photosensitizer (PS) and calcium hydroxide (CH) as intracanal medication on adhesive bond strength, sealing, and integrity of the luting interface of glass-fiber posts to different thirds of endodontically treated root canal dentin.

MATERIAL AND METHODS

102 incisors were sorted into 6 groups: a negative control irrigated with deionized water; a positive control irrigated with deionized water and filled with CH; CH + MB 50 mg/L without laser radiation; CH + MB 100 mg/L without laser radiation; CH + MB 50 mg/L radiated by red laser; and CH + MB 100 mg/L radiated by red laser. Push-out bond strength (n = 8), adhesive interface sealing (n = 3), and volume and quantification of voids (n = 6) were assessed using a universal testing machine, confocal laser scanning microscope, and computerized microtomography, respectively. Scanning electron micrographs were obtained from representative samples to qualify the fracture patterns. Push-out bond strength and adhesive interface integrity data were subjected to 2-way ANOVA for repeated measures followed by Tukey's test (α = 0.05). Adhesive interface sealing was evaluated by the inter-examiner Kappa test and submitted to Kruskal-Wallis and Dunns tests (α = 0.05).

RESULTS

Assessing the apical region, the positive control and MB_100WA + Ca(OH)₂ groups showed lower adhesive bond strength compared to the MB_100A + Ca(OH)₂ group (P < 0.05). The cervical third showed higher bond strength than the apical third for the positive control, MB_50WA + Ca(OH)_2, MB_100WA + Ca(OH)_2, and MB_50A + Ca(OH)₂ groups (P < 0.05). A prevalence of mixed failure was observed in all experimental groups. There were no statistically significant differences in adhesive interface sealing for any of the parameters assessed (P > 0.05). MB_100WA + Ca(OH)₂ and MB_100A + Ca(OH)₂ groups promoted a higher volume and quantification of voids compared to the negative control group evaluating the cervical third (P < 0.05). In general, there were no differences in the quantification of voids comparing the intraradicular thirds (P > 0.05), differently to the volume of voids in which, in general, the cervical third promoted higher values compared to the middle and apical thirds (P < 0.05).

CONCLUSION

aPDT with methylene blue PS at 50 mg/L associated with calcium hydroxide as intracanal medication demonstrated satisfactory bond strength, sealing, and integrity of the adhesive interface at any intraradicular depth.

Weak adhesion between ceramic and resin cement impairs the load-bearing capacity under fatigue of lithium disilicate glass-ceramic crowns

OBJECTIVE

To evaluate the fatigue behavior of lithium disilicate crowns with a simplified anatomy against progressive cement/ceramic debonding scenarios.

MATERIALS AND METHODS

Lithium disilicate crowns were fabricated via CAD/CAM and luted onto a dentin analogue material using resin cement following the manufacturer's instructions. Then, the different crown regions were isolated with paraffin oil for the absence of chemical adhesion according to four experimental groups (n = 15): Shoulder; Shoulder + Axial; Fully isolated; and Control (no insulation/fully bonded). Load to failure tests (n = 3) were run to determine cyclic fatigue parameters, and the specimens were subsequently submitted to a cyclic fatigue test (n = 12) (initial load 200 N for 5000 cycles, step 100 N, 15,000 cycles/step, frequency 20 Hz) until cracks were observed, and later fracture. The data were analyzed by Kaplan-Meier + Mantel-Cox post-hoc tests for both outcomes (cracks and fracture). Fractographic, cross-sectional surface, and finite element (FEA) analyzes were performed.

RESULTS

When it comes to crack occurrence when the chemical adhesion to the occlusal surface is compromised, there is worsening (p < 0.05) in fatigue behavior compared to groups where the occlusal portion of the crown is still bonded. Considering fracture occurrence, there was no difference (p > 0.05) among the tested groups. All cracks occurred in the occlusal portion, first as a radial crack at the ceramic intaglio surface, and posteriorly unleashing a Hertzian cone crack at the top surface, resulting in fractures on the frontal walls. The interface analysis showed no interference of the insulating agent. FEA showed that as the isolated areas increased, there was also an increase in both tensile and shear stresses concentration in the crown and in the cement layer.

CONCLUSION

The chemical adhesion between cement and ceramic is essential for better fatigue behavior of lithium disilicate crowns with a simplified anatomy, especially in the occlusal portion, but the restoration performance is impaired when such adhesion is compromised. There is an increase in crown and cement stress concentration with the progressive loss of chemical bonding of the crown's walls.

Resin-bonded bridge as a simplified approach to restore missing teeth in esthetic zone by conventional and digital techniques

One of the most challenging esthetic concerns in dentistry is conservative replacement of the missing anterior teeth. Although implants are considered to be a better treatment option for rehabilitation of such patients, resin-bonded bridges (RBBs) can conservatively restore the missing teeth and have thus gained popularity over the years. It consists of an artificial tooth with a wing-like extension that is cemented to the adjacent teeth. There are various types of RBBs among which Maryland bridge is the simplest and the popular most due to its micromechanical retention enabled by acid etching of both tooth and metal retainer. It can be fabricated by various techniques and materials. In this case reports, we have discussed about two unique designs of Maryland bridge fabricated by two different materials (Porcelain-fused metal and Graphene) and utilizing two different techniques (conventional and digital).

Current Protocols for Resin-Bonded Dental Ceramics

Resin-bonded ceramic restorations are common treatment options. Clinical longevity of resin-bonded ceramic restorations depends on the quality and durability of the resin-ceramic bond. The type and composition of the specific ceramic determines the selection of the most effective bonding protocol. Such protocol typically includes a surface pretreatment step followed by application of a priming agent. Understanding of fundamental ceramic properties and chemical compositions enables the clinician to make proper material selection decisions for clinically successful and long-lasting restorations. Based on research accrued over the past decades, this article reviews and discusses current resin-bonding protocols to most commonly used dental ceramics.

Digital image analysis of fluorescence of ceramic veneers with different ceramic materials and resin cements

The objective of this study was to analyze the effect of the type of ceramics and resin cements on the fluorescence of ceramic veneers under the 405 nm UV-light by digital imaging. One hundred and ninety-two veneers were fabricated using three types of ceramics (IPS e.max CAD, IPS Empress CAD, and Zenostar). Eight pieces of substrates were made of resin-nano-ceramic (Lava Ultimate). The level of fluorescence for each sample cemented with the substrate using three kinds of resin cements (RelyX U200, Variolink N, and Choice 2) was analyzed by using histogram data of luminosity from Adobe Photoshop software. Furthermore, the fluorescence values were evaluated by two-way ANOVA and Tukey's test. The highest fluorescence values were observed for the IPS e.max CAD cemented with Choice 2 cement, followed by IPS Empress CAD, and Zenostar the lowest. The final fluorescence intensity of ceramic veneer is affected by ceramic materials and resin cements.

Degree of conversion of resin-cements (light-cured/dual-cured) under different thicknesses of vitreous ceramics: systematic review

PURPOSE

This systematic review synthesized and analyzed the scientific evidence on the degree of conversion (DC) obtained by Fourier-transform infrared spectroscopy (FTIR) of light-cured and dual-cured resinous cements, photopolymerized under different thicknesses of vitreous ceramics.

STUDY SELECTION

The study protocol of this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017069319). A comprehensive search (PubMed/MEDLINE, Scopus, EMBASE, and LILACS) was performed for papers including an in vitro design and indexed from January 2007 to December 2020 according to the study purposes. A quality appraisal (specific instrument) and descriptive analysis of the articles that met the inclusion criteria were conducted.

RESULTS

Nine included studies were analyzed. Two of them used feldspathic ceramics, six used lithium disilicate, and one used both (comparing different types and opacities of ceramics). Three studies found a higher DC in dual cements, while one did not find any significant differences, and five studies found a higher DC in light-cured resin cements. Light-cured cements showed a better DC in relation to dual-cured cements in vitreous ceramic restorations with thicknesses up to 2 mm.

CONCLUSION

According to the findings, the use of good photoactivation is the most relevant variable to achieve an adequate DC in light-cured and dual-cured resin cements. The use of vitreous ceramic restorations with a thickness of less than 2 mm (light-curing cements) shows a better DC. Standardized in vitro studies are required to generate accurate scientific evidence.

Push-out bond strength and failure mode of single adjustable and customized glass fiber posts

Purpose

To evaluate the push-out bond strength (PBS) and failure mode of single adjustable (SAP) and customized (CP) posts cemented to root canal dentin using conventional (RelyX Ultimate) or self-adhesive (RelyX U200) dual-cure resin cements.

Methods

Herein, 40 bovine mandibular incisors were divided into four groups (n = 10): SAP cemented with RelyX Ultimate (SAP-UT), SAP cemented with RelyX U200 (SAP-U2), CP cemented with RelyX Ultimate (CP-UT), and CP cemented with RelyX U200 (CP-U2). PBS and failure modes were analyzed. Three-way repeated measures ANOVA test followed by Tukey’s test and Fisher–Freeman–Halton exact test were used for data analysis (α = 5%).

Results

The PBS values for SAP (p < .05) were higher than those for CP and were not influenced by the root third and resin cement (p > .05). When conventional resin cement was used, the SAP showed significant differences compared to CP (p < .05). When cemented with RelyX Ultimate, a higher prevalence of mixed and adhesive failures for SAP and CP, respectively, was observed (p < .05). For the self-adhesive resin cement, the failures were mostly adhesive (p < .05).

Conclusion

SAP showed better performance than CP. The root third and resin cements did not influence the PBS. The most prevalent failures were adhesive and mixed.

Bonding properties of third-generation zirconia CAD-CAM blocks for monolithic restorations to composite and resin-modified glass-ionomer cements

PURPOSE

To compare the interfacial fracture toughness (IFT) of two MDP-based composite cements and a resin-modified glass-ionomer cement (RMGIC) with third-generation zirconia CAD-CAM restorations using two different airborne-particle abrasion (AB) pressures.

METHODS

Blocks were cut into prisms (n=60), split and sintered to the desired equilateral half prisms. Half-prisms were divided into two groups for AB at 0.5 or 2.5 bar with 50 µm Al₂O₃ particles. Each group was then further divided into 3 subgroups, and half-prisms were bonded to their counterparts with Panavia V5 (V5), Panavia Self Adhesive Cement Plus (SA), or RMGIC Fuji Plus (n=10/group). The IFT was determined using the Notchless Triangular Prism test in a water bath at 36°C after thermocycling (10,000 cycles). Surface roughness and SEM analyses were performed for representative zirconia samples after AB, and composite cements were tested for flexural strength and wettability.

RESULTS

SA (2.5 bar) showed a significantly higher IFT. The 3 other groups with SA and V5 showed no significant difference in their IFT values regardless of the AB pressure (1-way ANOVA). Weibull analysis of SA was higher than V5. All RMGIC samples debonded while thermocycling, and were, therefore, not included in the statistical analysis. Surface roughness increased with increasing AB pressure, and both cements showed similar flexural strength values and good wettability.

CONCLUSION

Contrary to RMGIC, composite cements show high performance with zirconia after AB. Increasing AB pressure enhances the micromechanical retention of composite cement. Future perspectives should include study of the effect of AB pressure on zirconia surface properties.

The effect of thermocyclic aging on color stability of high translucency monolithic lithium disilicate and zirconia ceramics luted with different resin cements: an in vitro study

Background

High-translucency monolithic zirconia were developed to combine the esthetics of all ceramic restorations with the strength properties of zirconia. The purpose of this study was to compare the color stability of high-translucency monolithic zirconia ceramics with lithium disilicate luted using light-cure versus dual-cure resin cements following thermocyclic aging.

Methods

Forty specimens, each composed of 10 × 10 × 1 mm ceramic slice luted to dentin surface of an extracted tooth, were prepared and assigned into four groups (n = 10) as follows; LiDi/LC: lithium disilicate luted by light-cure resin cement; LiDi/DC: lithium disilicate luted by dual-cure resin cement; Zr/LC: zirconia luted by light-cure resin cement; and Zr/DC: zirconia luted by dual-cure resin cement. Color analysis of the specimens was performed before and after 3000 thermal cycles by means of spectrophotometry. The CIE L*a*b* values of the specimens were measured, and data were analyzed statistically at a significance value of p < 0.05.

Results

Thermocycling resulted in a significant change in color coordinates of specimens with an overall ΔE = 3.59 ± 1.60, but there was no statistically significant difference in the color change value among all tested groups (P = 0.756).

Conclusions

At 1 mm restoration thickness, the color stability of high-translucency monolithic lithium disilicate and zirconia ceramics were not significantly different irrespective of the cement type used.

Clinical implication Understanding the difference in color stability of dental ceramics may help in determining long-term esthetic result.

The effect of silane and universal adhesives on the micro-shear bond strength of current resin-matrix ceramics

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.

Novel testing method to evaluate the mechanical strength of self-adhesive resin cements with reflection of cement thickness

This study aimed to propose an evaluation method for testing the mechanical strength of film-formed self-adhesive resin cements (SARCs) while reflecting cement layer thickness. Three commercially available dual-cure type SARCs were used for tensile and shear tests using specimens with varying thicknesses (0.05, 0.2, and 0.4 mm). There were no significant differences in tensile strengths among the various specimen thicknesses. In the shear test, there was a significant decrease in the strength with a reduction in specimen thickness. Stress distribution and fracture patterns were analyzed using in silico nonlinear dynamic finite element analysis. Finite element analysis demonstrated that stress distribution on the specimen surface was homogeneous even with different thicknesses in the tensile test, whereas it was inhomogeneous and induced different fracture patterns on the 0.05-mm-thick specimen in the shear test. These results suggest that the tensile test is useful for testing the mechanical strength of film-formed SARCs.

Effect of cement space on marginal discrepancy and retention of CAD/CAM crown

This research aimed to evaluate the effect of cement space on the marginal discrepancy and retention of computer-aided design/computer-aided manufacturing (CAD/CAM) crowns. A total of 30 premolar Frasaco teeth were machined to receive crowns with cement spaces of 70, 90, and 110 μm. The marginal discrepancy measurements were done before and after cementation. Pull-off test was conducted using universal testing machine (UTM). Data was analyzed using two-way mixed ANOVA with post-hoc Bonferroni test and Kruskal-Wallis test. The crowns with cement space of 70 μm showed a significantly higher absolute marginal discrepancy than those with 90 and 110 μm. No significant effect on the crown retention was found. Within the limitations of this study, modifying cement space to 90 μm and 110 μm may improve the marginal adaptation of CAD/CAM crown, whereas adjusting cement space from 70 to 110 μm did not significantly affect the crown retention.

Effect of epigallocatechin-3-gallate and thermal cycling on the bond strength of resin cements to the root dentin

This study evaluated the effect of epigallocatechin-3-gallate (EGCG) solution and thermal cycling on the bond strength (BS) of fiber posts to the root dentin using two different resin cements (conventional or self-adhesive). One hundred and forty-four bovine roots were endodontically treated. After post space preparation, specimens were randomly divided into six groups (n = 24) according to dentin pretreatment [distilled water, 0.05% EGCG solution or 2% chlorhexidine (CHX) solution] and resin luting agent used for fiber post cementation (RelyX ARC or RelyX U200-3 M ESPE). Then, the samples were separated into two subgroups (n = 12): storage in distilled water at 37 °C for 24 h and thermal cycling (5 °C/55 °C, dwell time 30 s-12,000 cycles) during 6 months. After that, the specimens were subjected to the pull-out BS test (Universal Testing Machine-0.5 mm/min) and the failures pattern was analyzed in a stereomicroscope. According to the BS results (three-way ANOVA, Tukey's test, α = 0.05), the highest values were reported in the group EGCG + RelyX U200, showing significant statistical differences compared to all the other experimental groups. For Control and CHX groups BS values, there was no significant difference (p > .05) between the resin cements. For conventional resin cement, there was no significant difference among treatment solutions (p > .05). The thermal cycling did not influence the BS results (p > .05). As reported by the failure mode analysis, adhesive failure was predominant in all groups. EGCG solution improved the bond strength of self-adhesive resin cement to root dentin.

Development of novel measurement method for consistency of resin cements

The aim of this study was to develop a new method to evaluate the consistency of resin cements by modeling the operation of setting a crown. First, the weight of the resin cements and the inner surface area of the crown were measured to configure the conditions for consistency evaluation using a model abutment tooth and a model crown. As the evaluation method, a 200 mm² contact surface area of a glass plate was placed on top of 30.0 mg of resin cement paste, and a pressure of 10.0 N was applied to the glass plate. When the paste was spread over the entire bottom surface of the glass plate, it was designated a "Pass". A "Pass" result was obtained for all resin cements tested and a "Fail" result for all resin composites, indicating the usefulness of the new method for assessing cement flowability when setting a crown.

Evaluation of various methods of methylene blue removal from the post space after photodynamic therapy on the bonding interface using different resin cementation systems

BACKGROUND

To evaluate the effects of three protocols for removing 0.01 % methylene blue from the post space after photodynamic therapy on bond strength and tag formation in the dentin of the fiber post space, using a conventional cementation system with an etch-and-rinse or universal adhesive system.

METHODS

Sixty human canines were endodontically treated for fiber post cementation. The specimens were randomized into 6 groups (n = 10): G1, G2, G3, G4, G5, and G6. The G1, G2, and G3 groups were irrigated with saline solution, 2.5 % sodium hypochlorite (NaOCl), and 2.5 % NaOCl, agitated by passive ultrasonic irrigation (PUI), respectively. In these groups, a conventional cementation system with etch-and-rinse adhesive was used. The G4, G5, and G6 groups were irrigated with the respective solutions mentioned above and cemented using a conventional cementation system with universal adhesive. Tag formation in the dentin was evaluated by confocal laser scanning microscopy. The push-out bond strength test was performed on three thirds of the specimens.

RESULTS

In the cervical and middle thirds, the greatest extent of dentin tag formation occurred in the G1 (p = 0.023 and p = 0.033, respectively). In the apical third, G1, G2, and G3 demonstrated similar tag formation between themselves (p = 0.089). In the cervical and middle thirds, G4 demonstrated the highest bond strength when compared to the other groups (p < 0.05).

CONCLUSION

The protocols for removing 0.01 % methylene blue with NaOCl, irrespective of the involvement of passive ultrasonic irrigation, negatively effects the bond strength and tag formation in the dentin of the post space.

[Effects of different surface treatments on the bonding strength between the lithium disilicate glass ceramic and resin cements]

Objective: To investigate the effects of different surface treatments protocol on the bonding strength between lithium disilicate glass ceramic and resin cements. Methods: Ceramic specimens of 15 mm×13 mm×3 mm were used to evaluate the effects of different surface treatments of hydrofluoric acid etching and silane coupling in current research. Firstly, the standard lithium ceramic specimens were divided into 8 groups (n=16), and were etched by 4.5% hydrofluoric acid for 0, 10, 20, 30, 40, 60, 120 and180 s. Then specimens in each group was further divided into two sub-groups. In one sub-group specimens were coated with coupling agents and in the other were not. Shear bonding strength (SBS) and failure mode were tested and analyzed. The surface morphologies of hydrofluoric acid-etched ceramic specimens were observed by the scanning electron microscopy (SEM). Secondly, after being etched by 4.5% hydrofluoric acid for 30 s, the lithium ceramic specimens were coated with coupling agents at different temperatures: room temperature (12 ℃) for 60 s, 60 ℃ hot air for 60 s and 100 ℃ hot air for 60 s (n=8). SBS and fracture mode were tested and analyzed. The infrared spectrum analysis was used to characterize the coupled surfaces of the ceramic samples. Results: The maximum SBS values were obtained after the specimens were etched for 30 s. The silane coupled group showed a higher SBS value [(25.91±4.30) MPa, P<0.05] than the no-silane-coupled group [(20.27±4.92) MPa]. SBS decreased with extended etching time (>30 s) and the SEM photos showed over-etching morphologies. The 60 ℃ hot air treatment resulted in the maximum SBS value [(28.70±5.32) MPa] than that of the room temperature [(20.08±3.64) MPa] or 100 ℃ hot air [(25.64±4.86) MPa, P<0.05]. And the cohesive failure mode was found in 60 ℃ hot air treatment group. The infrared spectroscopy analysis showed the highest amount of silicon oxide bond in the 60 ℃ hot air treatment group. Conclusions: In this study, for this product, the optimum etching time of 4.5% hydrofluoric acid was 30 s. Furthermore, an ideal SBS value could be obtained when the silane coupling agents were applied additionally. SBS could be increased substantially when the 30 s-etched-ceramic product was coated with silane coupling agents at 60 ℃ hot air for 60 s.

The effect of curing mode of dual-cure resin cements on bonding performance of universal adhesives to enamel, dentin and various restorative materials

The effect of curing mode of dual-cure resin cements on the tensile bond strength (TBS) of universal adhesives to enamel, dentin, zirconia, lithium disilicate ceramics (LDS), feldspathic porcelain (FP), and a Pd-Au alloy was evaluated. The substrates were bonded using Tokuyama Universal Bond (TUB) or Scotchbond Universal Adhesive (SBU), followed by luting with Estecem II (ECII) or Rely-X Ultimate (RXU), respectively, which were used either in light-curing or self-curing mode. The TBS test was performed after 24 h or 5,000 thermal cycles. Light-curing significantly improved the 24-h TBS of TUB/ECII to enamel, dentin and FP, as well as the TBS of SBU/RXU to all substrates except LDS. After thermal cycling, light-curing significantly increased the TBS of both adhesives/cements to dentin, but significant differences between curing modes were seldom observed for other substrates. This suggested that light-curing is essential for the hydrophilic dentin, but self-curing might be sufficient for other substrates.

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.

Influence of a propolis-based irrigant solution on gap formation and bond strength of posts bonded to root canal dentin using different resin cements

This study evaluated the influence of an aqueous propolis-based solution (PROP) on gap formation and bond strength of posts bonded to root canal dentin using resin cements. Endodontically-treated bovine incisors received different irrigation protocols: 1) 2.5% sodium hypochlorite (NaOCl)/17% EDTA/NaOCl; 2) saline solution (NaCl)/EDTA/0.12% chlorhexidine (CHX); 3) NaOCl/PROP/NaOCl; 4) NaCl/PROP/CHX; 5) NaCl/PROP/NaCl. Posts were then bonded with cements: RelyX ARC; Panavia F2.0; or RelyX U200 (n=10). The specimens were cross-sectioned. Gaps were assessed and performed the push-out bond strength test. Surface roughness of dentin fragments was also evaluated. Statistical analysis was performed (5%). RelyX U200 exhibited greater gap-free interfaces. Bond strength varied as a function of cements and irrigation protocols. PROP irrigation had no negative effect on the bond strength (p>0.05). Roughness increased significantly after NaOCl/EDTA/NaOCl, but remained unaltered after PROP irrigation protocols. Propolis-based irrigation protocols do not interfere in the bonding performance of posts cemented to root canal dentin.

Influence of 10-MDP concentration on the adhesion and physical properties of self-adhesive resin cements

Objectives

Self-adhesive resin cements contain functional monomers that enable them to adhere to the tooth structure without a separate adhesive or etchant. One of the most stable functional monomers used for chemical bonding to calcium in hydroxyapatite is 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP). The aim of this study was to evaluate the influence of the10-MDP concentration on the bond strength and physical properties of self-adhesive resin cements.

Materials and Methods

We used experimental resin cements containing 3 different concentrations of 10-MDP: 3.3 wt% (RC1), 6.6 wt% (RC2), or 9.9 wt% (RC3). The micro-tensile bond strength of each resin cement to dentin and a hybrid resin block (Estenia C&B, Kuraray Noritake Dental) was measured, and the fractured surface morphology was analyzed. Further, the flexural strength of the resin cements was measured using the three-point bending test. The water sorption and solubility of the cements following 30 days of immersion in water were measured.

Results

The bond strength of RC2 was significantly higher than that of RC1. There was no significant difference between the bond strength of RC2 and that of RC3. The water sorption of RC3 was higher than that of any other cement. There were no significant differences in the three-point bending strength or water solubility among all three types of cements.

Conclusions

Within the limitations of this study, it is suggested that 6.6 wt% 10-MDP showed superior properties than 3.3 wt% or 9.9 wt% 10-MDP in self-adhesive resin cement.

[Color stability of computer aided design and computer aided manufacture composite ceramic/resin cements after accelerated ageing]

Objective: To investigate the color stability of computer aided design and computer aided manufacture (CAD/CAM) composite ceramic/resin cements after accelerated ageing. Methods: Twelve groups (ten samples each group) were used as experimental groups, which were composed of CAD/CAM composite ceramic of three kinds of thickness (0.50, 0.75, 1.00 mm) (Lava Ultimate) associated with resin cements (Variolink N) of four colors (A1, A3, T, BL1). Another three groups of CAD/CAM composite ceramic/resin cements of three different kinds of thickness (0.50, 0.75, 1.00 mm) were used as control groups (ten samples each group). All samples were put into the xenon lamp ageing instrument to implement accelerated ageing. Spectrophotometers were used to measure the lightness (L(*)), red green color value (a(*)) and blue yellow color value (b(*)) of all samples before and after accelerated ageing process, and the changes of color variation (ΔE) was calculated. The effect of composite ceramic thickness and resin cement color on the changes of color variation (ΔE) before and after the ageing of CAD/CAM composite ceramic/resin cement and whether there was an interaction between them were tested by two-way ANOVA. Results: Before and after accelerated ageing, the ΔE of CAD/CAM composite ceramic/resin cements were <3.3. Two-way ANOVA showed that the thickness of CAD/CAM composite ceramics had an effect on ΔE (F=27.025, P<0.001), and the color of resin cement also had an effect on ΔE (F=15.606, P<0.001), but there was no interaction between them (F=0.534, P=0.829). Conclusions: The thickness of CAD/CAM composite ceramics and the color of resin cements could both affect the color stability of composite ceramic/resin cements combination. However, the resulted color change is within the clinically acceptable range.

Influence of N-(2-hydroxyethyl)acrylamide addition in light- and dual-cured resin cements

OBJECTIVE

To develop experimental light-cured (L) and dual-cured (D) resin cements containing N-(2-hydroxyethyl)acrylamide and evaluate the physicochemical and optical properties.

METHODS

Experimental resin cements were formulated using bisphenol A-glycidyl dimethacrylate (70%) and 2-hydroxyethyl methacrylate (30%), in the control groups, and, bisphenol A-glycidyl dimethacrylate (70%) and N-(2-hydroxyethyl)acrylamide (30%). Polymerization kinetics were evaluated by differential scanning calorimetry (n = 3), softening in solvent (ΔKHN) evaluated by the difference of Knoop microhardness before (KHN₁) and after (KHN₂) ethanol solution immersion (n = 5), radiopacity in mmAl (n = 5), film thickness (n = 3) and color stability were evaluated. Mechanical properties as ultimate tensile strength (UTS) and micro-shear bond strength (μSBS) were analyzed immediately and after 6 months. Results were analyzed using ANOVA, Tukey's test and Student's t-test (α = 0.050).

RESULTS

The L_HEAA1 group had no statistical difference from the control group regarding polymerization kinetics, KHN₁, ΔKHN and color stability (p > 0.050). In dual-cured cements, the acrylamide groups presented a lower degree of conversion and higher ΔKHN than the D_HEMA0.6 group, which obtained a higher rate of polymerization (p < 0.050). There was no statistical difference in radiopacity and film thickness (p > 0.050). Dual-cured cements with N-(2-hydroxyethyl)acrylamide showed higher color change than methacrylates. Immediate mechanical properties were lower for acrylamide groups (p < 0.050), with higher hydrolytic stability.

CONCLUSIONS

The addition of N-(2-hydroxyethyl)acrylamide negatively affected the properties of the dual-cured resin cements. LHEAA1 did not differ in physicochemical and optical properties from the control, with higher hydrolytic stability.

CLINICAL SIGNIFICANCE

The results of the study indicate that acrylamides increased mechanical properties over time independently of the curing system mode, with more hydrolytic stability. The clinical performance of experimental resin cements should be evaluated.

Hydroxyapatite coating effect on the bond strength between CAD/CAM materials and a resin cement

The purpose of this study was to evaluate the bond strength between CAD/CAM materials and a resin cement using hydroxyapatite coating as a surface treatment method. Different surface treatments (Control, no treatment-C; Sandblasting-SB; Hydrofluoric acid etching-HF; applying tooth desensitizer-TeM; applying topical crème-ToM, HAp coating with Pulse Laser Deposition technique-PLD) were applied to three different CAD/CAM materials (LAVA Ultimate, VITA Enamic, and Cerec Blocs). After surface treatments, a universal adhesive (Single Bond Universal, 3M ESPE) was applied and adhesive resin (Rely X Ultimate, 3M ESPE) were cemented on each material surface using plastic tubes (4 mm in diameter). The shear bond strength values were measured using a universal testing machine. Scanning electron microscope analysis were performed to evaluate failure modes and effects of surface treatments. Obtained data were statistically analyzed using two-way ANOVA and Tukey's post hoc test (p = 0.05). The bond strength of PLD groups were significantly higher than other groups in resin-ceramics (p < 0.05). In Cerec Blocs, HF resulted significantly higher bond strength than other groups (p < 0.05). SEM analysis of surface treatment methods (except TeM and ToM) revealed an increase in surface alterations compared to control groups. Failure modes were dominantly adhesive in groups C, TeM, and ToM, whereas mostly mix or cohesive failures were observed in PLD, HF, and SB. Hydroxyapatite coating with PLD technique exhibited promising bond strength results for CAD/CAM resin-ceramics. HAp coating can be used as a replacement for hydrofluoric acid etching and sandblasting in CAD/CAM resin-ceramic materials to obtain better bond strength values.

Antibacterial activity of self-adhesive resin cements against Streptococcus mutans at different time intervals

BACKGROUND AND OBJECTIVES

Self-adhesive resin cements release fluoride and have cytotoxic and preventive monomers against the bacteria in their composition. They have acidic property before their complete setting too. The antibacterial activity of three different self-adhesive resin cements against Streptococcus mutans at different time intervals was investigated in this study.

MATERIALS AND METHODS

The modified direct contact test was used to evaluate the antibacterial effect of Max-Cem, G-Cem and Bis-Cem on S. mutans after aging the samples in phosphate-buffered saline solution for one hour, 24 hours and 1 week. Data were analyzed using one-way ANOVA, repeated measurement ANOVA and Tukey HSD tests (P<0.05).

RESULTS

The differences in the mean bacterial counts between all the study groups and between the study groups and the corresponding control groups were significant at 1-hour and 24-hour intervals (P<0.001). At 1-week, only the differences between Bis-Cem and G-Cem, between Max-Cem and Bis-Cem, and between Bis-Cem and the corresponding control group were significant (P<0.001). There were significant differences between G-Cem and Max-Cem at all the time intervals (P<0.001). In addition, with the use of Bis-Cem there were significant differences between 1-hour and 1-week (P=0.01) and 24-hour and 1-week (P<0.001).

CONCLUSION

All the cements exhibited antibacterial activity after 1 hour and 24 hours. However, after 1 week, only Bis-Cem retained its antibacterial activity.

Choice of cement for single-unit crowns: Findings from The National Dental Practice-Based Research Network

BACKGROUND

In this article, the authors present clinical factors associated with the type of cement practitioners use for restoration of single-unit crowns.

METHODS

A total of 202 dentists in The National Dental Practice-Based Research Network recorded clinical details (including cement type) used for 3,468 single-unit crowns. The authors classified crowns as bonded if the dentist used a resin cement. The authors used mixed-model logistic regression to assess the associations between various clinical factors and the dentist's decision to bond.

RESULTS

A total of 38.1% of crowns were bonded, and 61.9% were nonbonded; 39.1% (79 of 202) of dentists never bonded a crown, and 20.3% (41 of 202) of dentists bonded every crown in the study. Crowns with excessive occlusal reduction (as judged by laboratory technicians) were more likely to be bonded (P = .02); however, there was no association with bonding and excessive taper (P = .15) or axial reduction (P = .08). Crowns were more likely to be bonded if they were fabricated from leucite-reinforced glass ceramic (76.5%) or lithium disilicate (70.8%) than if they were fabricated from layered zirconia (38.8%), full-contour zirconia (30.1%), full metal (14.7%), or porcelain-fused-to-metal (13.8%) (P < .01) restorative material. There was no significant association between choice to bond and crown margin location (P = .35). Crowns in the anterior maxilla were more likely to be bonded (P < .01).

CONCLUSIONS

Excessive occlusal tooth preparation, anterior location of a crown, and the use of glass ceramic crowns were associated significantly with the decision to bond.

PRACTICAL IMPLICATIONS

In this study, the authors identified factors significantly associated with the clinical decision made by practicing dentists when selecting a cement for restoration of single-unit crowns.

Effect of non-thermal plasma on the shear bond strength of resin cements to Polyetherketoneketone (PEKK)

PURPOSE

This study aimed to assess the effect of non-thermal plasma on the shear bond strength of resin cements to polyetherketoneketone (PEKK) in comparison to other surface treatment methods.

MATERIALS AND METHODS

Eighty PEKK discs were subjected to different surface treatments: (1) Untreated (UT); (2) Non-thermal plasma (NTP); (3) Sandblasting with 50 µm Al₂O₃ particles (SB); and (4) Sandblasting + Non-thermal plasma (SB+NTP). After each surface treatment, the contact angle was measured. Surface conditioning with Visio.Link was applied in all groups after pre-treatment. RelyX Unicem resin cement was bonded onto the PEKK specimens. After fabrication of the specimens, half of each group (n=10) was initially tested, while the other half was subjected to thermocycling (5℃ to 55℃ at 10,000 cycles). Shear bond strength (SBS) testing was performed using a universal testing machine, and failure modes were assessed using stereomicroscopy. The SBS results were analyzed statistically using one-way ANOVA followed by Tukey's post hoc test. Independent t-test was used to examine the effect of thermocycling (P<.05).

RESULTS

The highest SBS values with or without thermocycling were observed with PEKK specimens that were treated with SB+NTP followed by the SB group. The lowest SBS results were observed in the UT groups.

CONCLUSION

The shear bond strength between PEKK and resin cements was improved using non-thermal plasma treatment in combination with sandblasting.

Microtensile bond strength of CAD/CAM-fabricated polymer-ceramics to different adhesive resin cements

Objectives

This study evaluated the microtensile bond strength (µTBS) of polymer-ceramic and indirect composite resin with 3 classes of resin cements.

Materials and Methods

Two computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated polymer-ceramics (Enamic [ENA; Vita] and Lava Ultimate [LAV; 3M ESPE]) and a laboratory indirect composite resin (Gradia [GRA; GC Corp.]) were equally divided into 6 groups (n = 18) with 3 classes of resin cements: Variolink N (VAR; Vivadent), RelyX U200 (RXU; 3M ESPE), and Panavia F2 (PAN; Kuraray). The μTBS values were compared between groups by 2-way analysis of variance and the post hoc Tamhane test (α = 0.05).

Results

Restorative materials and resin cements significantly influenced µTBS (p < 0.05). In the GRA group, the highest μTBS was found with RXU (27.40 ± 5.39 N) and the lowest with VAR (13.54 ± 6.04 N) (p < 0.05). Similar trends were observed in the ENA group. In the LAV group, the highest μTBS was observed with VAR (27.45 ± 5.84 N) and the lowest with PAN (10.67 ± 4.37 N) (p < 0.05). PAN had comparable results to those of ENA and GRA, whereas the μTBS values were significantly lower with LAV (p = 0.001). The highest bond strength of RXU was found with GRA (27.40 ± 5.39 N, p = 0.001). PAN showed the lowest µTBS with LAV (10.67 ± 4.37 N; p < 0.001).

Conclusions

When applied according to the manufacturers' recommendations, the µTBS of polymer-ceramic CAD/CAM materials and indirect composites is influenced by the luting cements.

Physical and mechanical properties of dual functional cements-an in vitro study

OBJECTIVES

The aim of this study was to evaluate the physical and mechanical properties of different dual functional cements.

MATERIALS AND METHODS

Three dual functional cements (Allcem Core (FGM), Rebilda DC (VOCO), and LuxaCore Z (DMG)), a luting resin cement (Rely X ARC (3 M ESPE)), and a Core Buildup composite resin GrandioSo (VOCO) were used. Flexural strength (n = 10) and film thickness (n = 6) were evaluated according to ISO 4049:2009. Flow (n = 6) was evaluated according to ISO 6876:2001. Degree of conversion (DC) was assessed immediately and 24 h after polymerization (n = 5). For resistance to dislodgment (RD) analysis, bovine teeth were prepared to receive fiber glass posts, and a push-out test (n = 12) was used.

RESULTS

Luxacore Z presented lower flexural strength when compared to GrandioSo (p < 0.001). No statistical difference was found between cements for film thickness (p = 0.66). Reduced flow values were found for Allcem Core (p = 0.006). No statistical difference was found for immediate DC for different cements (p > 0.05). After 24 h, DC increased for all groups, except for Luxacore Z (p = 0.054). The RD did not differ from the control Rely X ARC, regardless of the root third (p > 0.05). Luxacore Z showed lower mean values in the apical third compared to the coronal third (p = 0.046).

CONCLUSIONS

The dual functional cements (Allcem Core and Rebilda DC) possessed similar physical and mechanical properties of luting resin cement (RelyX ARC) and Core Buildup composite resin (GrandioSo). Hence, they could be used for one-stage post and core buildup restorations.

CLINICAL RELEVANCE

The dual functional cements could be used for one-stage post and core buildup restorations since they possess similar physical and mechanical properties of luting resin cements and Core Buildup composite resin.

Light transmittance of CAD/CAM ceramics with different shades and thicknesses and microhardness of the underlying light-cured resin cement

Objectives

The aim of this in vitro study was to evaluate the effects of the thickness and shade of 3 types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials.

Materials and Methods

A total of 120 specimens of 2 shades (A1 and A3) and 2 thicknesses (1 and 2 mm) were fabricated using VITA Mark II (VM; VITA Zahnfabrik), IPS e.max CAD (IE; IvoclarVivadent), and VITA Suprinity (VS; VITA Zahnfabrik) (n = 10 per subgroup). The amount of light transmission through the ceramic specimens was measured by a radiometer (Optilux, Kerr). Light-cured resin cement samples (Choice 2, Bisco) were fabricated in a Teflon mold and activated through the various ceramics with different shades and thicknesses using an LED unit (Bluephase, IvoclarVivadent). In the control group, the resin cement sample was directly light-cured without any ceramic. Vickers microhardness indentations were made on the resin surfaces (KoopaPazhoohesh) after 24 hours of dark storage in a 37°C incubator. Data were analyzed using analysis of variance followed by the Tukey post hoc test (α = 0.05).

Results

Ceramic thickness and shade had significant effects on light transmission and the microhardness of all specimens (p < 0.05). The mean values of light transmittance and microhardness of the resin cement in the VM group were significantly higher than those observed in the IE and VS groups. The lowest microhardness was observed in the VS group, due to the lowest level of light transmission (p < 0.05).

Conclusion

Greater thickness and darker shades of the 3 types of CAD/CAM ceramics significantly decreased the microhardness of the underlying resin cement.

Microtensile bond strength of resin cement primer containing nanoparticles of silver (NAg) and amorphous calcium phosphate (NACP) to human dentin

PURPOSE

The purpose of the current study was to evaluate the effect of incorporating nanoparticles of silver (NAg) and amorphous calcium phosphate (NACP) into a self-etching primer of a resin cement on the microtensile bond strength of dentin, regarding the proven antibacterial feature of NAg and remineralizing effect of NACP.

MATERIALS AND METHODS

Flat, mid-coronal dentin from 20 intact extracted human third molars were prepared for cementation using Panavia F2.0 cement. The teeth were randomly divided into the four test groups (n=5) according to the experimental cement primer composition: cement primer without change (control group), primer with 1% (wt) of NACP, primer with 1% (wt) of physical mixture of NACP+Nag, and primer with 1% (wt) of chemical mixture of NACP+Nag. The resin cement was used according to the manufacturer's instructions. After storage in distilled water at 37℃ for 24 h, the bonded samples were sectioned longitudinally to produce 1.0 × 1.0 mm beams for micro-tensile bond strength testing in a universal testing machine. Failure modes at the dentin-resin interface were observed using a stereomicroscope. The data were analyzed by one-way ANOVA and Tukey's post-hoc tests and the level of significance was set at 0.05.

RESULTS

The lowest mean microtensile bond strength was obtained for the NACP group. Tukey's test showed that the bond strength of the control group was significantly higher than those of the other experimental groups, except for group 4 (chemical mixture of NACP and NAg; P=.67).

CONCLUSION

Novel chemical incorporation of NAg-NACP into the self-etching primer of resin cement does not compromise the dentin bond strength.

Resin cements formulated with thio-urethanes can strengthen porcelain and increase bond strength to ceramics

OBJECTIVES

The use of thio-urethane oligomers has been shown to significantly improve the mechanical properties of resin cements (RCs). The aim of this study was to use thio-urethane-modified RC to potentially reinforce the porcelain-RC structure and to improve the bond strength to zirconia and lithium disilicate.

METHODS

Six oligomers were synthesized by combining thiols - pentaerythritol tetra-3-mercaptopropionate (PETMP, P) or trimethylol-tris-3-mercaptopropionate (TMP, T) - with di-functional isocyanates - 1,6-Hexanediol-diissocyante (HDDI) (aliphatic, AL) or 1,3-bis(1-isocyanato-1-methylethyl)benzene (BDI) (aromatic, AR) or Dicyclohexylmethane 4,4'-Diisocyanate (HMDI) (cyclic, CC). Thio-urethanes (20 wt%) were added to a BisGMA/UDMA/TEGDMA organic matrix. Filler was introduced at 60 wt%. The microshear bond strength (μSBS), Weibull modulus (m), and failure pattern of RCs bonded to zirconia (ZR) and lithium disilicate (LD) ceramics was evaluated. Biaxial flexural test and fractographic analysis of porcelain discs bonded to RCs were also performed. The biaxial flexural strength (σ_bf) and m were calculated in the tensile surfaces of porcelain and RC structures (Z = 0 and Z = -t₂, respectively).

RESULTS

The μSBS was improved with RCs formulated with oligomers P_AL or T_AL bonded to LD and P_AL, P_AR or T_CC bonded to zirconia in comparison to controls. Mixed failures predominated in all groups. σ_bf had superior values at Z = 0 with RCs formulated with oligomers P_AL, P_AR, T_AL, or T_CC in comparison to control; σ_bf increased with all RCs composed by thio-urethanes at Z = -t₂. Fractographic analysis revealed all fracture origins at Z = 0.

CONCLUSION

The use of specific thio-urethane oligomers as components of RCs increased both the biaxial flexural strength of the porcelain-RC structure and the μSBS to LD and ZR.

CLINICAL SIGNIFICANCE

The current investigation suggests that it is possible to reinforce the porcelain-RC pair and obtain higher bond strength to LD and ZR with RCs formulated with selected types of thio-urethane oligomers.

Polymerization shrinkage stress of resin-based dental materials: A systematic review and meta-analyses of composition strategies

PURPOSE

A systematic review was conducted to determine whether there were composition strategies available to reduce and control polymerization shrinkage stress development in resin-based restorative dental materials.

DATA SOURCES

This report was reported in accordance with the PRISMA Statement. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO.

STUDY SELECTION

Only laboratory studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis, or theoretical and mathematical models were excluded. Of the 6113 eligible articles, 62 studies were included in the qualitative analysis, and the meta-analysis was performed with 58 studies. The composition strategy was subdivided according to the modified part of the material: filler phase, coupling agent, or resin matrix. A global comparison was performed with random-effects models (α = 0.05). The only subgroup that did not show a statistical difference between the alternative strategy and the control was 'the use of alternative photo-initiators' (p = 0.29).

CONCLUSION

Modification of the resin matrix made the largest contribution to minimizing stress development. The technology used for decreasing stress in the formulation of low-shrinkage and bulk-fill materials was shown to be a promising application for reducing and controlling stress development.

Polymerization shrinkage stress of resin-based dental materials: A systematic review and meta-analyses of technique protocol and photo-activation strategies

PURPOSE

A systematic review was conducted to determine whether there were any alternative technique or additional step strategies available to reduce and control polymerization shrinkage stress development in dental resin-based restorative materials.

DATA SOURCES

This report followed the PRISMA Statement. A total of 36 studies were included in this review. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO.

STUDY SELECTION

Only in vitro studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis or mathematical models were excluded. Of the 6.113 eligible articles, 36 studies were included in the qualitative analysis, and the meta-analysis was performed with 25 studies. A global comparison was performed with random-effects models (α = 0.05). The strategies were subdivided as follows: the use of an alternative technique protocol of placing the material inside the tooth cavity; the modification of the irradiation intensity or total energy delivered to the material; the use of an alternative light-curing source; or the use of an alternative photo-activation mode. All alternative strategies showed statistically significant differences when compared with their respective controls (p < 0.05).

CONCLUSION

The use of alternative light-curing sources contributed more to minimizing stress development than placing the material by means of an alternative technique protocol or by modifying the irradiant intensity or total energy delivered to the material during photo-activation. Moreover, the use of an alternative photo-activation mode (intermittent light, exponential, soft-start or pulse delay modes) was shown to be an effective strategy for reducing and controlling stress development in resin-based dental materials.

Evaluation of the water sorption of luting cements in different solutions

OBJECTIVE

To evaluate and compare the water sorption of three luting cements in three different solutions: distilled water and artificial saliva with different pH values (7.4 and 3.0).

MATERIALS AND METHODS

Resin-modified glass-ionomer cement (GC Fuji Plus) and two resin cements (Multilink Automix and Variolink II) were used. A total of 45 specimens - 15 specimens (15x1 mm) for each cement were prepared according to ISO standard 4049:2009. The water sorptions of the cements were calculated by weighing the specimens before and after immersion and desiccation.

RESULTS

. Nonparametric statistic methods were applied. GC Fuji Plus cement showed significantly higher values of water sorption in all three solutions of both resin cements (p<0.009) and significantly higher values of sorption in artificial saliva pH 3.0. Multilink Automix showed significantly higher values of water sorption compared with Variolink II in artificial saliva pH 7.4, and higher values of sorption in this solution compared with pH value 3.0.

CONCLUSION

Water sorption values are mainly influenced by the proportion of hydrophilic matrix, the type and composition of filler, and the pH value of solutions.

In-vitro evaluation of bond strength of four self-etching cements

Indirect restorations need to be attached with adhesive luting agents to prevent them from becoming dislodged and provide adequate marginal sealing. The aim of this study was to evaluate bond strength to dentin of self-etching resin cements.

MATERIALS AND METHODS

75 flat dentin surfaces were randomly distributed among 5 groups, according to cements used; Group 1: RelyxU100 (3M/ESPE), Group 2: Bis Cem (Bisco), Group 3: Max Cem (Kerr), Group 4: SeT PP (SDI) and Group 5: Relyx ARC (3M/ESPE), control. Ceramic test cylinders (IPS Empress 2 / Ivoclar-Vivadent) 4.1 mm across were prepared and attached to the dentin surfaces using the different cements. A constant 25N load was applied for 1 minute and they were light-polymerized. Following storage for 24 hours at 100% humidity and 37 °C, the specimens were tested for bond strength under shear strain in an Instron testing machine at a crosshead speed of 1 mm/minute; at 7, 14 and 21 days. Data were analyzed by ANOVA and Tukey's test. There were significant differences between materials (p < 0.0001), but not between times or material/time interaction. RelyXARC (Control Group) had the highest bond strength (15.52 MPa). Among the self-etching cements, the best behavior was found for Relyx U100 (10.80MPa), followed by BisCem (6.36 MPa), MaxCem (5.45 MPa) and SeTPP (3.17 MPa). The bond strength of the self-adhesive cements evaluated was lower than that for resin cements which require previous treatment of the dental substrate (control group). This should be taken into account during clinical selection, in particular for tooth preparations with poor retention.

The effect of ultrafast fiber laser application on the bond strength of resin cement to titanium

The purpose of this study was to investigate the effect of ultrafast fiber laser treatment on the bond strength between titanium and resin cement. A total of 60 pure titanium discs (15 mm × 2 mm) were divided into six test groups (n = 10) according to the surface treatment used: group (1) control, machining; group (2) grinding with a diamond bur; group (3) ultrafast fiber laser application; group (4) resorbable blast media (RBM) application; group (5) electro-erosion with copper; and group (6) sandblasting. After surface treatments, resin cements were applied to the treated titanium surfaces. Shear bond strength testing of the samples was performed with a universal testing machine after storing in distilled water at 37 °C for 24 h. One-way ANOVA and Tukey's HSD post hoc test were used to analyse the data (P < 0.05). The highest bond strength values were observed in the laser application group, while the lowest values were observed in the grinding group. Sandblasting and laser application resulted in significantly higher bond strengths than control treatment (P < 0.05). Ultrafast fiber laser treatment and sandblasting may improve the bond strength between resin cement and titanium.

Effect of zirconia surface treatment using nitric acid-hydrofluoric acid on the shear bond strengths of resin cements

PURPOSE

The aim of this study was to compare the surface roughness of zirconia when using Zircos E etching system (ZSAT), applying a nitric acid-hydrofluoric acid compound as a pretreatment agent, and also to compare the shear bonding strength according to different resin cements.

MATERIALS AND METHODS

ZSAT, air abrasion, and tribochemical silicacoating were applied on prepared 120 zirconia specimens (10 mm in diameter, 7 mm in height) using CAD/CAM. Each 12 specimens with 4 different resin cements (Panavia F 2.0, Rely X Unicem, Superbond C&B, and Hot bond) were applied to test interfacial bond strength. The statistical analysis was performed using SAS 9.1 (SAS Institute Inc., Cary, NC, USA). The results are as follows: after application of the ZSAT on the zirconia specimens, surface roughness value after 2-hour etching was higher than those after 1- and 3-hour etching on SEM images.

RESULTS

For Superbond C&B and Rely X Unicem, the specimens treated with ZSAT showed higher shear bond strength values than those treated with air abrasion and tribochemical silicacoating system. Regarding the failure mode of interface over cement and zirconia surface, Rely X Unicem and Hot bond showed cohesive failures and Panavia F 2.0 and Superbond C&B showed mixed failures.

CONCLUSION

Zircos E etching system in zirconia restoration could increase its shear bond strength. However, its long term success rate and clinical application should be further evaluated.

The effect of repeated bonding on the shear bond strength of different resin cements to enamel and dentin

PURPOSE

Cementation failures of restorations are frequently observed in clinical practice. The purpose of this study is to compare the effect of initial and repeated bonding on the bond strengths of different resin cements to enamel and dentin.

MATERIALS AND METHODS

Ninety human maxillary central incisors were bisected longitudinally. The 180 tooth halves were divided into 2 groups (n = 90) for enamel and dentin bonding. The enamel and dentin groups were further divided into 3 groups (n = 30) for different resin cement types. Composite resin (Filtek Ultimate) cylinders (3 × 3 mm) were prepared and luted to enamel and dentin using Variolink II (Group V), RelyX ARC (Group R), or Panavia F 2.0 (Group P) resin cement. After 24 hours, initial shear bond strengths of the resin cements to enamel and dentin were measured. Using new cylinders, the specimens were de-bonded and re-bonded twice to measure the first and the second bond strengths to enamel and dentin. Failure modes and bonding interfaces were examined. Data were statistically analyzed.

RESULTS

Initial and repeated bond strengths to enamel were similar for all the groups. The first (15.3 ± 2.2 MPa) and second (10.4 ± 2.2 MPa) bond strengths to dentin were significantly higher in Group V (P<.0001). Second bond strengths of dentin groups were significantly lower than initial and first bond strengths to dentin (P<.0001).

CONCLUSION

All resin cements have similar initial and repeated bond strengths to enamel. Variolink II has the highest first and second bond strength to dentin. Bond strength to dentin decreases after the first re-bonding for all resin cements.

Effects of radiant exposure and wavelength spectrum of light-curing units on chemical and physical properties of resin cements

Objectives

In this study, we evaluated the influence of different radiant exposures provided by single-peak and polywave light-curing units (LCUs) on the degree of conversion (DC) and the mechanical properties of resin cements.

Materials and Methods

Six experimental groups were established for each cement (RelyX ARC, 3M ESPE; LuxaCore Dual, Ivoclar Vivadent; Variolink, DMG), according to the different radiant exposures (5, 10, and 20 J/cm²) and two LCUs (single-peak and polywave). The specimens were made (7 mm in length × 2 mm in width × 1 mm in height) using silicone molds. After 24 hours of preparation, DC measurement was performed using Fourier transform infrared spectrometry. The same specimens were used for the evaluation of mechanical properties (flexural strength, FS; elastic modulus, E) by a three-point bending test. Data were assessed for normality, after which two-way analysis of variance (ANOVA) and post hoc Tukey's test were performed.

Results

No properties of the Variolink cement were influenced by any of the considered experimental conditions. In the case of the RelyX ARC cement, DC was higher when polywave LCU was used; FS and E were not influenced by the conditions evaluated. The LuxaCore cement showed greater sensitivity to the different protocols.

Conclusions

On the basis of these results, both the spectrum of light emitted and the radiant exposure used could affect the properties of resin cements. However, the influence was material-dependent.

Rheological and mechanical properties and interfacial stress development of composite cements modified with thio-urethane oligomers

OBJECTIVES

Thio-urethane oligomers have been shown to reduce stress and increase toughness in highly filled composite materials. This study evaluated the influence of thio-urethane backbone structure on rheological and mechanical properties of resin cements modified with a fixed concentration of the oligomers.

METHODS

Thio-urethane oligomers (TU) were synthesized by combining thiols - pentaerythritol tetra-3-mercaptopropionate (PETMP) or trimethylol-tris-3-mercaptopropionate (TMP) - with isocyanates - 1,6-hexanediol-diissocyante (HDDI) (aliphatic) or 1,3-bis(1-isocyanato-1-methylethyl)benzene (BDI) (aromatic) or dicyclohexylmethane 4,4'-diisocyanate (HMDI) (cyclic), at 1:2 isocyanate:thiol, leaving pendant thiols. 20wt% TU were added to BisGMA-UDMA-TEGDMA (5:3:2). 60wt% silanated inorganic fillers were added. Near-IR was used to follow methacrylate conversion and rate of polymerization ( [Formula: see text] ). Mechanical properties were evaluated in three-point bending (ISO 4049) for flexural strength/modulus (FS/FM, and toughness), and notched specimens (ASTM Standard E399-90) for fracture toughness (KIC). PS was measured on the Bioman. Viscosity (V) and gel-points (defined as the crossover between storage and loss shear moduli (G'/G″)) were obtained with rheometry. Glass transition temperature (Tg), cross-link density and homogeneity of the network were obtained with dynamic mechanical analysis. Film-thickness was evaluated according to ISO 4049.

RESULTS

DC and mechanical properties increased and [Formula: see text] and PS decreased with the addition of TUs. Gelation (G'/G″) was delayed and DC at G'/G″ increased in TU groups. Tg and cross-link density dropped in TU groups, while oligomers let to more homogenous networks. An increase in V was observed, with no effect on film-thickness. Significant reductions in PS were achieved at the same time conversion and mechanical properties increased.

SIGNIFICANCE

The addition of thio-urethane oligomers proved successful in improving several key properties of resin cements, without disrupting the procedures dentists use to polymerize the material. This approach has potential to be translated to commercial materials very readily.

Feasibility of ossicular chain reconstruction with resin cement

Introduction

Disjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium.

Objective

Because of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation.

Methods

Two anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method.

Results

A total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed.

Conclusion

Resin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.