Marginal adaptation in dentin of a self-adhesive universal resin cement compared with well-tried systems

Effects of Material Thickness and Pretreatment on the Interfacial Gap of Translucent Zirconia Restorations with Self-adhesive Resin Cement

Purpose

The first objective was to determine if the dual-curing of self-adhesive resin cement (SAC) with reduced light penetrating through zirconia had an effect on interfacial gap of zirconia restorations. The second purpose was to examine whether pretreatment methods for universal adhesive affected interfacial gap. The last aim was to compare the microhardness of SAC polymerized under different zirconia thicknesses.

Methods and Materials

This study evaluated self-adhesive resin cement (RelyX U200, 3M ESPE) after different pretreatment with universal adhesive (Single Bond Universal, 3M ESPE) under different polymerization conditions. CAD/CAM inlay cavities were prepared on extracted third molars. Translucent zirconia restorations were milled using Katana UTML (Kuraray). The teeth were divided into three groups: Groups I, II, and III in which the restoration thicknesses were 1, 2, and 3 mm. Each Group had three subgroups according to different pretreatment methods. For subgroup-1, no pretreatment was done on the prepared cavity. For subgroup-2, universal adhesive was applied and light-cured before cement placement (precure method). For subgroup-3, universal adhesive was applied; however, light-curing was done after cement placement (cocure method). After thermo-cycling, the interfacial gap at the restoration-tooth interface was investigated using swept-source optical coherence tomography imaging. Finally, microhardness was measured for SAC under different zirconia thicknesses. For statistical analysis, the interfacial gap was analyzed using two-way analysis of variance (ANOVA) to test the effect of cavity depth and pretreatment. In terms of each cavity depth and pretreatment, the interfacial gap was compared using one-way ANOVA and Scheffe’s test. One-way ANOVA was also performed for comparison of the Vickers hardness results.

Results

Different thicknesses of the restoration resulted in differences in interfacial gaps except between the precure method of Groups I and II (p<0.05). The effect of universal adhesive pretreatment was different depending on the restoration thickness with exceptions in Groups I and III (p<0.05). Vickers hardness number decreased as the low radiant exposure of light was applied (p<0.05).

Conclusion

Interfacial gap of zirconia restorations can differ depending on the material thickness, pretreatment, and activation mode. Reduced light intensity penetrating through zirconia may lead to higher interfacial gap percentage and lower microhardness of the self-adhesive resin cement. Application of a universal adhesive showed similar or reduced interfacial gaps in the cement space.

Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses

Objective: The aim of this systematic review was to summarize the literature regarding the clinical performance of zirconia crowns for primary teeth. Materials and Methods: Four electronic databases, Ovid, PubMed, Scopus, and Web of Science were searched. Clinical, observational, and laboratory studies were included. Studies that assessed the performance of zirconia crowns for primary teeth using outcomes such as gingival and periodontal health, parental satisfaction, color stability, crown retention, contour, fracture resistance, marginal integrity, surface roughness, and recurrent caries were included. Risk of bias was assessed using different assessment tools depending on the type of the assessed study. Results: Out of the 2400 retrieved records, 73 full-text records were assessed for eligibility. Thirty-six studies were included for qualitative analysis. The included studies reported that zirconia crowns for primary teeth were associated with better gingival and periodontal health, good retention, high fracture resistance, color stability, high parental acceptance, good marginal adaptation, smooth cosmetic surface, and no recurrent caries. Conclusion: Zirconia crowns are promising alternative to other restorative materials and crowns in the field of pediatric dentistry. They showed higher properties and performance in different clinical aspects and great parental satisfaction.

The Effect of Commercially Available Desensitizers on Bond Strength Following Cementation of Zirconia Crowns Using Self-Adhesive Resin Cement-An In Vitro Study

The improvement of the tensile strength of zirconia crowns after the application of commercially available desensitizers can provide added advantages for the durability and strength of zirconia prostheses. We assessed the retention of zirconia crowns when Gluma, Shield Force Plus, and Telio CS desensitizers were used with resin luting cement. Four groups with ten specimens each (n = 10) were considered as Group 1 (Control group, with no desensitizer application before crown cementation with resin cement) and Groups 2, 3, and 4 (with a single coat of Gluma dentin desensitizer, Telio CS desensitizer, or Shield Force Plus desensitizer applied before crown cementation, respectively). Thermocycling was then carried out, and each group was tested to determine the associated retentive forces and type of failure. The data were statistically analyzed, which showed that the mean tensile-strength values were significantly higher in Group 2 (p-value = 0.001), Group 3 (p-value = 0.027), and Group 4 (p-value = 0.014), when compared with the Control group. Clinicians should consider the application of any of these three desensitizers, as they can successfully abate dentin hypersensitivity after tooth preparation, as well as increase the durability and strength of the zirconia prosthesis.

Effect of Pretreatment and Activation Mode on the Interfacial Adaptation of Nanoceramic Resin Inlay and Self-adhesive Resin Cement

OBJECTIVES

The first objective of this study was to determine if the luting material used for resin nanoceramic inlay affects interfacial adaptation. The second was to investigate whether pretreatment and the adhesive curing method before cementation affects interfacial adaptation. The final objective was to compare activation modes of luting material.

METHODS

Class I cavities were prepared on extracted human third molars. Resin nanoceramic inlays were fabricated using Lava Ultimate CAD/CAM block (3 M). For the control groups, inlays were cemented using Panavia V5 (Kuraray Noritake). For the experimental groups, teeth were randomly divided into five experimental groups with four subgroups using different self-adhesive cements (SACs). Cement in Group I was dual-cured without pretreatment. In Group II, the cement was dual-cured after polyacrylic acid treatment of the tooth cavity. In Groups III and IV, the cement was dual-cured after universal dentin adhesive treatment with pre-cure and co-cure methods. In Group V, the inlay was cemented in self-cure mode. After thermocycling, interfacial adaptation at the inlay-tooth interface was measured using swept-source optical coherence tomography (SS-OCT) imaging. Finally, polymerization shrinkage strain of the luting material was measured and compared.

RESULTS

Interfacial adaptation differed depending on the luting material. After application of a universal adhesive, some subgroups showed improved interfacial adaptation. Interfacial adaptation and polymerization shrinkage strain differed significantly depending on activation mode.

SIGNIFICANCE

Interfacial adaptation for a resin nanoceramic inlay can differ according to the type of SAC and activation mode. For some SACs, application of a universal adhesive before cementation improves interfacial adaptation.

Effect of Exclusive Primer and Adhesive on Microtensile Bond Strength of Self-Adhesive Resin Cement to Dentin

The aim of this study was to investigate the effect of G-CEM One Primer (GCOP) and self-etching adhesive on the microtensile bond strength (µTBS) between self-adhesive resin cement G-CEM One (GCO) and dentin. Teeth were sectioned to expose the flat dentin surface and randomly assigned into five groups (n = 15) according to the dentin surface treatment: 1) no surface treatment, 2) GCOP, 3) All-Bond Universal (ABU), 4) GCOP followed by ABU (GCOP/ABU), 5) ABU followed by GCOP (ABU/GCOP). The composite resin blocks were bonded to the dentin surface using GCO. The specimens were stored in distilled water at 37 °C for 24 h, then sectioned into sticks (1 mm × 10 mm). The μTBS values were statistically analyzed using 1-way analysis of variance (ANOVA) and Tukey’s honestly significant difference (HSD) test (α = 0.05) and failure mode was examined under a stereomicroscope. The bonding interface of each specimen was evaluated using confocal laser scanning microscopy. The GCOP group exhibited the highest µTBS value and there were no significant differences observed between GCOP, GCOP/ABU, ABU/GCOP groups (p > 0.05). The use of GCOP with GCO results in the improved µTBS between GCO and dentin. In conclusion, using only GCOP with GCO for bonding of indirect restoration is extremely simple and increasing bond strength.

Reproducibility of different coping arrangements fabricated by dental micro-stereolithography: Evaluation of marginal and internal gaps in metal copings

Background/purpose

To evaluate the reproducibility of the marginal and internal gaps of metal copings fabricated using dental micro-stereolithography (μ-SLA), which is an additive manufacturing system.

Materials and methods

A study cast of abutment tooth 46 was made from type-IV dental stone and was scanned to create a standard triangulation language file. Arrays of one (ORM), three (TRM), and six (SRM) resin copings were then fabricated on the μ-SLA build platform using investment, burnout, and casting (n = 12). The marginal and internal gaps of these metal copings were measured using a silicone-replica technique with a digital microscope (×160). The data obtained were analyzed using a non-parametric Kruskal–Wallis H test, a post-hoc Mann–Whitney U test, and a Bonferroni correction.

Results

The mean and standard deviation of the marginal gap for each group were measured and found to be 81.1 and 53.2 μm, 68.3 and 44.8 μm, and 90.3 and 57.7 μm for ORM, TRM, and SRM, respectively. There were no statistical differences in the marginal gaps of the three groups (p > 0.05).

Conclusion

The marginal and internal gap of ORM, TRM and SRM groups were considered clinically acceptable.

Retentive strength and marginal discrepancies of a ceramic-reinforced calcium phosphate luting agent: An in vitro pilot study

STATEMENT OF PROBLEM

Information on the properties of a relatively new luting agent with a unique formulation (ceramic-reinforced calcium phosphate) is limited.

PURPOSE

The purpose of this in vitro study was to compare the retentive strengths and marginal discrepancies of a ceramic-reinforced calcium phosphate luting agent (CM) with a self-adhesive resin luting agent (RX) and to determine and compare the mode of failure of dislodged cemented copings.

MATERIAL AND METHODS

Forty extracted human molar teeth were prepared to receive zirconia copings. After cementation, the specimens were divided into 4 subgroups (n=10): CM A (axial loading), CM OA (off-axis loading), RX A (axial loading), and RX OA (off-axis loading). For each subgroup, 9 of the specimens received experimental treatment (thermocycling and dynamic loading), and the tenth received no experimental treatment. Eight copings were pulled off in a universal testing machine (MTS Insight; MTS). The ninth specimen was treated experimentally but was not pull tested. The marginal discrepancy and the dentin interface of the specimens that were not pull tested were analyzed with scanning electron microscopy and energy dispersion spectroscopy. The mode of failure of the dislodged copings was also subjectively evaluated.

RESULTS

The mean retentive strengths were 5.92 MPa for CM A, 5.81 MPa for CM OA, 5.75 MPa for RX A, and 5.69 MPa for RX OA. The marginal discrepancy recorded for both CM and RX ranged from 30 to 45 μm, (mean, 36 ±4.6 μm). Energy dispersion spectroscopy analysis showed the presence of calcium, phosphorus, silicon, and aluminum for the CM marginal discrepancy and the presence of aluminum in the dentinal tubules adjacent to the CM. Calcium and phosphorus were detected in lesser amounts adjacent to the RX marginal discrepancy. The mode of failure for CM was primarily adhesive to the tooth preparation, and, for RX, the failure mode was predominantly adhesive to the coping.

CONCLUSIONS

CM had statistically significantly higher mean retentive strength compared with RX. Subgroups loaded axially had statistically significantly higher retentive strengths compared with those loaded off axis.

Marginal Fit and Retention Strength of Zirconia Crowns Cemented by Self-adhesive Resin Cements

The absolute marginal gap (AMG) precementation and postcementation and the retention of zirconia crowns cemented to standardized molar preparations (4×10) by self-adhesive resin cements (SARCs) were evaluated. The following SARCs were used: RelyX U-200 (RXU200; 3M ESPE, Seefeld, Germany), SmartCem 2 (SC2; Dentsply, Milford, DE, USA), and G-Cem Automix (GCA; GC, Alsip, IL, USA). The control adhesive resin cement was Panavia 21 (PAN; Kuraray Dental Co Ltd, Osaka, Japan). Twenty measuring locations at a constant interval along the margins were marked, and the AMG was measured by an image analysis system connected to a stereomicroscope (20×). The cemented copings were aged 270 days at 100% humidity and 37°C and then underwent 10,000 thermal cycles, 5°C-55°C. After aging, the crowns were tested for retention, and the debonded surfaces were examined at 3× magnification. The mean marginal gaps precementation and postcementation were 34.8 ± 17.4 μm and 72.1 ± 31 μm, respectively, with no statistically significant differences between the cements. A significant difference ( p≤0.001) in retention between the cements was found. The highest values were obtained for SC2 and GCA (1385 Pa and 1229 Pa, respectively), but these presented no statistically significant differences. The lowest values were found for PAN and RXU200 (738 Pa and 489 Pa, respectively), but these showed no statistically significant differences. The predominant mode of failure in all of the groups was mixed, and no correlations were found between marginal gap and retention.

Effect of Laser Etching on Glass Fiber Posts Cemented with Different Adhesive Systems

BACKGROUND

Glass fiber-reinforced posts have been preferred frequently because of some physical properties similar to the dentin, chemically bonding to dentin, biocompatibility, and esthetics.

OBJECTIVE

This study aimed to evaluate the microleakage and bond strength of glass fiber posts cemented with various adhesive systems on laser-etched root canal walls.

METHODS

Roots of 120 human mandibular premolars were divided into two groups for push-out bond strength test and the microleakage test (n = 60). Erbium-doped yttrium-aluminum-garnet (Er:YAG) laser etching of the root canal walls was carried out on half of the specimens in both test groups. The laser-treated and laser-nontreated groups were divided again into three subgroups (n = 10). Glass fiber posts (everStick Post) were luted using three different resin cements: total-etch (Variolink N), self-etch (Panavia F 2.0), and self-adhesive (Rely X Unicem). Three dentin discs were obtained from each root, and the bond strength of the glass fiber posts was measured by push-out tests. The dye penetration method was used to investigate coronal microleakage. In addition, surface treatments and the bonding interfaces were observed using scanning electron microscope.

RESULTS

The highest bond strengths were observed for the total-etch and self-adhesive resin cement groups with laser etching (p < 0.05), and the lowest bond strength was obtained for the self-etch resin cement group (p < 0.05). There were no statistically significant differences in terms of microleakage (p > 0.05), except for the self-adhesive resin cement group (p < 0.05).

CONCLUSIONS

Er:YAG laser etching enhances the bonding strength of glass fiber posts. In addition, laser etching can reduce microleakage of self-adhesive resin cement.

Comparison of the shear bond strength of self-adhesive resin cements to enamel and dentin with different protocol of application

AIM

The aim of the present study was to determine the shear bond strength of self-adhesive resin cements to enamel and dentin with and without surface treatments, and compare them with conventional resin cement as the control group.

METHODS

In this experimental study, buccal and lingual surface of the thirty sound human premolars were polished in order to obtain a flat surface of enamel (E) in buccal, and dentin (D) in lingual. Sixty feldspathic ceramic blocks (2×3×3 mm) were prepared and randomly divided into six groups (n=10). Each block was cemented to the prepared surface (30 enamel and 30 dentin surface) according to different protocol: E1 and D1; RelyX ARC as control group, E2, D2; RelyX Unicem, E3, D3; acid etching +RelyX Unicem. The specimens were termocycled and subjected to shear forces by a universal testing machine at a cross head speed of 0.5 mm/min. The mode of fracture were evaluated by stereomicroscope. Data were analyzed with descriptive statistical methods using SPSS version 15. One-way ANOVA, and post hoc Tukey tests were used to compare bond strengths between the groups with different adhesives at α=0.05.

RESULTS

Statistical analysis showed no significant differences within the enamel subgroups, but there were significant differences within the dentinal subgroups, and statistically significant differences were found between the groups D1and D3 (p=0.02). Comparison between similar enamel and dentinal subgroups showed that there was a significant difference just between the subgroups E3 and D3 (p=0.01).

CONCLUSION

Elective etching of enamel did not lead to significant increase in the shear bond strength of RelyX Unicem in comparison to RelyX ARC. On the other hand, elective etching of dentin reduces the bond strength of RelyX Unicem with the dentin.

Effect of activation modes on the compressive strength, diametral tensile strength and microhardness of dual-cured self-adhesive resin cements

The purpose of this study was to compare the compressive strength, diametral tensile strength and microhardnss of several selfadhesive resin cements (Rely-X U200, Clearfill SA Luting, G-CEM LinkAce, Maxcem Elite, PermaCem 2.0, and Zirconite) using different activation modes (self-cured, light-cured) and testing time (immediately, 24 h, thermocycling). Specimens were prepared for the compressive strength (Ø 4×6 mm) and diametral tensile strength and microhardness (Ø 6×3 mm) according to ISO standards. The strength after 24 h was higher than immediately after. In addition, G-CEM showed the highest values. In terms of the activation modes, Rely-X U200, PermaCem 2.0 had higher values in the light-curing than the self-curing. In conclusion, all cements demonstrated clinically available strength values and revealed differences in strength according to their composition, testing time and activation mode. Furthermore, correlation was found between the microhardness (degree of conversion) and mechanical strengths of the cements tested.

Marginal Adaptation and Quality of Interfaces in Lithium Disilicate Crowns — Influence of Manufacturing and Cementation Techniques

Purpose: To evaluate the cement line thickness and the interface quality in milled or injected lithium disilicate ceramic restorations and their influence on marginal adaptation using different cement types and different adhesive cementation techniques.

Methods and Materials: Sixty-four bovine teeth were prepared for full crown restoration (7.0±0.5 mm in height, 8.0 mm in cervical diameter, and 4.2 mm in incisal diameter) and were divided into two groups: CAD/CAM automation technology, IPS e.max CAD (CAD), and isostatic injection by heat technology, IPS e.max Press (PRESS). RelyX ARC (ARC) and RelyX U200 resin cements were used as luting agents in two activation methods: initial self-activation and light pre-activation for one second (tack-cure). Next, the specimens were stored in distilled water at 23°C ± 2°C for 72 hours. The cement line thickness was measured in micrometers, and the interface quality received scores according to the characteristics and sealing aspects. The evaluations were performed with an optical microscope, and scanning electron microscope images were presented to demonstrate the various features found in the cement line. For the cement line thickness, data were analyzed with three-way analysis of variance (ANOVA) and the Games-Howell test (α=0.05). For the variable interface quality, the data were analyzed with the Mann-Whitney U-test, the Kruskal-Wallis test, and multiple comparisons nonparametric Dunn test (α=0.05).

Results: The ANOVA presented statistical differences among the ceramic restoration manufacturing methods as well as a significant interaction between the manufacturing methods and types of cement (p&lt;0.05). The U200 presented lower cement line thickness values when compared to the ARC with both cementation techniques (p&lt;0.05). With regard to the interface quality, the Mann-Whitney U-test and the Kruskal-Wallis test demonstrated statistical differences between the ceramic restoration manufacturing methods and cementation techniques. The PRESS ceramics obtained lower scores than did the CAD ceramics when using ARC cement (p&lt;0.05).

Conclusions: Milled restorations cemented with self-adhesive resin cement resulted in a thinner cement line that is statistically different from that of CAD or pressed ceramics cemented with resin cement with adhesive application. No difference between one-second tack-cure and self-activation was noted.

Reproducibility of different arrangement of resin copings by dental microstereolithography: Evaluating the marginal discrepancy of resin copings

STATEMENT OF PROBLEM

Microstereolithography (μ-SLA), a form of additive manufacturing, can produce one or more platforms of resin copings. However, no evaluation has been made of the variation in marginal discrepancy using this method, even though this is an important factor for a successful restoration.

PURPOSE

The purpose of this in vitro study was to evaluate the reproducibility and marginal discrepancy of resin copings fabricated using dental μ-SLA.

MATERIAL AND METHODS

A master die of a mandibular right first molar tooth was made from Type IV stone and scanned to produce a stereolithography file. Resin copings were then fabricated using μ-SLA additive manufacturing by repeating 1, 3, or 6 arrays to give a total number of 18. The marginal discrepancies of these resin copings were measured using digital microscopy (at ×160 magnification), and the data obtained were analyzed using a nonparametric Kruskal-Wallis H test, post hoc Mann-Whitney U-test, and Bonferroni correction.

RESULTS

The mean ±SD total marginal discrepancies of 1, 3, and 6 arrays were found to be 72.2 ±39.1 μm, 61.2 ±37.3 μm, and 92.5 ±54.1 μm. Statistically significant differences were found among the compared groups (P<.05).

CONCLUSIONS

Based on the marginal discrepancy, μ-SLA of additive manufacturing is more precise when 3 arrays are used than when 1 or 6 arrays are used on a single build platform. Because the fit is affected by the number of copings fabricated, further research of multiple resin copings is required.

Effect of glycine pretreatment on the shear bond strength of a CAD/CAM resin nano ceramic material to dentin

Background

The purpose of this study was to evaluate the effect of glycine pretreatment on the shear bond strength between dentin and a CAD/CAM resin nano ceramic material (LavaTM Ultimate Restorative), bonded together with adhesive cements using three different luting protocols (total-etch; self-etch; self-adhesive).

Material and Methods

Thirty cylinders were milled from resin nano ceramic blocks with CAD/CAM technology. The cylinders were subsequently cemented to the exposed dentin of 30 bovine permanent mandibular incisors. The specimens were assigned into six groups of five teeth each according to luting procedure and dentin pretreatment. In the first two groups (A1, A2) 10 cylinders were cemented using a total-etch protocol; in groups B1 and B2, 10 cylinders were cemented using a self-etch protocol; in groups C1 and C2, 10 cylinders were cemented using a self-adhesive protocol; in groups A1, B1 and C1 the dentinal surface was also treated with glycine powder. All cemented specimens were submitted to a shear bond strength test. Statistical analysis was performed with Stata 9.0 software.

Results

ANOVA showed the presence of significant differences among the various groups (P <0.0001).

Conclusions

Glycine did not change the different bond strength demonstrated by the various luting protocols tested. Conventional resin composite cements used together with a self-etch adhesive reported the highest values. However the use of glycine seems to increase the bond strength of self-adhesive resin cements.

Key words:Adhesive cements, CAD/CAM, glycine, luting system, resin nano ceramic, shear bond strength.

Pull-out retentive strength of fiber posts cemented at different times in canals obturated with a eugenol-based sealer

STATEMENT OF PROBLEM

Currently, no standard luting protocol exists for fiber posts. In addition, no agreement has been reached on the time interval between canal obturation and post space preparation and cementation.

PURPOSE

The purpose of this in vitro study was to evaluate the retention of fiber posts cemented with 3 different types of cement: Paracore, Variolink II, and RelyX Unicem cement after 24 hours or 2 weeks in root canals obturated with gutta percha and a eugenol-based sealer.

MATERIAL AND METHODS

Seventy-two caries-free, freshly extracted, single-rooted human mandibular first premolar teeth with straight root canals were prepared and obturated with gutta percha and Endofil sealer. Specimens were divided into 2 groups (n=36): post spaces prepared 24 hours after obturation and post spaces prepared 2 weeks after obturation. Posts in both groups were luted with 1 of 3 different luting agents (n=12), ParaCore, Variolink II, or RelyX Unicem cement. Each tooth specimen was vertically secured in a universal testing machine, and a constant pull-out loading rate of 0.5 mm/min was applied until cement failure occurred. Data were statistically analyzed with 2-way and 1-way ANOVAs and t tests.

RESULTS

Two-way ANOVA indicated statistically significant differences in mean post retention among the 3 cement types (P<.001) and among the means of the different time intervals investigated (P<.001). Significant differences were noted among all cement types tested between the 24-hour and 2-week time intervals (P<.05).

CONCLUSIONS

Time elapsed between canal obturation and post cementation significantly influenced fiber post retention, regardless of the type of resin cement. Fiber posts showed significantly higher retention if cemented after 24 hours of obturation than if cementation occurred after 2 weeks.

Tensile Bond Strength of Self Adhesive Resin Cement After Various Surface Treatment of Enamel

INTRODUCTION

In self adhesive resin cements adhesion is achieved to dental surface without surface pre-treatment, and requires only single step application. This makes the luting procedure less technique-sensitive and decreases postoperative sensitivity.

AIM

The purpose of this study was to evaluate bond strength of self adhesive resin after surface treatment of enamel for bonding base metal alloy.

MATERIALS AND METHODS

On the labial surface of 64 central incisor rectangular base metal block of dimension 6 mm length, 5mm width and 1 mm height was cemented with RelyX U200 and Maxcem Elite self adhesive cements with and without surface treatment of enamel. Surface treatment of enamel was application of etchant, one step bonding agent and both. Tensile bond strength of specimen was measured with universal testing machine at a cross head speed of 1mm/min.

RESULTS

Least tensile bond strength (MPa) was in control group i.e. 1.33 (0.32) & 1.59 (0.299), Highest bond strength observed when enamel treated with both etchant and bonding agent i.e. 2.72 (0.43) & 2.97 (0.19) for Relyx U200 and Elite cement. When alone etchant and bonding agent were applied alone bond strength is 2.19 (0.18) & 2.24 (0.47) for Relyx U200, and 2.38 (0.27) 2.49 (0.16) for Max-cem elite. Mean bond strength was higher in case of Max-cem Elite as compared to RelyX U200 resin cement, although differences were non-significant (p > 0.05).

CONCLUSION

Surface treatment of enamel increases the bond strength of self adhesive resin cement.

Cementation of Glass-Ceramic Posterior Restorations: A Systematic Review

Aim. The aim of this comprehensive review is to systematically organize the current knowledge regarding the cementation of glass-ceramic materials and restorations, with an additional focus on the benefits of Immediate Dentin Sealing (IDS). Materials and Methods. An extensive literature search concerning the cementation of single-unit glass-ceramic posterior restorations was conducted in the databases of MEDLINE (Pubmed), CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE. To be considered for inclusion, in vitro and in vivo studies should compare different cementation regimes involving a “glass-ceramic/cement/human tooth” complex. Results and Conclusions. 88 studies were included in total. The in vitro data were organized according to the following topics: (micro)shear and (micro)tensile bond strength, fracture strength, and marginal gap and integrity. For in vivo studies survival and quality of survival were considered. In vitro studies showed that adhesive systems (3-step, etch-and-rinse) result in the best (micro)shear bond strength values compared to self-adhesive and self-etch systems when luting glass-ceramic substrates to human dentin. The highest fracture strength is obtained with adhesive cements in particular. No marked clinical preference for one specific procedure could be demonstrated on the basis of the reviewed literature. The possible merits of IDS are most convincingly illustrated by the favorable microtensile bond strengths. No clinical studies regarding IDS were found.

Bond strength of self-adhesive resin cements to tooth structure

OBJECTIVES

The aim of this study was to evaluate the strength of the bond between newly introduced self-adhesive resin cements and tooth structures (i.e., enamel and dentin).

METHODS

Three self-adhesive cements (SmartCem2, RelyX Unicem, seT SDI) were tested. Cylindrical-shaped cement specimens (diameter, 3 mm; height, 3 mm) were bonded to enamel and dentin. Test specimens were incubated at 37 °C for 24 h. The shear bond strength (SBS) was tested in a Zwick Roll testing machine. Results were analyzed by one-way ANOVA and t-test. Statistically significant differences were defined at the α = 0.05 level. Bond failures were categorized as adhesive, cohesive, or mixed.

RESULTS

The SBS values ranged from 3.76 to 6.81 MPa for cements bonded to enamel and from 4.48 to 5.94 MPa for cements bonded to dentin (p > 0.05 between surfaces). There were no statistically significant differences between the SBS values to enamel versus dentin for any given cement type. All cements exhibited adhesive failure at the resin/tooth interface.

CONCLUSIONS

Regardless of their clinical simplicity, the self-adhesive resin cements examined in this study exhibit limited bond performance to tooth structures; therefore, these cements must be used with caution.

Effect of different adhesives combined with two resin composite cements on shear bond strength to polymeric CAD/CAM materials

This study tested the impact of different adhesives and resin composite cements on shear bond strength (SBS) to polymethyl methacrylate (PMMA)- and composite-based CAD/CAM materials. SBS specimens were fabricated and divided into five main groups (n=30/group) subject to conditioning: 1. Monobond Plus/Heliobond (MH), 2. Visio.link (VL), 3. Ambarino P60 (AM), 4. exp. VP connect (VP), and 5. no conditioning-control group (CG). All cemented specimens using a. Clearfil SA Cement and b. Variolink II were stored in distilled water for 24 h at 37 °C. Additionally, one half of the specimens were thermocycled for 5,000 cycles (5 °C/55 °C, dwell time 20 s). SBS was measured; data were analyzed using descriptive statistics, four- and one-way ANOVA, unpaired two-sample t-test and Chi(2)-test. CAD/CAM materials without additional adhesives showed no bond to resin composite cements. Highest SBS showed VL with Variolink II on composite-based material, before and after thermocycling.

The effect of dentin desensitizers and Nd:YAG laser pre-treatment on microtensile bond strength of self-adhesive resin cement to dentin

PURPOSE

The purpose of this study is to evaluate if pre-treatment with desensitizers have a negative effect on microtensile bond strength before cementing a restoration using recently introduced self-adhesive resin cement to dentin.

MATERIALS AND METHODS

Thirty-five human molars' occlusal surfaces were ground to expose dentin; and were randomly grouped as (n=5); 1) Gluma-(Glutaraldehyde/HEMA) 2) Aqua-Prep F-(Fluoride), 3) Bisblock-(Oxalate), 4) Cervitec Plus-(Clorhexidine), 5) Smart protect-(Triclosan), 6) Nd:YAG laser, 7) No treatment (control). After applying the selected agent, RelyX U200 self-adhesive resin cement was used to bond composite resin blocks to dentin. All groups were subjected to thermocycling for 1000 cycles between 5-55℃. Each bonded specimen was sectioned to microbars (6 mm × 1 mm × 1 mm) (n=20). Specimens were submitted to microtensile bond strength test at a crosshead speed of 0.5 mm/min. Kolmogorov-Smirnov, Levene's test, Kruskal-Wallis One-way Analysis of Variance, and Conover's nonparametric statistical analysis were used (P<.05).

RESULTS

Gluma, Smart Protect and Nd:YAG laser treatments showed comparable microtensile bond strengths compared with the control group (P>.05). The microtensile bond strengths of Aqua-Prep F, and Cervitec Plus were similar to each other but significantly lower than the control group (P<.05). Bisblock showed the lowest microtensile bond strength among all groups (P<.001). Most groups showed adhesive failure.

CONCLUSION

Within the limitation of this study, it is not recommended to use Aqua-prep F, Cervitec Plus and Bisblock on dentin when used with a self-adhesive resin cement due to the decrease they cause in bond strength. Beside, pre-treatment of dentin with Gluma, Smart protect, and Nd:YAG laser do not have a negative effect.

Influence of surface treatment of yttrium-stabilized tetragonal zirconium oxides and cement type on crown retention after artificial aging

STATEMENT OF PROBLEM

Information about the influence of zirconia crown surface treatment and cement type on the retention of zirconia crowns is limited. It is unclear whether zirconia crowns require surface treatment to enhance their retention.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of surface treatment on the retention of zirconia crowns cemented with 3 different adhesive resin cements after artificial aging.

MATERIAL AND METHODS

Ninety extracted human molars were prepared for ceramic crowns (approximately 20-degree taper, approximately 4-mm axial length) and were divided into 3 groups (n=30). Computer-aided design and computer-aided manufacturing zirconia copings were fabricated. Three surface treatments were applied to the intaglio surface of the copings. The control group received no treatment, the second group was airborne-particle abraded with 50 μm Al2O3, and the third group was treated with 30 μm silica-modified Al2O3, The copings were luted with a self-etch (RelyX Unicem 2), a total-etch (Duo-Link), or a self-etch primer (Panavia F 2.0) adhesive cement. They were stored for 24 hours at 37°C before being artificially aged with 5000 (5°C-55°C) thermal cycles and 100,000 cycles of 70 N dynamic loading. Retention was measured on a universal testing machine under tension, with a crosshead speed of 0.5 mm/min. Statistical analysis was performed with 1-way and 2-way ANOVA.

RESULTS

Mean retention values ranged from 0.72 to 3.7 MPa. Surface treatment increased crown retention, but the difference was not statistically significant (P>.05), except for the Duo-Link cement group (P<.05). Analysis of the adhesives revealed that the Duo-Link cement resulted in significantly lower crown retention (P<.05) than the other 2 cements.

CONCLUSION

For zirconia crowns, retention seems to be dependent on cement type rather than surface treatment.

Effect of long-term simulated pulpal pressure on the bond strength and nanoleakage of resin-luting agents with different bonding strategies

This study evaluated the effects of simulated hydrostatic pulpal pressure (SPP) on the microtensile bond strength (μTBS) to dentin and nanoleakage patterns produced by self-adhesive luting agents after 12 months. Three self-adhesive luting agents (RelyX Unicem [UN], RelyX U100 [UC], and Clearfil SA Luting [SA]) and three conventional luting agents (Rely X ARC [RX], Panavia F [PF], and a two-step self-etching adhesive system [Clearfil SE Bond] associated with Panavia F [PS]) were evaluated. One hundred twenty-three human molars were abraded to expose occlusal surfaces. Resin cements were used to lute cylindrical composite blocks to the teeth either subjected or not to SPP. Sixty specimens were subjected to 15 cm H2O of SPP for 24 hours before and 24 hours or 12 months after cementation procedures. Afterward, restored teeth were serially sectioned into beams with a cross-sectional area of 1 mm(2) at the bonded interface and were tested in tension (cross-head speed of 1 mm/min). Failure mode was determined using scanning electron microscopy (SEM). Data were statistically analyzed by three-way analysis of variance and post hoc Tukey test (p=0.05). Two additional teeth in each group were serially sectioned into 0.9-mm-thick slabs, which were submitted to a nanoleakage protocol with AgNO3 and analyzed with scanning and transmission electron microscopes. The μTBS values of the etch-and-rinse group (RX) were negatively influenced by SPP and long-term water storage with SPP. After 12 months, UC and SA presented premature failures in all specimens when submitted to SPP. SPP increased silver deposition in most groups in both evaluation times. The hydrostatic pulpal pressure effect was material dependent. The storage time without SPP did not affect bond strength. However, long-term SPP influenced the performance of the etch-and-rinse and self-adhesive cements regarding μTBS and nanoleakage pattern, except to UN.

Luting of ceramic crowns with a self-adhesive cement: effect of contamination on marginal adaptation and fracture strength

Objectives: This study evaluated the percentages of continuous margins (%CM) and fracture strength (FS) of crowns made out from blocs of leucite-reinforced ceramic (IPS Empress CAD) and luted with a representative self-adhesive cement (RelyX Unicem) under four contaminating agents: saliva, water, blood, a haemostatic solution containing aluminium chloride (pH= 0.8) and a control group with no contamination. Study Design: %CM at both tooth-cement (TC) and cement-crown (CC) interfaces were determined before and after a fatigue test consisting of 600’000 chewing loads and 1’500 temperature cycles changing from 5º C to 50º C. Load to fracture was recorded on fatigued specimens. Kruskal-Wallis test was used to compare %CM and FS between the five groups with a level of confidence of 95%. Results: At the TC interface, no significant differences in marginal adaptation before loading could be detected between groups. After loading, a significant marginal degradation was observed in the group contaminated with aluminium chloride (52 ± 22 %CM) in respect to the other groups. No significant differences in %CM could be detected between the groups contaminated with saliva, water, blood and the control. At the CC interface, no significant differences in marginal adaptation were observed between the groups. The FS on loaded specimens was around 1637N, with no significant differences between groups as well. Conclusions: An adverse interaction of the highly acidic haemostatic agent with either dentin or the self-adhesive cement could explain the specimens’ marginal degradation. The self-adhesive cement tested in this study was no sensitive to moisture contamination either with saliva, water or blood.

Key words:Marginal adaptation, RelyX Unicem, contamination, all-ceramic crowns.

Microleakage of a self-adhesive class V composite on primary and permanent dentitions

AIM

This study aimed to evaluate the microleakage of Class V restorations filled with a 7th-generation self-adhesive composite.

MATERIALS AND METHODS

In 40 permanent premolars and 80 primary canines, 160 Class V cavities were prepared, which were filled with four restorative materials (n of each material=20 permanent and 20 primary restorations): control: nonbonded composite (Heliomolar), GI: glass ionomer (Fuji IX GP), BC: bonded Heliomolar, SC: self-adhesive composite (Embrace WetBond). Dye penetration was scored 0 to 4 at 160 coronal and 160 gingival margins under 40× magnification by two examiners. The data were analyzed with Mann-Whitney U test (α=0.01).

RESULTS

The mean microleakages of the materials (in the order of 'control, GI, BC, SC') at each margin-dentition (n=20 margins) were: coronal-permanent (3.25±0.72, 2.75±0.72, 0.35±0.59, 2.7±0.73), coronal-primary (3.3±0.66, 2.85±0.88, 0.55±0.76, 2.65±1.14), gingival-permanent (3.35±0.67, 0.85±0.67, 2.95±0.83, 1.55±1.23), and gingival-primary (3.25±0.72, 0.85±0.59, 2.85±0.89, 2.85±0.93). Compared with the control microleakage at each margin-dentition (each group's n=20 margins), BC microleakage was significantly lesser at coronal margins only (p=0.000), GI microleakage was lower at gingival margins only (p=0.000), and SC microleakage was smaller at gingival margins of permanent teeth only (p=0.000). After combining coronal/gingival margins, only SC microleakage in primary dentition (n=40 margins) was not significantly lesser than the control in primary teeth (p=0.018); and microleakage of all other material-dentitions were lesser than corresponding control-dentitions (p=0.000). Permanent and primary teeth had similar results for all material-margins (p>0.5) except for SC at gingival margins (p=0.001).

CONCLUSION

SC should be used only at gingival margins of permanent teeth.

CLINICAL SIGNIFICANCE

Application of self-adhesive composite should be limited to gingival margins of permanent teeth.

The Effects of Different Adhesive Agents on the Shear Bond Strength of a Self-Adhesive Resin Cement

Purpose

To compare the clinical success of a self-adhesive resin cement used in combination with different adhesive bonding systems with that of a conventional dual-cure resin cement.

Methods

The study was performed with 136 freshly extracted molars embedded in acrylic resin blocks and 136 IPS e.max Press discs. Teeth and discs were randomly divided into four equal groups and cemented together using either RelyX ARC (ARC), RelyX Unicem (Unicem), RelyX Unicem+Adper-Prompt L-pop (L-pop), or RelyX and Unicem+Total-etch (Total-etch). Shear bond strength measurements were obtained before and after thermocycling. Following bond testing, the surfaces of one sample per subgroup (thermocycled and non-thermocycled), were assessed using scanning electron microscopy (SEM).

Results

Among the non-thermocylced subgroups, ARC exhibited the highest bond strength values, followed by Total Etch, Unicem and L-pop. ARC also exhibited the highest bond strength values among the thermocycled subgroups, followed by Unicem, Total-etch, and L-pop. SEM analysis clearly revealed the negative effects of thermo-cycling on the mechanical properties of adhesive agents.

Conclusions

RelyX Unicem may be preferable in many cases because of its simplified application and reduced technique-sensitivity.

Adhesion of Indirect MOD Resin Composite Inlays Luted With Self-adhesive and Self-etching Resin Cements

This study investigated the effect of loading on the bond strength to dentin and microleakage of MOD indirect composite restorations bonded with self-adhesive and self-etching resin cements with or without acid etching of the proximal enamel margins. Class II MOD cavities were prepared in 48 molar teeth into dentin and divided into three groups of 16 teeth. Impressions were taken and indirect composite inlays fabricated (Estenia C & B). The enamel margins of the proximal boxes of half the specimens were phosphoric acid etched, and the inlays were cemented with one of three cements (Panavia F 2.0, SA Cement, or Rely X Unicem). After luting, eight teeth in each cement group were mechanically loaded at 2.5 cycles/s for 250,000 cycles. Unloaded teeth acted as controls. Teeth were stored in Rhodamine B solution for 24 hours, sectioned buccolingually at the proximal boxes to examine microleakage using confocal microscopy, and further sectioned for μTBS testing of the resin-dentin interface. Analysis of variance was performed to assess the effect of loading and acid etching on microleakage and bond strength. Acid etching had no effect on microleakage. No significant difference in the dentin bond strengths between the three cements existed after loading. Panavia F 2.0 exhibited a significant reduction in bond strength. With regard to microleakage at the proximal boxes, loading had no effect on dye penetration at the cavity floor. However, at the axial walls, loading had a significant deleterious effect on Panavia F 2.0. No difference in microleakage existed between the three cements at both sites before and after loading. In conclusion, the two tested self-adhesive cements exhibited similar bond strengths before and after loading to the self-etching resin cement. Loading reduced dentin bond strengths and increased microleakage at the resin-dentin interface. However, acid etching of the enamel margins had no significant effect on microleakage in the approximal regions of the bonded inlays.

1-Year clinical study of indirect resin composite restorations luted with a self-adhesive resin cement: effect of enamel etching

In vitro studies have recommended enamel-etching before luting indirect restorations with self-adhesive resin cement. However, there is no scientific proof that this procedure has any clinical relevance. Thus, the aim of this study was to evaluate the effect of enamel-etching on the marginal quality of indirect composite resin restorations (inlay/onlay) using the self-adhesive cement RelyX Unicem clicker. Forty-two posterior teeth were selected from 25 patients that presented one or two teeth with large restorations in need of replacement. All teeth were prepared by the same operator and impressed with polyvinylsiloxane material. The composite resin restorations were built over plaster casts using the incremental technique with a LED device for light-curing the increments. The inlays/onlays were cemented according to one of the following protocols: 1. Etched group (ETR) - selective enamel phosphoric-acid etching + RelyX Unicem clicker; 2. Non-etched group (NER) - RelyX Unicem clicker alone. Each surface was light-cured for 60 s. Recalls occurred after 1 week (baseline), 6 and 12 months when the teeth were evaluated according to previously established scores (modified USPHS criteria). The clinical analysis showed little or no visible changes in the marginal quality after 1 year, even though a probe could detect all the restorations margins. Statistical analysis (Fisher’s exact test, p<0.05) detected no differences between the groups after 12 months. No restorations failed and no secondary caries were found. Enamel acid etching had no clinical relevance on the marginal quality of indirect composite resin restorations luted with RelyX Unicem clicker after 1 year of follow up.

The effect of calcium silicate-based sealer on the push-out bond strength of fibre posts

BACKGROUND

The aim of this study was to assess the effect of the iRoot SP root canal sealer on the push-out bond strength of fibre posts cemented with self-adhesive resin cement.

METHODS

Forty-eight extracted maxillary incisors were randomly divided into four groups according to the tested sealer (n = 12): group 1 - control (only gutta-percha points, no sealer); group 2 - AH Plus Jet (resin-based sealer); group 3 - Endofill (zinc oxide-eugenol-based sealer); and group 4 - iRoot SP (calcium silicate-based sealer). All root canals were filled with gutta-percha, and groups 2-4 additionally received one of the sealers. Fibre posts were cemented with the self-adhesive resin cement Clearfil SA Cement. The specimens were sectioned in the coronal, middle and apical regions, producing three slices of 1 mm thickness. The push-out test was performed. All data were submitted to ANOVA and Tukey tests (α = 0.05).

RESULTS

No statistically significant differences were found between the control group, AH Plus Jet and iRoot SP (p > 0.05). The Endofill sealer showed significantly lower bond strength compared to the other sealers and the control group (p < 0.05).

CONCLUSIONS

The calcium silicate-based sealer did not adversely affect the bond strength of the fibre posts cemented with self-adhesive resin cement.

The effect of dentin desensitizer on shear bond strength of conventional and self-adhesive resin luting cements after aging

This study tested the impact of Gluma Desensitizer on the shear bond strength (SBS) of two conventional (RelyX ARC, Panavia 21) and two self-adhesive (RelyX Unicem, G-Cem) resin luting cements after water storage and thermocycling. Human third molars (N=880) were embedded in acrylic resin. The buccal dentin was exposed. Teeth were randomly divided into four main groups, and the following cements were adhered: 1) RelyX ARC, 2) Panavia 21, 3) RelyX Unicem, and 4) G-Cem. In half of the teeth in each group, dentin was treated with Gluma Desensitizer. In the conventional cement groups, the corresponding etchant and adhesive systems were applied. SBS of the cements was tested after 1 hour (initial); at 1, 4, 9, 16, and 25 days of water storage; and at 1, 4, 9, 16, and 25 days of thermocycling. SBS data were analyzed by one-way analysis of variance (ANOVA); this was followed by the post hoc Scheffé test and a t-test. Overall, the highest mean SBS (MPa) was obtained by RelyX ARC (ranging from 14.6 ± 3.9 to 17.6 ± 5.2) and the lowest by Panavia 21 in combination with Gluma Desensitizer (ranging from 0.0 to 2.9 ± 1.0). All tested groups with and without desensitizer showed no significant decrease after aging conditions compared with baseline values (p>0.05). Only the Panavia 21/Gluma Desensitizer combination showed a significant decrease after 4 days of thermocyling compared with initial values and 1 day thermocycling. Self-adhesive cements with Gluma Desensitizer showed increased SBS after aging conditions (ranging from 7.4 ± 1.4 to 15.2 ± 3) compared with groups without desensitizer (ranging from 2.6 ± 1.2 to 8.8 ± 2.9). No cohesive failures in dentin were observed in any of the test groups. Although self-adhesive cements with and without desensitizer presented mainly adhesive failures after water storage (95.8%) and thermocyling (100%), conventional cement (RelyX ARC) showed mainly mixed failures (90.8% and 89.2%, after water storage and thermocyling, respectively). Application of the Gluma Desensitizer to dentin before cementation had a positive effect on the SBS of self-adhesive cements.

Microleakage and Marginal Gap of Adhesive Cements for Noble Alloy Full Cast Crowns

Very limited comparative information about the microleakage in noble alloy full cast crowns luted with different types of adhesive resin cements is available. The purpose of this study was to evaluate the microleakage and marginal gap of two self-adhesive resin cements with that of other types of adhesive luting cements for noble alloy full cast crowns. Fifty noncarious human premolars and molars were prepared in a standardized manner for full cast crown restorations. Crowns were made from a noble alloy using a standardized technique and randomly cemented with five cementing agents as follows: 1) GC Fuji Plus resin-modified glass ionomer cement, 2) Panavia F 2.0 resin cement, 3) Multilink Sprint self-adhesive resin cement, 4), Rely X Unicem self-adhesive resin cement with pretreatment, and 5) Rely X Unicem with no pretreatment. The specimens were stored in distilled water at 37°C for two weeks and then subjected to thermocycling. They were then placed in a silver nitrate solution, vertically cut in a mesiodistal direction and evaluated for microleakage and marginal gap using a stereomicroscope. Data were analyzed using a nonparametric Kruskal-Wallis test followed by Dunn multiple range test at a p&lt;0.05 level of significance. The Rely X Unicem (with or with no pretreatment) exhibited the smallest degree of microleakage at both tooth-cement and cement-crown interfaces. The greatest amount of microleakage was found for Panavia F 2.0 resin cement followed by GC Fuji Plus at both interfaces. No statistically significant difference in the marginal gap values was found between the cementing agents evaluated (p&gt;0.05). The self-adhesive resin cements provided a much better marginal seal for the noble alloy full cast crowns compared with the resin-modified glass ionomer or dual-cured resin-based cements.