Fracture resistance of CAD/CAM blocks cemented on dentin using different cementation strategies

PURPOSE

To determine whether the fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) resin-based composites and polymer-infiltrated ceramic network materials cemented on dentin is influenced by the restoration thickness and composite cement application strategy.

METHODS

Disc-shaped specimens (Ø = 7 mm) of 0.8 mm and 1.5 mm thicknesses were milled from two CAD/CAM materials: resin-based composite (RBC, Cerasmart 270) and polymer-infiltrated ceramic network (PICN, Vita Enamic). The discs (n = 8 per group) were cemented on flattened dentin using three different cementation strategies: 1) self-adhesive composite cement (RelyX U200) in light-curing mode (LC-SAC), 2) universal adhesive (Single Bond Universal) with composite cement (RelyX Ultimate) in auto-curing mode (AC cement), and 3) adhesive and composite cement as in 2) but in light-curing mode (LC cement). The restorative surface was indented perpendicularly with a compressive load using a universal testing machine until fracture. The fracture resistance (N) of RBC and PICN was separately analyzed using two-way ANOVA and Tukey's post-hoc test (α = 0.05).

RESULTS

The fracture resistance of each material was significantly influenced by the material thickness and cementation strategy (P < 0.05). Irrespective of the material type and cementation strategy, thicker materials exhibit higher fracture resistance. For RBC, the fracture resistance of the LC cement group was significantly higher than that of AC cement only at 0.8 mm thickness. For PICN, the LC-cement cementation strategy produced superior fracture resistance, regardless of the restoration thickness.

CONCLUSIONS

The fracture resistance of Cerasmart 270 was higher for the thicker material; the fracture resistance of LC cement was higher than that of AC cement at 0.8 mm thickness cemented to dentin. In comparison, LC cement showed the highest fracture resistance for Vita Enamic for both material thicknesses.

Contamination of Dentin with Hemostatic Agents - Is EDTA a Valuable Decontaminant before Using a Self-etch Universal Adhesive?

PURPOSE

To investigate the effects of dentin decontamination procedures with ethylenediaminetetraacetic acid (EDTA) after contamination with two hemostatic agents, ViscoStat (VS) and ViscoStat Clear (VSC), on the microtensile bond strength (μTBS) of two different universal adhesives, before and after thermocycling (TC).

MATERIALS AND METHODS

Dentin surfaces of 100 human caries-free molars were either contaminated with one of the hemostatic agents or contaminated and then decontaminated with EDTA before the universal adhesives Scotchbond Universal Adhesive (SBU) or Prime & Bond Active (PBA) were applied in self-etch mode. Composite buildups were made and the teeth were sectioned into sticks (n = 90). Half of them immediately underwent the μTBS test, the other half after aging via TC. The data were statistically analyzed using Welch's ANOVA and the Games-Howell post-hoc test (p < 0.05).

RESULTS

Significant differences were observed between the groups (p < 0.001). When the dentin surface was contaminated with VSC, TC significantly reduced the mean bond strength, regardless of the universal adhesive. Decontamination with EDTA showed a significant decrease in bond strength after VS contamination and SBU application. The fracture analysis showed mainly adhesive fractures (78.8%) in all test groups.

CONCLUSION

As EDTA application did not significantly increase the μTBS of either universal adhesive in self-etch mode in-vitro, it cannot be recommended as a decontaminant.

Do Different Pretreatment Methods Influence the Microtensile Bond Strength of Composite Cements to Silicate Ceramic?

PURPOSE

The pretreatment of glass-ceramic before adhesive cementation can be performed with hydrofluoric acid (HF)/silanization (S) or with an ammonium polyfluoride-containing primer (APF). It can be modified by application of a silane-containing universal adhesive (UA) and/or additional silanization. The aim of this study was to evaluate the bond strength of composite cements to two different glass ceramics after different pretreatments and aging.

MATERIALS AND METHODS

Disks of leucite-reinforced glass-ceramic or lithium-disilicate glass-ceramic were pretreated with HF+S, HF+UA, HF+S+UA, APF, or APF+S, bonded in pairs with composite cement and sectioned into microsticks (n = 96/group). The microtensile bond strength was determined either after 24 h (n = 48) or after aging for 6 months in water (n = 48). Fracture patterns were analyzed at 50X magnification. Statistical evaluation was performed using the Kruskal-Wallis test, pairwise comparisons with Bonferroni's correction, and the chi-squared test (p < 0.05).

RESULTS

Pretreatment with HF+UA or APF led to significantly lower bond strength compared to HF+S. Additional silanization after application of UA or APF resulted in a significant increase in bond strength. After aging, HF+UA groups showed significantly lower bond strengths, independent of additive silanization. Aging did not affect APF-pretreated leucite-reinforced glass-ceramic; for lithium-disilicate glass-ceramic, the bond strength dropped significantly. Additional silanization improved aging resistance for the respective groups.

CONCLUSION

Bond strength and its long-term stability depend on the ceramic used and on the pretreatment. An ammonium polyfluoride-containing primer seems to be a promising option compared to conventional pretreatment with hydrofluoric acid. Additive silanization improves the long-term stability of the microtensile bond strength.

Composite restorations placed in non-carious cervical lesions-Which cavity preparation is clinically reliable?

The purpose of this in-vivo study was to evaluate the clinical performance of restorations placed in non-carious cervical lesions (NCCLs), using different cavity preparation designs, after 7.7 years. A total of 85 NCCLs with coronal margins in enamel and cervical margins in dentin were randomly assigned to the following treatment protocols: dentin surface cleaning, dentin surface roughening with round bur plus flowable composite, dentin surface roughening/cervical groove preparation with round bur, dentin surface roughening/cervical groove preparation with round bur plus flowable composite. After enamel beveling and selective enamel etching, the defects were restored with composite. The restorations were assessed by two independent, calibrated and blinded investigators, using modified USPHS criteria. At 7 years (7.7 (± 0.35)), a total of 64 restorations (75.3%) were available for follow-up examination. The total retention rate, irrespective of the test groups, was 82.8%. Restorations placed without any preparation showed the highest loss rate (27.8%). Esthetic appearance, marginal adaptation, anatomic form and marginal discoloration did not differ significantly between the groups. Composites are long-term stable materials for restoring NCCLs. Restorations placed without any dentin preparation (cavity cleaning only) showed the highest loss rate.

Comparison of the shear bond strength of 3D printed temporary bridges materials, on different types of resin cements and surface treatment

Background

Thus, purpose of this study was to compare the shear bond strength of the resin cement and the resin modified glass ionomer cement on 3D printed temporary material for crowns and bridges in combination with different surface treatment modalities.

Material and Methods

Test specimens VarseoSmile Temp material (Bego, Bremen, Germany) (n=64) in the form of rectangular blocks (n=32) and cylindrical test specimens (n=32) were printed using the Varseo S 3D printer (Bego, Bremen, Germany). The specimens were divided into 4 groups, with 8 specimens of each kind. Two groups (n=16 pairs) were blasted with Perlablast® Micro [PM] 50µm (Bego, Bremen, Germany) and two groups (n=16 pairs) were blasted with alumina [AL] 50µm. The cylindric specimen were cemented on the rectangular block with a load of 20N using a Zwick/Roell machine (Ulm, Germany), to ensure a comparable cementing process. One group (n=8) of each pre-treatment was cemented with Fuji Cem 2 [Fuji+AL & Fuji+PM] and one of each with Variolink® Esthetic [Vario+AL & Vario+PM]. The Fuji Cem 2 was chemically cured while dual curing Variolink® Esthetic was additionally light cured using LED (Bluephase II, Ivoclar Vivadent, Ellwagen, Germany; light intensity, >1,000 mW/cm2, high power modus). The shear strength was performed with Zwick/Roell universal test machine (speed, 0.8 mm/min), fracture and statistical analysis was performed (T-test, p<0.05).

Results

T-test showed a significant difference Fuji Cem 2 (Fuji+AL & Fuji&PM) and Variolink® Esthetic (Vario+AL &Vario+PM) (p=0.000). Fuji+AL & Fuji+PM showed a significant difference for surface pre-treatment (p=0.002). Vario+AL & Vario+PM no significance (p=0.872) for pre-treatment method was detectable.

Conclusions

Variolink® Esthetic showed a higher bond strength compared to Fuji Cem 2 and an increasing bond strength for Fuji Cem 2 with alumina pre-treatment. There was no significant difference for Vario+AL and Vario+PM.

Key words:Shear bond strength, adhesion, adhesive resin cement, resin modified glass ionomer cement, 3D printable materials, mechanical testing, provisional restoration.

Luting of CAD/CAM ceramic inlays: direct composite versus dual-cure luting cement

The aim of this study was to investigate bonding effectiveness in direct restorations. A two-step self-etch adhesive and a light-cure resin composite was compared with luting with a conventional dual-cure resin cement and a two-step etch and rinse adhesive. Class-I box-type cavities were prepared. Identical ceramic inlays were designed and fabricated with a computer-aided design/computer-aided manufacturing (CAD/CAM) device. The inlays were seated with Clearfil SE Bond/Clearfil AP-X (Kuraray Medical) or ExciTE F DSC/Variolink II (Ivoclar Vivadent), each by two operators (five teeth per group). The inlays were stored in water for one week at 37°C, whereafter micro-tensile bond strength testing was conducted. The micro-tensile bond strength of the direct composite was significantly higher than that from conventional luting, and was independent of the operator (P<0.0001). Pre-testing failures were only observed with the conventional method. High-power light-curing of a direct composite may be a viable alternative to luting lithium disilicate glass-ceramic CAD/CAM restorations.

Use of elaborate feedback and an audience-response-system in dental education

Introduction: The aim of the study was to examine the effect of an elaborate feedback and an audience response system (ARS) on learning success.

Methods: Students of the 1^st clinical semester were randomly assigned to a study and a control group. The randomization was carried out considering the factors of age, gender and power spectrum during preliminary dental examination. Within 10 lectures 5 multiple-choice questions were asked about the learning objectives and answered by the students using an ARS. Only the study group received an immediate comprehensive feedback on the results. A final exam at the end was carried out in order to evaluate whether the elaborate feedback leads to a successful learning. Furthermore the effect of the ARS on the lecture atmosphere was investigated.

Result: The results of the final exams showed no significant difference between the study and the control group regarding the learning success.

Conclusion: Although no significant effect on learning success was found, the ARS creates a more interactive, positive learning environment.

3D-microleakage assessment of adhesive interfaces: exploratory findings by μCT

OBJECTIVES

To explore the feasibility of a 3D-microleakage protocol for the evaluation of various configurations of adhesive-tooth interfaces.

METHODS

Three different kinds of specimens were prepared: (1) a Class-I composite restoration placed without any bonding to maximize gap formation at the interface; (2) a glass-fiber post cemented with a self-adhesive composite cement into a prepared root canal; and (3) inlay MOD composite restorations placed with either a 1-step self-adhesive or a 2-step etch-and-rinse composite cement. After silver-nitrate (AgNO3) infiltration, the specimens were scanned using a Skyscan 1172 X-ray microtomograph (μCT; Skyscan Bruker) at 100kV, 100μA and 7.8-9.5μm resolution. Projection images were reconstructed, after which maximum-intensity projections (MIPs) and 3D-volumetric renderings were produced. For the inlays, an additional conventional stereomicroscopic (SM) microleakage evaluation was accomplished after specimen sectioning.

RESULTS

MIPs and 3D-renderings from specimens (1) and (2) revealed strongly varying microleakage patterns along the marginal gap/interface. For the specimens of setup (3), the high radiopacity of the 2-step composite cement hindered evaluation of the MIPs. MIP-microleakage patterns along the enamel margin of the restoration cemented with the 1-step composite cement corresponded well to the stereomicroscopic images.

SIGNIFICANCE

The reported μCT-protocol revealed good sensitivity to detect AgNO3 infiltration at the adhesive-tooth interface when considerable microleakage was present. When microleakage was less apparent and spread in a more diffuse pattern, evaluation with μCT was less sensitive compared to stereomicroscopic evaluation.

Potential smear layer interference with bonding of self-etching adhesives to dentin

PURPOSE

To evaluate the effect of smear-layer interposition on the bonding effectiveness of self-etching adhesives with different etching potential.

MATERIALS AND METHODS

Bur-cut dentin specimens were obtained from 25 human molars after preparation of the dentin surface with a medium-grit diamond bur (bur-cut). An additional 25 molars were fractured at the midcoronal dentin to create a smear-layer-free surface (smear-free dentin). The prepared teeth were assigned to 5 groups, according to the adhesive to be applied: a strong one-step self-etching adhesive (PLP, Adper Prompt L-Pop, 3M ESPE, pH = 0.8); two ultra-mild one-step self-etching adhesives (C3S, Clearfil Tri-S Bond, Kuraray, pH = 2.7; AEB, Adper Easy Bond, 3M ESPE; pH = 2.7 ); as the self-etching control, a mild two-step self-etching adhesive (CSE, Clearfil SE Bond, Kuraray, pH of primer = 1.9); and as the etch-and-rinse control, a three-step etch-and-rinse adhesive (OFL, Optibond FL, Kerr). After composite buildups were made, all specimens were stored in distilled water (24 h/37°C) prior to microtensile bond strength testing (µTBS). The failure mode was determined with a stereomicroscope at 50X magnification. Representative µTBS specimens were processed for analysis in a Feg-SEM. The Kruskal-Wallis test was performed to determine statistical differences (p < 0.05).

RESULTS

Except for the strong one-step self-etching adhesive, all other self-etching adhesives (mild and ultramild) revealed a significantly lower bond strength to bur-cut dentin than to smear-free dentin. The etch-and-rinse adhesive presented the highest µTBS, which was not significantly different when bonded to bur-cut or smear-free dentin. Fracture analysis demonstrated a prevalence of adhesive failures for the self-etching adhesives, while OFL revealed more mixed failures. SEM revealed that smear debris remained part of the adhesive interfacial complex produced by the ultra-mild one-step self-etching adhesive C3S when applied on bur-cut dentin.

CONCLUSION

Smear debris interferes with the interaction of mild and ultra-mild self-etching adhesives with dentin.

Does inhibition of proteolytic activity improve adhesive luting?

Endogenous enzymes may be involved in the biodegradation of adhesive restoration-tooth interfaces. Inhibitors of matrix metalloproteinases (MMPs) have been suggested to retard the bond-degradation process. Limited data are available on whether composite cements may also benefit from MMP inhibitors. Therefore, the aim of this study was to determine the effect of two MMP inhibitors--chlorhexidine digluconate (CHX) and galardin--on the microtensile bond strength (μTBS) of two self-adhesive composite cements to dentin. Ceramic specimens were cemented to bur-cut dentin surfaces using the self-adhesive composite cements RelyX Unicem 2 (3M ESPE) or Clearfil SA (Kuraray), or the etch-and-rinse composite cement Nexus 3 (Kerr) that served as the control. The surfaces were left untreated or were pretreated with MMP inhibitors (2% CHX or 0.2 mM galardin). The μTBS was determined 'immediately' and upon ageing (water storage for 6 months). Statistical analysis revealed a significant effect of the factors 'composite cement' and 'storage', as well as all interactions, but no effect of the MMP inhibitors. After 6 months of ageing, the μTBS decreased for all cements, except for the multistep etch-and-rinse luting composite when it was applied without MMP inhibitors. The MMP inhibitors could not prevent the decrease in μTBS upon ageing and therefore do not improve the luting durability of the composite cements tested.

Conservative treatment of periodontal recessions with class V-defects using gingiva-shaded composite--A systematic treatment concept

Periodontal recessions can cause aesthetic and functional problems, especially in the anterior region or when combined with exposed crown margins. A combination of periodontal disease, recession with exposed root surface, hard-tissue defects and age emphasizes the need for treating these defects. If crown margins are exposed and surgical treatment is not possible, aesthetics and function can only be improved by replacement of the restoration. The restorative treatment option with a gingiva-shaded composite is especially valuable for dental fear patients or older patients with general or local risk factors, surgical contra-indications or Class III and IV recessions with questionable prognosis of surgery. The step-by-step-approach described in this article is an alternative, minimal-invasive treatment concept for cervical lesions in combination with all kinds of periodontal recessions, that is especially suitable for wedge-shaped defects next to exposed crown margins.

CLINICAL RELEVANCE

With this treatment concept, the reader should be able to use gingiva-shaded composite for different indications, such as exposed root surfaces or crown margins in combination with recessions.