Effect of different repair methods on the bond strength of resin composite to CAD/CAM materials and microorganisms adhesion: An in situ study

How the repair bonding strength of hybrid ceramic CAD/CAM blocks is influenced by the use of surface treatments and universal adhesives

We examined how different methods of surface treatment and different universal adhesives with or without extra silane affected the repair bonding strength of hybrid ceramic CAD/CAM restorations. Cerasmart specimens (n=320) were subjected to thermocycling and assigned to the following surface pretreatment protocols: control, diamond bur (DB), hydrofluoric acid (HF), and tribochemical silica coating (TSC). Half the specimens received a coating of silane, followed by application of the universal adhesives Futurabond M+ (FMU), Tokuyama Universal Bond (TUB), Single Bond Universal (SBU), or Clearfil Universal Bond Quick (CUQ) (n=10). A hybrid composite resin was used to simulate repair; then the specimens underwent further thermocycling. Shear bond strength (SBS) was determined and modes of failure were examined. The TSC-CUQ silane (-) group showed the highest SBS values. The best repairs were obtained when the surface was treated with TSC, with the exception of the DB-TUB silane (-) group. TUB increased SBS more than the other adhesives. Additional silane decreased SBS in the HF-TUB and TSC-CUQ groups, while increasing it in the TSC-TUB and DB-FMU groups (p<0.05).

Repair protocols for indirect monolithic restorations: a literature review

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

Influence of surface treatments and adhesive protocols on repair bond strength of glass-matrix and resin-matrix CAD/CAM ceramics

OBJECTIVE

To specify the effects of self-etching ceramic primer, Monobond Etch and Prime (MEP), and universal adhesive (UA) on repair bond strength between CAD/CAM blocks and resin composite.

MATERIALS AND METHODS

Vita Mark II (VM), IPS e.max CAD (EMAX), Shofu Block HC (SHC), and Tetric CAD (TET) blocks were sliced and thermocycled. They were divided into four groups according to surface treatments (n = 24): control, sandblasting (AL), hydrofluoric acid etching (HF), and MEP application. SEM analysis assessed surface topography. Subdivided, specimens followed distinct adhesive protocols (n = 12): control (silane + adhesive [SA] or adhesive [A] only for MEP group) and UA. Microshear bond strength (μSBS) was measured following resin composite repair. Data were analyzed using two-way ANOVA and Tukey tests (p < 0.05).

RESULTS

The μSBS of CAD/CAM blocks was significantly influenced by surface treatment type and adhesive protocol. The highest μSBS values for each block, considering surface treatment + adhesive protocol, were VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA.

CONCLUSIONS

Except for EMAX, it was not the adhesive protocol that made the significant difference in bond strength for each CAD/CAM block, but the surface treatment. MEP + UA application on glass ceramics lowered μSBS values significantly, so it is not recommended in clinical conditions.

CLINICAL SIGNIFICANCE

Repair is an essential therapeutic option, particularly in esthetic restorations, to swiftly repair the impaired esthetics caused by fracture. Repair protocol is dependent on the restorative material, and to have a reliable repair bond strength, the following surface treatment and adhesive protocol combinations are recommended for each CAD/CAM block: VM, HF + SA, or HF + UA; EMAX, MEP + A; and SHC and TET, AL + SA, or AL + UA.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of Various Beverages on Adhesion of Repaired CAD/CAM Restorative Materials

(1) Background: The purpose of this study was to determine the effect of commonly consumed beverages on the bond strength of three different computer-aided design-computer-aided manufacturing (CAD/CAM) resin-ceramic hybrid materials repaired with resin-based composite (RBC) materials. (2) Materials and Methods: Rectangular prism specimens (N = 138) measuring 6 mm × 5 mm × 2 mm were obtained from GC Cerasmart (GC), Lava Ultimate (LU), and Vita Enamic (VE) blocks. These blocks were polished and then subjected to thermal cycling (10,000 cycles, 5 °C to 55 °C). After the surface treatment was applied, the average surface roughness value was measured. All the surfaces were repaired with RBC. Thermal cycling was performed for the second time. Each group was then distributed into three subgroups according to the beverage used: tea (t), cola (c), and distilled water (0) (n = 15). The specimens were stored in these solutions for 28 days and then subjected to the shear bond strength (SBS) test. Statistical analysis was performed using a two-way ANOVA test with Bonferroni adjustment. (3) Results: The surface roughness of the materials presented no significant difference after different surface treatments (p > 0.05). No significant difference was observed among the materials (p > 0.05). Tea and cola presented similar SBS values (p > 0.05). Both were significantly lower than distilled water (p < 0.001, p < 0.001, respectively). (4) Conclusions: Consumption of beverages reduces the bond strength in surfaces repaired with RBC to CAD/CAM resin-ceramic hybrid materials. (5) Clinical Significance: Repairing damaged resin matrix dental restorations with RBC is advantageous in terms of time and cost by achieving adequate bond strengths. Frequently consumed beverages reduce the bond strength of repaired CAD/CAM resin-ceramic hybrid materials.

Indirect restorative systems-A narrative review

OBJECTIVE

The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes.

OVERVIEW

Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth.

CONCLUSIONS

Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process.

CLINICAL SIGNIFICANCE

The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.

Effect of Different Surface Treatments on Repair Bond Strength of CAD/CAM Resin-Matrix Ceramics

The purpose of this study was to investigate the influence of different surface treatment methods on the micro-tensile bond strength (μTBS) of resin-matrix ceramic (RMC) blocks repaired with resin composite. Three different prefabricated RMC blocks including Lava Ultimate (LU), Grandio Blocs (GB), and Shofu Block HC (HC) were thermo-cycled and divided into five surface treatment groups: Control (C), bur grinding (G), airborne particle abrasion (APA), Er,Cr:YSGG laser irritation (LI), and APA combined with LI (APA+LI). After surface treatments, topographic alterations were examined by scanning electron microscopy. Then, Universal Adhesive (Single Bond Universal) was applied and repair was simulated with nanohybrid composite (Grandio SO). Bonded specimens were cut into 1 mm2 sized beams (n = 16) and a μTBS test was conducted by using a universal test machine. Fracture types were evaluated by using a stereomicroscope. The bond- strength data was evaluated by two-way ANOVA and Tukey post-hoc test (α = 0.05). The μTBS values were significantly affected by the surface treatment variable and the interaction terms of the variables (p ≤ 0.001). However, no significant effect of RMC type was detected (p > 0.05). Among all materials, GBAPA+LI indicated the highest µTBS value. Except for the GBC, all surface treatments showed clinically acceptable bond-strength values. However, the surface treatments applied to GB and LU before the repair processes increased the repair bond-strength values while causing a negative effect for HC. In addition, LI and APA+LI can be applied as an alternative route compared to other procedures recommended by the manufacturer for surface preparation in intraoral RMC repair.

Effect of finishing/polishing techniques and aging on topography, C. albicans adherence, and flexural strength of ultra-translucent zirconia: an in situ study

OBJECTIVE

To investigate the influence of different finishing/polishing techniques and in situ aging on the flexural strength (σ), surface roughness, and Candida albicans adherence of 5 mol% yttria-stabilized zirconia (ultratranslucent zirconia).

MATERIALS AND METHODS

A total of 120 zirconia bars (Prettau Anterior, Zirkonzahn) with dimensions of 8 × 2 × 0.5 mm were divided into 8 groups (n = 15) according to two factors: "in situ aging" (non-aged and aged (A)) and "finishing/polishing" (control (C), diamond rubber polishing (R), coarse grit diamond bur abrasion (B), and coarse grit diamond bur abrasion + diamond rubber polishing (BR)). Half of the samples from each group were subjected to a 60-day in situ aging by fixing the bars into cavities prepared in the posterior region of the base of complete or partial dentures of 15 patients. The samples were then subjected to the mini flexural (σ) test (1 mm/min). A total of 40 zirconia blocks (5 × 5 × 2 mm) were prepared and subjected to roughness (Ra) analyses and fungal adherence and complementary analyses (X-ray diffraction (XRD) and scanning electron microscopy (SEM)). The data of mean σ (MPa) and roughness Ra (μm) were statistically analyzed by two-way and one-way ANOVA, respectively, and Tukey's test. The Weibull analysis was performed for σ data. The fungal adhesion (Log CFU/mL) data were analyzed by Kruskal-Wallis tests.

RESULTS

For flexural resistance, the "finishing/polishing" factor was statistically significant (P = 0.0001); however, the "in situ aging" factor (P = 0.4458) was not significant. The non-aged (507.3 ± 115.7 MPa) and aged (487.6 ± 118.4 MPa) rubber polishing groups exhibited higher mean σ than the other techniques. The non-aged (260.2 ± 43.3 MPa) and aged (270.1 ± 48.8 MPa) bur abrasion groups presented lower σ. The coarse-grit diamond bur abrasion group (1.82 ± 0.61 µm) presented the highest roughness value (P = 0.001). Cell adhesion was not different among groups (P = 0.053). Group B presented the most irregular surface and the highest roughness Ra of 0.61 m.

CONCLUSIONS

The finishing of ultratranslucent zirconia might be preferably done with a diamond rubber polisher. Moreover, the protocols used did not interfere with Candida albicans adhesion.

CLINICAL RELEVANCE

Coarse-grit diamond burs might be avoided for finishing ultratranslucent monolithic zirconia, which might be preferably performed with a diamond rubber polisher.

Surface Characterisation of Dental Resin Composites Related to Conditioning and Finishing

Due to the little information related to surface processing and conditioning of resin matrix ceramic materials previous glazing, the main purpose of this in vitro study was to investigate the effect of different surface treatments on the surface morphology of different resin composite materials. Five types of resin composite CAD-CAM materials: a resin composite ceramic Vita Enamic (E) and four types of nanoparticle-filled resins, like Lava Ultimate (L), Cerasmart (C), Shofu HC (S), Hyramic (H) were taken into consideration. Specimens received the following surface treatment protocols: conventional polishing [p], polishing and glazing [pg], conditioning with CoJet [c], conditioning with CoJet and glazing [cg], sandblasting [s], sandblasting and glazing [sg], etching [e], etching and glazing [eg]. Surface roughness was analyzed for all samples and nanosurface topographic characterization was made by Atomic Force Microscopy. The highest roughness was registered for sandblasted surfaces [s], followed by tribochemical silica airborne particle abrasion [c], and etching [e]. A very strong correlated conditioning behavior of resin nanoceramic materials, like L, C and S samples was found. The microroughness decreased thus [s] > [c] > [e]. These are moderate correlated with H, and are moderate negative correlated to E, where e is more efficient. Three-dimensional images indicated visible grain boundaries after conditioning, for all materials. After polishing and glazing, surfaces became smoother. For all tested conditioning and finishing methods, surface roughness values were within clinically acceptable limits. Finishing by polishing was proved to be a good choice for all materials taken into consideration, polishing and glazing likewise, excepting Hyramic. For Enamic and Shofu HC sandblasting or tribochemical conditioning and glazing and for Hyramic polishing and glazing are not the best options, related to nanoroughness values. Referring to the nanosurface topography, for Enamic, Cerasmart and Hyramic, glazing would be the method of choice, associated with the adequate conditioning method for each material.

Which surface treatment promotes higher bond strength for the repair of resin nanoceramics and polymer-infiltrated ceramics? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Which surface treatment provides the optimal bond strength (BS) for the repair of resin nanoceramics (RNCs) and polymer-infiltrated ceramics (PICs) is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis of in vitro studies was to determine the best surface treatment protocols for the repair of PICs and RNCs.

MATERIAL AND METHODS

The PubMed, Scopus, and Web of Science electronic databases were searched to select in vitro studies in English up to March 2020. Studies with fewer than 5 specimens, those that did not evaluate the BS of PICs or RNCs, and those with aging for fewer than 30 days and 5000 cycles were excluded. Data sets were extracted, and the mean differences were analyzed by using a systematic review software program.

RESULTS

Among 284 potentially eligible studies, 21 were selected for full-text analysis, and 9 were included in the systematic review, of which 6 were used in the meta-analysis. The meta-analyses were performed for each treatment surface versus their respective control group and their combinations according to material: RNCs and PICs. For RNCs, airborne-particle abrasion with aluminum oxide (Al₂O₃) treatment was statistically higher than tribochemical silica airborne-particle abrasion (CoJet) (P=.02, I²=90%) and that in the hydrofluoric acid (HF) (P<.001, I²=0%) groups and was statistically similar to diamond rotary instrument grinding (P=.40, I²=54%). For PICs, the treatment with hydrofluoric acid (HF) was statistically significantly higher than with CoJet (P=.03, I²=62%) and airborne-particle abrasion with Al₂O₃ (P<.001, I²=98%).

CONCLUSIONS

The best surface treatment protocol for repair varied according to the restorative material. HF followed by silanization is suggested for PICs, and airborne-particle abrasion with Al₂O₃ or preparation with a diamond rotary instrument for RNCs.

Survival of implant-supported resin-matrix ceramic crowns: In silico and fatigue analyses

OBJECTIVE

To evaluate the fatigue survival, failure mode, and maximum principal stress (MP Stress) and strain (MP Strain) of resin-matrix ceramic systems used for implant-supported crowns.

METHODS

Identical molar crowns were milled using four resin-matrix ceramics (n = 21/material): (i) Shofu Hard, (ii) Cerasmart (iii) Enamic, and (iv) Shofu HC. Crowns were cemented on the abutments, and the assembly underwent step-stress accelerated-life testing. Use level probability Weibull curves at 300 N were plotted and the reliability at 300, 500 and 800 N was calculated for a mission of 50,000 cycles. Fractographic analysis was performed using stereomicroscope and scanning electron microscope. MP Stress and MP Strain were determined by finite element analysis.

RESULTS

While fatigue dictated failures for Cerasmart (β > 1), material strength controlled Shofu Hard, Enamic, and Shofu HC failures (β < 1). Shofu HC presented lower reliability at 300 N (79%) and 500 N (59%) than other systems (>90%), statistically different at 500 N. Enamic (57%) exhibited a significant reduction in the probability of survival at 800 N, significantly lower than Shofu Hard and Cerasmart; however, higher than Shofu HC (12%). Shofu Hard and Cerasmart (>93%) demonstrated no significant difference for any calculated mission (300-800 N). Failure mode predominantly involved resin-matrix ceramic fracture originated from occlusal cracks, corroborating with the MP Stress and Strain location, propagating through the proximal and cervical margins.

SIGNIFICANCE

All resin-matrix ceramics crowns demonstrated high probability of survival in a physiological molar load, whereas Shofu Hard and Cerasmart outperformed Enamic and Shofu HC at higher loads. Material fracture comprised the main failure mode.

Effect of different surface treatments on the biaxial flexure strength, Weibull characteristics, roughness, and surface topography of bonded CAD/CAM silica-based ceramics

OBJECTIVE

To investigate the influence of different surface treatments on biaxial flexure strength, roughness, and surface topography of lithium silicate/disilicate-based ceramics.

METHODS

225 discs (∅: 12 mm; 1.2 mm - ISO 6872) were made from three ceramics: IPS e.max CAD (LD - Ivoclar Vivadent), Suprinity (LSS - Vita) and Celtra Duo (LSC - Dentsply). The samples were randomly divided into 5 groups (n = 15): no treatment (C); 10% hydrofluoric acid + silane (HF); sandblasting Al₂O₃ + silane (SB); silicatization + silane (SC); and self-etching ceramic primer (SEP). After surface treatment, a resin cement layer was applied to the disc surface (RelyX U200, 3M ESPE), mechanical cycled (1.2 × 10⁶ cycles, 50 N, 3.8 Hz) and submitted to biaxial flexural strength test (1 mm/min, 1000 Kgf). Roughness, EDS and SEM were also performed. Data were analyzed by one-way ANOVA, Tukey test (5%) and Weibull.

RESULTS

ANOVA revealed that the "surface treatment" factor was significant for all ceramics (p < 0.05). The groups LD-HF (289.30 ± 40) LD-SEP (298. 87 ± 53.29), LSC-HF (195.51 ± 42.12), LSS-HF (269.58 ± 27.07) and LSS-SEP (207.45 ± 28.63) presented significantly higher biaxial flexure strength than respective control groups, except for the LSC-SEP (165.41 ± 33.86), which was statistically similar to the control. The Weibull modulus was significantly higher for the LD-SB, LSC-SC groups. Additionally, the LD-SB, LSC-SC and LSS-HF groups showed higher roughness compared to the other treatments.

SIGNIFICANCE

HF etching followed by silanization and self-etching ceramic primer are the most suitable surface treatments for lithium silicate/disilicate-based glass-ceramics.

Bonding performance of dispersed filler resin composite CAD/CAM blocks with different surface treatment protocols

The effect of various pretreatments on the bonding of a resin cement to resin-composite CAD/CAM blocks (RCBs) was examined. The surface of dispersed-filler RCBs (DF-RCBs) and a polymer infiltrated ceramic network RCB (PICN-RCB) was roughened using hydrofluoric acid etching (HF) or sandblasting, and followed by silanization and/or universal adhesive (UA) application. Microtensile bond strength (µTBS), surface roughness parameters (arithmetical mean height (Sa); developed interfacial area ratio (Sdr)), and critical surface energy (γ_c) were determined. For most DF-RCBs, the highest µTBS was obtained using HF+UA. UA application to DF-RCBs resulted in similar or higher µTBS compared to silanization, which indicates that silane treatment is not crucial for DF-RCBs, especially after HF. In contrast, the highest µTBS to PICN-RCB was obtained with silanization. Both roughening pretreatments significantly increased the surface roughness parameters and the γ_c of all RCBs. The γ_c was positively correlated with Sa (r=0.756, p<0.001) and Sdr (r=0.837, p<0.001).