Influence of cleaning methods on bond strength to saliva contaminated zirconia

Cleaning methods of contaminated zirconia: A systematic review and meta-analysis

OBJECTIVES

The aims of this study were to systematically review the literature and statistically analyze the effectiveness of different cleaning methods on the bond strength of resin cement to zirconia in short- and long-term aging conditions.

DATA/SOURCES

The literature was electronically searched in PubMed (MEDLINE), EMBASE, Wiley, Scopus, and Open Access Theses and Dissertations databases to select relevant articles that evaluated the bond strength between contaminated zirconia and resin cements. A manual search was performed by scanning the reference lists of included studies.

STUDY SELECTION

All articles were published online before April 2022 and in English. Meta-analyses were conducted using random effects models to calculate standardized mean differences (SMD) between uncontaminated zirconia and various cleaning methods in two aging conditions (short- and long-term). Statistical heterogeneity was assessed using I-square statistics. The risk of bias of all included studies was assessed. All statistical analyses were conducted using STATA (StataCorp, College Station, Texas).

RESULTS

Of the 1181 studies, 25 studies met the inclusion criteria for qualitative analyses. In short-term aging condition, cleaning contaminated zirconia with water, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. For long-term aging condition, cleaning contaminated zirconia with water, cleaning agents, alcohol, or acid etching reported significantly lower bond strength than uncontaminated zirconia. Alumina air-abrasion or cleaning with sodium hypochlorite were comparable to uncontaminated zirconia for both short- and long-term aging conditions.

CONCLUSIONS

This meta-analysis appeared to indicate that the cleaning methods of contaminated zirconia restoration have an effect on zirconia bonding.

The effects of applying a novel cleaner on the bonding strength of zirconia surfaces

This study evaluates how pre-treatment with an MDP-containing cleaning agent (Katana Cleaner, Kuraray) influences the micro-shear bond strength (µSBS) of saliva-contaminated zirconia when used with universal adhesive (UA) systems. Rectangular specimens (2 mm × 12 mm × 15 mm) were obtained (IPS, e.max ZirCAD, MO, B65L17, Ivoclar Vivadent) and divided into three groups; a non-contaminated group (control group)(CON), a contaminated and cleaned with isopropyl alcohol group(ISP), and lastly, a group contaminated and cleaned with an MDP-containing cleaning agent(KAC). Each group was then subdivided into three subgroups according to the UAs used (n = 12). Composite cylinders were prepared and bonded to each surface with Panavia V5 (Kuraray, Noritake Dental). A µSBS test was performed and the data were evaluated with the two-way analysis of variance (two-way ANOVA) and multiple comparisons test (α = 0.05). The highest µSBS values were obtained in the non-contaminated group (p < 0.001), regardless of UAs. All subgroups showed lower µSBS values after saliva contamination, but KAC resulted in significantly higher µSBS values than 99% isopropanol (p < 0.001). Overall, the lowest µSBS value was obtained with 99% isopropanol. The KAC-Clearfil UA subgroup resulted in statistically significantly higher µSBS values than the other UAs (p = 0.035 and 0.007), although all three UAs resulted in sufficient µSBS values. This study revealed that applying KAC followed by a UA containing phosphate monomers produces promising results for improving µSBS values of zirconia, greater than results using 99% isopropanol.Clinical relevance: An MDP-containing cleaning agent followed by a phosphate monomer containing a universal adhesive is a promising method to obtain acceptable bonds with saliva-contaminated zirconia ceramics.

Adhesion of Resin to Lithium Disilicate with Different Surface Treatments before and after Salivary Contamination—An In-Vitro Study

The salivary contamination occurring at the try-in procedures of lithium disilicate (LDS) can jeopardize their bond strength. Various laboratory reports have concluded that applying 37% phosphoric acid (H₃PO₄) could be considered as a predictable way of removing salivary contaminants. An experimental method that consists of sealing the intaglio of the ceramic restorations with a layer of cured adhesive could allow consequent time saving for dental practitioners. It is, besides, necessary to establish an optimal decontamination protocol. Hence, this study aimed to determine the most efficient surface treatment, before and after salivary contamination, by comparing the adhesion between resin and LDS. In order to do so, five groups of ten specimens (n = 10) each underwent the different types of surface treatments before bonding, followed by 2500 cycles in the thermocycler. A shear bond strength (SBS) test was then conducted on a universal testing machine (YLE GmbH Waldstraße Bad König, Germany), followed by a fracture-type analysis on an optical microscope (Olympus BX53, Shinjuku, Tokyo, Japan). Statistical analysis was set with a level of significance of α = 0.05. The surface treatment significantly affected the SBS results. The decontamination with HF (12.59 ± 2.71 MPa) and H₃PO₄ (13.11 ± 1.03 MPa) obtained the highest values, silanizing only before contamination obtained intermediate values (11.74 ± 3.49 MPa), and silanizing both before and after the salivary contamination (10.41 ± 2.75 MPa) along with applying a bonding agent before contamination (9.65 ± 1.99 MPa) resulted in the lowest values. In conclusion, H₃PO₄ proved to be efficient, thus, allowing the practitioner to avoid the clinical use of HF; it can, therefore, be considered as a valid alternative. Presilanization and resilanization of specimens, along with applying a bonding agent before contamination, did not yield satisfying results.

Immediate bond performance of resin composite luting systems to saliva-contaminated enamel and dentin in different curing modes

The purpose of this study was to evaluate the immediate shear bond strength of resin composite luting systems to tooth with or without saliva contamination in different curing modes. The Knoop hardness number of the resin composite luting agents was measured. Four combinations of resin composite luting systems were used. The shear bond strength to bovine teeth was measured with and without saliva contamination in different curing modes at different storage periods. The Knoop hardness number of the resin composite luting agents was also evaluated. Significantly lower enamel and dentin shear bond strengths and Knoop hardness number values were observed in all resin composite luting systems at 5 min versus 24 h, regardless of the curing mode or saliva contamination. The influence of the curing mode of the resin composite luting systems on shear bond strengths and Knoop hardness number was dependent on material. For the saliva contamination conditions, only G-CEM ONE EM did not show any significant difference in shear bond strength among the groups with and without saliva contamination, regardless of curing mode, storage period, or tooth substrate. All the resin composite luting systems showed lower shear bond strengths and Knoop hardness number values immediately after setting.

The effect of different cleaning agents and resin cement materials on the bond strength of contaminated zirconia

The purpose of this study was to examine the effect of different cleaning methods and resin cements on the shear bond strength (SBS) of contaminated zirconia. A total of 92 disc-shaped zirconia specimens were contaminated with different procedures. Then, the specimens were grouped according to cleaning methods and resin cements: no cleaning + Variolink Esthetic DC (CN_V ), no cleaning + Panavia V5 (CN_P ), sandblasted + Variolink Esthetic DC (SB_V ), sandblasted + Panavia V5 (SB_P ), Ivoclean + Variolink Esthetic DC (IC_V ), Ivoclean + Panavia V5 (IC_P ), Katana Cleaner + Variolink Esthetic DC (KC_V ), and Katana Cleaner + Panavia V5 (KC_P ). Following an aging protocol in a 37°C for 1 week, SBS analysis was performed with a universal test machine. For the surface topography and elemental analysis, scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS) were used. Significance was evaluated as p < .05 and p < .01. The highest SBS results were found in the SB_P group, showing a statistically significant difference from all other groups (p < .05). For the same cleaning method, Panavia V5 showed statistically significantly higher SBS values than Variolink Esthetic DC (p < .01), except the CN_P -CN_V (p = .880) and KC_P -KC_V (p = .082) groups. The most detected surface elements by EDS were Zr, O, C, and N, respectively. The contaminated zirconia surfaces must be cleaned for successful adhesion. The use of phosphate-containing adhesives in combination with sandblasting will increase the adhesion strength, and universal cleaning agents can be a good alternative to sandblasting.

Microshear bond strength of dual-cure resin cement in zirconia after different cleaning techniques: an in vitro study

PURPOSE

This study aimed to compare the microshear bond strength (µSBS) of dual-cure resin cement in CAD-CAM zirconia after different cleaning techniques.

MATERIALS AND METHODS

Fifty discs of zirconia-based ceramic from Ivoclar Vivadent were embedded in acrylic resin. The discs were divided into five groups according to the cleaning methods used: Group 1: drying with spraying + sandblasting with Al₂O₃; Group 2: washed with water and dried with spraying + sandblasting with Al₂O₃; Group 3: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + zirconium oxide (Ivoclean); Group 4: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + potassium hydroxide (Zirclean); and Group 5: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + 1% NaClO. All of the groups were contaminated with artificial saliva for 1 minute and then cleaned. Statistical analyses were performed using ANOVA and Tukey's tests.

RESULTS

There were statistically significant differences among all groups for µSBS (P < .05). The group treated with zirconium oxide (Group 3) showed the highest µSBS (18.75 ± 0.23 MPa).

CONCLUSION

When applied to zirconia, the cleaning methods affected the bonding with resin cement differently.

Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions

PURPOSE

To evaluate resin cement bond strength after removal of salivary contamination from a zirconia surface using different cleaning solutions and air-borne particle abrasion.

MATERIALS AND METHODS

One-hundred and twenty zirconia specimens (KATANA STML, Noritake) were prepared and divided into 12 groups (n = 10). Groups were subjected to a notched-edge shear bond strength test (ISO 29022) to analyze the bonding efficiency of a resin cement (Panavia V5, Kuraray Noritake Dental Inc.) before and after contamination with saliva. Group 1 (control) was prepared and cemented without salivary contamination. Group 2 was coated with ceramic primer (Clearfil Ceramic Primer Plus, Kuraray Noritake Dental Inc.) then subjected to salivary contamination then tested. Group 3 was contaminated, cleaned by air-borne particle abrasion, ceramic primer and resin cement applied, and tested. Groups 4 to 12 were contaminated, and then different cleaning solutions (water, 4.5% hydrofluoric acid, 35% phosphoric acid, Ivoclean, KATANA cleaner, Zirclean, sodium hypochlorite 4%, and 7.5%) were used to decontaminate the zirconia surface, followed by ceramic primer, resin cement application, and tested. One-way ANOVA and Tukey post-hoc analysis was used to analyze the data.

RESULTS

One-way ANOVA showed statistical differences among cleaning procedures (p < 0.001, F = 13.48). Air-borne particle abrasion was the only group which provided a bond strength (21 ± 2.8 MPa) that was not statistically different than the control group in which no contamination occurred (25.3 ± 3.3 MPa) (p = 0.247). The use of hydrofluoric acid and zirconia cleaning solutions resulted in bond strengths values which were not statistically different from each other (17.5-19.1 MPa).

CONCLUSION

Air-borne particle, zirconia cleaning solutions and hydrofluoric acid are feasible to decontaminate the zirconia surface from saliva prior to bonding the restoration.

Effect of zirconia decontamination protocols on bond strength and surface wettability

OBJECTIVE

To evaluate the effects of human saliva decontamination protocols on bond strength of resin cement to zirconia (Y-PSZ), wettability, and microbial decontamination.

MATERIALS AND METHODS

Zirconia plates were sandblasted and divided into (a) not contaminated, (b) contaminated with human saliva and: (c) not cleaned, (d) cleaned with air-water spray, (e) cleaned with 70% ethanol, (f) cleaned with Ivoclean, or (g) cleaned with nonthermal atmospheric plasma (NTAP). The wettability and microbial decontamination of the surfaces were determined after saliva contamination or cleaning. Monobond Plus (Ivoclar Vivadent) was applied after cleaning, followed by Variolink LC (Ivoclar Vivadent). The samples were stored 1 week before shear bond strength (SBS) testing, and data (SBS and wettability) were analyzed by one-way analysis of variance and Tukey test (α = .05).

RESULTS

Saliva contamination reduced SBS to zirconia compared to not contaminated. Both Ivoclean and NTAP produced higher SBS compared to not cleaned and were not significantly different from the not contaminated. Ivoclean produced the highest contact angle, and NTAP the lowest. With the exception of using just water-spray, all cleaning protocols decontaminated the specimens.

CONCLUSIONS

Both Ivoclean and NTAP overcame the effects of saliva contamination, producing an SBS to zirconia comparable to the positive control.

CLINICAL SIGNIFICANCE

Dental ceramics should be cleaned prior to resin cementation to eliminate the effects of human saliva contamination, and Ivoclean and NTAP are considered suitable materials for this purpose.